The 2017 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 8 million records. The 2017 Pediatric Report is based on 156,244 admission year records for 2016 submitted by 762 facilities. There are 27 Level I or Level II pediatric-only centers; 20 are standalone Level I pediatric centers, and seven are standalone Level II pediatric centers. The NTDB classifies pediatric patients in this report as patients who are younger than 20 years of age.
Use of ICD-10 in report development
The International Classification of Diseases (ICD), owned and published by the World Health Organization, 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 report uses admission year 2016 records, and 95 percent of those containing valid ICD codes are reported with ICD-10 nomenclature (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|
ACS COT goals in publishing the report
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 decision makers about a variety of issues that characterize the current state of care for injured pediatric patients in our nation. It has implications for many areas, including epidemiology, injury control, research, education, acute care, and resource allocation.
Many dedicated individuals of the ACS COT, including the Pediatric Surgery Subspecialty group, along with dedicated individuals who provide care to pediatric patients at trauma centers across the country, contributed to the early development of the NTDB and its rapid 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 NTDB data through brief monthly reports in the Bulletin. All previous years of the NTDB Pediatric Annual Report are available on the ACS website as a PDF file. In addition, the website contains information on how to obtain NTDB data for more detailed study. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at firstname.lastname@example.org.
Statistical support for this article was provided by Ryan Murphy, Data Analyst, NTDB.
*World Health Organization. Classifications. Available at: www.who.int/classifications/icd/en/. Accessed December 27, 2017.