2017 PTOS Manual and Collector Changes

DEMOGRAPHIC DATA

Race, Ethnicity, Sex, Date of Birth and Age

2016 PTOS Manual Page #: 17-18

Tab in Collector: Demographic (Patient)

2017 Change: Moved this group of elements after Zip Code of Residence within the PTOS manual

Reason for Change: These elements are currently located after the cause of injury codes in the PTOS Manual. Moving this group of elements before these injury related elements and after Zip Code of Residence created a better flow between the PTOS Manual and the Collector software.

Age

2016 PTOS Manual Page #: 18

Tab in Collector: Demographic (Patient)

2017 Change: The language“(Age <2 Years)” after “2, Months” was removed from the dropdown menu

Reason for Change: The PTOS Manual states, “2 = Months (< 1 year).” The language “(Age <2 Years)” was removed from Collector to be consistent with the PTOS Manual.

PREHOSPITAL DATA

Scene and/or Transport Paralyzing Drugs

Referring Facility Paralyzing Drugs

Interhospital Vital Signs Paralyzing Drugs

2016 PTOS Manual Page #: 27, 37, 45

Tab in Collector: Prehospital (Scene, Transport), Referring Facility (Referring Facility Vitals, Interhospital Transport)

2017 Change:

  • Removed “Paralyzing Drugs” element
  • Added “GCS Qualifiers” element under “GCS Total”
  • “GCS Qualifiers” matches the NTDB’s “Initial ED/Hospital GCS Assessment Qualifiers”
  • Moved “Paralyzing Drugs Specify” field under the new “GCS Qualifiers” element
  • Removed “Eye Obstruction” and “Hospital Sedation” on appropriate Additional NTDS Elements screens

Reason for Change: The Paralyzing Drugs elements were revised to better capture scenarios in which a patient is chemically paralyzed before an entire set of vital signs could be taken. For example, pulse, and systolic blood pressure were assessed prior to administration of paralytics and respiratory rate and GCS were taken after paralytics were administered.

Referring Facility – ETOH/BAC

2016 PTOS Manual Page #: 42

Tab in Collector:Referring Facility (Referring Facility Vitals)

2017 Change:

  • Removed “Referring Facility – ETOH/BAC”
  • Added “Referring Facility – Alcohol Screen” utilizing the NTDB’s “Alcohol Screen”
  • Added “Referring Facility – Alcohol Screen Results” utilizing the NTDB’s “Alcohol Screen Results”

Reason for Change: The NTDB added “Alcohol Screen” and “Alcohol Screen Results” for 2017 admissions.

Referring Facility – Drug Screen

2016 PTOS Manual Page #: 42

Tab in Collector:Referring Facility (Referring Facility Vitals)

2017 Change:

  • Revised dropdown menu to match NTDB’s “Drug Screen” Field Values
  • Added an “Other Specify” field

Reason for Change: The NTDB added “Drug Screen” for 2017 admissions.

Ambulance Scene Time (Auto Calculation)

2016 PTOS Manual Page #: N/A

Tab in Collector: Prehospital (Scene, Transport)

2017 Change: Added “Ambulance Scene Time”

Reason for Change: This auto calculation was added so that the ambulance scene time could be easily calculated and seen within Collector.

PROCESS OF ACUTE CARE

Time Administratively Discharged from ED

2016 PTOS Manual Page #: 53

Tab in Collector: Acute Care (Arrival/Admission)

2017 Change: Added note stating, “Time Administratively Discharged from ED should never be after Time Transported to Post ED Destination. Record ??:?? in this situation.”

Reason for Change: The PTOS manual states, “The physician’s admission order time may be used as the patient’s Time Administratively Discharged from the ED.” Also, PTSF staff has recently recommended that this time be used since the NTDB’s definition for ED Discharge Time states, “The time the order was written for the patient to be discharged from the ED.” Since this element is mapped from PTOS to NTDB, this time would be most accurate. In some EHRs, the time the order is written is timestamped after further documentation states that the patient physically left the ED (Time Transported to Post ED Destination). In these situations, record ??:?? for Time Administratively Discharged from ED. Do not record the time the order was written if it is documented as after the time that the patient physically left the ED.

Advanced Practitioner Arrival Date, Time and PGY Level / Others Called to ED

2016 PTOS Manual Page #: 61

Tab in Collector: Acute Care (ED Response)

2017 Change:

  • Disabled PGY for APs(Residents only)
  • Added “Pediatrician” to dropdown list

Reason for Change: The PGY field should only be activated if a resident is selected. “Pediatrician” was added at the request of the pediatric trauma centers.

