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New York State Trauma RegistryStatistical Summary Report 2010-2013

New York State Department of HealthOffice of Primary Care and Health System ManagementSeptember, 2015

Table of Contents - 2

Table of Contents

Table of ContentsExecutive SummaryFacility Information

Geographic DistributionRegional Summaries

Patient CharacteristicsYearly IncidentsIncidents and IncidenceCase FatalitiesVital StatisticsTemporal DistributionsPayer Types

Injury CharacteristicsMechanism of InjuryPlace of InjuryFallsMotor Vehicle TrafficFirearmInjury Severity Characteristics

Emergency Medical ServicesResponse TimesTransport TimesInitial Destination

Outcome StatisticsDischarge Disposition

Length of StayComplicationsHospital Wait TimesEmergency DepartmentIntensive Care UnitVentilatorPediatric Final DestinationCost of Trauma

Risk Adjusted ComparisonsTrauma Center DesignationPediatric Treatment by DesignationReferral StatusYear of DischargeRegionRegion and Injury

Comparison to National Trauma Data BankCase Fatality Rates By Injury Severity ScoreCase Fatality Rates By Age

AppendixIncidence By Trauma Mechanism and CountyMortality By Trauma Mechanism and CountyInjury StatisticsMaterials and MethodsRisk Adjustment MethodologyInclusion CriteriaReferences

Executive Summary - 3

Executive Summary

Introduction

The purpose of this report is to present summary statistics oftrauma-related injuries and outcomes of the care provided in the40 trauma centers designated in New York State for the years 2010-2013. Trauma clinicians, administrators and policy makers may usethis report to identify important areas and issues for enhancing sys-tems development and clinical quality improvement; the public mayuse this report to learn more about the trauma system in New York.As trauma centers in New York State transition to the standards ofthe American College of Surgeons Committee on Trauma, and ad-ditional levels of trauma center are added to the State system, thisreport will serve as a baseline for measuring improvements in out-come and injury prevention.

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 NewYork State designated trauma centers during 2010-2013 were in-cluded.

Summary of Results

For the discharge years 2010-2013, the New York State Trauma Reg-istry received a total of 69,657 trauma cases submitted by the 40trauma centers across the state. The key findings are:

I Annually, there were an average of 17,414 traumaincidents with a 6.63% case fatality rate. The traumaincidence and case fatality rate increased with patient’sage.

I Males had statistically significant higher traumaincidence and case fatality rate than females, particularlyfor patients aged 17-55; black people aged 17-35 yearshad statistically significant higher trauma incidence andcase fatality rate compared to white people.

I Private health insurance was the primary payer for 49.6%of all trauma incidents and for 80.0% of injuries due tomotor vehicle accidents. Medicare was the primarypayer for 50.0% of injuries due to fall; Worker’sCompensation was the primary payer for 54.0% of themachinery injuries.

Executive Summary - 4

I The leading causes of trauma were falls (45.0% ) andmotor vehicle accidents (30.5%), these were also theleading causes of trauma death, followed by firearmtrauma. Fire, suffocation, and firearm trauma had thehighest case fatality rates, 23.1%, 21.4%, and 14.0%respectively.

I 61% of trauma patients had emergency medical services(EMS) response time within 8 minutes; 94% had responsetime within 30 minutes; and 98% had response timewithin 60 minutes. The median transport time to traumaand non-trauma centers were 16 minutes and 19 minutes,respectively.

I Adult trauma patients were taken directly to anappropriate trauma center in 82% of cases, approaching95% for very severe trauma. Pediatric trauma patientshowever where taken to an appropriate trauma center inonly 51% of reported cases.

I The risk adjusted case fatality rate among traumapatients residing in Central New York region (7.3%) wasstatistically significantly higher than the statewide rate(6.5%); while trauma patients residing in Northern andWestern New York regions had statistically significantlylower adjusted fatality rates (5.6% for Northern, 5.8% forWestern New York).

I Trauma centers with an adult only designation had asignificantly higher risk adjusted case fatality rate thantrauma centers with a pediatric or dual desigantion.

I Compared to the national estimates (National TraumaData Bank), the 2013 trauma case fatality rate in NewYork was significantly higher among trauma patients 75year of age or older with an injury severity score greaterthan 24.

Acknowledgement

The State Health Department would like to thank: the New YorkTrauma Center program staff and the Bureau of Emergency Med-ical Services and Trauma Systems program manager of the Officeof Primary Care and Health System Management (OPCHSM) whohave worked diligently to provide the data utilized in this report, theNYSDOH Bureau of Occupational Health and Injury Prevention forthe injury statistics (Appendix), and the Data Management, Analysisand Research Group of the OPCHSM who created the trauma registyand performed the descriptive and predictive statistical analyses togenerate the tables and figures presented in this report.

Facility Information

Facility Information - Geographic Distribution 6

Western New YorkFinger Lakes RegionCentral New YorkNorthern New YorkHudson Valley RegionNew York CityLong Island NassauLong Island Suffolk

