The Nevada Experience Department of Surgery Laura K Gryder MA Project Director Samantha Slinkard BA Research Assistant Paul J Chestovich MD CoPrincipal Investigator Deborah A ID: 780226
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Creating a Longitudinal Linked Traffic/Injury Records Database:The Nevada Experience
Department of Surgery
Laura K. Gryder, MA; Project DirectorSamantha Slinkard, BA; Research AssistantPaul J. Chestovich, MD; Co-Principal InvestigatorDeborah A. Kuhls, MD FACS; Principal InvestigatorUniversity of Nevada, Las Vegas School of MedicineATSIP Traffic Safety Forum, Austin TXAugust 4-7, 2019
Slide2Funding for Traffic Safety Research at UNLV School of Medicine comes from:
The Nevada Department of Public Safety – Office of Traffic Safety
Grant #TS-2019-UNLV-00089
Slide3Overview of Nevada
Population in 2018: 3,034,982 (US Census estimates)Clark County (Las Vegas and surrounding area): 2,231,647Washoe County (Reno and surrounding area): 465,735
14 other rural counties and Carson City: 337,010Licensed drivers in 2017: 1,918,305 (Federal Highway Administration)3
Slide4Overview of Nevada
4
Year-to-date (YTD): June 30, 2019 (vs. 2018)
Sources: Nevada FARS data, and Nevada Monthly State Fatal Crash Report
Slide5Overview of Nevada
5
Source: http://data-ndot.opendata.arcgis.com/pages/crash-dataTotal: 41,007Total: 53,525
Total: 52,219
Slide6NDOT Traffic Safety App
http://data-ndot.opendata.arcgis.com/pages/crash-dataArcGIS platformData also available in tabular format.
Currently 2015-2017 available, 2018 pending6
Slide7NV Fatal Crash Characteristics (2017)
7
Source: NHTSA FARS reporting
Slide8NV Fatal Crash Characteristics (2018)
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Source: Nevada Monthly State Fatal Crash Report, NV Office of Traffic Safety: 2018 end of year
2018 NV Fatalities: 331
Passenger Vehicle Occupants: 183
Pedestrians: 80
Motorcyclists: 57
Unrestrained: 83
Restrained or Unknown: 100
Slide9NV Fatal Crash Characteristics (2019 YTD June 30)
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Source: Nevada Monthly State Fatal Crash Report, NV Office of Traffic Safety: YTD 6/30/19
2019 YTD NV Fatalities: 125
Passenger Vehicle Occupants: 55
Pedestrians: 38
Motorcyclists: 26
Unrestrained: 20
Restrained or Unknown: 35
Slide10However there is more to the story than what crash data alone can tell us…
10
Slide11Nevada Office of Traffic Safety Database Grant
Main objectives:To reduce/eliminate Nevada Road User injuries and fatalities
via evidence-based research.Link Nevada crash data with Nevada trauma center registry data via personal identifiers.Maintain a longitudinal database (current: 2005-2017)Respond to data requests from stakeholdersTestify/provide data during NV Legislative sessionsCommunity outreach and educationActively participate on road-user task forces (e.g. SHSP)Knowledge disseminationTREND newsletters and infographics (min. quarterly)
Professional conferences/meetingsInfographic 1.4
Slide12Data Sources
Standalone statewide crash scene report data from Nevada DOTStandalone
trauma data from all of Nevada’s trauma centersSouthern NevadaUniversity Medical Center (UMC) Trauma [Las Vegas]Dignity Health St. Rose Dominican Trauma Center [Henderson]Sunrise Hospital Trauma Center [Las Vegas]Northern NevadaRenown Trauma Center [Reno]Data provided annuallyTabular format12
Slide13Statewide Crash Data (Form 5)
Data collected at scene of crash by Law Enforcement
All 43 Law Enforcement agencies statewide participateStatewide database maintained by NDOTData collected is based on the Federal Model Minimum Uniform Crash Criteria (MMUCC).Allows for reliable state-to-state and national data comparisonsData includes:Person & vehicle typeDriver & vehicle factorsSeating position & restraintKABCO injury severity scoreCollision details (type, internal/external factors, location)
Road, lighting, and weather conditionsSpecific crash reports for non-motoristsAnd more
13
Slide14Form 5 Codes