CLINICAL DATA

On Admission – Paralyzing Drugs

2016 PTOS Manual Page #: 65

Tab in Collector: Clinical (Admission Vitals)

2017 Change:

  • Removed “Paralyzing Drugs” element
  • Added “GCS Qualifiers” under “GCS Total”
  • “GCS Qualifiers” will match the NTDB’s “Initial ED/Hospital GCS Assessment Qualifiers”
  • Moved “Paralyzing Drugs Specify” field under the new “GCS Qualifiers” element.
  • Removed “Eye Obstruction” and “Hospital Sedation” on Additional NTDS Elements screen

Reason for Change: The Paralyzing Drugs elements had to be revised to better capture scenarios in which a patient is chemically paralyzed before an entire set of vital signs could be taken. For example, pulse, and systolic blood pressure were assessed prior to administration of paralytics and respiratory rate and GCS were taken after paralytics were administered.

On Admission – ETOH/BAC

2016 PTOS Manual Page #: 71

Tab in Collector:Clinical (Admission Vitals)

2017 Change:

  • Removed “On Admission – ETOH/BAC”
  • Added “On Admission – Alcohol Screen” utilizing the NTDB’s “Alcohol Screen”
  • Added “On Admission – Alcohol Screen Results” utilizing the NTDB’s “Alcohol Screen Results”

Reason for Change: The NTDB added “Alcohol Screen” and “Alcohol Screen Results” for 2017 admissions.

On Admission – Drug Screen

2016 PTOS Manual Page #: 71

Tab in Collector:Clinical (Admission Vitals)

2017 Change:

  • Revised dropdown menu to match NTDB’s “Drug Screen” Field Values
  • Added an “Other Specify” field

Reason for Change: The NTDB added “Drug Screen” for 2017 admissions.

OUTCOME DATA

Source of Final Anatomical Diagnoses

2016 PTOS Manual Page #: 81

Tab in Collector: Outcome (Discharge)

2017 Change: Removed

Reason for Change: It was determined that this element is no longer meaningful to the registry.

Autopsy Requested

2016 PTOS Manual Page #:

Tab in Collector: Outcome (If Death)

2017 Change: Removed

Reason for Change: It was determined that this element is no longer meaningful to the registry.

PROCEDURE CODES

Procedure Location Menu

2016 PTOS Manual Page #: 94

Tab in Collector: Procedures (Procedures 1)

2017 Change: Added “Pediatric Unit (In-House)” to dropdown list

Reason for Change: The place for issues list in POPIMS matches the procedure location menu used in Collector. Since Pediatric Unit (In-House) was added to the post ED destination menu in 2016, it is now a location where issues can occur.

APPENDIX 11: PROCEDURE CODES ~ LIST B

Computerized Tomography

2016 PTOS Manual Page #: 132

Tab in Collector: Procedures (Procedures 1)

2017 Change: Removed “1x per body region” language and replaced with “1x per ICD-10 code”

Reason for Change: ICD-10 contains many more Computerized Tomography codes than ICD-9. Coding one CT procedure code per body region is no longer meaningful to the registry.

REBOA

2016 PTOS Manual Page #: N/A

Tab in Collector: Procedures (Procedures 1)

2017 Change: Added REBOA (ICD-10 04L03DZ)

Reason for Change: The NTDB added REBOA as a recommended procedure for 2017 admissions.

Ventilator

2016 PTOS Manual Page #: 134

Tab in Collector: Procedures (Procedures 1)

2017 Change: Changed wording from “(>6 hours post operative and any other mechanical ventilation)” to “(>6 hours post operativeOR any other mechanical ventilation)”

Reason for Change: There was confusion regarding “any other mechanical ventilation.” Some registrars were only capturing “any other mechanical ventilation” as a procedure if it was greater than 6 hours. Any other mechanical ventilation should be captured regardless of the length of time.

OCCURRENCES

Occurrence 20 – Adult Respiratory Distress Syndrome (ARDS)

2016 PTOS Manual Page #: 122

Tab in Collector: Outcome (Occurrences)

2017 Change: Updated name to “Acute Respiratory Distress Syndrome (ARDS)”

Reason for Change: The NTDB updated the name of this occurrence for 2017 admissions.

Occurrence 35 – Myocardial Infarction (MI)

2016 PTOS Manual Page #: 124

Tab in Collector: Outcome (Occurrences)

2017 Change: Revised definition to match the NTDB’s “Myocardial Infarction (MI)” Complication

Reason for Change: The NTDB updated“Myocardial Infarction” for 2017 admissions.

Occurrence 50 – Acute Kidney Injury

2016 PTOS Manual Page #: 124

Tab in Collector: Outcome (Occurrences)

2017 Change: Removed “(within 48 hours)” from the definition

Reason for Change: PTOS’s “Acute Kidney Injury” Occurrence utilizes the NTDB Complication definition for “Acute Kidney Injury.” In 2016, the NTDB removed “(within 48 hours)” from their “Acute Kidney Injury” definition.