albany

allegany

bronx

broome

cattaraugus

cayuga

chautauquachemung

chenango

clinton

columbia

cortland

delaware

dutchess

erie

essex

franklin

fulton

genesee

greene

hamilton

herkimer

jefferson

kings

lewis

livingston

madison

monroe

montgomery

nassaunew york

niagara oneida

onondaga

ontario

orange

orleans

oswego

otsego

putnam

queens

rensselaer

richmond

rockland

st lawrence

saratoga

schenectady

schoharie

schuyler

seneca

steuben

suffolk

sullivan

tioga

tompkins

ulster

warren

washington

wayne

westchester

wyomingyates

New York Trauma Regions


Geographic Distribution of Upstate New York Trauma Centers

University Hospital SUNY Health Science CenterSt Elizabeth Medical Center

United Health Services Hospitals Inc. − Wilson Medical Center

Strong Memorial Hospital

Westchester Medical Center

Mid−Hudson Valley Division of Westchester Medical Center

Nyack Hospital

Montefiore New Rochelle Hospital

Good Samaritan Hospital of Suffern

Albany Medical Center Hospital

The University of Vermont Health Network − Champlain Valley Physicians Hospital

Mary Imogene Bassett Hospital

Erie County Medical CenterWomen And Children's Hospital Of Buffalo

Regional (black)Area (blue)Adult OnlyPediatric OnlyDual Designation

0 50 100 mi


bronx

kings

new york

queens

richmond

Geographic Distribution of New York City Trauma Centers

Kings County Hospital Center

Lutheran Medical Center

Elmhurst Hospital Center

New York Presbyterian Hospital − New York Weill Cornell Center

Jamaica Hospital Medical Center

Staten Island University Hosp−North

Lincoln Medical & Mental Health Center

Jacobi Medical Center

Richmond University Medical Center

Bellevue Hospital Center

Harlem Hospital Center

Brookdale Hospital Medical Center

SBH Health System

Mount Sinai St. Luke's

New York Hospital Medical Center of Queens

New York Presbyterian Hospital − Columbia Presbyterian Center


0 5 10 mi


nassau

suffolk

Geographic Distribution of Long Island Trauma Centers

South Nassau Communities Hospital

North Shore University Hospital

Winthrop−University HospitalNassau University Medical Center

Huntington Hospital

Good Samaritan Hospital Medical Center

Brookhaven Memorial Hospital Medical Center Inc

Southside Hospital

University Hospital


0 10 20 30 mi

Facility Information - Regional Summaries 10

Trauma Region

Central New York

Finger Lakes

Hudson Valley

Long Island Nassau

Long Island Suffolk

New York City

Northern New York

Western New York

All Regions

Total Trauma Centers

3 (8%)

1 (2%)

5 (12%)

4 (10%)

5 (12%)

17 (42%)

3 (8%)

2 (5%)

40 (100%)

Area Trauma Centers

2

0

4

1

4

0

2

0

13

Regional Trauma Centers

1

1

1

3

1

17

1

2

27

Dual Designation Trauma Centers

1

1

1

3

2

8

1

0

17

Adult Only Trauma Centers

2

0

4

1

3

7

2

1

20

Pediatric Only Trauma Centers

0

0

0

0

0

2

0

1

3

Types of Trauma Centers By Region


Distribution of New York Trauma Centers by Region

Central New York 8 %

Finger Lakes 2 %

Hudson Valley 12 %

Long Island Nassau 10 %

Long Island Suffolk 12 %

New York City 42 %Northern New York

8 %

Western New York 5 %

Distribution of New York Trauma Centers by Number of Certified Beds

0−200 certified beds:

5.1%200−400

certified beds: 28.2%


41%600−800 certified beds:

15.4%


10.3%

Distribution of New York Trauma Centers by DesignationDual Designation Trauma Centers

