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Download NYS Trauma Registry Statistical Summary Report 2010 - 2013
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New York State Trauma Registry Statistical Summary Report 2010-2013 New York State Department of Health Office of Primary Care and Health System Management September, 2015 Table of Contents - 2 Table of Contents Table of Contents Executive Summary Facility Information Geographic Distribution Regional Summaries Patient Characteristics Yearly Incidents Incidents and Incidence Case Fatalities Vital Statistics Temporal Distributions Payer Types Injury Characteristics Mechanism of Injury Place of Injury Falls Motor Vehicle Traffic Firearm Injury Severity Characteristics Emergency Medical Services Response Times Transport Times Initial Destination Outcome Statistics Discharge Disposition Length of Stay Complications Hospital Wait Times Emergency Department Intensive Care Unit Ventilator Pediatric Final Destination Cost of Trauma Risk Adjusted Comparisons Trauma Center Designation Pediatric Treatment by Designation Referral Status Year of Discharge Region Region and Injury Comparison to National Trauma Data Bank Case Fatality Rates By Injury Severity Score Case Fatality Rates By Age Appendix Incidence By Trauma Mechanism and County Mortality By Trauma Mechanism and County Injury Statistics Materials and Methods Risk Adjustment Methodology Inclusion Criteria References Executive Summary - 3 Executive Summary Introduction Summary of Results The purpose of this report is to present summary statistics of trauma-related injuries and outcomes of the care provided in the 40 trauma centers designated in New York State for the years 20102013. Trauma clinicians, administrators and policy makers may use this report to identify important areas and issues for enhancing systems development and clinical quality improvement; the public may use this report to learn more about the trauma system in New York. As trauma centers in New York State transition to the standards of the American College of Surgeons Committee on Trauma, and additional levels of trauma center are added to the State system, this report will serve as a baseline for measuring improvements in outcome and injury prevention. For the discharge years 2010-2013, the New York State Trauma Registry received a total of 69,657 trauma cases submitted by the 40 trauma centers across the state. The key findings are: Data Sources The New York State Trauma Registry serves as the data source. Trauma patients identified as being moderately to severely injured (Inclusion Criteria in Appendix 84) and discharged from the New York State designated trauma centers during 2010-2013 were included. I I I Annually, there were an average of 17,414 trauma incidents with a 6.63% case fatality rate. The trauma incidence and case fatality rate increased with patient’s age. Males had statistically significant higher trauma incidence and case fatality rate than females, particularly for patients aged 17-55; black people aged 17-35 years had statistically significant higher trauma incidence and case fatality rate compared to white people. Private health insurance was the primary payer for 49.6% of all trauma incidents and for 80.0% of injuries due to motor vehicle accidents. Medicare was the primary payer for 50.0% of injuries due to fall; Worker’s Compensation was the primary payer for 54.0% of the machinery injuries. Executive Summary - I I I I The leading causes of trauma were falls (45.0% ) and motor vehicle accidents (30.5%), these were also the leading causes of trauma death, followed by firearm trauma. Fire, suffocation, and firearm trauma had the highest case fatality rates, 23.1%, 21.4%, and 14.0% respectively. 61% of trauma patients had emergency medical services (EMS) response time within 8 minutes; 94% had response time within 30 minutes; and 98% had response time within 60 minutes. The median transport time to trauma and non-trauma centers were 16 minutes and 19 minutes, respectively. Adult trauma patients were taken directly to an appropriate trauma center in 82% of cases, approaching 95% for very severe trauma. Pediatric trauma patients however where taken to an appropriate trauma center in only 51% of reported cases. The risk adjusted case fatality rate among trauma patients residing in Central New York region (7.3%) was statistically significantly higher than the statewide rate (6.5%); while trauma patients residing in Northern and Western New York regions had statistically significantly lower adjusted fatality rates (5.6% for Northern, 5.8% for Western New York). 4 I I Trauma centers with an adult only designation had a significantly higher risk adjusted case fatality rate than trauma centers with a pediatric or dual desigantion. Compared to the national estimates (National Trauma Data Bank), the 2013 trauma case fatality rate in New York was significantly higher among trauma patients 75 year of age or older with an injury severity score greater than 24. Acknowledgement The State Health Department would like to thank: the New York Trauma Center program staff and the Bureau of Emergency Medical Services and Trauma Systems program manager of the Office of Primary Care and Health System Management (OPCHSM) who have worked diligently to provide the data utilized in this report, the NYSDOH Bureau of Occupational Health and Injury Prevention for the injury statistics (Appendix), and the Data Management, Analysis and Research Group of the OPCHSM who created the trauma registy and performed the descriptive and predictive statistical analyses to generate the tables and figures presented in this report. Facility Information Facility Information - Geographic Distribution 6 New York Trauma Regions Western New York Finger Lakes Region Central New York Northern New York Hudson Valley Region New York City Long Island Nassau Long Island Suffolk clinton franklin st lawrence essex jefferson lewis hamilton warren oswego herkimer washington niagara orleans oneida wayne monroe onondaga cayuga madison ontario erie saratoga fulton genesee montgomery schenectady seneca wyoming livingston rensselaer yates otsego cortland tompkins albany schoharie chenango schuyler chautauqua cattaraugus allegany greene steuben chemung tioga broome delaware columbia ulster dutchess sullivan orange putnam westchester rockland bronx new york nassau queens kings richmond suffolk Facility Information - Geographic Distribution 7 Geographic Distribution of Upstate New York Trauma Centers Regional (black) Area (blue) Adult Only Pediatric Only Dual Designation The University of Vermont Health Network − Champlain Valley Physicians Hospital Strong Memorial Hospital St Elizabeth Medical Center University Hospital SUNY Health Science Center Erie County Medical Center Women And Children's Hospital Of Buffalo Mary Imogene Bassett Hospital Albany Medical Center Hospital United Health Services Hospitals Inc. − Wilson Medical Center Mid−Hudson Valley Division of Westchester Medical Center Good Samaritan Hospital of Suffern Westchester Medical Center Nyack Hospital Montefiore New Rochelle Hospital 0 50 100 mi Facility Information - Geographic Distribution 8 Geographic Distribution of New York City Trauma Centers Regional (black) Area (blue) Adult Only Pediatric Only Dual Designation Jacobi Medical Center SBH Health System bronx New York Presbyterian Hospital − Columbia Presbyterian Center Lincoln Medical & Mental Health Center Harlem Hospital Center Mount Sinai St. Luke's New York Presbyteriannew Hospital york − New York Weill Cornell Center Bellevue Hospital Center New York Hospital Medical Center of Queens Elmhurst Hospital Center Jamaica Hospital Medical Center queens Kings County Hospital Center Lutheran Medical Center Brookdale Hospital Medical Center Richmond University Medical Center kings Staten Island University Hosp−North richmond 0 5 10 mi Facility Information - Geographic Distribution 9 Geographic Distribution of Long Island Trauma Centers Regional (black) Area (blue) Adult Only Pediatric Only Dual Designation University Hospital Huntington Hospital suffolk North Shore University Hospital Brookhaven Memorial Hospital Medical Center Inc Winthrop−University Hospital nassau Medical Center Nassau University Southside Hospital Good Samaritan Hospital Medical Center South Nassau Communities Hospital 0 10 20 30 mi Facility Information - Regional Summaries 10 Types of Trauma Centers By Region Trauma Region Total Trauma Centers Area Trauma Centers Regional Trauma Centers Dual Designation Trauma Centers Adult Only Trauma Centers Pediatric Only Trauma Centers Central New York 3 (8%) 2 1 1 2 0 Finger Lakes 1 (2%) 0 1 1 0 0 Hudson Valley 5 (12%) 4 1 1 4 0 Long Island Nassau 4 (10%) 1 3 3 1 0 Long Island Suffolk 5 (12%) 4 1 2 3 0 New York City 17 (42%) 0 17 8 7 2 Northern New York 3 (8%) 2 1 1 2 0 Western New York 2 (5%) 0 2 0 1 1 All Regions 40 (100%) 13 27 17 20 3 Facility Information - Regional Summaries 11 Distribution of New York Trauma Centers by Region New York City 42 % Northern New York 8% Distribution of New York Trauma Centers by Number of Certified Beds 400−600 certified beds: 41% 600−800 certified beds: 15.4% Western New York 5% Central New York 8% 800−1000 certified beds: 10.3% Finger Lakes 2% Long Island Suffolk 12 % Hudson Valley 12 % 0−200 certified beds: 5.1% 200−400 certified beds: 28.2% Long Island Nassau 10 % Distribution of New York Trauma Centers by Designation Distribution of New York Trauma Centers by Type Dual Designation Trauma Centers 42 % Area Trauma Centers 32 % Pediatric Only Trauma Centers 8% Adult Only Trauma Centers 50 % Regional Trauma Centers 68 % Facility Information - Regional Summaries 12 New York