CSTR Exam Cards

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1

ACS Inclusion Guidelines

  • ICD-10 falling in S00-S99 7th character of A, B, or C only and excluding superficial injuries
  • T07 - unspecified multiple injuries
  • T14 - Injury of unspecified body region
  • T20-T28 7th character A only - burns by specific body area
  • T30-T32 - burns by TBSA percentages
  • T79.A1-T79.A9 7th character A only - traumatic compartment syndrome

And must include one of the following:

  • Hospital admission
  • Hospital transfer via EMS transport
  • Death resulting from the traumatic injury
2

External Cause Code Hierarchy

  1. Child and Adult abuse
  2. Terrorism
  3. Cataclysmic events
  4. Transport accidents
  5. Cause that causes the most serious injury
3

ED Discharge Date and Time

The date and time orders were written - NOT the date and time the PT actually left the ED

4

AIS Severity

The post dot number that reflects the severity of the injury

1. Minor Injury

2. Moderate Injury

3. Serious Injury

4. Severe Injury

5. Critical Injury

6. Maximum Injury, Virtually Unsurvivable

9. Not Possible to Assign

5

ICU Length of Stay

Any partial or full day in the ICU is counted as 1 day.

6

Ventilator Days

Any partial or full day on a vent is counted a 1 day.

7

Hospital Discharge Date and Time

The date and time the order was written for the patient - NOT when the patient actually left.

8

TQIP Lowest BP Time Frame

Lowest BP within first 4 hours of arrival.

9

TQIP Angiography/Embolization Time Frame

Angiogram and/or Embolization within first 24 hours of arrival

10

TQIP Surgery for Hemorrhage Control Time Frame

Surgery for hemorrhage control within first 24 hours of arrival

11

What flags will cause a submission file to be rejected?

Level 1 and Level 2

These must be resolved before submitting data

12

What is Cranial Nerve I?

Olfactory - Smell

13

What is Cranial Nerve II?

Optic - Vision

14

What is Cranial Nerve III?

Oculomotor - Pupil, some extraocular movement

15

What is Cranial Nerve IV?

Trochlear - Extraocular movements

16

What is Cranial Nerve V?

Trigeminal - Some monvement of jaw, sensation

17

What is Cranial Nerve VI?

Abducens - Lateral extraocular movement

18

What is Cranial Nerve VII?

Facial - facial muscle movement, taste

19

What is Cranial Nerve VIII?

Acoustic - Hearing, balance

20

What is Cranial Nerve IX?

Glossopharyngeal - Pharynx (motor, ear/pharynx/tongue sensory

21

What is Cranial Nerve X?

Vagus - Palate, larynx, pharynx, involuntary muscles

22

What is Cranial Nerve XI?

Accessory - Sternocleidomastoid/trapezius muscles

23

What is Cranial Nerve XII?

Hypoglossal - Tongue

24

What makes up the Neurologic System?

  • Brain
  • Spinal Cord
  • Nerves
25

What makes up the Respiratory System?

  • Trachea
  • Lungs
  • Diphragm
26

What makes up the Circulatory System?

  • Heart
  • Arteries
  • Veins
27

What makes up the Digestive System?

  • Esophagus
  • Stomach
  • Bowels
28

What makes up the Urinary System?

  • Kidneys
  • Ureters
  • Bladder
  • Urethera
29

What makes up the Musculoskeletal System?

  • Bones
  • Muscles
  • Tendons
30

What makes up the Integumentary System?

  • Skin
31

What are the bones of the skull?

  • Frontal
  • Parietal x 2
  • Temporal x 2
  • Occipital
  • Sphenoid
  • Ethmoid
32

Why are the skull bones there?

  • Important landmarks
  • Cover the corresponding lobes of the brain
  • Protection
  • Take a tremendous force to injure
  • When broken, need to look at what else might be injured
33

What are the types of skull fractures?

  • Closed - skin is not broken, also called simple
  • Open - skin is broken, bone visible, compound
  • Depressed - bone is pushed into brain cavity
34

What are signs of Basilar Skull fractures?

  • Raccoon Eyes (black eyes) - Anterior Fossa (front of head)
  • CSF Leak - Middle Fossa
  • Battle Signs (bruising behind ears) - Posterior Fossa (back of head)
35

Describe CSF leaks

Could be clear or mixed with blood from brain, highly suggestive of skull fracture through middle fossa of skull.