42 %

Adult Only Trauma Centers

50 %

Pediatric Only Trauma Centers

8 %

Distribution of New York Trauma Centers by TypeArea

Trauma Centers 32 %

Regional Trauma Centers

68 %


Facility

Bellevue Hospital Center

Brookdale Hospital Medical Center

Elmhurst Hospital Center

Harlem Hospital Center

Jacobi Medical Center

Jamaica Hospital Medical Center

Kings County Hospital Center

Lincoln Medical & Mental Health Center

Lutheran Medical Center

New York Hospital Medical Center of Queens

New York Presbyterian Hospital

Columbia Presbyterian Center

New York Presbyterian Hospital

New York Weill Cornell Center

Richmond University Medical Center

St Barnabas Hospital

St Lukes Roosevelt Hospital

St Lukes Hospital Division

Staten Island University Hosp

North

Steven & Alexandra Cohen Children's Medical Center

Adult Trauma Cases 2010

460

373

570

199

535

363

486

378

493

475

9

420

174

373

218

321

39


521

327

529

216

446

312

484

366

439

431

10

361

161

265

151

335

32


394

316

526

198

524

206

497

303

473

427

7

272

104

300

196

389

41


53

208

396

144

405

344

493

138

576

446

8

284

138

244

182

498

16

Pediatric Trauma Cases 2010

29

44

44

19

47

16

34

9

12

17

66

90

17

8

7

20

152


26

33

53

9

41

2

24

20

5

8

66

48

20

8

6

16

178


10

27

33

7

43

0

14

21

7

5

52

28

10

4

1

24

203


5

11

28

9

35

0

19

12

6

11

42

33

11

4

1

21

163

Type

Regional

Regional

Regional

Regional

Regional

Regional

Regional

Regional

Regional

Regional

Regional

Regional

Regional

Regional

Regional

Regional

Regional

Designation

DualDesig

AdultOnly

DualDesig

DualDesig

DualDesig

AdultOnly

DualDesig

AdultOnly

AdultOnly

AdultOnly

Pediatric

DualDesig

DualDesig

AdultOnly

AdultOnly

DualDesig

Pediatric

New York City Trauma Center Case Loads


Facility

Brookhaven Memorial Hospital Medical Center Inc

Good Samaritan Hospital Medical Center

Huntington Hospital

Nassau University Medical Center

North Shore University Hospital

South Nassau Communities Hospital

Southside Hospital

University Hospital

Winthrop

University Hospital


308

303

286

486

795

276

262

781

471


280

351

280

336

813

239

273

732

429


263

309

222

440

706

193

243

727

432


271

330

274

306

823

297

292

715

421


2

34

2

19

7

0

2

74

43


5

29

2

11

9

4

2

82

30


0

36

3

10

8

3

1

74

36


0

18

0

12

5

4

8

60

31

Type

Area

Area

Area

Regional

Regional

Area

Area

Regional

Regional

Designation

AdultOnly

DualDesig

AdultOnly

DualDesig

DualDesig

AdultOnly

AdultOnly

DualDesig

DualDesig

Long Island Trauma Center Case Loads


Facility

Albany Medical Center Hospital

Champlain Valley Physicians Hospital Medical Center

Erie County Medical Center

Good Samaritan Hospital of Suffern

Mary Imogene Bassett Hospital

Nyack Hospital

Sound Shore Medical Center of Westchester

St Elizabeth Medical Center

St Francis Hospital

Poughkeepsie

Strong Memorial Hospital

United Health Services Hospitals Inc

Wilson Hospital Division

University Hospital SUNY Health Science Center

Westchester Medical Center

Women And Children's Hospital Of Buffalo


1241

75

874

88

154

143

33

196

389

1090

358

976

973

26


1201

41

996

91

138

225

23

225

409

1123

445

980

958

27


1253

122

1142

134

124

258

36

153

331

1143

369

1042

1060

23


1393

91

1140

80

95

245

33

96

347

1017

333

1059

990

27


108

4

2

0

6

7

1

5

14

122

18

158

210

190


128

0

3

0

7

21

0

9

6

122

24

124

196

191


148

3

4

1

6

26

1

1

4

92

21

144

162

212


155

4

2

0

3

24

0

2

12

93

12

139

156

163

Type

Regional

Area

Regional

Area

Area

Area

Area

Area

Area

Regional

Area

Regional

Regional

Regional

Designation

DualDesig

AdultOnly

AdultOnly

AdultOnly

AdultOnly

AdultOnly

AdultOnly

AdultOnly

AdultOnly

DualDesig

AdultOnly

DualDesig

DualDesig

Pediatric

Upstate Trauma Center Case Loads

Patient Characteristics

Patient Characteristics - Yearly Incidents 16

2010 2011 2012 2013

Trauma Incidents and Fatalities by Year

Year

Nu

mb

er

of

Ca

ses

(in

th

ou

san

ds)

0

5

10

15

20

1,163 (6.4%) 1,188 (6.8%) 1,168 (6.7%) 1,097 (6.6%)

18,13317,575 17,386

16,563

incidentsdeaths

Patient Characteristics - Yearly Incidents 17

Female Male

2010

Nu

mb

er

of C

ase

s (in

th

ou

san

ds)

0

2

4

6

8

10

12

370 (6.2%)757 (6.4%)

5,922

11,754

Female Male

2011*

367 (6.2%)

793 (7.0%)

5,874

11,283

Female Male

2012*

354 (6.2%)

794 (7.0%)

5,682

11,301

Female Male

2013

365 (6.3%)703 (6.7%)

5,749

10,488

incidents deaths

Trauma Incidents and Fatalities by Year and Gender

Astrix (*) indicates a statistically significant difference in case falalities betweenmales and females with 95% confidence.For the combined four year period therewas a statistically significant difference in case fatality rates of males and females(6.8% and 6.2% respectively) with 99% confidence.

Patient Characteristics - Incidents and Incidence 18

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

Average Annual Trauma Incidents and Fatalities by Age

Age (years)

Nu

mb

er

of C

ase

s

0

50

100

150

200

250

300 incidentsdeaths

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 70 73 76 79 82 >85

Average Annual Trauma Incidence and Mortality by Age

Age (years)

Ca

ses

pe

r 1

,00

0 P

eo

ple

0

1

2

3

4

Population data source: Surveillance, Epidemiology, and End Results (SEER)Program of the National Cancer Institute.


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

Average Annual Trauma Incidents by Gender and Age

Age (years)

Nu

mb

er

of C

ase

s

0

200

400

600

800

1000Male Female

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

Average Annual Trauma Incidence by Gender and Age

Age (years)

Ca

ses

pe

r 1

,00

0 P

eo

ple

0

1

2

3

4Male Female



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

Average Annual Trauma Incidents by Race and Age

Age (years)

Nu

mb

er

of C

ase

s

0

200

400

600

White Black Asian

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

Average Annual Trauma Incidence by Race and Age

Age (years)

Ca

ses

pe

r 1

,00

0 P

eo

ple

0

1

2

3

4 White Black Asian


Patient Characteristics - Case Fatalities 21

0 20 40 60 80

0

2

4

6

8

10

12

14

16

Case Fatality Rate by Age

Age (years)

Ca

se F

ata

lity

Ra

te (

%)

observedsmoothed95% Confidence Interval

0 20 40 60 80

0

2

4

6

8

10

12

14

16

Case Fatality Rate by Age and Gender

Age (years)

Male 95% Confidence IntervalMale smoothedFemale 95% Confidence IntervalFemale smoothed

0 20 40 60 80

0

2

4

6

8

10

12

14

16

Case Fatality Rate by Age and Race

Age (years)

Black 95% Confidence IntervalBlack smoothedWhite 95% Confidence IntervalWhite smoothed

Smoothed using a local regression algorithm (LOESS) weighting each point bynumber of incidents.

Patient Characteristics - Vital Statistics 22

<1 1−9 10−19 20−24 25−34 35−44 45−54 55−64 65−74 75−84 85+

Trauma Registry Deaths as a Percent of All New York State Deaths in 2013 by Age (NYS residents only)

Age (years)

Pe

rce

nt o

f a

ll D

ea

ths

0

2

4

6

8

0.4%

5.2%

7.1% 7.1%

4.9%

1.8%

1.0%0.6%

0.4% 0.6% 0.5%

Patient Characteristics - Temporal Distributions 23

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Percent of Trauma Occurrences by Day of the Week

Pe

rce

nt

11

12

13

14

15

16

17

18

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Percent of Trauma Occurrences by Month of the Year