City Trauma Center Case Loads Facility Adult Trauma Cases 2010 Adult Trauma Cases 2011 Adult Trauma Cases 2012 Adult Trauma Cases 2013 Pediatric Trauma Cases 2010 Pediatric Trauma Cases 2011 Pediatric Trauma Cases 2012 Pediatric Trauma Cases 2013 Type Designation Bellevue Hospital Center 460 521 394 53 29 26 10 5 Regional DualDesig Brookdale Hospital Medical Center 373 327 316 208 44 33 27 11 Regional AdultOnly Elmhurst Hospital Center 570 529 526 396 44 53 33 28 Regional DualDesig Harlem Hospital Center 199 216 198 144 19 9 7 9 Regional DualDesig Jacobi Medical Center 535 446 524 405 47 41 43 35 Regional DualDesig Jamaica Hospital Medical Center 363 312 206 344 16 2 0 0 Regional AdultOnly Kings County Hospital Center 486 484 497 493 34 24 14 19 Regional DualDesig Lincoln Medical & Mental Health Center 378 366 303 138 9 20 21 12 Regional AdultOnly Lutheran Medical Center 493 439 473 576 12 5 7 6 Regional AdultOnly New York Hospital Medical Center of Queens 475 431 427 446 17 8 5 11 Regional AdultOnly New York Presbyterian Hospital Columbia Presbyterian Center 9 10 7 8 66 66 52 42 Regional Pediatric New York Presbyterian Hospital New York Weill Cornell Center 420 361 272 284 90 48 28 33 Regional DualDesig Richmond University Medical Center 174 161 104 138 17 20 10 11 Regional DualDesig St Barnabas Hospital 373 265 300 244 8 8 4 4 Regional AdultOnly St Lukes Roosevelt Hospital St Lukes Hospital Division 218 151 196 182 7 6 1 1 Regional AdultOnly Staten Island University Hosp North 321 335 389 498 20 16 24 21 Regional DualDesig Steven & Alexandra Cohen Children's Medical Center 39 32 41 16 152 178 203 163 Regional Pediatric Facility Information - Regional Summaries 13 Long Island Trauma Center Case Loads Facility Adult Trauma Cases 2010 Adult Trauma Cases 2011 Adult Trauma Cases 2012 Adult Trauma Cases 2013 Pediatric Trauma Cases 2010 Pediatric Trauma Cases 2011 Brookhaven Memorial Hospital Medical Center Inc 308 280 263 271 2 5 Good Samaritan Hospital Medical Center 303 351 309 330 34 29 Huntington Hospital 286 280 222 274 2 2 Nassau University Medical Center 486 336 440 306 19 Pediatric Trauma Cases 2012 Pediatric Trauma Cases 2013 Type Designation 0 0 Area AdultOnly 36 18 Area DualDesig 3 0 Area AdultOnly 11 10 12 Regional DualDesig North Shore University Hospital 795 813 706 823 7 9 8 5 Regional DualDesig South Nassau Communities Hospital 276 239 193 297 0 4 3 4 Area AdultOnly Southside Hospital 262 273 243 292 2 2 1 8 Area AdultOnly University Hospital 781 732 727 715 74 82 74 60 Regional DualDesig Winthrop University Hospital 471 429 432 421 43 30 36 31 Regional DualDesig Facility Information - Regional Summaries 14 Upstate Trauma Center Case Loads Facility Adult Trauma Cases 2010 Adult Trauma Cases 2011 Adult Trauma Cases 2012 Adult Trauma Cases 2013 Pediatric Trauma Cases 2010 Pediatric Trauma Cases 2011 Pediatric Trauma Cases 2012 Pediatric Trauma Cases 2013 Type Designation Albany Medical Center Hospital 1241 1201 1253 1393 108 128 148 155 Regional DualDesig Champlain Valley Physicians Hospital Medical Center 75 41 122 91 4 0 3 4 Area AdultOnly Erie County Medical Center 874 996 1142 1140 2 3 4 2 Regional AdultOnly Good Samaritan Hospital of Suffern 88 91 134 80 0 0 1 0 Area AdultOnly Mary Imogene Bassett Hospital 154 138 124 95 6 7 6 3 Area AdultOnly Nyack Hospital 143 225 258 245 7 21 26 24 Area AdultOnly Sound Shore Medical Center of Westchester 33 23 36 33 1 0 1 0 Area AdultOnly St Elizabeth Medical Center 196 225 153 96 5 9 1 2 Area AdultOnly St Francis Hospital Poughkeepsie 389 409 331 347 14 6 4 12 Area AdultOnly Strong Memorial Hospital 1090 1123 1143 1017 122 122 92 93 Regional DualDesig United Health Services Hospitals Inc Wilson Hospital Division 358 445 369 333 18 24 21 12 Area AdultOnly University Hospital SUNY Health Science Center 976 980 1042 1059 158 124 144 139 Regional DualDesig Westchester Medical Center 973 958 1060 990 210 196 162 156 Regional DualDesig Women And Children's Hospital Of Buffalo 26 27 23 27 190 191 212 163 Regional Pediatric Patient Characteristics Patient Characteristics - Yearly Incidents 16 Trauma Incidents and Fatalities by Year incidents deaths 20 Number of Cases (in thousands) 18,133 17,575 17,386 16,563 15 10 5 1,163 (6.4%) 1,188 (6.8%) 2010 2011 1,168 (6.7%) 1,097 (6.6%) 2012 2013 0 Year Patient Characteristics - Yearly Incidents 17 Trauma Incidents and Fatalities by Year and Gender incidents 11,754 12 deaths 11,301 11,283 10,488 Number of Cases (in thousands) 10 8 6 5,922 5,874 5,749 5,682 4 2 794 (7.0%) 793 (7.0%) 757 (6.4%) 370 (6.2%) 367 (6.2%) 703 (6.7%) 365 (6.3%) 354 (6.2%) 0 Female Male 2010 Female Male Female Male 2011* 2012* Astrix (*) indicates a statistically significant difference in case falalities between males and females with 95% confidence.For the combined four year period there was a statistically significant difference in case fatality rates of males and females (6.8% and 6.2% respectively) with 99% confidence. Female Male 2013 Patient Characteristics - Incidents and Incidence 18 Average Annual Trauma Incidents and Fatalities by Age Number of Cases 300 incidents deaths 250 200 150 100 50 0 1 4 7 11 15 19 23 27 31 35 39 43 47 51 55 59 63 67 71 75 79 83 87 91 95 99 104 Age (years) Average Annual Trauma Incidence and Mortality by Age Cases per 1,000 People 4 3 2 1 0 0 2 4 6 8 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 Age (years) Population data source: Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. 70 73 76 79 82 >85 Patient Characteristics - Incidents and Incidence 19 Average Annual Trauma Incidents by Gender and Age 1000 Number of Cases Male Female 800 600 400 200 0 0 3 6 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 102 112 Age (years) Cases per 1,000 People Average Annual Trauma Incidence by Gender and Age 4 Male Female 3 2 1 0 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66 69 72 75 78 81 84 Age (years) Population data source: Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. Patient Characteristics - Incidents and Incidence 20 Average Annual Trauma Incidents by Race and Age Number of Cases White Black Asian 600 400 200 0 0 3 6 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 102 112 Age (years) Average Annual Trauma Incidence by Race and Age Cases per 1,000 People 4 White Black Asian 3 2 1 0 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66 69 72 75 78 81 84 Age (years) Population data source: Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. Patient Characteristics - Case Fatalities 21 Case Fatality Rate by Age Case Fatality Rate (%) Case Fatality Rate by Age and Gender observed smoothed 95% Confidence Interval 16 Male 95% Confidence Interval Male smoothed Female 95% Confidence Interval Female smoothed 16 Case Fatality Rate by Age and Race 14 14 12 12 12 10 10 10 8 8 8 6 6 6 4 4 4 2 2 2 0 0 0 20 40 60 Age (years) 80 Black 95% Confidence Interval Black smoothed White 95% Confidence Interval White smoothed 16 14 0 0 20 40 60 80 0 20 Age (years) Smoothed using a local regression algorithm (LOESS) weighting each point by number of incidents. 40 Age (years) 60 80 Patient Characteristics - Vital Statistics 22 Trauma Registry Deaths as a Percent of All New York State Deaths in 2013 by Age (NYS residents only) 8 7.1% 7.1% Percent of all Deaths 6 5.2% 4.9% 4 1.8% 2 1.0% 0.6% 0.4% 0.4% 0.6% 0.5% 75−84 85+ 0 <1 1−9 10−19 20−24 25−34 35−44 Age (years) 45−54 55−64 65−74 Patient Characteristics - Temporal Distributions 23 Percent of Trauma Occurrences by Day of the Week 18 Percent 17 16 15 14 13 12 11 Monday Tuesday Wednesday Thursday Friday Saturday Sunday Percent of Trauma Occurrences by Month of the Year 11 Percent 10 9 8 7 6 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Percent of Trauma Occurrences by Time of the Day 5 4 3 PM 11 M PM 10 M 9P M 8P M 7P M 6P M 5P M 4P M 3P M 2P PM 1P AM 12 AM 11 9A M 10 8A M 7A M 6A M 5A M 4A M 3A M 2A M AM 1A M 2 12 Percent 6 Patient Characteristics - Payer Types 24 Average Annual Trauma Incident Distribution by Primary Payer 49.6% Insurance Company 24.7% Medicare 9.7% Medicaid 7.9% Self−Pay 3.5% Workers Compensation 3.2% Other Non−Federal Program Unknown 0.6% Other Federal Program 0.5% CHAMPUS 0.3% 0 10 20 30 Percent of Total Cases 40 50 Patient Characteristics - Payer Types 25 Payer Types by Region Finger Lakes Region 51% Insurance Company 21% Medicare 8% Self−Pay 3% Workers Compensation 0 26% 7% Self−Pay 5% Medicaid 3% Workers Compensation 0 10 20 30 40 50 Percent of Total Cases 35% Medicare 9% Self−Pay 7% Medicaid 4% Medicaid 6% Self−Pay 4% 6% 0 10 20 Workers Compensation 30 40 25% 16% Medicaid 10% Self−Pay 2% Workers Compensation 0 10 30 40 Percent of Total Cases 0 23% Medicare Western New York 48% Insurance Company 17% Other Non−Federal Program Medicaid 6% Medicare Self−Pay 5% Self−Pay 4% 0 10 13% 8% 7% Medicaid 30 10 20 30 40 50 Percent of Total Cases 55% Insurance Company Unknown 20 50 Northern New York 46% Medicare 3% Workers Compensation 30 Percent of Total Cases New York City Insurance Company 5% 0 10 Percent of Total Cases Long Island Suffolk 31% 53% Insurance Company 8% Percent of Total Cases Medicare 22% Medicare Self−Pay Medicaid 50% 59% Insurance Company Long Island Nassau Other Non−Federal Program 10 20 30 40 50 Insurance Company Hudson Valley Region 46% Insurance Company Medicare 15% Medicaid Central New York 50 Percent of Total Cases 0 10 20 30 40 Percent of Total Cases Patient Characteristics - Payer Types 26 Payer Types by Mechanism of Trauma Fall Motor Vehicle Traffic 50% Medicare 32% Insurance Company 7% Medicaid Self−Pay Workers Compensation 0 80% Insurance Company 7% Other Non−Federal Program Insurance Company 35% Medicaid Self−Pay 5% Self−Pay 3% Other Non−Federal Program 3% Medicaid 2% 