36

CSF Rhinorrhea

CSF fluid leaking from the nose. Highly suggestive of a skull base fracture through the middle fossa.

37

CSF Otorrhea

CSF fluid leaking from the ear. Highly suggestive of a skull base fracture through the middle fossa.

38

What diagnostic tools are used to determine a skull fractures and head injuries?

  • Head CT
  • MRI
  • Arteriorgram - assess vasculature
  • Nuclear Med Scan - assess brain flow
39

What interventions are used for brain bleeds?

  • ICP Monitor
  • Ventriculostomy - these are monitoring and/or therapeutic - read the chart
  • Craniotomy - incision
  • Evacuation of Hematoma
  • Craniectomy - excise part of skull
40

What are some focal intracranial injuries?

Localized to an area

  • Contusion
  • Epidural Hematoma
  • Subdural Hematoma
  • Subarachnoid Hematoma
  • Intraparenchymal Hematoma
41

What are some non-focal (diffuse) intracranial injuries?

  • Concussion
  • Shear Injury
  • DAI - Diffuse Axonal Injury
  • Anoxic Brain Injury
42

What is Decorticate Posturing?

PT's arms and legs are pulling into himself or are turned inward.

A very bad sign of brain injury.

43

What is Decerebrate Posturing?

PT's hands, arms, and legs are turned outward or are externally rotated.

A very bad sign of brain injury.

44

What are the bones of the face?

  • Orbits
  • Zygoma x 2
  • Nasal Bones
  • Maxilla
  • Mandible
45

What is a Le Fort I fracture?

Transverse Maxillary fracture that must include:

  • Pterygoid Plate
  • Lower Maxilla including the Alveolar Process and Maxillary Sinus
  • Palatine Process (Hard Palate)
46

What is a Le Fort II fracture?

Pyramidal fracture that must include:

  • Pterygoid Plate
  • Nasal Bone
  • Lacrimal Bone
  • Orbit Floor
  • Infraorbital Margin
  • Upper portion of the Zygomatic-maxillary Suture Line
  • Maxillary Sinus
47

What is a Le Fort III fracture?

Complete separation of the facial bones from their cranial attachments that must include:

  • Pterygoid Plate
  • Nasofrontal Suture Fracture
  • Ethmoid and Frontal Bone
  • Superior and Lateral Orbit Fracture
  • Zygomaticofrontal and Temporal Suture
48

What diagnostic tools are used to diagnose facial fractures and/or injuries?

  • X-ray
  • CT Scan
  • MRI
49

What treatments are used on facial injuries?

  • Intubation
  • ORIF
  • Enucleation
50

What are common procedures for neck injuries?

AIRWAY FIRST! then stop bleeding

  • Intubation
  • Cricothyroidotomy - Rescue maneuver. Needle or syringe is used to make a hole and can be kept in place for several days
  • Trachesotomy
51

What are the parts of the spine?

  • Cervical - 7 Vertebrae
  • Thoracic - 12 Vertebrae - one for each rib pair
  • Lumbar - 5 Vertebrae
  • Sacral - 5 Fused Vertebrae
  • Coccyx - 4 Fused Vertebrae
52

What bone is the Atlas?

C1

53

What bone is the Axis?

C2

54

What are spinal cord injuries?

  • Concussion
  • Contusion
  • Transection
  • Interruption in vascular supply
  • SCI w/o radiographic abnormality - SCIWORA - Diffuse injury
55

Cervical Vertebral Injuries

  • Atlanto-Occipital Dissociation - death
  • Jefferson's Fracture of C1 - whiplash but worse
  • Hangman's Fracture of C2 - whiplash but worse
  • Axis or Odontoid (Dens) Fracture of C2 - most common
56

What is the largest vertebra?

C2

57

What are Incomplete spinal cords injuries?