Pe

rce

nt

6

7

8

9

10

11

Percent of Trauma Occurrences by Time of the Day

Pe

rce

nt

2

3

4

5

6

12AM

1AM

2AM

3AM

4AM

5AM

6AM

7AM

8AM

9AM

10AM

11AM

12PM

1PM

2PM

3PM

4PM

5PM

6PM

7PM

8PM

9PM

10PM

11PM

Patient Characteristics - Payer Types 24

CHAMPUS

Other Federal Program

Unknown

Other Non−Federal Program

Workers Compensation

Self−Pay

Medicaid

Medicare

Insurance Company

Average Annual Trauma Incident Distribution by Primary Payer

Percent of Total Cases

0 10 20 30 40 50

0.3%

0.5%

0.6%

3.2%

3.5%

7.9%

9.7%

24.7%

49.6%



Self−Pay

Medicaid

Medicare

Insurance Company

Finger Lakes Region


0 10 20 30 40 50

3%

8%

15%

21%

51%

Medicaid


Self−Pay

Medicare

Insurance Company

Central New York


0 10 20 30 40

6%

8%

9%

26%

46%


Medicaid

Self−Pay

Medicare

Insurance Company

Hudson Valley Region


0 10 30 50

5%

6%

7%

22%

59%


Self−Pay

Medicaid

Medicare

Insurance Company

Long Island Nassau


0 10 20 30 40 50

3%

4%

4%

35%

53%


Medicaid

Self−Pay

Medicare

Insurance Company

Long Island Suffolk


0 10 20 30 40 50

3%

5%

7%

31%

50%


Self−Pay

Medicaid

Medicare

Insurance Company

New York City


0 10 20 30 40

2%

10%

16%

25%

46%

Unknown

Self−Pay

Medicaid

Medicare

Insurance Company

Northern New York


0 10 30 50

4%

5%

6%

23%

55%

Medicaid

Self−Pay

Medicare


Insurance Company

Western New York


0 10 20 30 40

7%

8%

13%

17%

48%

Payer Types by Region



Self−Pay

Medicaid

Insurance Company

Medicare

Fall


0 10 20 30 40 50

3%

5%

7%

32%

50%

Medicaid


Self−Pay


Insurance Company

Motor Vehicle Traffic


0 20 40 60

2%

3%

5%

7%

80%

Medicare


Self−Pay

Medicaid

Insurance Company

Firearm


0 5 15 25 35

3%

3%

22%

35%

36%


Medicare

Self−Pay

Medicaid

Insurance Company

Cut / Pierce


0 10 20 30

2%

5%

21%

29%

39%


Medicare

Self−Pay

Medicaid

Insurance Company

Struck by, against


0 10 20 30 40

5%

9%

15%

18%

48%

Medicaid

Self−Pay

Medicare

Insurance Company


Machinery


0 10 30 50

4%

7%

11%

22%

54%


Medicare

Medicaid

Self−Pay

Insurance Company

Transport, non traffic


0 20 40 60

4%

7%

7%

9%

68%

Self−Pay


Medicaid

Medicare

Insurance Company

Overexertion


0 10 20 30 40 50

4%

7%

15%

16%

52%

Payer Types by Mechanism of Trauma

Injury Characteristics

Injury Characteristics - Mechanism of Injury 28

Unintentional

Assault

Self−Inflicted

Undetermined

Other

Average Annual Trauma Incidents by Intention of Injury

Number of Cases

0 5000 10000 15000

14,151 (86.3%)

2,022 (12.3%)

166 (1.0%)

58 (0.4%)

9 (0.1%)

Unintentional

Assault

Self−Inflicted

Undetermined

Other

Average Annual Trauma Fatalities by Intention of Injury

Number of Deaths

0 200 400 600 800 1000

933 (85.4%)

120 (11.0%)

33 (3.0%)

7 (0.6%)

0 (0.0%)

Unintentional

Assault

Self−Inflicted

Undetermined

Other

Case Fatality Rate by Intention of Injury

Case Fatality Rate (%)

0 5 10 15 20

6.6%

5.9%

19.7%

11.6%

2.8%

Injury Characteristics - Mechanism of Injury 29

Fall


Struck by, against

Firearm


Cut / Pierce

Pedal cyclist, Non Traffic

Unspecified

Other Specified, NEC

Other Specified and Classifiable

Machinery

Pedestrian, non traffic

Natural, environmental

Overexertion

Drowning, Submersion

Suffocation

Fire, burn

Average Annual Trauma Incidents by Injury Category

Number of Cases

0 2000 4000 6000 8000

7,381 (45.0%)

5,006 (30.5%)

1,110 (6.8%)

756 (4.6%)

572 (3.5%)

488 (3.0%)

296 (1.8%)

260 (1.6%)

170 (1.0%)

117 (0.7%)

82 (0.5%)

72 (0.4%)

39 (0.2%)

32 (0.2%)

9 (0.1%)

7 (0.0%)

6 (0.0%)

Fall


Struck by, against

Firearm


Cut / Pierce


Unspecified



Machinery



Overexertion


Suffocation

Fire, burn

Average Annual Trauma Fatalities by Injury Category

Number of Deaths

0 100 300 500

538 (49.2%)

338 (30.9%)

23 (2.1%)

106 (9.7%)

18 (1.7%)

16 (1.5%)

6 (0.5%)

18 (1.7%)

5 (0.5%)

11 (1.0%)

2 (0.2%)

6 (0.6%)

0 (0.0%)

0 (0.0%)

0 (0.0%)

2 (0.1%)

2 (0.1%)

Fall


Struck by, against

Firearm


Cut / Pierce


Unspecified



Machinery



Overexertion


Suffocation

Fire, burn

Case Fatality Rate by Injury Category


0 5 10 15 20 25

7.3%

6.7%

2.0%

14.0%

3.2%

3.3%

1.9%

7.1%

3.1%

9.4%

2.7%

9.0%

1.3%

1.6%

5.7%

21.4%

23.1%

Injury Characteristics - Place of Injury 30

Street

Home

Unspecified

Other

Recreation

Residential Institution

Public Building

Industry

Farm

Mine

Average Annual Trauma Incidents by Place of Injury

Number of Cases

0 1000 3000 5000 7000

6,590 (37.8%)

5,330 (30.6%)

1,727 (9.9%)

1,508 (8.7%)

776 (4.5%)

586 (3.4%)

572 (3.3%)

244 (1.4%)

74 (0.4%)

6 (0.0%)

Street

Home

Unspecified

Other

Recreation


Public Building

Industry

Farm

Mine

Average Annual Trauma Fatalities by Place of Injury

Number of Deaths

0 100 200 300 400 500

429 (37.2%)

