Improving National Trauma Data Bank® coding data reliability for traumatic injury using a prospective systems approach.

Trauma centers manage an active Trauma Registry from which research, quality improvement, and epidemiologic information are extracted to ensure optimal care of the trauma patient. We evaluated coding procedures using the Relational Trauma Scoring System™ to determine the relative accuracy of the Relational Trauma Scoring System for coding diagnoses in comparison to the standard retrospective chart-based format. Charts from 150 patients admitted to a level I trauma service were abstracted using standard methods. These charts were then randomized and abstracted by trauma nurse clinicians with coding software aide. For charts scored pre-training, percent correct for the trauma nurse clinicians ranged from 52 to 64 percent, while the registrars scored 51 percent correct. After training, percentage correct for the trauma nurse clinicians increased to a range of 80-86 percent. Our research has demonstrated implementable changes that can significantly increase the accuracy of data from trauma centers.

Active intravascular rewarming for hypothermia associated with traumatic injury: early experience with a new technique.

Hypothermia is a significant contributor to mortality in severely injured patients. Rewarming is an enormous challenge, especially in those who require operative or angiographic intervention. In this patient population, external warming methods are only capable of reducing further heat loss, whereas active rewarming adds heat to the body's core but is invasive. This article analyzes our initial experience with a minimally invasive, continuous, automated, and easily portable intravascular rewarming technique using the Alsius Corporation's CoolGard system. The records of 11 hypothermic critically injured patients presenting to our level 1 trauma center over a 6-month period were reviewed. The patients' mean age was 39 +/- 22 years, 7 (64%) were male, and 7 (64%) had blunt mechanisms of injury. The mean injury severity score was 40 +/- 16, and the mean initial systolic blood pressure was 91 +/- 60 mm Hg. The mean core temperature at the initiation of rewarming was 33.6 +/- 1.0 degrees C, and the mean rewarming rate was 1.5 +/- 1.0 degrees C/h. Six patients died (55%), two of acute exsanguination and four of unsurvivable traumatic brain injuries. One patient developed a deep vein thrombosis at the femoral catheter site and experienced a nonfatal pulmonary embolus. Our experience demonstrates that active intravascular balloon-catheter rewarming represents a practical, automated technique for the immediate and continuous treatment of hypothermia in all phases of the acute care of trauma patients.