0 18% Medicaid 5% 10 20 22% 11% 4% Medicaid 30 40 Percent of Total Cases 0 10 2% Other Non−Federal Program 15 25 35 0 Insurance Company 9% 50 Percent of Total Cases 52% 16% Medicare 7% Medicaid 7% Workers Compensation 4% 15% 7% 4% Self−Pay 40 60 Percent of Total Cases 30 Insurance Company Medicare 20 20 Overexertion Medicaid 0 10 Percent of Total Cases 68% Workers Compensation 30 5% Percent of Total Cases Self−Pay 7% Self−Pay 21% Self−Pay Transport, non traffic Workers Compensation Medicare 9% 0 5 54% Insurance Company 15% Self−Pay Medicare 60 39% 29% Medicare 3% Medicare 40 Machinery 48% Insurance Company 20 22% 3% Percent of Total Cases Struck by, against 0 36% Medicaid Workers Compensation 10 20 30 40 50 Cut / Pierce Insurance Company 5% Percent of Total Cases Workers Compensation Firearm 0 10 20 30 40 50 Percent of Total Cases Injury Characteristics Injury Characteristics - Mechanism of Injury Average Annual Trauma Incidents by Intention of Injury 9 (0.1%) Other 28 Average Annual Trauma Fatalities by Intention of Injury Other 0 (0.0%) Other 7 (0.6%) Undetermined Undetermined 58 (0.4%) Undetermined Self−Inflicted 166 (1.0%) Self−Inflicted 2,022 (12.3%) Assault 14,151 (86.3%) 0 5000 33 (3.0%) 10000 Number of Cases 15000 933 (85.4%) 200 11.6% 19.7% 400 5.9% Assault Unintentional 0 2.8% Self−Inflicted 120 (11.0%) Assault Unintentional Case Fatality Rate by Intention of Injury 600 800 Number of Deaths 1000 6.6% Unintentional 0 5 10 15 Case Fatality Rate (%) 20 Injury Characteristics - Mechanism of Injury Average Annual Trauma Incidents by Injury Category 29 Average Annual Trauma Fatalities by Injury Category Case Fatality Rate by Injury Category Fire, burn 6 (0.0%) Fire, burn 2 (0.1%) Fire, burn Suffocation 7 (0.0%) Suffocation 2 (0.1%) Suffocation Drowning, Submersion 9 (0.1%) 23.1% 21.4% Drowning, Submersion 0 (0.0%) Drowning, Submersion Overexertion 32 (0.2%) Overexertion 0 (0.0%) Overexertion 1.6% Natural, environmental 39 (0.2%) Natural, environmental 0 (0.0%) Natural, environmental 1.3% Pedestrian, non traffic 72 (0.4%) Pedestrian, non traffic 6 (0.6%) Pedestrian, non traffic Machinery 82 (0.5%) Machinery 2 (0.2%) Machinery Other Specified and Classifiable 117 (0.7%) Other Specified and Classifiable Other Specified, NEC 170 (1.0%) Other Specified, NEC Unspecified 260 (1.6%) Unspecified Pedal cyclist, Non Traffic 296 (1.8%) Pedal cyclist, Non Traffic 11 (1.0%) 5.7% 9.0% 2.7% 9.4% Other Specified and Classifiable 5 (0.5%) 3.1% Other Specified, NEC 18 (1.7%) 7.1% Unspecified 6 (0.5%) 1.9% Pedal cyclist, Non Traffic Cut / Pierce 488 (3.0%) Cut / Pierce 16 (1.5%) Cut / Pierce 3.3% Transport, non traffic 572 (3.5%) Transport, non traffic 18 (1.7%) Transport, non traffic 3.2% Firearm 756 (4.6%) 7,381 (45.0%) Fall 0 2000 4000 6000 8000 Number of Cases 338 (30.9%) 538 (49.2%) Fall 100 2.0% Struck by, against Motor Vehicle Traffic 0 14.0% Firearm 23 (2.1%) Struck by, against 5,006 (30.5%) Motor Vehicle Traffic 106 (9.7%) Firearm 1,110 (6.8%) Struck by, against 300 500 Number of Deaths Motor Vehicle Traffic 6.7% Fall 7.3% 0 5 10 15 20 25 Case Fatality Rate (%) Injury Characteristics - Place of Injury Average Annual Trauma Incidents by Place of Injury 30 Average Annual Trauma Fatalities by Place of Injury Case Fatality Rate by Place of Injury Mine 6 (0.0%) Mine 0 (0.0%) Mine Farm 74 (0.4%) Farm 4 (0.3%) Farm Industry 8 (0.6%) Industry 244 (1.4%) Industry Public Building 572 (3.3%) Public Building Residential Institution 586 (3.4%) Residential Institution 776 (4.5%) Recreation 1,508 (8.7%) Other 1,727 (9.9%) Unspecified 5,330 (30.6%) Home 6,590 (37.8%) Street 0 1000 3000 5000 Number of Cases 7000 14 (1.2%) 4.5% 10.3% 1.7% Recreation Other 85 (7.4%) Other Unspecified 86 (7.4%) Unspecified 443 (38.4%) Home 429 (37.2%) Street 100 3.1% Residential Institution 60 (5.2%) 0 5.4% Public Building 26 (2.3%) Recreation 4.2% 200 300 400 Number of Deaths 500 5.7% 5.0% 8.3% Home 6.5% Street 0 2 4 6 8 10 Case Fatality Rate (%) Injury Characteristics - Falls 31 Number of Cases Fall Trauma: Average Annual Incidents and Fatalities by Age incidents deaths 150 100 50 0 1 4 7 11 15 19 23 27 31 35 39 43 47 51 55 59 63 67 71 75 79 83 87 91 95 99 103 Age (years) Fall Trauma: Average Annual Incidence and Mortality by Age Cases per 1,000 People 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 0 2 4 6 8 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 Age (years) Population data source: Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. 70 73 76 79 82 >85 Injury Characteristics - Motor Vehicle Traffic 32 Motor Vehicle Traffic Trauma: Average Annual Incidents and Fatalities by Age incidents deaths Number of Cases 120 100 80 60 40 20 0 1 4 7 10 14 18 22 26 30 34 38 42 46 50 54 58 62 66 70 74 78 82 86 90 94 98 104 Age (years) Cases per 10,000 People Motor Vehicle Traffic Trauma: Average Annual Incidence and Mortality by Age 4 3 2 1 0 0 2 4 6 8 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 Age (years) Population data source: Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. 70 73 76 79 82 >85 Injury Characteristics - Firearm 33 Firearm Trauma: Average Annual Incidence by Age and Intention Cases per 100,000 People 20 Assault Other Self−Inflicted Undetermined Unintentional 15 10 5 0 0 2 4 8 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 71 75 78 81 Age (years) Firearm Trauma: Average Annual Incidence by Region and Intention Hudson Valley Region Long Island Nassau Long Island Suffolk Northern New York Central New York New York City Finger Lakes Region Western New York Assault Other Self−Inflicted Undetermined Unintentional 0 1 2 3 4 5 6 Cases per 100,000 people Population data source: Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. 7 >85 Injury Characteristics - Injury Severity Characteristics 34 Average Annual Incidents of Trauma and Fatalities by Injury Severity Score 8000 incidents deaths 7,751 Number of Cases 6000 4,512 4000 2,134 2000 0 1,806 30 (1.4%) 147 (1.9%) 1−8 9−15 454 (25.2%) 622 284 (45.6%) 24−34 35−75 200 (4.4%) 16−24 Injury Severity Score Injury Characteristics - Injury Severity Characteristics 35 Average Annual Trauma Case Fatality Rate by Age and Injury Severity Score (ISS) ISS 0−15 100 ISS 16−24 ISS 25−34 ISS 35−75 Case Fatality Rate (%) 80 60 40 20 0 0 20 40 Age (years) 60 80 Emergency Medical Services Emergency Medical Services - Response Times 37 Distribution of Emergency Medical Services (EMS) Response Times Distribution of Emergency Medical Services Response Times by Injury Severity Score and Outcome max 25 35 max 20 30 max 3rd quartile 3rd quartile 10 15 15 Time (minutes) max 20 3rd quartile 3rd quartile 10 median median median 5 median 5 0 0 0− 5− 5 10 10 −1 15 5 − 20 20 − 25 25 − 30 30 − 35 35 − 40 40 − 45 45 − 50 50 − 55 55 − 60 60 − 65 65 − 70 70 − 75 75 − 80 80 − 85 85 − 90 90 − 95 95 −1 00 Percent of Cases 25 1st quartile 1st quartile 1st quartile 1st quartile min Alive ISS<30 min Dead ISS<30 min Alive ISS>30 min Dead ISS>30 Time (minutes) Response time is calculated as the time from emergency phone call to medical service’s arrival at scene. Statistical outliers are omitted from boxplots. Notches represent a 95% confidence interval around the medians. Nonoverlapping notches sugest a meaningfull difference in group medians. Emergency Medical Services - Response Times 38 New York State Median EMS Response Time by County of Residence st lawrence schuyler hamilton steuben franklin chemung yates lewis putnam jefferson delaware allegany wyoming sullivan chenango ulster orange essex schoharie seneca otsego livingston herkimer cattaraugus wayne washington tioga tompkins ontario montgomery genesee chautauqua cayuga oswego niagara madison greene westchester warren suffolk rensselaer orleans oneida dutchess clinton schenectady saratoga rockland onondaga monroe erie cortland columbia broome albany richmond queens nassau fulton new york kings bronx clinton franklin st lawrence essex jefferson lewis hamilton warren oswego herkimer washington orleans niagara wayne monroe genesee wyoming livingston cattaraugus allegany montgomery schenectady seneca yates otsego cortland tompkins schuyler chautauqua saratoga fulton onondaga cayuga madison ontario erie oneida rensselaer schoharie albany chenango greene steuben chemung tioga broome delaware columbia ulster dutchess sullivan orange putnam westchester rockland bronx new york nassau queens kings richmond suffolk 0 10 20 30 40 EMS Response Time (minutes) Emergency Medical Services - Transport Times 20 39 Distribution of Emergency Medical Services (EMS) Transport Times to Non−trauma Centers Distribution of Emergency Medical Services (EMS) Transport Time by Initial Destination 18 max 16 50 Percent of Cases 14 12 max 10 8 40 6 4 2 Time (minutes) 30 3rd quartile 3rd quartile 20 24 22 20 18 16 14 12 10 8 6 4 2 0 median median 1st quartile 1st quartile 10 0 0− 5 5− 1 10 0 −1 15 5 −2 20 0 −2 25 5 −3 30 0 −3 35 5 −4 40 0 −4 45 5 −5 50 0 −5 55 5 −6 60 0 −6 65 5 −7 70 0 −7 75 5 −8 80 0 −8 85 5 −9 0 Percent of Cases Distribution of Emergency Medical Services (EMS) Transport Times to Trauma Center Time (minutes) 0− 5 5− 1 10 0 −1 15 5 −2 20 0 −2 25 5 −3 30 0 −3 35 5 −4 40 0 −4 45 5 −5 50 0 −5 55 5 −6 60 0 −6 65 5 −7 70 0 −7 75 5 −8 80 0 −8 85 5 −9 0 0 Time (minutes) min min Trauma Center Non−Trauma Center Initial Destination Transport time is calculated as time from emergency medical service’s departure from the scene of injury to arrival at hospital. Statistical outliers are omitted from boxplots. Notches represent a 95% confidence interval around the medians. Nonoverlapping notches sugest a meaningfull difference in group medians. Emergency Medical Services - Transport Times 40 Median EMS Transport Time To Appropriate Trauma