American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Frequently Asked Questions

Will the new dataset become the NTDB and what is the difference between the two?

Think of the National Trauma Data Bank (NTDB) as a bank that conducts deposits and withdraws. Data are deposited in the NTDB and reports are generated from the data and provided to researchers. The data dictionary is simply that, a data standard defining the structure and format of the data deposited within the NTDB. It represents variables characterizing trauma events that are important to aggregate at the national level.

Why are the NTDS and NEMSIS (pre-hospital) data dictionaries similar?

The National Trauma Data Standard (NTDS) data dictionary contains a number of variables that are to be obtained from the pre-hospital record. The programming language that defines variables in the NTDS and NEMSIS were designed to exactly match. This was done so that “next generation” trauma registry software and pre-hospital software could exchange data. Thus, in the future, trauma registrars may open a new record on a patient, only to find that all of the pre-hospital variables have “auto-populated” the record. Similarly, when an abstractor finishes a trauma record, ED and hospital outcome data could “back-populate” the ENMD record, allowing EMS to evaluate QA topics for transported patients.

Based on the NTDS, how is total ICU LOS calculated when a patient stays a partial day?

The spirit of this question is the ensure that we not only document time spent in the intensive care unit (ICU), but that we also document all who were transferred to the ICU even if for a very short period of time. Thus, if a patient is transferred into an ICU and then is transferred out in less than one day, the total ICU LOS should be calculated as one day. If the patient stays more than one day, or experiences multiple admissions to an ICU, the total time spent in the ICU should be calculated (in hours) and rounded to the next full day increment. Thus, if a patient is admitted to the ICU on two different occasions for a total of 31 hours, the total ICU LOS would be recorded as two (2) days.

The NTDS Data Dictionary definition for Operative and/or essential procedures is vague and seems inadequate?

This question is one that content experts developing the NTDS data dictionary really wrestled with. In summary, the content experts determined that it would be very difficult to maintain a lengthy list of procedures performed in an Operating Suite, Emergency Department, or Intensive Care Unit that would be considered important to the diagnosis, stabilization, or treatment of the patients with specific injuries. New procedures are developed continuously, and procedures important to the care of trauma differ somewhat based upon the type of severity of trauma. The list would be very, very long.

The value of a standardized list of procedures (in the past) was that researchers could use the NTDB to determine if patients “expected” to receive a particular procedure actually received it. Nevertheless, a major bias with the NTDB was always that researchers did not know if a patient didn’t receive a needed procedure or if it was just not recorded. Conducting this type of research using a retrospective dataset is almost impossible.

The approach that was taken allows hospital based registries some flexibility. Most trauma registries in designated trauma centers are collecting data on a set of procedures “they” consider important or rely on administrative procedure codes to document procedures the patient receives. The approach adopted by the NTDB requires that abstractors have some idea of what procedures were considered “essential to the diagnoses, stabilization, or treatment of the patient’s specific injuries” or work with clinicians in there institutions to develop a list to capture the appropriate procedures.

It is understandable that the current definition for the variable appears somewhat inadequate. It was meant to be flexible. We would admonish everyone to work with their facility to determine what list they would like use (or method) for abstracting this information.