443 (38.4%)

86 (7.4%)

85 (7.4%)

14 (1.2%)

60 (5.2%)

26 (2.3%)

8 (0.6%)

4 (0.3%)

0 (0.0%)

Street

Home

Unspecified

Other

Recreation


Public Building

Industry

Farm

Mine

Case Fatality Rate by Place of Injury


0 2 4 6 8 10

6.5%

8.3%

5.0%

5.7%

1.7%

10.3%

4.5%

3.1%

5.4%

4.2%

Injury Characteristics - Falls 31

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

Fall Trauma: Average Annual Incidents and Fatalities by Age

Age (years)

Nu

mb

er

of C

ase

s

0

50

100

150incidentsdeaths

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 70 73 76 79 82 >85

Fall Trauma: Average Annual Incidence and Mortality by Age

Age (years)

Ca

ses

pe

r 1

,00

0 P

eo

ple

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5


Injury Characteristics - Motor Vehicle Traffic 32

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

Motor Vehicle Traffic Trauma: Average Annual Incidents and Fatalities by Age

Age (years)

Nu

mb

er

of C

ase

s

0

20

40

60

80

100

120 incidentsdeaths

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 70 73 76 79 82 >85

Motor Vehicle Traffic Trauma: Average Annual Incidence and Mortality by Age

Age (years)

Ca

ses

pe

r 1

0,0

00

Pe

op

le

0

1

2

3

4


Injury Characteristics - Firearm 33

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 >85

Firearm Trauma: Average Annual Incidence by Age and Intention

Age (years)

Ca

ses

pe

r 1

00

,00

0 P

eo

ple

0

5

10

15

20AssaultOtherSelf−InflictedUndeterminedUnintentional

Western New YorkFinger Lakes Region

New York CityCentral New York

Northern New YorkLong Island SuffolkLong Island Nassau

Hudson Valley Region

Firearm Trauma: Average Annual Incidence by Region and Intention

Cases per 100,000 people

0 1 2 3 4 5 6 7

AssaultOtherSelf−InflictedUndeterminedUnintentional


Injury Characteristics - Injury Severity Characteristics 34

1−8 9−15 16−24 24−34 35−75

Average Annual Incidents of Trauma and Fatalities by Injury Severity Score

Injury Severity Score

Nu

mb

er

of C

ase

s

0

2000

4000

6000

8000

30 (1.4%) 147 (1.9%) 200 (4.4%)454 (25.2%)

284 (45.6%)

2,134

7,751

4,512

1,806

622

incidentsdeaths

Injury Characteristics - Injury Severity Characteristics 35

0 20 40 60 80

0

20

40

60

80

100

Average Annual Trauma Case Fatality Rate by Age and Injury Severity Score (ISS)

Age (years)

Ca

se F

ata

lity

Ra

te (

%)

ISS 0−15 ISS 16−24 ISS 25−34 ISS 35−75

Emergency Medical Services

Emergency Medical Services - Response Times 37

Distribution of Emergency Medical Services (EMS) Response Times

Time (minutes)

Pe

rce

nt o

f C

ase

s

0

5

10

15

20

25

30

35

0−55−

10

10−1

5

15−2

0

20−2

5

25−3

0

30−3

5

35−4

0

40−4

5

45−5

0

50−5

5

55−6

0

60−6

5

65−7

0

70−7

5

75−8

0

80−8

5

85−9

0

90−9

5

95−1

00

05

10

15

20

25

Distribution of Emergency Medical Services Response Times by Injury Severity Score and Outcome

Tim

e (

min

ute

s)

Alive ISS<30

Dead ISS<30

Alive ISS>30

Dead ISS>30

min min min min

1st quartile 1st quartile 1st quartile 1st quartile

medianmedian

medianmedian

3rd quartile

3rd quartile

3rd quartile

3rd quartile

max

max

max

max

Response time is calculated as the time from emergency phone call to medicalservice’s arrival at scene. Statistical outliers are omitted from boxplots. Notchesrepresent a 95% confidence interval around the medians. Nonoverlapping notchessugest a meaningfull difference in group medians.

Emergency Medical Services - Response Times 38

albany

allegany

bronx

broomecattaraugus

cayuga

chautauquachemung

chenango

clinton

columbia

cortland

delaware

dutchess

erie

essex

franklin

fultongenesee

greene

hamilton

herkimer

jefferson

kings

lewis

livingston

madison

monroe

montgomery

nassaunew york

niagara oneida

onondaga

ontario

orange

orleans

oswego

otsego

putnam

queens

rensselaer

richmond

rockland

st lawrence

saratoga

schenectady

schoharie

schuyler

seneca

steuben

suffolk

sullivan

tioga

tompkins

ulster

warren

washington

wayne

westchester

wyomingyates

bronxkings

new yorkfultonnassauqueens

richmondalbany

broomecolumbiacortland

eriemonroe

onondagarocklandsaratoga

schenectadyclinton

dutchessoneidaorleans

rensselaersuffolkwarren

westchestergreene

madisonniagaraoswegocayuga

chautauquagenesee

montgomeryontario

tompkinstioga

washingtonwayne

cattaraugusherkimer

livingstonotsegoseneca

schoharieessex

orangeulster

chenangosullivan

wyomingalleganydelawarejeffersonputnam

lewisyates

chemungfranklinsteuben

hamiltonschuyler

st lawrence

EMS Response Time (minutes)

0 10 20 30 40

New York State Median EMS Response Time by County of Residence

Emergency Medical Services - Transport Times 39

Distribution of Emergency Medical Services (EMS) Transport Times to Non−trauma Centers

Time (minutes)

Pe

rce

nt

of

Ca

ses

0

2

4

6

8

10

12

14

16

18

20

0−5

5−10

10−1

5

15−2

0

20−2

5

25−3

0

30−3

5

35−4

0

40−4

5

45−5

0

50−5

5

55−6

0

60−6

5

65−7

0

70−7

5

75−8

0

80−8

5

85−9

0

Distribution of Emergency Medical Services (EMS) Transport Times to Trauma Center

