Northwest Ohio Regional Trauma Registry

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Northwest Ohio Regional Trauma Registry

Data Request Form

Requestor’s Name:___________________________ Requestor’s Workplace:_________________________

Requestor’s Phone Number (include area code and extension where applicable) Date Required:___________

Work #:________-_________-________________ Pager #:________-_________-________________

Fax #:________-_________-________________ Cell #:________-_________-________________

E-mail address:__________________________________________________________________________

Specifications of Data Request:

Date Range: From________________________ through ________________________

(Earliest Available Data = January 1999)

Format for delivery of data to requestor: ( Excel Spreadsheet ( ASCII File ( Hard Copy (paper)

Data delivery mode: ( e-mail ( U.S. Post ( Fax ( Other

Specify_______________________

Please describe your data request and how the data will be used. Use the following pages to indicate specific data elements you are requesting.

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NOTE: There is an approval process for all requests from NORTR, and it is not a foregone conclusion that your request will be approved. The NORTR Board may approve your request as submitted, may approve you request with modifications, or may reject your request outright. You will be notified of the Board’s decision and can expect fulfillment of your request within three weeks of approval.

If you include data resulting from this request in any type of publication, we request that the Northwest Ohio Regional Trauma Registry be cited as the source of the data.

Please submit the completed 4-page request form to: Susan Murphy, Program Coordinator, Northwest Ohio Regional Trauma Registry, HCNO, 3231 Central Park West Dr., Suite 200, Toledo, OH 43617.

When considering data, keep in mind that other information can be provided based on computations, e.g. Scene Time could be computed based on Scene Arrival Time/Date and Scene Departure Time/Date, and E.D. Length of Stay could be computed based on the same concept. Descriptive statistics, i.e., mean, median, mode, standard deviation, etc., can be provided for any numeric data element. Additional information can be extracted from the regional registry based on existing fields, e.g., injury e-codes can be used to indicate intentionality of an injury. That being said, don’t assume you are limited strictly to the data elements listed. Use the ‘Other’ section for requesting data that is not included in the list of data elements.

Please indicate the data you are requesting by placing an ‘X’ in the corresponding box.

|Requested |Data Variable |Variable Definition |Office Use Only |

|Demographic Data |

| |Gender |The gender of the patient |SEX |

| |Race |The race of the patient |RACE |

| |Age |The age of the patient |AGE |

| |Age Units |The age unit of the patient (years, months, weeks, days, hours) |AGE_UNIT |

| |Residence Zip Code |The zip code of residence for the patient |ZIP_CODE |

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|Diagnosis Data | |

| |ICD |Prior to 2017, this would be ICD-9-CM; otherwise ICD-10-CM |ICD9; ICD10 |

| |Diagnoses |The detail of the specified ICD code | |

| |AIS Code |The full 7-digit AIS code assigned to each injury identified |AIS_CODE |

| |Region |The body region associated with each injury identified (based on ISS rules) |REGION |

| |AIS |The post-dot AIS code (indicating the severity only of each injury identified) |AIS |

| |AIS Version |The version of AIS utilized | |

| |ISS |The default Injury Severity Score for the injuries identified |ISS |

| |Comorbid Conditions |Pre-Existing condition codes (generic, such as DM for Diabetes, etc.) |RISK_TYPE |

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|Procedure/Laboratory Data | |

| |Procedure ICD |Prior to 2017, this would be ICD-9-PCS; otherwise ICD-10-PCS |PROCEDURE_ICD |

| | | |PROCEDURE_ICD10 |

| |Procedure Location |The location where the procedure was performed (Scene, ED, OR, etc.) |PROCEDURE_LOCATION_CODE |

| |Procedure Start Time |The time the procedure started (inconsistently documented) |PROCEDURE_START_TIME |

| |Procedure Start Date |The date the procedure started (inconsistently documented) |PROCEDURE_START_DATE |

| |Vent Days |Total days the patient was on a ventilator |VENT_DAYS |

| |ETOH |Alcohol result (inconsistently documented) |ETOH |

| |TOX |Toxicology result (inconsistently documented) |TOX |

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|Event Data | |

| |Injury Time |The time the injury occurred (not consistently known) |INJURY_TIME |

| |Cause Code |The generic code for the mechanism of injury |CAUSE_CODE |

| |Trauma Type |The type of injury (blunt, penetrating, burn, other) |TRAUMA_TYPE |

| |External Cause Code |The External Cause Code for the mechanism (E-Code) |ECODES |

| |Protective Devices |Whether protective devices were utilized |PROTECTIVE_DEVICES |

| |Injury Location Code |Prior to 2017, this is a generic listing of street, home, work; otherwise ICD10 |INJURY_LOCATION_CODE |

| |Injury County or State |The county or state where the injured occurred (inconsistently documented) |RES_COUNTY_STATE |

| |Work-relatedness |Was this incident work-related (Yes/No/Not Documented) |INDUST_ACC |

| |Transferred Patient |Was the patient transferred from an acute care facility to another (Yes/No) |PATIENT_TRANSFERRED |

| |Transfer Mode |Mode of transportation from one acute care facility to another |TRANSFER_MODE |

|Requested |Data Variable |Variable Definition |Office Use Only |

|Hospital Data |

| |Arrival Time |Time patient arrived at the acute care facility |HOSPITAL_ARRIVAL_TIME |

| |Arrival Date |Date patient arrived at the acute care facility |HOSPITAL_ARRIVAL_DATE |

| |ED Disposition |Immediate disposition from the ED |ED_DISPOSITION_CODE |

| |ED Destination |Destination of patient transferred from ED to acute care facility |ED_DESTINATION_CODE |

| |ED Discharge Time |Date patient was discharged from the emergency department status (or expired) |ED_DISCHARGE_TIME |

| |ED Discharge Date |Date patient was discharged from the emergency department status (or expired) |ED_DISCHARGE_DATE |

| |Inpatient Disposition |Disposition of patient following an inpatient admission |DC_DISPOSITION_CODE |

| |Inpatient Destination |Destination of patient from inpatient status |DC_DESTINATION_CODE |

| |Inpatient Discharge Time |Time patient was discharged from inpatient status (or expired) |DC_TIME |

| |Inpatient Discharge Date |Date patient was discharged from inpatient status (or expired) |DC_DATE |

| |Outcome |Final outcome of patient (Alive/Dead) |OUTCOME |

| |Death Time |Time patient pronounced dead |DEATH_TIME |

| |Organs Donated |Organs donated from expired patient |ORGANS |

| |Autopsy |Autopsy performed (Yes/No) |AUTOPSY_STATUS |

| |Length of Stay |Total length of stay |LOS |

| |ICU Length of Stay |Total length of stay in an intensive care unit |TOTAL_DAYS_ICU |

| |Payment Source |Primary payor source (Medicare, Commercial Ins, Self, etc.) |PAYOR_SOURCE |

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|Vitals |

| |ED Systolic Blood Pressure |Initial ED systolic blood pressure |SBP2 |

| |ED Respiratory Rate |Initial ED respiratory rate |RESP2 |

| |ED Pulse Rate |Initial ED pulse rate |PULSE2 |

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| |Glasgow Total |Initial ED Glasgow total |GCS2 |

| | |(Eye/Verbal/Motor) | |

| |Intubation |Was the patient intubated at initial ED vital signs (Yes/No) |INTUB |

| |Weight |Patient weight |WEIGHT |

| |Weight unit |Patient weight unit (Pounds/Kilograms) |WEIGHT_UNIT |

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|OTHER |

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For additional clarification, contact the NORTR office.

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