Occurrence 94 – Decubitus ulcer

2016 PTOS Manual Page #: 125

Tab in Collector: Outcome (Occurrences)

2017 Change: Revised name and definition to match the NTDB’s “Pressure Ulcer” Complication

Reason for Change: The NTDB retired “Decubitus Ulcer” and added Complication “Pressure Ulcer” for 2017 admissions.

Occurrence 201 – Drug or alcohol withdrawal syndrome

2016 PTOS Manual Page #: 126

Tab in Collector: Outcome (Occurrences)

2017 Change:

  • Removed Occurrence 201
  • Added Occurrence 210 – Alcohol Withdrawal Syndrome utilizing the NTDB’s “Alcohol Withdrawal Syndrome Complication”

Reason for Change: The NTDB retired “Drug or Alcohol Withdrawal Syndrome” and added Complication “Alcohol Withdrawal Syndrome” for 2017 admissions.

Occurrence 204 – Unplanned Admission to ICU

2016 PTOS Manual Page #: 126

Tab in Collector: Outcome (Occurrences)

2017 Change: Added an exclude note stating, “EXCLUDE: •Patients in which ICU care was required for postoperative care of a planned surgical procedure” to the definition

Reason for Change: The occurrences that fall under the NTDS Complication section within the PTOS manual should match the appropriate NTDB Complication. This exclude note is included within the NTDB’s “Unplanned admission to ICU” definition.

PRE-EXISTING CONDITIONS

A.05 – Myocardial Infarction

2016 PTOS Manual Page #: 135

Tab in Collector: Demographic (Pre-Existing Conditions)

2017 Change: Definition revised to match the NTDB’s “Myocardial Infarction (MI)” Co-Morbid Condition

Reason for Change: The NTDB retired “History of Myocardial Infarction” and Added Co-Morbid Condition “Myocardial Infarction (MI)” for 2017 admissions.

A.06 – Hypertension Requiring medication

2016 PTOS Manual Page #: 135

Tab in Collector: Demographic (Pre-Existing Conditions)

2017 Change: Name and definition revised to match the NTDB’s “Hypertension” Co-Morbid Condition

Reason for Change: The NTDB updated Co-Morbid Condition “Hypertension” for 2017 admissions.

D.02 - Reversible Anticoagulant Therapy

2016 PTOS Manual Page #: 136

Tab in Collector: Demographic (Pre-Existing Conditions)

2017 Change: Removed

Reason for Change: To make PTOS’s bleeding disorder Pre-Existing conditions more clear, this condition was removed.

D.05 - Anti-platelet Agents

2016 PTOS Manual Page #: 136

Tab in Collector: Demographic (Pre-Existing Conditions)

2017 Change: Removed

Reason for Change: To make PTOS’s bleeding disorder Pre-Existing conditions more clear, this condition was removed.

D.07 - Non-Reversible Anticoagulant Therapy

2016 PTOS Manual Page #: 136

Tab in Collector: Demographic (Pre-Existing Conditions)

2017 Change: Removed

Reason for Change: To make PTOS’s bleeding disorder Pre-Existing conditions more clear, this condition was removed.

D.08 – Other Bleeding Disorder

2016 PTOS Manual Page #: 137

Tab in Collector: Demographic (Pre-Existing Conditions)

2017 Change: Name and definition revised to match the NTDB’s “Bleeding Disorder” Co-Morbid Condition

Reason for Change: The NTDB updated Co-Morbid Condition “Bleeding Disorder” for 2017 Admissions.

D.09 – Chronic Aspirin Use

2016 PTOS Manual Page #: N/A

Tab in Collector: Demographic (Pre-Existing Conditions)

2017 Change: Added

Reason for Change: The addition of a pre-existing condition to capture chronic aspirin use has been requested by the Trauma Registry Committee for the past few years.

D.10 – Anticoagulant Therapy

2016 PTOS Manual Page #: N/A

Tab in Collector: Demographic (Pre-Existing Conditions)

2017 Change: Added to match the NTDB’s “Anticoagulant Therapy” Co-Morbid Condition

Reason for Change: The NTDB Added Co-Morbid Condition “Anticoagulant Therapy” for 2017 admissions.

E.00 – History of Psychiatric Disorders

2016 PTOS Manual Page #: 137

Tab in Collector: Demographic (Pre-Existing Conditions)

2017 Change: Name and definition revised to match the NTDB’s “Mental/Personality Disorder” Co-Morbid Condition

Reason for Change: The NTDB retired “Major Psychiatric Illness” and added Co-Morbid Condition “Mental/ Personality Disorder” for 2017 admissions.