Time (minutes)

Pe

rce

nt

of

Ca

ses

0

2

4

6

8

10

12

14

16

18

20

22

24

0−5

5−10

10−1

5

15−2

0

20−2

5

25−3

0

30−3

5

35−4

0

40−4

5

45−5

0

50−5

5

55−6

0

60−6

5

65−7

0

70−7

5

75−8

0

80−8

5

85−9

0

Trauma Center Non−Trauma Center

0

10

20

30

40

50

Distribution of Emergency Medical Services (EMS) Transport Time by Initial Destination

Initial Destination

Tim

e (

min

ute

s)

min min

1st quartile 1st quartile

median

median

3rd quartile

3rd quartile

max

max

Transport time is calculated as time from emergency medical service’s departurefrom the scene of injury to arrival at hospital. Statistical outliers are omitted fromboxplots. Notches represent a 95% confidence interval around the medians.Nonoverlapping notches sugest a meaningfull difference in group medians.

Emergency Medical Services - Transport Times 40

albany

allegany

bronx

broomecattaraugus

cayuga

chautauquachemung

chenango

clinton

columbia

cortland

delaware

dutchess

erie

essex

franklin

fultongenesee

greene

hamilton

herkimer

jefferson

kings

lewis

livingston

madison

monroe

montgomery

nassaunew york

niagara oneida

onondaga

ontario

orange

orleans

oswego

otsego

putnam

queens

rensselaer

richmond

rockland

st lawrence

saratoga

schenectady

schoharie

schuyler

seneca

steuben

suffolk

sullivan

tioga

tompkins

ulster

warren

washington

wayne

westchester

wyomingyates

bronxnassau

new yorkonondagarichmond

suffolkerie

kingsmonroequeensoneida

chemungbroome

rocklandwestchester

albanyclinton

rensselaerotsego

dutchessgeneseeputnam

hamiltonherkimer

niagaraorange

wyomingwaynecayuga

essexontario

schenectadyorleansoswegosullivanmadison

chautauqualivingston

schuyleryates

cortlandtiogaulster

franklincattaraugus

saratogaallegany

chenangosteubenseneca

jeffersonlewis

columbiagreene

tompkinsdelaware

st lawrencemontgomerywashington

schohariefulton

warren

EMS Transport Time (minutes)

0 10 30 50

Median EMS Transport Time To Appropriate Trauma Center by County of Residence

Emergency Medical Services - Initial Destination 41

Adult Only 35.4%

Dual Designation 46.1%

Pediatric 0.2%

Non−Trauma 17.2%

Unknown 1.1%

Distribution of Adult Trauma Cases by Inital Destination

Adult Only 23.6%Dual Designation 34.4%

Pediatric 9.1%

Non−Trauma 30.1%

Unknown 2.8%

Distribution of Pediatric Trauma Cases by Inital Destination

0−24 25−50 50−75

Transport to Appropriate Trauma Center by Age and Injury Severity Score


Pe

rce

nt

of

Ca

ses

0

5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

80

85

90

95

100Adult Pediatric

Registry data does not include data from patients that never made it to a TraumaCenter. 95% confidence intervals are shown around sample means in the barchart.Walk-ins excluded.

Outcome Statistics

Outcome Statistics - Discharge Disposition 43

Home − No Sevices

Inpatient Rehab

Home Health Services

Skilled Nursing Facility

Died

Short−Term General Hospital

Left Against Medical Advice

Other

Law Enforcement

Psychiatric Hospital

Unknown

Hospice

Average Annual Discharges By Disposition

Number of Cases

0 2000 4000 6000 8000 10000

8,917 (51.2%)

3,268 (18.8%)

1,751 (10.1%)

1,296 ( 7.4%)

1,154 ( 6.6%)

251 ( 1.4%)

241 ( 1.4%)

166 ( 1.0%)

153 ( 0.9%)

117 ( 0.7%)

99 ( 0.6%)

1 ( 0.0%)

Outcome Statistics - Length of Stay 44

0−24 25−49 50−75

0

20

40

60

80

Length of Stay by Injury Severity Score for Patients Who Lived


Tim

e (

da

ys)

4

11

26

0−24 25−49 50−75

0

20

40

60

80

Length of Stay by Injury Severity Score for Patients Who Died


Tim

e (

da

ys)

52

0

Outcome Statistics - Complications 45

other unspecified

pneumonia

acute lung injury

new urinary tract infection

withdrawal from alcohol or drugs

severe sepsis

acute kidney injury

cardiac arrest in hospital

deep vein thrombosis

new decubitus ulcer

unplanned intubation

pulmonary embolism

extremity compartment syndrome

new myocardial infarction

superficial surgical site infection

new stroke or cerebral vascular accident

deep surgical site infection

unplanned return to ICU

organ or space surgical site infection

catheter related blood stream infection

failure of graft, flap, or prosthesis

new bone infection

Average Annual Trauma Incidents by Complication

Number of Cases

0 400 800

747

470

394

336

163

160

156

152

144

120

107

61

54

41

33

25

23

22

20

18

5

4

other unspecified

pneumonia

acute lung injury



severe sepsis

acute kidney injury



new decubitus ulcer


pulmonary embolism










new bone infection

Average Annual Trauma Fatalities by Complication

Number of Deaths

0 60 120

136

77

93

27

5

53

44

126

14

16

30

8

2

14

1

5

2

3

1

3

0

0

other unspecified

pneumonia

acute lung injury



severe sepsis

acute kidney injury



new decubitus ulcer


pulmonary embolism










new bone infection

Average Annual Case Fatality Rate by Complication


0 40 80

18.2%

16.4%

23.6%

8.1%

2.9%

33.3%

28.1%

82.3%

9.6%

13.3%

28.5%

13.1%

4.6%

33.3%

2.3%

19.0%

7.5%

14.6%

3.7%

15.1%

0.0%

5.6%

Outcome Statistics - Hospital Wait Times 46

0−24 25−49 50−75

0

5

10

15

20

25

30

Distribution of Time In Emergency Department


Tim

e (

ho

urs

)