Center by County of Residence warren fulton schoharie washington montgomery st lawrence delaware tompkins greene columbia lewis jefferson seneca steuben chenango allegany saratoga cattaraugus franklin ulster tioga cortland yates schuyler livingston chautauqua madison sullivan oswego orleans schenectady ontario essex cayuga wayne wyoming orange niagara herkimer hamilton putnam genesee dutchess otsego rensselaer clinton albany westchester rockland broome chemung oneida queens monroe kings erie suffolk richmond onondaga new york nassau bronx clinton franklin st lawrence essex jefferson lewis hamilton warren oswego herkimer washington orleans niagara wayne monroe genesee wyoming livingston cattaraugus allegany montgomery schenectady seneca yates otsego cortland tompkins schuyler chautauqua saratoga fulton onondaga cayuga madison ontario erie oneida rensselaer schoharie albany chenango greene steuben chemung tioga broome delaware columbia ulster dutchess sullivan orange putnam westchester rockland bronx new york nassau queens kings richmond suffolk 0 10 30 50 EMS Transport Time (minutes) Emergency Medical Services - Initial Destination 41 Distribution of Adult Trauma Cases by Inital Destination Transport to Appropriate Trauma Center by Age and Injury Severity Score 100 Adult Only 35.4% Adult Pediatric 95 90 85 Unknown 1.1% 80 75 Dual Designation 46.1% Non−Trauma 17.2% 70 65 Pediatric 0.2% Distribution of Pediatric Trauma Cases by Inital Destination Percent of Cases 60 55 50 45 40 35 Adult Only 23.6% Dual Designation 34.4% 30 25 20 Unknown 2.8% 15 10 Pediatric 9.1% 5 Non−Trauma 30.1% 0 0−24 25−50 Injury Severity Score Registry data does not include data from patients that never made it to a Trauma Center. 95% confidence intervals are shown around sample means in the barchart. Walk-ins excluded. 50−75 Outcome Statistics Outcome Statistics - Discharge Disposition 43 Average Annual Discharges By Disposition Hospice 1 ( 0.0%) Unknown 99 ( 0.6%) Psychiatric Hospital 117 ( 0.7%) Law Enforcement 153 ( 0.9%) Other 166 ( 1.0%) Left Against Medical Advice 241 ( 1.4%) Short−Term General Hospital 251 ( 1.4%) 1,154 ( 6.6%) Died 1,296 ( 7.4%) Skilled Nursing Facility 1,751 (10.1%) Home Health Services 3,268 (18.8%) Inpatient Rehab 8,917 (51.2%) Home − No Sevices 0 2000 4000 6000 Number of Cases 8000 10000 Outcome Statistics - Length of Stay 44 Length of Stay by Injury Severity Score for Patients Who Died 80 80 60 60 Time (days) Time (days) Length of Stay by Injury Severity Score for Patients Who Lived 40 40 26 20 20 11 5 4 2 0 0 0 0−24 25−49 Injury Severity Score 50−75 0−24 25−49 Injury Severity Score 50−75 Outcome Statistics - Complications 45 Average Annual Trauma Incidents by Complication new bone infection 4 failure of graft, flap, or prosthesis 5 Average Annual Trauma Fatalities by Complication Average Annual Case Fatality Rate by Complication new bone infection 0 new bone infection 5.6% failure of graft, flap, or prosthesis 0 failure of graft, flap, or prosthesis 0.0% catheter related blood stream infection 18 catheter related blood stream infection 3 catheter related blood stream infection organ or space surgical site infection 20 organ or space surgical site infection 1 organ or space surgical site infection unplanned return to ICU 22 unplanned return to ICU 3 unplanned return to ICU deep surgical site infection 23 deep surgical site infection 2 deep surgical site infection new stroke or cerebral vascular accident 25 new stroke or cerebral vascular accident 5 new stroke or cerebral vascular accident superficial surgical site infection 33 superficial surgical site infection 1 superficial surgical site infection new myocardial infarction 41 new myocardial infarction extremity compartment syndrome 54 extremity compartment syndrome 2 pulmonary embolism 61 pulmonary embolism 8 unplanned intubation 107 unplanned intubation new decubitus ulcer 120 new decubitus ulcer 16 14 deep vein thrombosis 144 deep vein thrombosis cardiac arrest in hospital 152 cardiac arrest in hospital acute kidney injury 156 acute kidney injury severe sepsis 160 severe sepsis withdrawal from alcohol or drugs 163 withdrawal from alcohol or drugs new urinary tract infection 336 new urinary tract infection acute lung injury 394 acute lung injury 470 pneumonia 747 other unspecified 0 400 800 Number of Cases 14 19.0% 2.3% 33.3% new myocardial infarction 4.6% 13.1% pulmonary embolism 28.5% unplanned intubation 13.3% new decubitus ulcer 9.6% deep vein thrombosis 126 44 82.3% cardiac arrest in hospital 28.1% acute kidney injury 53 33.3% severe sepsis 5 27 93 136 other unspecified withdrawal from alcohol or drugs 2.9% new urinary tract infection 8.1% 23.6% acute lung injury 77 0 14.6% 7.5% extremity compartment syndrome 30 pneumonia 15.1% 3.7% 60 120 Number of Deaths pneumonia 16.4% other unspecified 18.2% 0 40 80 Case Fatality Rate (%) Outcome Statistics - Hospital Wait Times 46 Distribution of Time Until First Procedure 30 30 25 25 20 20 Time (hours) Time (hours) Distribution of Time In Emergency Department 15 10 5 15 10 5:06 5 4:34 3:15 2:17 1:26 0 0:44 0 0−24 25−49 Injury Severity Score 50−75 0−24 25−49 Injury Severity Score 50−75 Outcome Statistics - Emergency Department 47 Average Annual Trauma Fatalities by Location of Patient Deaths Average Annual Incidents of Required Emergency Department Procedures 1100 Number of Cases 1,648 (9%) 1500 87% 1000 1000 727 (4%) 500 0 ED Intubation Chest Tube 40 (0%) 24 (0%) 14 (0%) CPR In Progress CPR Start Unknown CPR Initiated 9 (0%) Thoracotomy 900 4 (0%) Surgical Airway 800 100 90 80 70 60 50 40 30 20 10 0 700 86% 53% 29% 19% 11% CPR In Progress CPR Initiated CPR Start Unknown Thoracotomy Surgical Airway 5% 2% ED Intubation Chest Tube Number of Cases Case Fatality Rate (%) Emergency Department Case Fatality Rates by Required Emergency Department Procedure 600 500 400 300 Case Fatality Rate (%) Inpatient Case Fatality Rates by Required Emergency Department Procedure 100 90 80 70 60 50 40 30 20 10 0 97% 89% 200 76% 13% 64% 33% 31% Surgical Airway ED Intubation 100 9% CPR In Progress CPR Initiated CPR Start Unknown Thoracotomy Chest Tube 0 Died in ED Died after ED Outcome Statistics - Intensive Care Unit 48 Trauma Patients Admitted to the Intensive Care Unit (ICU) Days in the Intensive Care Unit (ICU) ICU: 45% Survived Died No ICU: 55% 1 3 5 7 9 11 13 15 Time in ICU (days) Case Fatalities in the Intensive Care Unit (ICU) as a Function of Time Case Fatality Rate (%) 25 observed smoothed 20 15 10 5 0 0 10 20 30 Time in ICU (days) 40 50 Outcome Statistics - Ventilator 49 Trauma Patients Requiring a Ventalator Days on a Ventalator Ventalator: 17% Survived Died No Ventalator: 83% 1 3 5 7 9 11 13 15 17 19 21 Time on a Ventalator (days) Case Fatality Rate of Patients on a Ventilator as a Function of Time 30 observed smoothed 95% Confidence Interval Case Fatality Rate (%) 25 20 15 10 5 0 0 10 20 30 Time on a Ventilator (days) 40 50 Outcome Statistics - Pediatric Final Destination 50 Percent of Pediatric Patients Treated at an Appropriate Final Destination by County of Residence yates wyoming wayne washington warren tompkins sullivan steuben st lawrence schenectady saratoga rensselaer oswego orleans ontario onondaga livingston lewis jefferson greene genesee fulton franklin columbia chemung chautauqua cattaraugus allegany albany monroe richmond niagara erie westchester madison orange putnam montgomery nassau suffolk cayuga cortland schuyler essex new york ulster queens seneca delaware oneida schoharie chenango herkimer dutchess bronx kings tioga rockland otsego broome clinton clinton franklin st lawrence essex jefferson lewis hamilton warren oswego herkimer washington orleans niagara wayne monroe genesee wyoming livingston cattaraugus allegany montgomery schenectady seneca yates otsego cortland tompkins schuyler chautauqua saratoga fulton onondaga cayuga madison ontario erie oneida rensselaer schoharie albany chenango greene steuben chemung tioga broome delaware columbia ulster dutchess sullivan orange putnam westchester rockland bronx new york nassau queens kings richmond suffolk 0 20 40 60 80 Percent Treated by Appropriate Trauma Center Outcome Statistics - Cost of Trauma 51 Probability Density of Gross Charges of Trauma Patients (94% of all charges shown) 20 18 16 Percent of Registry Cases (%) 14 12 10 8 6 4 2 0 0 10 20 30 40 50 60 70 80 90 100 110 120 Gross Charges ($ in thousands) 130 140 150 160 170 180 190 200 Outcome Statistics - Cost of Trauma 52 Median Gross Charges by Injury Severity Score Median Gross Charges by Length of Stay (LOS) Gross Charges = $10,301 + $6,362 × LOS 120 600 500 Gross Charges ($ in thousands) Gross Charges ($ in thousands) 100 80 60 400 300 200 40 100 20 0 0 0 15 30 45 Injury Severity Score 60 75 0 20 40 Length of Stay (days) 60 80 Risk Adjusted Comparisons Risk Adjusted Comparisons - Trauma Center Designation 54 Risk Adjusted Fatality Rate (%) Risk Adjusted Case Fatality Rates by Trauma Center Type and Designation 10 Observed Statewide Fatality Rate: 6.5% 8 6 6.9% 6.4% 5.6% 6.6% 5.2% 4 2 Regional Pediatric Facility Type Area DualDesig Regional DualDesig Area AdultOnly Regional AdultOnly Facility Designation Number of Patients Observed Fatality Rate Expected Fatality Rate Risk Ratio Risk Adjusted Fatality Rate Regional Pediatric 1,735 1.2% 1.3% 0.92 ± 0.38 5.6% ± 2.5 Area DualDesig 1,384 6.1% 7.6% 0.80 ± 0.17 5.2% ± 1.1 Regional DualDesig 40,132 6.6% 6.7% 0.99 ± 0.04 6.4% ± 0.2 Area AdultOnly 9,819 6.5% 6.1% 1.07 ± 0.08 6.9% ± 0.5 Regional AdultOnly 13,428 6.7% 6.6% 1.02 ± 0.06 6.6% ± 0.4 Risk Adjusted Comparisons - Pediatric Treatment by Designation 55 Risk Adjusted Fatality Rate (%) Pediatric Risk Adjusted Case Fatality Rates by Trauma Center Designation 10 