Paying the price of excluding patients from a trauma registry.
BACKGROUND
The goal of this study was to evaluate the impact of different trauma registry exclusion criteria on the assessment of trauma populations and outcome.


METHODS
All patients admitted to a Canadian regional trauma center from April 1, 1993 to March 31, 2002 with a diagnosis of trauma (ICD-9 codes 800 to 959) were reviewed. TOTAL included everyone. REGISTRY included only patients meeting any of four criteria: death during hospital stay, transfer received from another hospital, admission to the intensive care unit, or hospital stay of 3 days or more. NOHIP excluded patients with isolated hip fracture. REG/NOHIP combined both. ISS12 and ISS15 excluded patients with ISS <12 and 15, respectively.


RESULTS
There were 6,839 trauma patients. The percentage of excluded patients by group was: REGISTRY, 21.2%; NOHIP, 14.7%; REG/NOHIP, 34.9%; ISS12, 75%; and ISS15, 80.3%. Median length of stay was 7 days. Exclusions represented a total number of hospitalization days varying from 1.9% to 65.5% of TOTAL. Mortality was 6.9% for TOTAL, 8.6% for REGISTRY (p < 0.001), 5.7% for NOHIP (p = 0.009), 7.5% for REG/NOHIP (p=NS), 16.1% for ISS12 (p < 0.001), and 20.4% for ISS15 (p < 0.001). In groups with exclusions, transfer to long-term care varied from 0.14% to 23.5% in the excluded patients. For rehabilitation, these percentages varied from 0.14% to 17.6%.


CONCLUSIONS
Registry exclusion criteria significantly alter the apparent severity of injury and resource utilization. The use of divergent exclusion criteria in the analysis of trauma registry data may be misleading.
Bergeron
Eric
E
Department of Traumatology, Charles-LeMoyne Hospital, Greenfield Park, Canada. eric.bergeron@traumaquebec.org
Lavoie
André
A
Moore
Lynne
L
Bamvita
Jean-Marie
JM
Ratte
Sebastien
S
Clas
David
D
D000328:Adult; D015982:Bias; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D003625:Data Collection / Q000379:methods / Q000592:standards*; D003627:Data Interpretation, Statistical; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D038801:International Classification of Diseases; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D018579:Patient Selection; D010360:Patient Transfer / Q000706:statistics & numerical data; D011159:Population Surveillance / Q000379:methods; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries / Q000592:standards*; D014193:Trauma Centers; D014600:Utilization Review / Q000592:standards; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology*