Wynn A, Wise M, Wright M J, Rafaat A, Wang Y Z, Steeb G, McSwain N, Beuchter K J, Hunt J P
Department of Surgery, Louisiana State University at New Orleans, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
J Trauma. 2001 Sep;51(3):464-8. doi: 10.1097/00005373-200109000-00007.
Accurate data are needed to evaluate clinical outcomes, therapeutic modalities, and quality of care in trauma. Administrative data, usually used for billing, and trauma registries, have been used to perform these functions. This study compares data for trauma patients from administrative and trauma registry databases at a Level I trauma center.
Data from patients injured in 1998 were obtained from both the trauma registry and administrative database. These International Classification of Diseases, Ninth Revision, Clinical Modification codes signify an admitting diagnosis of trauma. Patients from each database were "matched" by admission date, medical record number, age, and name. The two matched data sets were compared for accuracy in recording data. Chi-square analysis was used to compare groups.
There were 2,702 patients found in both databases. One hundred eighteen patients with significant trauma were recorded in the trauma registry, but not in the administrative database. Comparison of recorded data for "matched" patients is as follows. The underreporting of mechanism of injury, diagnoses, diagnostic interventions, surgical procedures, and complications was rampant throughout the administrative database. Statistical significance was seen in the comparison between the trauma registry and the administrative database with motor vehicle collisions (458 vs. 391), abdominal injuries (346 vs. 293), orthopedic injuries (1,243 vs. 1,101), and thoracic injuries (486 vs. 397). Diagnostic interventions such as diagnostic peritoneal lavage, head computed tomographic scans, and abdominal computed tomographic scans were all grossly underrecorded, with only 40%, 12%, and 9% captured by the administrative database, respectively. Analysis of surgical procedures revealed these same trends, with statistical significance seen in abdominal and orthopedic procedures. Complications such as acute respiratory distress syndrome and deep venous thrombosis showed statistically significant differences. Mortality was underreported in the administrative database, with 14 deaths omitted.
This study shows that administrative data have copious omissions of specific injuries, diagnostic and therapeutic interventions, as well as complications. The trauma registry recorded more of the diagnoses, diagnostics, procedures, and outcomes in the care of trauma patients. Trauma registries may be more useful than administrative databases in assessing quality of care and diagnostic and therapeutic interventions.
评估创伤的临床结局、治疗方式及医疗质量需要准确的数据。行政数据（通常用于计费）和创伤登记处的数据已被用于执行这些功能。本研究比较了一级创伤中心行政数据库和创伤登记处数据库中创伤患者的数据。
从创伤登记处和行政数据库获取1998年受伤患者的数据。这些国际疾病分类第九版临床修订本代码表示创伤的入院诊断。每个数据库中的患者按入院日期、病历号、年龄和姓名进行“匹配”。比较两个匹配数据集记录数据的准确性。采用卡方分析比较各组。
两个数据库中共发现2702例患者。创伤登记处记录了118例有严重创伤的患者，但行政数据库中未记录。“匹配”患者记录数据的比较如下。行政数据库中损伤机制、诊断、诊断性干预、手术操作和并发症的漏报情况很普遍。在创伤登记处与行政数据库之间的比较中，机动车碰撞（458例对391例）、腹部损伤（346例对293例）、骨科损伤（1243例对1101例）和胸部损伤（486例对397例）有统计学意义。诊断性干预如诊断性腹腔灌洗、头部计算机断层扫描和腹部计算机断层扫描均记录严重不足，行政数据库分别仅记录了40%、12%和9%。手术操作分析显示了相同的趋势，腹部和骨科手术有统计学意义。急性呼吸窘迫综合征和深静脉血栓形成等并发症显示出统计学差异。行政数据库中死亡率漏报，有14例死亡被遗漏。
本研究表明行政数据对特定损伤、诊断和治疗干预以及并发症有大量遗漏。创伤登记处记录了创伤患者护理中更多的诊断、诊断性检查、操作和结局。在评估医疗质量以及诊断和治疗干预方面，创伤登记处可能比行政数据库更有用。