Observed Statewide Pediatric Fatality Rate: 2.2% 8 6.1% 6 4 2 3.2% 2.2% 0 Pediatric DualDesig AdultOnly Facility Designation Number of Patients Observed Fatality Rate Expected Fatality Rate Risk Ratio Risk Adjusted Fatality Rate Pediatric 1,489 1.3% 1.2% 1.06 ± 0.46 2.2% ± 1.0 DualDesig 3,174 2.2% 1.5% 1.49 ± 0.35 3.2% ± 0.7 AdultOnly 449 4.5% 1.6% 2.78 ± 1.21 6.1% ± 2.6 Pediatric patients are defined here as less than 15 years of age. Risk Adjusted Comparisons - Referral Status 56 Risk Adjusted Fatality Rate (%) Risk Adjusted Case Fatality Rates by Patients' Referral Status (excluding patients who died in the ED to reduce possible bais in the comparison) 7 Observed Statewide Fatality Rate: 5.7% 6 5.6% 5.4% 5 4 3 Patients Not Referred From Another Hospital Patients Referred From Another Hospital Referal Status Number of Patients Observed Fatality Rate Expected Fatality Rate Risk Ratio Risk Adjusted Fatality Rate Not Referred 52,402 5.7% 6.0% 0.95 ± 0.03 5.4% ± 0.2 Referred 13,550 5.6% 5.7% 0.98 ± 0.07 5.6% ± 0.4 Risk Adjusted Comparisons - Year of Discharge 57 Risk Adjusted Fatality Rate (%) Risk Adjusted Case Fatality Rates by Discharge Year Observed Statewide Fatality Rate: 6.5% 8 7 6.9% 6.8% 6.3% 6 6.0% 5 4 3 2010 2011 2012 2013 Year Number of Patients Observed Fatality Rate Expected Fatality Rate Risk Ratio Risk Adjusted Fatality Rate 2010 17,226 6.2% 5.9% 1.05 ± 0.06 6.8% ± 0.4 2011 16,751 6.6% 6.2% 1.06 ± 0.06 6.9% ± 0.4 2012 16,686 6.6% 6.8% 0.97 ± 0.06 6.3% ± 0.4 2013 15,835 6.5% 7.0% 0.93 ± 0.06 6.0% ± 0.4 Risk Adjusted Comparisons - Region 58 Risk Adjusted Fatality Rate (%) Risk Adjusted Case Fatality Rates by Region Observed Statewide Fatality Rate: 6.5% 9 8 7 7.3% 6.7% 6.8% 6.7% 6.0% 6 5.6% 5.9% 5 4 3 Central New York Hudson Valley Long Island Nassau Long Island Suffolk New York City Northern New York Region Number of Patients Observed Fatality Rate Expected Fatality Rate Risk Ratio Risk Adjusted Fatality Rate Central New York 6,724 8.3% 7.4% 1.12 ± 0.09 7.3% ± 0.6 Hudson Valley 7,301 5.5% 5.4% 1.02 ± 0.10 6.7% ± 0.6 Long Island Nassau 7,271 7.3% 7.1% 1.03 ± 0.08 6.7% ± 0.5 Long Island Suffolk 7,790 6.8% 7.3% 0.93 ± 0.08 6.0% ± 0.5 New York City 21,754 6.0% 5.7% 1.05 ± 0.06 6.8% ± 0.4 Northern New York 6,222 5.7% 6.6% 0.86 ± 0.09 5.6% ± 0.6 Western NY/ Finger Lakes 9,436 6.6% 7.2% 0.92 ± 0.07 5.9% ± 0.4 Western NY/ Finger Lakes Risk Adjusted Comparisons - Region and Injury 59 Risk Adjusted Fatality Rate (%) Fall Trauma: Risk Adjusted Case Fatality Rates by Region Observed Statewide Fall Fatality Rate: 7.3% 10 8 8.2% 8.2% 7.4% 7.3% 7.1% 6.4% 6 4 Central New York Hudson Valley Long Island Nassau Long Island Suffolk New York City Northern New York Region Number of Patients Observed Fatality Rate Expected Fatality Rate Risk Ratio Risk Adjusted Fatality Rate Central New York 2,541 9.2% 8.2% 1.12 ± 0.14 8.2% ± 1.0 Hudson Valley 2,917 7.8% 6.9% 1.13 ± 0.14 8.2% ± 1.0 Long Island Nassau 4,249 7.7% 7.6% 1.01 ± 0.10 7.4% ± 0.8 Long Island Suffolk 3,905 7.5% 7.7% 0.97 ± 0.11 7.1% ± 0.8 New York City 8,331 6.4% 6.3% 1.02 ± 0.08 7.3% ± 0.6 Northern New York 2,700 7.6% 8.7% 0.87 ± 0.12 6.4% ± 0.8 Western NY/ Finger Lakes 3,332 6.8% 7.8% 0.87 ± 0.11 6.3% ± 0.8 6.3% Western NY/ Finger Lakes Risk Adjusted Comparisons - Region and Injury 60 Risk Adjusted Fatality Rate (%) Motor Vehicle Traffic Trauma: Risk Adjusted Case Fatality Rates by Region 10 8 Observed Statewide Motor Vehicle Traffic Fatality Rate: 6.6% 7.8% 7.6% 7.1% 6.1% 6 6.2% 5.8% 4 Central New York Hudson Valley Long Island Nassau Long Island Suffolk New York City Northern New York Region Number of Patients Observed Fatality Rate Expected Fatality Rate Risk Ratio Risk Adjusted Fatality Rate Central New York 2,128 8.4% 7.2% 1.17 ± 0.16 7.6% ± 1.1 Hudson Valley 2,565 4.4% 4.8% 0.92 ± 0.17 6.1% ± 1.1 Long Island Nassau 2,023 7.4% 6.8% 1.09 ± 0.17 7.1% ± 1.1 Long Island Suffolk 2,500 6.6% 7.5% 0.88 ± 0.13 5.8% ± 0.8 New York City 5,127 6.8% 5.7% 1.19 ± 0.12 7.8% ± 0.8 Northern New York 1,918 5.1% 5.3% 0.96 ± 0.18 6.2% ± 1.2 Western NY/ Finger Lakes 3,142 7.2% 7.3% 0.99 ± 0.12 6.5% ± 0.8 6.5% Western NY/ Finger Lakes Risk Adjusted Comparisons - Region and Injury 61 Risk Adjusted Fatality Rate (%) Firearm Trauma: Risk Adjusted Case Fatality Rates by Region Observed Statewide Firearm Fatality Rate: 12.9% 20 15 13.6% 13.3% 14.0% 12.7% 12.7% 11.8% 10 7.7% 5 Central New York Hudson Valley Region Long Island Nassau Number of Patients Long Island Suffolk New York City Northern New York Observed Fatality Rate Expected Fatality Rate Risk Ratio Risk Adjusted Fatality Rate 13.3% ± 3.3 Central New York 207 23.7% 23.0% 1.03 ± 0.25 Hudson Valley 127 6.3% 10.5% 0.60 ± 0.40 7.7% ± 5.2 Long Island Nassau 112 17.0% 16.1% 1.06 ± 0.43 13.6% ± 5.6 Long Island Suffolk 104 17.3% 17.6% 0.98 ± 0.42 12.7% ± 5.4 New York City 1,628 10.4% 9.7% 1.07 ± 0.15 14.0% ± 2.0 Northern New York 133 12.0% 12.3% 0.98 ± 0.45 12.7% ± 5.9 Western NY/ Finger Lakes 605 16.0% 17.6% 0.91 ± 0.17 11.8% ± 2.2 Western NY/ Finger Lakes Comparison to National Trauma Data Bank Comparison to National Trauma Data Bank - Case Fatality Rates By Injury Severity Score 63 New York vs United States: 2013 Case Fatality Rates by Injury Severity Score 35 New York State Nation 30 Case Fatality Rate (%) 25 20 15 10 5 0 9−15 16−24 Injury Severity Score For this section, since different inclusion criteria is used by the NYSTR and NTBD, to reduce bias in the comparison only trauma with an injury severity score of greater than or equal to 9 was considered. >24 Comparison to National Trauma Data Bank - Case Fatality Rates By Age 64 New York vs United States: 2013 Case Fatality Rates by Age Group for Trauma with Injury Severity Score 9−15 New York State Nation Case Fatality Rate (%) 6 4 2 0 <1 1−4 5−9 10−14 15−19 20−24 25−34 35−44 45−54 55−64 65−74 Age (years) For this section, since different inclusion criteria is used by the NYSTR and NTBD, to reduce bias in the comparison only trauma with an injury severity score of greater than or equal to 9 was considered. 75−84 >84 Comparison to National Trauma Data Bank - Case Fatality Rates By Age 65 New York vs United States: 2013 Case Fatality Rates by Age Group for Trauma with Injury Severity Score 16−24 New York State Nation 12 Case Fatality Rate (%) 10 8 6 4 2 0 <1 1−4 5−9 10−14 15−19 20−24 25−34 35−44 45−54 55−64 65−74 Age (years) For this section, since different inclusion criteria is used by the NYSTR and NTBD, to reduce bias in the comparison only trauma with an injury severity score of greater than or equal to 9 was considered. 75−84 >84 Comparison to National Trauma Data Bank - Case Fatality Rates By Age 66 New York vs United States: 2013 Case Fatality Rates by Age Group for Trauma with Injury Severity Score 25−75 New York State Nation 50 Case Fatality Rate (%) 40 30 20 10 0 <1 1−4 5−9 10−14 15−19 20−24 25−34 35−44 45−54 55−64 65−74 Age (years) For this section, since different inclusion criteria is used by the NYSTR and NTBD, to reduce bias in the comparison only trauma with an injury severity score of greater than or equal to 9 was considered. 75−84 >84 Appendix Appendix - Incidence By Trauma Mechanism and County 68 Fall Trauma: Average Annual Incidence by County of Residence suffolk delaware nassau broome otsego montgomery greene rockland chenango fulton yates columbia herkimer hamilton ontario cattaraugus queens clinton cortland oswego orleans albany livingston rensselaer genesee jefferson dutchess schoharie ulster cayuga madison saratoga allegany oneida onondaga seneca richmond lewis erie niagara wyoming washington sullivan monroe westchester warren putnam tioga wayne new york bronx orange kings schenectady chautauqua steuben essex st lawrence tompkins schuyler chemung franklin clinton franklin st lawrence essex jefferson lewis hamilton warren oswego herkimer washington orleans niagara wayne monroe genesee wyoming livingston cattaraugus allegany montgomery schenectady seneca yates otsego cortland tompkins schuyler chautauqua saratoga fulton onondaga cayuga madison ontario erie oneida rensselaer schoharie albany chenango greene steuben chemung tioga broome delaware columbia ulster dutchess sullivan orange putnam westchester rockland bronx new york nassau queens kings richmond suffolk 0 1 2 3 4 5 6 7 Cases per 10,000 people Appendix - Incidence By Trauma Mechanism and County 69 Motor Vehicle Traffic Trauma: Average Annual Incidence by County of Residence greene chenango orleans wayne suffolk montgomery oswego ulster yates livingston sullivan delaware cayuga dutchess genesee cattaraugus wyoming ontario schoharie madison allegany washington columbia niagara cortland nassau herkimer broome lewis saratoga fulton rensselaer oneida seneca onondaga monroe orange schuyler jefferson schenectady albany tioga hamilton erie otsego putnam warren steuben westchester rockland queens bronx essex richmond clinton kings tompkins chautauqua st lawrence new york chemung franklin clinton franklin st lawrence essex jefferson lewis hamilton warren oswego herkimer washington orleans niagara wayne monroe genesee wyoming livingston cattaraugus allegany montgomery schenectady seneca yates otsego cortland tompkins schuyler chautauqua saratoga fulton onondaga cayuga madison ontario erie oneida rensselaer schoharie albany chenango greene steuben chemung tioga broome delaware columbia ulster dutchess sullivan orange putnam westchester rockland bronx new york nassau queens kings richmond suffolk 0 1 2 3 4 5 Cases per 10,000 people Appendix - Incidence By Trauma Mechanism and County 70 Firearm Trauma: Average Annual Incidence by County of Residence bronx monroe onondaga erie kings hamilton albany dutchess rensselaer niagara schenectady orange new york wayne richmond orleans