  • Central Cord - UE worse than LE
    • d/t vascular compromise
    • prognosis better than others
  • Anterior Cord - Paraplegia, sensory loss (pain/temp)
    • d/t infarction of cord
    • poorest prognosis
  • Brown-Sequard
    • usually penetrating trauma
    • loss motor/sensory 1 side
    • other side loss pain/temp
    • Some recovery
58

Incomplete spinal cord injury of Central Cord

  • UE worse than LE
    • d/t vascular compromise
    • prognosis better than others
59

Incomplete spinal cord injury of Anterior Cord

  • Paraplegia, sensory loss (pain/temp)
    • d/t infarction of cord
    • poorest prognosis
60

Incomplete spinal cord injury Brown-Sequard

  • usually penetrating trauma
  • loss motor/sensory 1 side
  • other side loss pain/temp
  • Some recovery
61

Complete spinal cord injury

Transection of spinal cord

62

What is Atlanto-Occipital Dissociation?

  • Head is completely separated from body
  • Results in death
  • Often found in shaken baby syndrome
63

What is Jefferson's Fracture of C1?

  • Back of head
  • Hyper extension/flexion - like whiplash but worse
  • Often seen in MVC or diving accidents
64

What is Hangman's Fracture of C2?

  • Hyperextension of neck
  • Often seen in hanging or MCCs
65

What is an Axis or Odontoid Fracture of C2?

  • Fracture of the dens
  • Most common fracture
  • Often seen in falls
66

Spinal cord injuries in the cervical spine typically result in what?

Quadriplegia

67

Spinal cord injuries in the thoracic spine typically result in what?

Paraplegia

68

Where does the spinal cord end?

L1 to L2

69

What is paresis?

Muscular weakness

70

What is paresthesia?

Tickling or pricking sensation

71

What is used to diagnose spinal injuries?

  • CT Scan
  • MRI
72

What is used to treat spinal injuries?

  • Cervical Collar
  • Tongs
  • Halo Traction
  • Spinal Decompression
73

What bones are in the thorax?

  • Spinal Column
  • Ribs
  • Clavicles
  • Sternum
  • Xiphoid Process
74

What is important to know about rib fractures when coding?

  • Location and ribs fractured
  • Right side vs. Left side
  • Anterior vs. Posterior
  • Unilateral vs. Bilateral
75

What muscles are in the thorax?

  • Diaphragm
  • Intercostals
76

What are the thoracic organs?

  • Trachea
  • Bronchus
  • Lungs
  • Heart
77

What is the thoracic vasculature?

  • Aorta
  • Pulmonary Arteries
  • Pulmonary Veins
  • Vena Cava
    • Superior
    • Inferior
78

What are tension pneumothorax signs?

  • Severe respiratory distress
  • Hypotension
  • Distended neck veins
  • Tracheal deviation
  • Cyanosis (late sign)
79

What bones are in the abdomen?

  • Bottom of rib cage
  • Lumbar spine
  • Pelvic bones
80

What muscles are in the abdomen?

  • Rectus Abdominis
  • External Oblique
  • Internal Oblique
  • Transverse Abdominus
81

What are the solid abdominal organs?

These are more susceptible to fracture. (Solid Viscus)

  • Liver
  • Spleen
  • Pancreas
  • Kidneys
82

What are the hollow organs of the abdomen?

These are more susceptible to rupture. (Hollow Viscus)

  • Stomach
  • Small Bowel
  • Large Bowel
  • Bladder
83

What are the abdominal vascular structures?

  • Descending Aorta
  • Mesentery Arteries
    • Superior
    • Inferior
  • Renal Arteries
  • Iliac Arteries
    • External
    • Internal
  • Vena Cava
    • Iliac
    • Renal
    • Hepatic
  • Portal System
    • Mesenteric
    • Splenic
84

What are the upper extremity bones?

  • Humerus
  • Radius & Ulna
  • Carpals & Metacarpals
  • Phalanges
85

What are the upper extremity joints?

  • Sternoclavicular
  • Acromioclavicular
  • Glenohumeral
  • Elbow
  • Wrist & Hand
86

What are the upper extremity nerves?

  • Median
  • Ulnar
  • Radial
87

What are the upper extremity arteries?

  • Subclavian
  • Axillary
  • Subscapular
  • Circumflex
  • Profundus
  • Brachial
  • Radial
  • Common Interosseous
  • Ulnar
  • Deep Palmar Arch
  • Superficial Palmar Arch
88

What are the lower extremity bones?

  • Sacrum
  • Pelvic Bone
  • Coccyx
  • Femur
  • Patella
  • Tibia
  • Fibula
  • Tarsals
  • Metatarsals
  • Phalanges
89

What are the lower extremity joints?