Standardized for whole state (MMUCC)Specific dataDemographicsEnvironmental factors
Behavioral factorsUsed for problem identification:Determine at-risk populationsRisky behaviorsDangerous locations (e.g. regions, intersections, etc.)Trends over timeEtc.14
Slide15Nevada Trauma Registry Data
4 trauma centers – road users onlyMotor vehicle, motorcycle, moped/scooter, ATV, pedalcycle
, pedestrianData delivered annually, checked for presence of all requested data elements, assuring data standardization across trauma centers, and appended together.15
Slide16National Trauma Data Bank
Largest aggregation of U.S. trauma registry data ever assembled.Data contributions come from trauma centers that have been verified by the American College of Surgeons (ACS)
All four of Nevada’s trauma centers are ACS verifiedIn 2016, 747 ACS verified trauma centers in the United States contributed trauma registry data to the NTDB.Allows for easy comparison of data across all participating trauma centers.Nationally recognized standardWithout a standard, combining data from all four Nevada Trauma Centers would be arduous/impossible.16
Slide17NTDS Data Dictionary
Allows for ease in interpreting registry data by secondary parties.Annual release of updated data dictionaryE-codes:
A code used to define an external cause of injury (ICD-10: International Classification of Diseases version 10).Great degree of specificity17
Slide18E-Codes
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Slide19E-Codes
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Slide20E-Codes
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Slide2121
Slide2222
Slide2323
Slide24Available Trauma Data: Demographics
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From this, you can get a proxy for socioeconomic status (SES). Using zip, you can determine: median household income, and the Community Needs Index.
Slide25Available Trauma Data: Injury Information
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Trauma as standalone (unlinked) data can still provide information on pre-crash behavior.
Slide26Available Trauma Data:Pre-Hospital Information
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Slide27Available Trauma Data:Emergency Department Information
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Slide28Available Trauma Data:Diagnoses, Outcomes, and Financial Info
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Slide29Sample of Trauma Registry Data Elements Helpful for Traffic Safety Research
Abbreviated Injury Scale (0-6)Anatomically-BasedHigher scores = more severe injuries
Helpful for identification of body region injured.Can correlate with mechanism of injury, risk-taking behaviors, etc.Injury Severity Score (0-75)Calculated by using top 3 AIS scores squared and summed.Risk of death increases the higher the score29
Categories
ISS
Minor
1-8
Moderate
9-15
Severe
16-24
Very Severe
25+
AIS
Head
Neck
Face
Abdomen
Thorax
Spine
Upper Extremities
Lower Extremities
External/Other
Skin Soft Tissue
https://www.facs.org/~/media/files/quality%20programs/trauma/ntdb/ntdb%20annual%20report%202016.ashx
Slide30Sample of Trauma Registry Data Elements Helpful for Traffic Safety Research
Alcohol & Drug UseLimitation: Collected for very few Nevada patients. This may vary by state and legal requirements.
30Alcohol Use
No (confirmed by test)
No (not tested)
Yes (confirmed by test [beyond legal
limit])
Yes (confirmed by test [trace levels
])
Not Applicable
Not Known/Not Reported
https://www.facs.org/~/media/files/quality%20programs/trauma/ntdb/ntdb%20annual%20report%202016.ashx
Drug
Use
No (confirmed by test)
No (not tested)
Yes (confirmed by test [illegal drug use
])
Yes (confirmed by test [prescription drug
])
Not Applicable
Not Known/Not Reported
Slide31Sample of Trauma Registry Data Elements Helpful for Traffic Safety Research
Primary Payment SourceIdentification of funding source reveals who is being charged for these preventable injuries.