queens genesee cortland yates livingston nassau suffolk jefferson ulster oneida sullivan ontario westchester montgomery tioga seneca cayuga wyoming delaware greene steuben chenango cattaraugus clinton st lawrence broome oswego otsego herkimer chautauqua rockland saratoga essex allegany tompkins fulton washington warren madison chemung schuyler schoharie putnam lewis franklin columbia clinton franklin st lawrence essex jefferson lewis hamilton warren oswego herkimer washington orleans niagara wayne monroe genesee wyoming livingston cattaraugus allegany montgomery schenectady seneca yates otsego cortland tompkins schuyler chautauqua saratoga fulton onondaga cayuga madison ontario erie oneida rensselaer schoharie albany chenango greene steuben chemung tioga broome delaware columbia ulster dutchess sullivan orange putnam westchester rockland bronx new york nassau queens kings richmond suffolk 0.0 0.2 0.4 0.6 0.8 Cases per 10,000 people Appendix - Incidence By Trauma Mechanism and County 71 Cut / Pierce Trauma: Average Annual Incidence by County of Residence albany broome bronx rensselaer niagara erie montgomery schenectady dutchess wyoming kings suffolk columbia fulton nassau schoharie queens greene ulster chautauqua clinton westchester new york delaware cattaraugus orange sullivan livingston saratoga chenango tioga franklin lewis richmond herkimer warren putnam rockland madison essex cortland ontario genesee otsego cayuga onondaga monroe jefferson oswego seneca schuyler st lawrence orleans oneida hamilton allegany chemung yates wayne washington tompkins steuben clinton franklin st lawrence essex jefferson lewis hamilton warren oswego herkimer washington orleans niagara wayne monroe genesee wyoming livingston cattaraugus allegany montgomery schenectady seneca yates otsego cortland tompkins schuyler chautauqua saratoga fulton onondaga cayuga madison ontario erie oneida rensselaer schoharie albany chenango greene steuben chemung tioga broome delaware columbia ulster dutchess sullivan orange putnam westchester rockland bronx new york nassau queens kings richmond suffolk 0.0 0.2 0.4 0.6 Cases per 10,000 people Appendix - Incidence By Trauma Mechanism and County 72 Machinery Trauma: Average Annual Incidence by County of Residence delaware cayuga allegany yates orleans schoharie cattaraugus montgomery lewis wyoming genesee wayne columbia ontario madison oswego clinton otsego herkimer livingston warren rensselaer niagara greene cortland chenango oneida washington steuben onondaga albany seneca dutchess schenectady essex broome suffolk saratoga tioga tompkins st lawrence erie jefferson rockland chautauqua orange sullivan putnam monroe nassau richmond queens ulster kings bronx westchester new york schuyler hamilton fulton franklin chemung clinton franklin st lawrence essex jefferson lewis hamilton warren oswego herkimer washington orleans niagara wayne monroe genesee wyoming livingston cattaraugus allegany montgomery schenectady seneca yates otsego cortland tompkins schuyler chautauqua saratoga fulton onondaga cayuga madison ontario erie oneida rensselaer schoharie albany chenango greene steuben chemung tioga broome delaware columbia ulster dutchess sullivan orange putnam westchester rockland bronx new york nassau queens kings richmond suffolk 0.0 0.1 0.2 0.3 0.4 Cases per 10,000 people Appendix - Mortality By Trauma Mechanism and County 73 Fall Trauma: Average Annual Mortality by County of Residence clinton franklin st lawrence essex jefferson lewis hamilton warren oswego niagara orleans monroe wayne herkimer washington oneida saratoga fulton genesee onondaga cayuga madison ontario seneca erie wyominglivingston yates cortland chenango tompkins schuyler steuben chautauqua cattaraugus allegany chemung tioga broome otsego montgomery schenectady rensselaer schoharie albany delaware greene columbia ulster dutchess sullivan orange putnam westchester rockland bronx new yorknassau queens kings richmond suffolk yates broome chenango otsego hamilton columbia nassau suffolk delaware oswego montgomery greene cattaraugus cortland jefferson albany livingston tioga cayuga rensselaer madison ulster ontario washington queens westchester herkimer onondaga clinton genesee rockland fulton allegany oneida wayne sullivan richmond saratoga seneca dutchess erie warren monroe schenectady niagara chautauqua kings schoharie putnam schuyler bronx new york tompkins wyoming orleans orange lewis st lawrence essex franklin chemung steuben 0.0 0.2 0.4 0.6 Cases per 10,000 people Appendix - Mortality By Trauma Mechanism and County 74 Motor Vehicle Traffic Trauma: Average Annual Mortality by County of Residence clinton franklin st lawrence essex jefferson lewis hamilton warren oswego niagara orleans monroe wayne herkimer washington oneida saratoga fulton genesee onondaga cayuga madison ontario seneca erie wyominglivingston yates cortland chenango tompkins schuyler steuben chautauqua cattaraugus allegany chemung tioga broome otsego montgomery schenectady rensselaer schoharie albany delaware greene columbia ulster dutchess sullivan orange putnam westchester rockland bronx new yorknassau queens kings richmond suffolk lewis hamilton oswego wayne seneca oneida onondaga broome herkimer wyoming tioga genesee suffolk cattaraugus cayuga monroe madison schuyler livingston essex nassau columbia delaware yates washington fulton niagara rensselaer ulster sullivan richmond greene warren chenango montgomery erie saratoga dutchess queens chautauqua schenectady albany clinton tompkins otsego orange westchester orleans bronx ontario kings allegany rockland schoharie new york chemung steuben franklin st lawrence jefferson putnam cortland 0.0 0.2 0.4 0.6 Cases per 10,000 people Appendix - Mortality By Trauma Mechanism and County 75 Firearm Trauma: Average Annual Mortality by County of Residence clinton franklin st lawrence essex jefferson lewis hamilton warren oswego niagara orleans monroe wayne herkimer washington oneida saratoga fulton genesee onondaga cayuga madison ontario seneca erie wyominglivingston yates cortland chenango tompkins schuyler steuben chautauqua cattaraugus allegany chemung tioga broome otsego montgomery schenectady rensselaer schoharie albany delaware greene columbia ulster dutchess sullivan orange putnam westchester rockland bronx new yorknassau queens kings richmond suffolk monroe onondaga orleans livingston bronx cortland erie jefferson genesee wayne kings seneca sullivan oneida allegany montgomery richmond ontario oswego albany washington madison nassau schenectady queens suffolk cayuga rensselaer new york clinton ulster steuben dutchess niagara saratoga st lawrence chautauqua rockland orange broome westchester schuyler schoharie cattaraugus putnam otsego lewis herkimer hamilton greene fulton franklin essex delaware columbia chenango chemung yates wyoming warren tompkins tioga 0.00 0.10 0.20 Cases per 10,000 people Appendix - Injury Statistics 76 Deaths Due to Injury Leading Causes by Age Group New York State Residents, 2010-2012 Age Group Rank 1 0<1 1-4 5-9 10-14 15-19 Suffocation Homicide Homicide Suicide Homicide Homicide Poisoning Poisoning Fall Suicide 27 (32%) 16 (28%) 6 (23%) 10 (19%) 96 (31%) 159 (26%) 20-24 613 (30%) 25-44 684 (29%) 45-64 1,013 (45%) 65+ 1,581 (20%) Total Homicide Suffocation MVT^, Unspecified MVT^, Pedestrian Suicide Poisoning Suicide Suicide Suicide Poisoning 2 14 (17%) 7 (12%) 5 (20%) 8 (16%) 73 (23%) 123 (20%) 492 (24%) 633 (27%) 254 (11%) 1,518 (20%) Fall 3 * MVT^, Pedestrian Unspecified Fall 5 ( 9%) 4 (14%) 7 (14%) 30 (10%) 118 (19%) 326 (16%) 180 ( 8%) 196 ( 9%) 1,257 (16%) Fire / Flame MVT^, Pedestrian Fire / Flame MVT^, Unspecified Homicide MVT^, Unspecified MVT^, Occupant MVT^, Unspecified Suicide MVT^, Unspecified Homicide Homicide Suffocation Homicide 4 ( 7%) 4 (14%) 4 * 4 ( 8%) 29 ( 9%) 52 ( 8%) 82 ( 4%) 126 ( 5%) 136 ( 6%) 790 (10%) Fire / Flame Poisoning MVT^, Occupant MVT^, Motorcyclist MVT^, Pedestrian MVT^, Pedestrian MVT^, Unspecified 5 * 3 ( 5%) * 3 ( 6%) Transport, NonTraffic 23 ( 8%) 43 ( 7%) 76 ( 4%) 93 ( 4%) 102 ( 5%) 354 ( 5%) MVT^, Pedestrian MVT^, Motorcyclist MVT^, Occupant MVT^, Unspecified MVT^, Occupant MVT^, Occupant 6 * * * 3 ( 6%) 13 ( 4%) 21 ( 3%) 76 ( 4%) 85 ( 4%) 94 ( 4%) 313 ( 4%) MVT^, Pedestrian MVT^, Pedestrian MVT^, Occupant MVT^, Unspecified MVT^, Pedestrian 19 ( 3%) MVT^, Unspecified MVT^, Pedal Cyclist MVT^, Motorcyclist 7 * * * 2 ( 4%) 8 * * * * 9 * 10 67 ( 3%) 65 ( 3%) 92 ( 4%) 311 ( 4%) MVT^, Pedal Cyclist 7 ( 2%) Fall Fall Suffocation Poisoning Unspecified 4 ( 1%) 49 ( 2%) 51 ( 2%) 70 ( 3%) 265 ( 3%) Fall 8 ( 1%) Pedestrian, NonTraffic Suffocation MVT^, Motorcyclist Fire / Flame Suffocation * * * 4 ( 1%) Pedestrian, NonTraffic 6 ( 1%) 21 ( 1%) 45 ( 2%) 55 ( 2%) 249 ( 3%) MVT^, Pedal Cyclist Unspecified Unspecified Homicide MVT^, Motorcyclist * * * 4 ( 1%) 5 ( 1%) 18 ( 1%) 42 ( 2%) 36 ( 2%) 155 ( 2%) Yearly Average (percent of age group) MVT^ = Motor Vehicle Traffic *Data based on three year total frequencies of less than six are not reportable Intentional Injury Unintentional Injury Source: NYSDOH, Bureau of Occupational Health and Injury Prevention www.health.ny.gov/prevention/injury_prevention/ Appendix - Injury Statistics 77 † Emergency Department (ED) Visits Due to Injury Leading Causes by Age Group New York State Residents, 2010-2012 Age Group Rank 1 2 0<1 1-4 5-9 10-14 15-19 20-24 25-44 45-64 65+ Fall Fall Fall Fall Struck By, Against Fall Fall Fall Fall Fall 7,283 (52%) 43,695 (42%) 30,735 (35%) 29,891 (27%) 26,336 (20%) 21,135 (15%) 73,014 (18%) 86,482 (29%) 88,930 (57%) 403,647 (28%) Struck By, Against Struck By, Against Struck By, Against Struck By, Against Fall Struck By, Against Overexertion Overexertion Unspecified Struck