  • Sacroiliac
  • Hip
  • Knee
  • Tibiofibular (Superior)
  • Tibiofibular Epicondoyle (Inferior)
  • Joints of the Foot
90

What are the lower extremity nerves?

  • Sciatis
  • Famoral
  • Peroneal
  • Anterior Tibial
91

What are the lower extremity veins?

  • External Iliac
  • Femoral
  • Popliteal
  • Dorsalis Pedis
  • Posterior Tibial
92

What are the bones of the pelvis?

  • Ilium x 2
  • Ischium x 2
  • Pubis x 2
  • Acetabulum x 2
  • Symphysis Pubis x 2
  • Sacroiliac Joint x 2
93

What are the layers of the skin?

  • Epidermis
  • Dermis
  • Subcutaneous
94

What are the degrees of burns and how far do they go?

  • First Degree - Superficial, Epidermis
  • Second Degree - Partial Thickness, Dermis
  • Third Degree - Full Thickness, Subcutaneous
  • Fourth Degree - Burn to the Bone
95

Rule of Nines

Used to calculate the Total Body Surface Area (TBSA) of burns

96

Rule of Nines in adults

  • Head = 9
  • Arms = 9 Each
  • Legs = 18 Each
  • Front of Body = 18
  • Back of Body = 18
  • Genitals = 1
97

Rule of Nines in children

  • Head = 18
  • Arms = 9 Each
  • Legs = 14 Each
  • Front of Body = 18
  • Back of Body = 18
  • Genitals = 1
98

What does Quality Improvement consist of?

Consists of systemic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups.

99

What does Quality Improvement ensure?

That all people experience the safest, highest quality, best value health care across all settings

100

What else is Quality Improvement?

The combined and unceasing efforts of everyone - healthcare professionals, patients and their families, researchers, payers, planners and educators - to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (NIH).

101

What is a goal of Quality Improvement?

To improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries.

102

What are the common themes of Quality Improvement?

  • Review process and delivery of care
  • Safety for all involved
  • Improve outcomes of care
  • Process is systemic and continuous
  • Process involves a team
103

How do you use Quality Improvement?

  • Gather Data
  • Generate Reports
  • Review Reports
  • Summarize Results
  • Share Information
104

How do you improve a method in Quality Improvement?

  • Identify Deficits
  • Develop Action Plan
  • Implement Plan
  • Gather Data
  • Generate Reports
  • Review Reports
  • Measure Change
105

PI Indicators

Used in Empiric Method

They determine when a PI process should be implemented

  • Rate Based: frequency of occurrences
  • Describes rates of occurrences
  • Sentinel Events/Never Events
    • Resultant in death or major permanent damage
    • Wrong site surgery, removal of wrong organ
106

Audit Filters (Think our ACS Filters and Complication tracking)

Used in Empiric Method

They

  • Measure effectiveness of care
  • Limited value
    • Ex: HEad CT w/i 2 hours s/p admission for low GCS
107

Focused Audit Filters (Think our ACS Filters and Complication tracking)

Used in Empiric Method

They are

  • In response to Abnormal trend (sudden increase in PE)
  • Time Limited (review data for 3 months) Ex: 3 month spot check of vitals w/i 10 minutes of addmisison
108

Benchmarking

Used in Empiric Method

  • A standard by which things can be measured or judged
  • Process of comparing cost, time, quality
  • Compare like organizations
109

Evidenced Based Measures

  • Use clinical pathways (Ex: TBI, SCI)
  • Use clinical management protocols (Ex: Algorithm for Shock, DVT chemoprophylaxis)
  • Use guidelines (Ex: Guidelines for Shock, Thorocotomy, Blood Draws, etc)
110

What is PI?

Performance Improvement

A required structured effort by a trauma program to demonstrate a continuous process for improving care for injured patients.

Systematic approach to examining the process of care delivered.

Required and the right thing to do.

111

How do you do PI?