5:06

3:15

1:26

0−24 25−49 50−75

0

5

10

15

20

25

30

Distribution of Time Until First Procedure


Tim

e (

ho

urs

)

4:34

2:17

0:44

Outcome Statistics - Emergency Department 47

ED Intubation

Chest Tube

CPR In Progress

CPR Start Unknown

CPR Initiated Thoracotomy

Surgical Airway

Average Annual Incidents of Required Emergency Department Procedures

Nu

mb

er

of

Ca

ses

0

500

1000

1500

1,648 (9%)

727 (4%)

40 (0%) 24 (0%) 14 (0%) 9 (0%) 4 (0%)

CPR In Progress

CPR Initiated

CPR Start Unknown Thoracotomy

Surgical Airway

ED Intubation

Chest Tube

Emergency Department Case Fatality Rates by Required Emergency Department Procedure

Ca

se F

ata

lity

Ra

te (

%)

0102030405060708090

10086%

53%

29%19%

11%5% 2%

CPR In Progress

CPR Initiated

CPR Start Unknown Thoracotomy

Surgical Airway

ED Intubation

Chest Tube

Inpatient Case Fatality Rates by Required Emergency Department Procedure

Ca

se F

ata

lity

Ra

te (

%)

0102030405060708090

10097%

89%

76%

64%

33% 31%

9%

Died in ED Died after ED

Average Annual Trauma Fatalities by Location of Patient Deaths

Nu

mb

er

of

Ca

ses

0

100

200

300

400

500

600

700

800

900

1000

1100

13%

87%

Outcome Statistics - Intensive Care Unit 48

Trauma Patients Admitted to the Intensive Care Unit (ICU)

ICU: 45%

No ICU: 55%

Died

Survived

Days in the Intensive Care Unit (ICU)

Time in ICU (days)

1 3 5 7 9 11 13 15

0 10 20 30 40 50

0

5

10

15

20

25

Case Fatalities in the Intensive Care Unit (ICU) as a Function of Time

Time in ICU (days)

Ca

se F

ata

lity

Ra

te (

%)

observed smoothed

Outcome Statistics - Ventilator 49

Trauma Patients Requiring a Ventalator

No Ventalator: 83%

Ventalator: 17%

Died

Survived

Days on a Ventalator

Time on a Ventalator (days)

1 3 5 7 9 11 13 15 17 19 21

0 10 20 30 40 50

0

5

10

15

20

25

30

Case Fatality Rate of Patients on a Ventilator as a Function of Time

Time on a Ventilator (days)

Ca

se F

ata

lity

Ra

te (

%)

observed smoothed 95% Confidence Interval

Outcome Statistics - Pediatric Final Destination 50

albany

allegany

bronx

broomecattaraugus

cayuga

chautauquachemung

chenango

clinton

columbia

cortland

delaware

dutchess

erie

essex

franklin

fultongenesee

greene

hamilton

herkimer

jefferson

kings

lewis

livingston

madison

monroe

montgomery

nassaunew york

niagara oneida

onondaga

ontario

orange

orleans

oswego

otsego

putnam

queens

rensselaer

richmond

rockland

st lawrence

saratoga

schenectady

schoharie

schuyler

seneca

steuben

suffolk

sullivan

tioga

tompkins

ulster

warren

washington

wayne

westchester

wyomingyates

clintonbroomeotsego

rocklandtiogakingsbronx

dutchessherkimerchenangoschoharie

oneidadelaware

senecaqueensulster

new yorkessex

schuylercortlandcayugasuffolknassau

montgomeryputnamorange

madisonwestchester

erieniagara

richmondmonroealbany

alleganycattarauguschautauqua

chemungcolumbia

franklinfulton

geneseegreene

jeffersonlewis

livingstononondaga

ontarioorleansoswego

rensselaersaratoga

schenectadyst lawrence

steubensullivan

tompkinswarren

washingtonwayne

wyomingyates

Percent Treated by Appropriate Trauma Center

0 20 40 60 80

Percent of Pediatric Patients Treated at an Appropriate Final Destination by County of Residence

Outcome Statistics - Cost of Trauma 51

Probability Density of Gross Charges of Trauma Patients (94% of all charges shown)

Gross Charges ($ in thousands)

Pe

rce

nt o

f R

eg

istr

y C

ase

s (%

)

0

2

4

6

8

10

12

14

16

18

20

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200

Outcome Statistics - Cost of Trauma 52

Median Gross Charges by Injury Severity Score


Gro

ss C

ha

rge

s ($

in th

ou

san

ds)

0

20

40

60

80

100

120

0 15 30 45 60 75 0 20 40 60 80

0

100

200

300

400

500

600

Median Gross Charges by Length of Stay (LOS)

Length of Stay (days)

Gro

ss C

ha

rge

s ($

in th

ou

san

ds)

Gross Charges = $10,301 + $6,362 × LOS

Risk Adjusted Comparisons

Risk Adjusted Comparisons - Trauma Center Designation 54

2

4

6

8

10

Risk Adjusted Case Fatality Rates by Trauma Center Type and Designation

Ris

k A

dju

ste

d F

ata

lity

Ra

te (

%)

RegionalPediatric

AreaDualDesig

RegionalDualDesig

AreaAdultOnly

RegionalAdultOnly

5.6% 5.2%

6.4%6.9% 6.6%

Observed Statewide Fatality Rate: 6.5%

Facility Type

Regional

Area

Regional

Area

Regional

Facility Designation

Pediatric

DualDesig

DualDesig

AdultOnly

AdultOnly

Number of Patients

1,735

1,384

40,132

9,819

13,428

Observed Fatality Rate

1.2%

6.1%

6.6%

6.5%

6.7%

Expected Fatality Rate

1.3%

7.6%

6.7%

6.1%

6.6%

Risk Ratio

0.92 ± 0.38

0.80 ± 0.17

0.99 ± 0.04

1.07 ± 0.08

1.02 ± 0.06

Risk Adjusted Fatality Rate

5.6% ± 2.5

5.2% ± 1.1

6.4% ± 0.2

6.9% ± 0.5

6.6% ± 0.4

Risk Adjusted Comparisons - Pediatric Treatment by Designation 55

0

2

4

6

8

10

Pediatric Risk Adjusted Case Fatality Rates by Trauma Center Designation

Ris

k A

dju

ste

d F

ata

lity

Ra

te (

%)