J.03 – Alzheimer’s Disease

J.06 – Chronic Dementia

2016 PTOS Manual Page #: 138

Tab in Collector: Demographic (Pre-Existing Conditions)

2017 Change:

  • Removed J.03
  • Removed J.06
  • Added J.12 – Dementia utilizing the NTDB definition for “Dementia”

Reason for Change: J.03 and J.06 both utilized the NTDB definition for Dementia.

L.05 – Respiratory Disease

2016 PTOS Manual Page #: 139

Tab in Collector: Demographic (Pre-Existing Conditions)

2017 Change: Name and definition revised to match the NTDB’s “Chronic Obstructive Pulmonary Disease” Co-Morbid Condition

Reason for Change: The NTDB updated Co-Morbid Condition “Chronic Obstructive Pulmonary Disease (COPD)” for 2017 admissions.

N.01 – Drug Use Disorder

2016 PTOS Manual Page #: 139

Tab in Collector: Demographic (Pre-Existing Conditions)

2017 Change: Name and definition revised to match the NTDB’s “Substance Abuse Disorder” Co-Morbid Condition

Reason for Change: The NTDB retired “Drug Use Disorder” and added Co-Morbid Condition “Substance Abuse Disorder” for 2017 admissions.

S.02 – Current Smoker

2016 PTOS Manual Page #: 140

Tab in Collector: Demographic (Pre-Existing Conditions)

2017 Change: Added “within the last 12 months” to the definition

Reason for Change: The NTDB’s “Current Smoker” definition includes a timeframe of 12 months.

S.05 – History of angina within 30 days

2016 PTOS Manual Page #: 140

Tab in Collector: Demographic (Pre-Existing Conditions)

2017 Change:

  • Removed S.05
  • Added S.09 – Angina Pectoris utilizing the NTDB’s “Angina Pectoris” Co-Morbid Condition

Reason for Change: The NTDB retired “History of Angina Within 30 Days” and added Co-Morbid Condition “Angina Pectoris” for 2017 admissions.

S.06 – History of Peripheral Vascular Disease (PVD)

2016 PTOS Manual Page #: 140

Tab in Collector: Demographic (Pre-Existing Conditions)

2017 Change: Name and definition revised to match the NTDB’s “Peripheral Arterial Disease” Co-Morbid Condition

Reason for Change: The NTDB retired “History of Peripheral Vascular Disease” and added Co-Morbid Condition “PeripheralArterial Disease” for 2017 admissions.

MISCELLANEOUS

Additional NTDS Elements

For 2017 admissions, the NTDB added the following element:

This element is optional, but will be available within the NTDB Module. This element is NOT included in PTOS.

EMS Scenario

In 2016, PTSF staff was informed of a discrepancy between PTOS and the NTDB/TQIP when it comes to certain EMS scenarios.

According to the NTDB/TQIP, if a patient is met by EMS at a location other than the scene of injury and is then transported to your center, you would report Not Known/Not Recorded for all scene vital sign data fields. Conversely, if the patient remains on the scene of injury, and is transported by EMS to your center at a later date and /or time, you would report the first recorded of all available vital signs. The NTDB/TQIP is primarily asking, “What was the patient’s condition at the scene of injury?”

For PTOS cases, registrars are to enter the initial assessment (first documented value for vital sign) by EMS regardless of where EMS is meeting the patient. The initial assessment is the earliest documented vital signs by either the scene or transport provider. The initial assessment must be documented on the patient care record.

In March 2016, the Trauma Registry Committee discussed this discrepancy. The Trauma Registry Committee determined that PTOS should not match the NTDB/TQIP in these situations. Registrars should continue to abstract the pre-hospital elements for PTOS cases as they have in the past.

Since PTOS is in disagreement with the NTDB, please note that these EMS scenarios will not map correctly to the NTDB. If you have any further questions regarding when the NTDB scene vital signs should not be recorded, please submit your question to the NTDB at .

Pre-Existing Conditions and Occurrences Mapping

The mapping to the Additional NTDS Elements screen for Pre-Existing Conditions and Occurrences will now work off of the same mappings set in the NTDB module. Also, the Co-Morbid Conditions and Complications fields on the Additional NTDS Elements screens will only populate if the “Set from PTOS” button is clicked. Previously this screen would auto-populate immediately upon entering the screen.This requires users to utilize the NTDB module to set appropriate mappings. This will help prevent incorrect mappings from occurring. Especially when a PTOS Pre-Existing Condition or Occurrence does not match a NTDB Co-Morbid Condition or Complication perfectly. A note will be added to the Additional NTDS Elements screen for Pre-Existing Conditions and Occurrences for clarification.

Audit Filters (Appendix 13)

The appropriate Audit Filters will be updated with ICD-10 codes in the 2017 PTOS Manual.