Through

  • Registry
  • M&M
  • Peer Review
  • Multidisciplinary Committee
  • Hospital Quality Review
112

PI Program Configuration

  • Data Collection (via Registry)
  • Analysis of Data
    • Reports
    • Graphs
    • Meetings
  • Corrective Action
  • Loop Closure
113

Data Registry Elements must be:

  • Clearly defined
  • Reliable
  • Consistently objective
  • Identify opportunities for improvement
  • Useful measures of quality
114

Data Analysis

  • Does it make sense?
  • Is it complete and accurate?
  • Is it validated?
  • Does it reflect service activity?
  • Should be shared by all involved in the care process
  • Collaborate with residents, TPM and TMD, and hospital quality department
115

Corrective Action

  • Monitor and evaluate to determine if performance meets or exceeds expectations
  • Monitor continuously or periodically
  • Define corrective strategies
  • Take action when consistent problems are identified
  • Must be documented
116

Examples of corrective action

  • New guideline, pathway or protocol
  • Revision of current guidelines, pathways, or protocols
  • Targeted education
  • Enhanced resources, facilities or communication
  • Counseling
  • PI team implementation, Peer Review, change in privileges or credentials
117

Loop Closure

  • Corrective action has to demonstrate desired effect
  • If it does, spot check and move on
  • If it doesn't, modify efforts and try again
  • 4 Steps are
    • Identification of Issues
    • Review of Issues
    • Corrective Action
    • Result Evaluation
118

Dashboards

  • Present data in a summary form
  • Facilitates quick decisions
119

Statistical Control Reports

Uses statistical tools to observe the performance of the process in order to predict significant deviations

120

Benchmark Reports

Compare data against like data at different periods of time or with different organizations or providers

121

Bar Graph

Composed of discrete bars that represent different categories of data.

The length or height of the bar is equal to the quantity within that category of data.

Quick comparison of information.

122

Pie Chart

A circular chart used to compare parts of the whole.

It is divided into sectors that are equal in size to the quantity represented.

Show a proportion of a whole or percentage of a whole.

123

Line Graph

Displays the relationship between two types of information.

They are useful in illustrating trends over time.

Created by connecting a series of data points together with a line.

124

Control Charts

A graph used to study how a process changes over time. Data are plotted in time order. They always have a central line for the average, an upper line for the upper control limit and a lower line for the lower control limit. These lines are determined from historical data.

125

Scattergrams

Displays values for two variables.

Displayed as a collection of points each having the value of one variable determining their position on the horizontal axis and the value of the other variable determining the position on the vertical axis.

126

Pareto Chart

Chart showing data from most to least frequently occurring information from left to right.

Used to clearly identify higher valued items.

127

Histogram

Has connected bars that display the frequency or proportion of cases that fall within defined intervals or columns and typically display continuous data

128

AIS Score

(Abbreviated Injury Scale)

Post dot number

Classifies each injury by body region according to its relative importance on a 6 point ordinal scale:

  • 1=Minor
  • 2=Moderate
  • 3=Serious
  • 4=Severe
  • 5=Critical
  • 6=Maximal (currently untreatable)
129

ISS Score

(Injury Severity Score)

Provides overall score for multiple injuries, correlates with mortality, morbidity, hospital LOS

Range: 0-75

Derived from post dot AIS number 6=automatic 75 and 9 is not scored

ISS = A2 + B2 + C2 Where A, B, and C, are the worst post dot from the three body regions with the highest post dot scores. Only one post dot per body region even if the two highest overall scores come from the same region.

130

NISS

New Injury Severity Score

Reflects severity of multi-organ injury in same region. Takes the top three post dot numbers regardless of body area

Range = 0-75 and will never be <ISS

NISS = Highest post dot2 + Highest post dot2 + Highest post dot2

131

Trauma Score (TS)

Assesses (score) multiple trauma

Range = 1-16

Uses SBP, RR, GCS

132

RTS

(Revised Trauma Score)

  • Increased accuracy for mortality prediction
  • Higher inter-rater reliability
  • Scored from the first set of data obtained
133

RTS Formula

Equation: Vitals derived from first set taken in facility, CV = Coded Value

Range = 0-12 unweighted & 0-7.8408 weighted

(0.9368 * [GCS CV]) + (0.7326 * [SPB CV]) + 0.2908 * [RR CV]) = RTS

134

TRISS

card image

Probability of survival

  • Formula: Ps = 1/(1+E-b) where E (Euler's Constant) = 2.718281
  • See chart to find b
  • Made up of ISS, RTS, patient's age, and MOI (blunt or penetrating
135

M Score

  • Characterizes case mix and based on ISS
  • Based on ISS
136

Z Score

  • The statistical significance of the outcome of the TRISS
  • If it is more negative than -1.96, significantly more patients died than were predicted. If it is higher than 1.96 than significantly more patients survived than predicted
    • Normal: -1.96 to 1.96
    • Better: >1.96
    • Worse: <-1.96
  • How does your hospital do against others?
  • Demonstrates performance
  • National comparison
137

W Score

Measures the clinical significance of the outcome. It represents the difference between the number of patients actually surviving and the number of survivors expected per 100 patients than would have been predicted. Thus a value of +4 indicates that 4 more patients survived per 100 patients than would have been predicted.

