The 2016 Pediatric Report of the National Trauma Data Bank® (NTDB®) is an updated analysis of the largest aggregation of U.S. trauma registry data ever assembled. In total, the NTDB now contains more than 7.5 million records. The 2016 Pediatric Report is based on 141,051 records, submitted by 744 facilities, for admission year 2015. There are 36 Level I or Level II pediatric-only centers—30 are standalone Level I pediatric centers, and six are standalone Level II pediatric centers. The NTDB classifies pediatric patients in this report as patients who are younger than 20 years old.
Use of ICD-10 in report development
The World Health Organization’s International Classification of Diseases (ICD), is the world-standard diagnostic tool for health management, epidemiology, and clinical purposes. ICD is used to monitor incidence and prevalence of diseases and other health care problems.* In 2009, the U.S. Department of Health and Human Services published a regulation requiring U.S. providers to transition from the ninth edition of the classification system (ICD-9) to ICD-10, which is what the rest of the world was using.
ICD-10 has several advantages over its predecessor. Some trauma-related highlights include expanded injury codes, a combination of diagnosis/symptom codes to reduce the number of codes necessary to describe a condition, and two additional characters added along with subclassifications to allow laterality and greater specificity in code assignment. This transition required a significant change in institutional infrastructure throughout the U.S. Consequently, the final date of implementation was delayed until October 1, 2016.† As a transitional year, this annual report allows the inclusion of both ICD-9 and ICD-10 codes (see Table 1).
Table 1. Differences between ICD-9-CM and ICD-10-CM code sets
|3 to 5 characters in length||3 to 7 characters in length|
|Approximately 13,000 codes||Approximately 68,000 current codes|
|First character may be alpha (E or V) or numeric; characters 2–5 are numeric||Character 1 is alpha;
characters 2 and 3 are numeric; characters 4–7 are alpha or numeric
|Limited space for new codes||New codes can be added|
|Limited code detail||Specific code detail|
|No laterality||Includes laterality|
The mission of the American College of Surgeons (ACS) Committee on Trauma (COT) is to develop and implement meaningful programs for trauma care. In keeping with this mission, the NTDB is committed to being the principal national repository for trauma center registry data. The purpose of this report is to inform the medical community, the public, and health policy decision makers about a variety of issues that characterize the current state of care for injured pediatric patients in our country. It has implications for many areas, including epidemiology, injury control, research, education, acute care, and resource allocation.
Many members of the ACS COT, including the Pediatric Surgery Subspecialty group, along with dedicated individuals caring for pediatric patients at trauma centers around the country, contributed to the early development of the NTDB and have helped to advance its growth in recent years. Building on these achievements, the goals in the coming years include improving data quality, updating analytic methods, and enabling more useful inter-hospital comparisons. These efforts will be reflected in future NTDB reports to participating hospitals, as well as in annual pediatric reports.
Throughout the year, we will be highlighting these data through brief monthly reports published in the Bulletin. The NTDB 2016 Pediatric Report is available on the ACS website as a PDF file. In addition, information is available on our website about how to obtain NTDB data for more detailed study. To submit your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at firstname.lastname@example.org.
*World Health Organization. Classifications. Available at: www.who.int/classifications/icd/en/. Accessed November 18, 2016.
†World Health Organization. International Classification of Diseases, Tenth Revision, Clinical Modification. Available at: www.cdc.gov/nchs/icd/icd10cm.htm. Accessed November 18, 2016.