Hospital ChargesHelps assess some of the financial burden upon primary payors.Missing other costs:RehabilitationLost wagesYears of Productive Life Lost (YPLL)Increase in insurance rates31
https://www.facs.org/~/media/files/quality%20programs/trauma/ntdb/ntdb%20annual%20report%202016.ashx
Primary Payment Source
Medicare
Private/Commercial
Insurance
Medicaid
Self Pay
Other Government
Other
Slide32Nevada Crash-Trauma Database
32
Slide33Data Sharing:How to work with data owners to share sensitive information complete with unique identifiers
(Personally Identifiable Information, PII) and Protected Health Information
(PHI)33
Slide34Data Sharing TipsTake time to
establish relationships with data owners.If at a research institution, establish an approved overarching (umbrella) protocol with your
Institutional Review Board (IRB)Details how data will be usedAssures research integrity and data securityNational Institutes of Health (NIH) Single IRB Policy for Multi-site ResearchConsider Data Use Agreements (DUAs) instead of individual IRBs, when possible.Once a relationship is established, be patient but persistent with data requests.34
Slide35How is Nevada Trauma and Crash Data Used to Inform Road User Safety?
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Slide36Informing Legislature…
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Slide37Nevada Legislative Session 2017: SB 156
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Child Passenger Safety Fact Sheet
NV trauma center registry data for years 2005-2014
Slide38Nevada Legislative Session 2017: SB 288
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Primary Seat Belt Fact Sheet
NV trauma center registry data for years 2005-2014
Slide3939
Nevada Legislative Session 2017:
SB 259
Slide40Nevada’s Ignition Interlock Device (IID) Law
Passed 2017 LegislatureEffective October 2018
Anyone arrested for a DUI required to install IID to retain driving privileges.Trauma Registry hospital outcomes provided related health data to support this bill.40
https://www.reviewjournal.com/crime/dui-offenders-in-nevada-must-install-alcohol-sensing-ignition-locks/
Slide41Nevada Legislative Session 2019:
SB 43
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Slide42Nevada Legislative Session 2019:
SB 408
Pedestrian intervalsClean-up language related to IID lawMoped & Trimobile helmetsIf it has handles and a saddle seat, you need a helmet.Moped crash-trauma data was used during testimony.42
Slide43Informing Traffic Safety Stakeholders…E.g. Government agencies, non-profit safety groups, public health officials, prevention efforts for the medical community, etc.
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Slide44TREND Newsletters: Volume 7
44
Slide45TREND Newsletters: Volume 8
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Slide46Informing the General Public…
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Slide47Infographics
Easily understood “at a glance”Infographics are a perfect addition to TREND Newsletters for targeting consumption by the
general public.Your average person may not understand statistical terminology, and has little interest in reading large tables of data.English and Spanish47Infographic 2.2
Slide48Future Goals for our Office
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Slide49Tell a story frompre-crash behaviors
, to long-term outcomes.
49
Slide50Data Sources: Promising Potential
Good place to start: anywhere data is centralized.
Potential issues: those who maintain the central data may not own the data.If cannot obtain personal identifiers, can utilize verified probabilistic methodology for linking using other data elements.50
Slide51Future Aims: Data Sharing
Can we share our data with other researchers?Currently, no. The Principal Investigator must be involved in all research related to data from this project.
Could we share data in the future?Potentially, yes, with the agreement of data partners. Establish a board with representatives from each data partnerRecommendation from researchers at the University of Maryland School of Medicine51
Slide52Challenges
Data sharingConcerns over data protectionLiability if data used improperlySharing exposes databases to increased scrutiny
Data dictionariesDo they exist? If so, will they share it? If shared, what is the quality?CostWill data partners provide for free, or is there an associated cost?IRBsNevada is unique with only 4 trauma centers, making it easier to maintain multiple IRBs for one research projectNot true for all states/regionsFor example, California has 64 ACS verified trauma centers alone.52
Slide53Contact Information
Laura K. Gryder, MAEmail: Laura.Gryder@unlv.edu
Link to Google library:http://bit.ly/UNLVSOMTrend53