138

Data validation is

  • On ongoing never-ending process
  • A multi-layered method
  • A Systemic approach
  • Used to determine the completeness, accuracy and reliability of information gathered during abstraction
139

Consistency

  • Harmonious uniformity
  • Measure of reliability and uniformity
  • Does NOT infer validity
140

Data Dictionary

  • Provides data structure
  • Key tool in validation
  • Can be published by different entities:
    • Local, regional, state, national
141

Data Entry Validation

  • Measures consistency
  • Test-retest reliability
  • Same individual
  • Does NOT infer validity
142

Homogeneity

  • Being the same or identical
  • Infers agreement
  • Implies lack of diversity
143

Inter-Rater Reliability

  • Process to measure homogeneity between analysts
  • Takes 3 people - abstractor, validator, mediator
144

Logic Validation

  • Process to measure consistency
  • Multi-variable validation (think our check button)
145

Multi-Variable Validation

  • Process to measure consistency
  • Logic validation
146

Outliers

  • Outside the norm or expected range
  • Lowest and highest values
147

Pick Lists

or

Pop-Up Lists

Pop-up lists with an array of values used in single level validation

148

Single Variable Validation

  • Process to measure consistency
  • What should exist vs what actually exists
  • Data Dictionary is a key tool
149

Test-Retest Reliability Validation

  • Measures consistency of self over time
  • Does NOT infer validity
150

Validation

Multi-level process that establishes soundness, consistency, and accuracy

151

Validation Levels

  • Single Variable - check data points individually
  • Multi-Variable (Logic) - Ex: Date/time flow, transfer in but n/a on ref facility tab
  • Test-Retest Reliability (Data Entry) - knowledge increases
  • Inter-Rater Reliability - are we all doing it the same?
152

Purpose of Reporting

  • Quality Improvement
  • Injury Prevention
  • Clinical Research
  • Policy Development
153

Queries

Who do you want me to pull from the database?

154

Report

What do you want me to show you in the report?

How do you want it displayed?

155

NTDB

National Trauma Data Bank

  • Program from the ACS-COT
  • Collects data from participating hospitals
  • Contains injury information
  • Assists in the evaluation of individual providers and the system as a whole.
  • Data In - Data Out
  • NOT representative of all trauma hospitals in the nation
156

Data Gap

Records without a codable trauma diagnosis

157

TQIP

Trauma Quality Improvement Program

  • To improve quality of care of trauma patients
  • Identifies best practices (Benchmarking)
  • Outcome focus
  • Working towards standardization of data
  • Compliments existing PI process
  • Confidential reports
  • Uses existing trauma center staff and data collection infrastructure
  • Based on NTDB/NTDS data collection
  • Raises trauma center to a higher level
158

TQIP Report

  • Measures trauma center performance using process & outcome measures
  • Provides centers with performance rating indicators: Low, Average, High
  • There is no public reporting
159

NTDS

National Trauma Data Standard

  • Establishes a National Standard for the exchange of trauma registry data, and serves and the operational definitions for the NTDB.
  • Standard inclusion criteria, data definitions, and comorbidities
  • Common subset of variables
  • Edit checks
160

What is a trauma registry?

A disease-specific data collection composed of a file of uniform data elements that describe the injury event, demographics, pre-hospital information, diagnosis, care, outcomes and costs of treatment of injured patients.