By, Against 1,265 ( 9%) 15,555 (15%) Natural / Environmental 17,734 (20%) Natural / Environmental 27,152 (24%) 22,481 (17%) 16,882 (12%) 45,004 (11%) 27,973 ( 9%) 11,674 ( 7%) 184771 (13%) Overexertion Overexertion Assault Struck By, Against Cut / Pierce Struck By, Against Overexertion 124504 ( 9%) Unspecified 3 4 864 ( 6%) Natural / Environmental 8,784 ( 8%) 6,500 ( 7%) 10,826 (10%) 14,196 (11%) 15,436 (11%) 44,109 (11%) 27,445 ( 9%) 8,864 ( 6%) Unspecified Cut / Pierce Cut / Pierce Assault MVT^, Occupant Cut / Pierce Struck By, Against Cut / Pierce Cut / Pierce 691 ( 5%) 5,376 ( 5%) 5,287 ( 6%) 6,296 ( 6%) 12,829 (10%) 15,270 (11%) 41,710 (10%) 26,875 ( 9%) 7,773 ( 5%) 116751 ( 8%) Unspecified MVT^, Occupant 5 6 Unspecified Unspecified MVT^, Occupant Cut / Pierce MVT^, Occupant MVT^, Occupant MVT^, Occupant 484 ( 3%) 4,276 ( 4%) 4,110 ( 5%) 5,756 ( 5%) 10,491 ( 8%) 14,042 (10%) 38,715 (10%) 24,990 ( 8%) 7,405 ( 5%) 104768 ( 7%) Hot Object / Scald Overexertion Overexertion Assault Cut / Pierce Overexertion Unspecified MVT^, Occupant Overexertion Unspecified 421 ( 3%) 3,361 ( 3%) 3,424 ( 4%) 8 9 10 Cut / Pierce 9,592 ( 7%) 13,014 ( 9%) 33,618 ( 8%) Unspecified Assault 6,469 ( 4%) Natural / Environmental 104289 ( 7%) Unspecified 24,778 ( 8%) Natural / Environmental 7,910 ( 6%) Natural / Environmental 9,990 ( 7%) Natural / Environmental 32,793 ( 8%) Natural / Environmental 13,420 ( 5%) 5,220 ( 3%) 81,464 ( 6%) Assault Poisoning Poisoning 15,844 ( 1%) Pedal Cyclist, NonTraffic Poisoning MVT^, Occupant 4,720 ( 4%) Natural / Environmental 365 ( 3%) 3,123 ( 3%) Cut / Pierce Hot Object / Scald 2,705 ( 3%) Pedal Cyclist, NonTraffic 4,149 ( 4%) Pedal Cyclist, NonTraffic 329 ( 2%) 2,062 ( 2%) 2,231 ( 3%) 3,165 ( 3%) 4,272 ( 3%) 5,461 ( 4%) 15,453 ( 4%) 12,733 ( 4%) 1,366 ( 1%) Overexertion MVT^, Occupant Assault MVT^, Occupant Self-Inflicted Self-Inflicted Hot Object / Scald Poisoning Assault 1,614 ( 1%) Poisoning 7 Total Assault 237 ( 2%) 1,976 ( 2%) 1,136 ( 1%) 1,204 ( 1%) 14,578 ( 1%) Hot Object / Scald 2,117 ( 2%) Pedal Cyclist, NonTraffic 3,007 ( 1%) Suffocation 2,943 ( 3%) Transport, NonTraffic 3,995 ( 1%) Suffocation Hot Object / Scald Poisoning MVT^, Pedestrian MVT^, Pedestrian Hot Object / Scald 185 ( 1%) 700 ( 1%) 835 ( 1%) 1,011 ( 1%) 1,828 ( 1%) 1,459 ( 1%) 3,970 ( 1%) 2,920 ( 1%) 1,100 ( 1%) 13,769 ( 1%) Yearly Average (percent of age group) †The incidence of ED visits does not include those that were subsequently admitted into the hospital MVT^ = Motor Vehicle Traffic Intentional Injury Unintentional Injury Source: NYSDOH, Bureau of Occupational Health and Injury Prevention www.health.ny.gov/prevention/injury_prevention/ SPARCS December 2013 Appendix - Injury Statistics 78 Hospitalizations Due to Injury Leading Causes by Age Group New York State Residents, 2010-2012 Age Group Rank 1 0<1 1-4 5-9 10-14 15-19 Fall Fall Fall Fall Self-Inflicted Assault Fall Fall Fall Fall 406 (39%) 938 (31%) 764 (27%) 1,422 (22%) 1,627 (20%) 5,076 (19%) 14,397 (38%) 52,640 (73%) 76,790 (48%) Hot Object / Scald Poisoning 881 (42%) Natural / Environmental 20-24 25-44 45-64 65+ Total Self-Inflicted Assault Self-Inflicted Self-Inflicted Poisoning Unspecified Self-Inflicted 1,204 (18%) 1,454 (18%) 4,659 ( 6%) 10,896 ( 7%) 2 117 (11%) 434 (14%) 153 ( 7%) 296 (11%) 4,208 (16%) 3,893 (10%) Assault Hot Object / Scald MVT^, Pedestrian Struck By, Against Fall Fall Assault Self-Inflicted Poisoning 3 87 ( 8%) 426 (14%) Natural / Environmental 137 ( 7%) 271 (10%) 783 (12%) 904 (11%) 3,403 (13%) 2,907 ( 8%) 2,069 ( 3%) 9,987 ( 6%) Struck By, Against MVT^, Pedestrian MVT^, Occupant MVT^, Occupant Poisoning Unspecified MVT^, Occupant Unspecified 9,075 ( 6%) Unspecified 4 5 6 Poisoning 77 ( 7%) 258 ( 8%) 133 ( 6%) 200 ( 7%) 636 (10%) 884 (11%) 2,503 ( 9%) 2,543 ( 7%) Suffocation Struck By, Against Hot Object / Scald Assault Struck By, Against Poisoning MVT^, Occupant MVT^, Occupant 1,566 ( 2%) Natural / Environmental 56 ( 5%) 127 ( 4%) 87 ( 4%) 364 ( 6%) 545 ( 7%) 1,861 ( 7%) 1,774 ( 5%) 1,132 ( 2%) 8,482 ( 5%) Poisoning Unspecified Poisoning 178 ( 6%) Pedal Cyclist, NonTraffic Poisoning MVT^, Motorcyclist Unspecified Assault Struck By, Against MVT^, Occupant 56 ( 5%) Natural / Environmental 83 ( 3%) 74 ( 4%) Pedal Cyclist, NonTraffic 134 ( 5%) Natural / Environmental 329 ( 5%) 246 ( 3%) MVT^, Pedestrian 1,604 ( 4%) Natural / Environmental 6,917 ( 4%) MVT^, Pedestrian 1,221 ( 5%) Natural / Environmental 971 ( 1%) MVT^, Pedestrian Suffocation Struck By, Against 42 ( 4%) Assault 65 ( 2%) 73 ( 3%) 1,271 ( 3%) 742 ( 1%) 3,668 ( 2%) MVT^, Occupant 215 ( 3%) Natural / Environmental 843 ( 3%) Assault 114 ( 4%) Transport, NonTraffic 224 ( 3%) Struck By, Against Struck By, Against Struck By, Against MVT^, Pedestrian MVT^, Pedestrian MVT^, Pedestrian 26 ( 3%) 63 ( 2%) 64 ( 3%) 87 ( 3%) 147 ( 2%) 221 ( 3%) 742 ( 3%) 907 ( 2%) 642 ( 1%) 3,088 ( 2%) MVT^, Occupant Suffocation Cut / Pierce Poisoning Unspecified Unspecified MVT^, Pedestrian Struck By, Against Self-Inflicted Cut / Pierce 9 10 ( 1%) Drowning / Submersion 61 ( 2%) 61 ( 3%) 84 ( 3%) 598 ( 1%) 1,955 ( 1%) Unspecified 214 ( 3%) Natural / Environmental 813 ( 2%) Unspecified 143 ( 2%) Transport, NonTraffic 696 ( 3%) MVT^, Occupant MVT^, Motorcyclist Cut / Pierce Overexertion Hot Object / Scald 10 7 ( 1%) 45 ( 1%) 53 ( 3%) 83 ( 3%) 138 ( 2%) 195 ( 2%) 649 ( 2%) 596 ( 2%) 543 ( 1%) 1,806 ( 1%) 7 8 Yearly Average (percent of age group) MVT^ = Motor Vehicle Traffic Intentional Injury Unintentional Injury Source: NYSDOH, Bureau of Occupational Health and Injury Prevention www.health.ny.gov/prevention/injury_prevention/ SPARCS December 2013 Appendix - Injury Statistics 79 Characteristics of Injury Incidence Deaths, Hospitalizations, and Emergency Department† (ED) Visits New York State Residents, 2010-2012 Gender Age Group Deaths Total 0<1 1-4 5-9 10-14 15-19 20-24 25-44 45-64 65+ Male Female Unknown Hospitalizations ED Visits Mean Annual Frequency Rate per 100,000 Residents Mean Annual Frequency Rate per 100,000 Residents Mean Annual Frequency Rate per 100,000 Residents 7,784 84 55 27 53 311 619 2,048 2,344 2,236 5,372 2,412 * 39.8 34.9 5.8 2.3 4.4 23.4 43.6 38.7 44.6 83 56.6 24 n/a 161,270 1,038 3,035 2,089 2,810 6,531 8,013 26,946 38,242 72,565 79,928 81,340 * 825.4 431.8 320.8 178.4 235.6 492.5 564.7 509.6 726.9 2693.9 841.2 810.3 n/a 1,447,251 13,998 104,854 87,310 111,210 133,457 139,113 402,900 298,196 156,213 764,718 682,502 31 7,407.5 5,820.7 11,082.9 7,454.2 9,323.1 10,062.8 9,803.3 7,620.1 5,668.2 5,799.4 8,061.6 6,789.9 n/a Percent Traumatic Brain Injury 29% Mean Charge per Hospitalization or ED Visit n/a $37,142 $1,587 n/a $5,989,883,314 $2,296,544,396 n/a $17,969,649,941 $6,889,633,188 Mean One Year Total Hospitalization or ED Visit Charges Three Year Total Hospitalization or ED Visit Charges Average Length of Hospital Stay (Days) n/a 12% 6 8% n/a †The incidence of ED visits does not include patients who were subsequently admitted into the hospital Rate = Frequency / Population * 100,000 *Data based on frequencies less than six not reported Source: NYSDOH, Bureau of Occupational Health and Injury Prevention www.health.ny.gov/prevention/injury_prevention SPARCS December 2013 Vital Statistics Death File February 2014 Appendix - Materials and Methods 80 Materials and Methods 1. Data Sources 2. The Cohort Trauma Registry - Established in 1993, the New York State Trauma Registry (NYSTR) receives reports from designated trauma centers on patients identified and treated as being moderately to severely traumatically injured (Inclusion Criteria in Appendix Inclusion Criteria in Appendix). The reports contains variables specified by the New York State Trauma Registry including patients’ demographic information, diagnoses and treatments. A very small portion of the trauma reports in the NYSTR were submitted from several non-trauma centers/hospitals. A cohort used for generating the NYSTR Summary Report was constructed with NYSTR data from 2010 through 2013 submitted from the certified trauma centers. Trauma records submitted by non-trauma centers were excluded in the data analyses. Statewide Planning and Research Cooperative System (SPARCS) - Implemented by the New York State Department of Health (NYSDOH) in 1979, SPARCS is a comprehensive, integrated information system available to assist hospitals and organizations in the health care industry with healthcare resource planning, financial analysis, decision making, and surveillance of New York State. SPARCS receives, processes, stores, and analyzes the inpatient and emergency department from data from all hospitals in New York. Each health care provider submits its SPARCS data, as mandated, in the uniform, computer-readable format described in the Universal Data Set. Surveillance, Epidemiology, and End Results Program (SEER) - The population estimates used to calculate trauma incidence and mortality were from Surveillance, Epidemiology, and End Results Program (SEER) of the National Cancer Institute. These data were produced by the US Census Bureau’s Population Estimates Program, in collaboration with the National Center for Health Statistics and with support from the National Cancer Institute.[3] National Trauma Data Bank (NTDB) - NTDB collects trauma registry data from participating trauma centers across the U.S. on an annual basis. The case fatality rates calculated using NYSTR 2013 data were compared with that published on NTDB 2014 Annual Report.