161

Injury Severity Ranking:

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  1. Minor
  2. Moderate
  3. Serious
  4. Severe
  5. Critical
  6. Maximum (Currently untreatable)
162

AIS Codes

  • First digit
  • Second digit
  • Third and Fourth digits
  • Fifth and Sixth digits
  • Post Dot digit

1. Body Region

2. Type of Anatomic Structure

3 & 4. Specific Anatomic Structure

5 & 6. Level of injury within the specific body region and anatomic structure

Post Dot. AIS Injury Severity number

163

In AIS Code Descriptions

Parenthes

  • Contain synonyms for a specific type of injury
  • Provide a definition for the injury description
164

In AIS Code Descriptions

Brackets

  • Contain inclusionary or exclusionary information
  • Contain Organ Injury Scale Grade (OIS 3)
165

In AIS Code Descriptions

Boxed Bold Type

  • Contains directives to assist the coder in the appropriate use of specific description. EX: "Use this description if specific nerve is not known."
166

In AIS Code Descriptions

Semicolons

  • Separate injury descriptions that are comparable in severity
167

In AIS Code Descriptions

Italics

  • Used for proper-named anatomical structures or injuries, and for OIS grades
168

Blood Loss >20%

220 lb/100 k weight = 1500 ml

165 lb/75 k weight = 1125 ml

Approx 5 liters of blood in person 165 lb/75 k

169

Hematology

Involves testing on the blood itself to determine the patient blood volumes in relation to the normal values.

170

Ratio

One value as compared to another.

Ex: Frequency of occurrence as in one to 240 or 1:240.

171

Standard Deviation

A measure to quantify the difference between the values in the data set.

172

Toxicology

Can involve either a blood or urine sample. Looks for levels of alcohol (BAC) or drugs in the system.

173

How many pre dot digits in an AIS code?

6

174

How many post dot digits in an AIS code?

1

175

What is the single digit after the dot show in an AIS code?

It is the post dot score and describes the severity of an injury.

176

What is a trend and how would you present it?

It is a series of consecutive information/data that is all moving upward or downward as time progresses. A line can be overlaid onto the chart information/data that allows the reader to more easily visualize if there is a trend over time.

177

What are the AIS body regions?

  • Head
  • Face
  • Neck
  • Thorax
  • Abdomen and Pelvis
  • Spine
  • Upper Extremities
  • Lower Extremities
  • External
178

What are the stages of Eye GCS?

  1. No eye opening
  2. Open to pain
  3. Open to verbal command
  4. Open spontaneously
179

What are the stages of Verbal GCS?

  1. No verbal response
  2. Incomprehensible
  3. Inappropriate
  4. Confused
  5. Oriented
180

What are the stages of Motor GCS?

  1. No movement
  2. Move to pain, extension
  3. Flexion to pain
  4. Withdrawal from pain
  5. Localizing pain
  6. Obeys commands
181

What are the AIS main body region numbers corresponding with AIS scores?

  1. Head and Neck
  2. Face
  3. Chest/Thorax
  4. Abdomen and Lumbar Spine
  5. Extremities, Shoulder, and Pelvic Girdle
  6. External, Burns, Hypothermia, Asphyxiation, Drowning, Electrocution, and Full Body Explosion
182

What created the Joint Commission?

It was created by merging the Hospital Standardization Program with similar programs run by the American College of Physicians, the American Hospital Association, the American Medical Association, and the Canadian Medical Association.

183

What do arterial blood gasses measure?

The amount of O2, CO2, Sodium Bicarbonate, Base Excesses, etc.

184

What does a Radar Chart show?

Same as a spider gram and shows the relationship between multiple variables with one or more axis.

185

What does a population analysis look at?

  • Age
  • Gender
  • Residence
  • Nationality
  • etc of a group
186

What does the AIS severity reflect?

The severity of one injury for a patient 25-40 years old with no co-morbidities and with timely appropriate care.

187

What does TRISS determine?

Survivability

188

What injury would cause raccoon eyes?

Skull Base fx or a Frontal fx

189

What is OIS?

Organ Injury Scoring - The scale is graded 1-6 for each organ, 1 being the least severe and 5 being the most severe injury from which the patient may survive. Grade 6 injuries are by definition not salvageable.

190

What is the Joint Commission?

It is a national organization that provides standards so that hospitals may obtain accreditation for licensure and gain the right to receive payment from Medicaid and Medicare.

191

What is the process of PIPS?

Recognition, assessment, and correction.

192

What is the trauma registry log?

Contains a listing of each change or update to the registry software. It is to include the specific changes that are made to the user defined fields, additions and deletions, along with the date of each event.

193

Who originated the National Trauma Data Bank?

The ACS