[4] 3. Data Matching A dataset containing all patients diagnosed with traumatic injuries and were treated in New York State trauma centers for discharge years 2010 2013 was created from SPARCS hospital inpatients and emergency department (ED) discharge files. This data file was matched to Trauma Registry records for the same discharge year period by using identifying variables such as hospital’s Permanent Facility Identifier, admission dates, discharge dates, hospital’s medical record numbers, Patients’ date of birth, etc. The matches were conducted without using patient’s name and address, because SPARCS does not contain patient name and SAPRCS ED data do not have patient’s address information. The records found in the SPARCS hospital data files or ED data files but not in the Trauma Registry database were defined as unmatched/missed reports and were sent to hospitals for audits. After checking their own unmatched/missed reports, hospitals resubmit the missing trauma cases and corrected trauma cases to Trauma Registry. Appendix - Materials and Methods 81 4. Statistical Analysis 6. Software Descriptive Analysis. Standard linear and weighted loess regression techniques were used. All confidence intervals shown represent a 95% confidence interval of the sample population. Box plots omits outliers, defened as 1.5 times the interquartile range. All figures, tables, maps, and calculations were created with R statistical software[5]. This document was typeset with LATEX. The two scripts were combined into a single program with Sweave[7]. Predictive Analysis. Predictive analysis of risk of mortality was performed to develop a risk adjusted model that provides unbiased estimates of trauma case fatality rates. The detailed description of the risk adjustment methodology was provided in the Risk Adjustment Methodology section in Appendix. 5. Specific Notes EMS Time Variables. Many omissions were present in the EMS time variables, approximately 47% of the cohort. Therefore, when time variables were quoted, a subset excluding the records with missing values was used. E-codes. In the cohort, about 3.5% of patients have more than one E Code for cause. In this analysis, only the primary E code cause was used, in the Mechanism of Injury section, page 28 Payer and total charges. Primary payer and total charges used for the Payer Types section, page 24 and the Cost of Trauma section, page 51 were obtained from SPARCS data. Pediatric patents. In this report, the pediatric patients were defined as those aged 14 years or younger. Comparison to the Nation. Since different inclusion criteria is used by the NYSTR and NTBD, only trauma with an injury severity score of greater than or equal to 9 was considered. Appendix - Risk Adjustment Methodology 82 Risk Adjustment Methodology 1. Introduction 4. Risk-adjustment model This section describes the risk adjustment methodology developed by the New York State Trauma Registry. The goal of the risk adjustment was to provide unbiased estimates of trauma fatality rate after controlling contributing risk factors. The risk adjustment model was developed using the New York Trauma Registry data submitted by the trauma centers across the state. We choose to use a logistic regression to model trauma patient fatality risk with trauma death as the dependent variable and the potential risks factors (listed in 3, Selection of factors) as the independent variables. The final risk adjustment model contains 25 variables, all of which are highly significant with greater than 95% confidence (Table 1). 2. Trauma data Trauma case reports submitted by the New York State certified trauma centers for patients discharged in 2010 through 2013 were included. About 5% of the patients were excluded from the analysis due to the missing values in the variables used for risk-adjustment model development. 3. Selection of factors 5. Calculation of the risk-adjusted fatality rate and confidence intervals I I I The contributing fatality risk factors among trauma patients include the following categories: I I I I I I Patient demographic variables: age, gender, race, ethnicity, health insurance/payer, body mass index, and comorbidities; I Patient condition upon arrival: Glasgow coma score, systolic blood pressure, pulse, respiratory rate, and oxygen saturation level; I Required pre-hospital and emergency room treatments: CPR, intubation, and ventilation Mechanism of injury; Transferring/referring; and Severity of injury: Abbreviated Injury Scale (AIS). Expected fatality rate: calculated using the developed risk adjustment model adjusting for the differences among groups. Observed fatality rate: calculated using the number of patient deaths observed in the group divided by the number of patients in the group. Rate ratio: calculated using the observed fatality rate divided by the expected fatality rate. If the ratio is larger than one, the group has a higher fatality rate than expected on the basis of its patient mix. Risk-adjusted fatality rate: calculated using the fatality rate ratio multiplied by the overall statewide observed fatality rate. Confidence intervals: The 95% confidence intervals for the risk-adjusted fatality rate were calculated using the standard error of the observed fatality rate[1]. A confidence interval is above the statewide rate indicating a statistically significantly higher than expected fatality rate after adjusting for risk. Appendix - Risk Adjustment Methodology Category 83 Independent variable (Intercept) Coefficient -4.274 Std. Error 0.117 z value -36.634 Pr(>|z|) 0.000 Age Male White 0.040 0.117 0.120 0.001 0.048 0.051 29.525 2.441 2.341 0.000 0.015 0.019 Bleeding disorder Advanced directive Disseminated cancer Prior renal failure Prehospital cardiac arrest 0.347 1.792 0.717 0.961 1.608 0.073 0.086 0.204 0.136 0.435 4.777 20.871 3.510 7.045 3.697 0.000 0.000 0.000 0.000 0.000 Glasgow Comma Score Motor Systolic Blood Pressure -0.344 -0.008 0.012 0.001 -29.781 -15.058 0.000 0.000 CPR administered in field or ED Ventilator required Intubation occurred in the ED 3.588 1.472 0.854 0.236 0.053 0.056 15.233 27.727 15.359 0.000 0.000 0.000 Severe head or neck trauma Severe face trauma Severe chest trauma Severe abdomen trauma Severe extremities trauma Severe external trauma 2.253 2.345 1.849 1.415 1.942 4.816 0.052 0.641 0.107 0.136 0.272 0.673 43.454 3.659 17.215 10.401 7.151 7.156 0.000 0.000 0.000 0.000 0.000 0.000 Pedestrian hit by car Firearm trauma Low fall 0.438 1.316 0.169 0.083 0.097 0.060 5.301 13.598 2.794 0.000 0.000 0.005 Self Pay Medicare 1.040 0.378 0.079 0.065 13.170 5.864 0.000 0.000 Referring Hospital -0.267 0.057 -4.664 0.000 Demographics Comorbidity Patient condition on arrival Required treatment Severe injuries (AIS = 5 or 6) Mechanism of Injury Insurance/payer Transfer status Table 1: Summary of risk adjusted mortality rate model Appendix - Inclusion Criteria 84 ICD-9 Codes for Inclusion in Registry 800 .00-.06 .09-.16 .19-.26 .29-.36 .39-.46 .49-.56 .59-.66 .69-.76 .79-.86 .89-.96 .99 801 .00-.06 .09-.16 .19-.26 .29-.36 .39-.46 .49-.56 .59-.66 .69-.76 .79-.86 .89-.96 .99 802 .7 803 .00-.01 .03-.05 .12-.15 .20-.25 .33-.35 .43-.45 .52-.55 .62-.65 .72-.75 .82-.85 .92-.95 804 .03-.05 .10-.16 .19-.26 .29-.36 .39-.46 .49-.56 .59-.66 .69-.76 .79-.86 .89-.96 .99 805 .01-.08 .10-.18 .3 .5 .6 .7 .8 806 .00-.39 .4 .5 . 60-.62 .69-.72 .79 .8 .9 807 .04-.19 .4 .5 .6 808 .1 .3 .43 .51-.53 .59 .9 819 .0 .1 821 .00-.01 .10-.11 .20-.23 .29-.33 .39 823 .10 .12 .30 .32 .90 .92 824 .1 .3 .5 .7 .9 828 .0 .1 836 .51-.52 .61-.64 .69 839 .01-.08 .11-.18 .20-.21 .30-.31 .40-.42 .51-.52 .59 .8 850 .2 .3 .4 851 .00-.06 .09-.16 .19-.26 .29-.36 .39-.46 .49-.56 .59-.66 .69-.76 .79-.86 .89-.96 .99 852 .00-.06 .09-.16 .19-.26 .29-.36 .39-.46 .49-.56 .59 853 .00-.06 .09-.16 .19 854 .03-.05 .10-.16 .19 860 .0 .1 .2 .3 .4 .5 861 .00-.03 .10-.13 .20-.22 .30-.32 862 .0 .1 .21-.22 .29 .31-.32 .39 .8 .9 863 .0 .1 .20-.21 .29-.31 .39-.46 .49-.56 .59 .80-.85 .89-.95 .99 864 .02-.05 .10-.15 .19 865 .01-.04 .09 .11-.14 .19 866 .02-.03 .11-.13 867 .1 .2 .3 .4 .5 868 .01-.04 .09-.14 .19 874 .00-.02 .10-.12 .4 .5 887 .0 .1 .2 .3 .4 .5 .6 .7 896 .0 .1 .2 .3 897 .0 .1 . 2.3 .4 .5 .6 .7 900 .00-.03 .1 .81-.82 .89 .9 901 .0 .1 .2 .3. 40-.42 .81-.83 .89 .9 902 .0 .10-.11 .19-.27 .29 .31-.34 .39-.42 .49-.56 .59 .81-.82 .87 .89 .9 903 .01-.02 904 .0 .1 925 .1 .2 927 .00-.03 .09-.11 .21 .8 .9 928 .00-.01 .10-.11 .20-.21 .8 .9 950 .0 .1 .2 .3 .9 952 .00-.19 .2 .3 .4 .8 .9 953 .0 .1 .2 .4 954 .8 .9 955 .8 956 .0. 8 958 .4 .9 .91 .92 .93 .99 Appendix - References References [1] Hosmer D. and Lemeshow S. Confidence Interval Estimates of an Index of Quality Performance Based on Logistic Regression Models. Statistics in Medicine, Volume 14, 2161-2172 (1995). [2] Baker, O’Neill, Haddon, and Long. The Injury Severity Score: A Method for Describing Patients with Multiple Injuries and Evaluating Emergency Care. Journal of Trauma, Volume 14 No. 3, March 1974. [3] Surveillance, Epidemiology, and End Results (SEER) Program Populations (1969-2013) (www.seer.cancer.gov/popdata), National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released January 2015. [4] Tables 21 and 22, Committee on Trauma, American College of Surgeons. NTDB Annual Report 2014. Chicago, IL. https://www.facs.org/quality%20programs/trauma/ntdb/docpub [5] R Core Team (2014). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL http://www.R-project.org/. [6] Original S code by Richard A. Becker and Allan R. Wilks. R version by Ray Brownrigg. Enhancements by Thomas P Minka <[email protected]> (2014). maps: Draw Geographical Maps. R package version 2.3-9. http://CRAN.R-project.org [7] Friedrich Leisch. Sweave: Dynamic generation of statistical reports using literate data analysis. In Wolfgang Härdle and Bernd Rönz, editors, Compstat 2002 - Proceedings in Computational Statistics, pages 575-580. Physica Verlag, Heidelberg, 2002. ISBN 3-7908-1517-9. 85
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