Pediatric DualDesig AdultOnly

2.2%3.2%

6.1%

Observed Statewide Pediatric Fatality Rate: 2.2%

Facility Designation

Pediatric

DualDesig

AdultOnly

Number of Patients

1,489

3,174

449


1.3%

2.2%

4.5%


1.2%

1.5%

1.6%

Risk Ratio

1.06 ± 0.46

1.49 ± 0.35

2.78 ± 1.21


2.2% ± 1.0

3.2% ± 0.7

6.1% ± 2.6

Pediatric patients are defined here as less than 15 years of age.

Risk Adjusted Comparisons - Referral Status 56

3

4

5

6

7

Risk Adjusted Case Fatality Rates by Patients' Referral Status (excluding patients who died in the ED to reduce possible bais in the comparison)

Ris

k A

dju

ste

d F

ata

lity

Ra

te (

%)

Patients Not Referred From Another Hospital

Patients Referred From Another Hospital

5.4% 5.6%


Referal Status

Not Referred

Referred

Number of Patients

52,402

13,550


5.7%

5.6%


6.0%

5.7%

Risk Ratio

0.95 ± 0.03

0.98 ± 0.07


5.4% ± 0.2

5.6% ± 0.4

Risk Adjusted Comparisons - Year of Discharge 57

3

4

5

6

7

8

Risk Adjusted Case Fatality Rates by Discharge Year

Ris

k A

dju

ste

d F

ata

lity

Ra

te (

%)

2010 2011 2012 2013

6.8% 6.9%6.3%

6.0%


Year

2010

2011

2012

2013

Number of Patients

17,226

16,751

16,686

15,835


6.2%

6.6%

6.6%

6.5%


5.9%

6.2%

6.8%

7.0%

Risk Ratio

1.05 ± 0.06

1.06 ± 0.06

0.97 ± 0.06

0.93 ± 0.06


6.8% ± 0.4

6.9% ± 0.4

6.3% ± 0.4

6.0% ± 0.4

Risk Adjusted Comparisons - Region 58

3

4

5

6

7

8

9

Risk Adjusted Case Fatality Rates by Region

Ris

k A

dju

ste

d F

ata

lity

Ra

te (

%)

CentralNewYork

HudsonValley

LongIslandNassau

LongIslandSuffolk

NewYorkCity

NorthernNewYork

WesternNY/

FingerLakes

7.3%6.7% 6.7%

6.0%6.8%

5.6% 5.9%


Region

Central New York

Hudson Valley

Long Island Nassau

Long Island Suffolk

New York City

Northern New York

Western NY/ Finger Lakes

Number of Patients

6,724

7,301

7,271

7,790

21,754

6,222

9,436


8.3%

5.5%

7.3%

6.8%

6.0%

5.7%

6.6%


7.4%

5.4%

7.1%

7.3%

5.7%

6.6%

7.2%

Risk Ratio

1.12 ± 0.09

1.02 ± 0.10

1.03 ± 0.08

0.93 ± 0.08

1.05 ± 0.06

0.86 ± 0.09

0.92 ± 0.07


7.3% ± 0.6

6.7% ± 0.6

6.7% ± 0.5

6.0% ± 0.5

6.8% ± 0.4

5.6% ± 0.6

5.9% ± 0.4

Risk Adjusted Comparisons - Region and Injury 59

4

6

8

10

Fall Trauma: Risk Adjusted Case Fatality Rates by Region

Ris

k A

dju

ste

d F

ata

lity

Ra

te (

%)

CentralNewYork

HudsonValley

LongIslandNassau

LongIslandSuffolk

NewYorkCity

NorthernNewYork

WesternNY/

FingerLakes

8.2% 8.2%7.4% 7.1% 7.3%

6.4% 6.3%

Observed Statewide Fall Fatality Rate: 7.3%

Region

Central New York

Hudson Valley

Long Island Nassau

Long Island Suffolk

New York City

Northern New York


Number of Patients

2,541

2,917

4,249

3,905

8,331

2,700

3,332


9.2%

7.8%

7.7%

7.5%

6.4%

7.6%

6.8%


8.2%

6.9%

7.6%

7.7%

6.3%

8.7%

7.8%

Risk Ratio

1.12 ± 0.14

1.13 ± 0.14

1.01 ± 0.10

0.97 ± 0.11

1.02 ± 0.08

0.87 ± 0.12

0.87 ± 0.11


8.2% ± 1.0

8.2% ± 1.0

7.4% ± 0.8

7.1% ± 0.8

7.3% ± 0.6

6.4% ± 0.8

6.3% ± 0.8


4

6

8

10

Motor Vehicle Traffic Trauma: Risk Adjusted Case Fatality Rates by Region

Ris

k A

dju

ste

d F

ata

lity

Ra

te (

%)

CentralNewYork

HudsonValley

LongIslandNassau

LongIslandSuffolk

NewYorkCity

NorthernNewYork

WesternNY/

FingerLakes

7.6%

6.1%7.1%

5.8%

7.8%

6.2% 6.5%

Observed Statewide Motor Vehicle Traffic Fatality Rate: 6.6%

Region

Central New York

Hudson Valley

Long Island Nassau

Long Island Suffolk

New York City

Northern New York


Number of Patients

2,128

2,565

2,023

2,500

5,127

1,918

3,142


8.4%

4.4%

7.4%

6.6%

6.8%

5.1%

7.2%


7.2%

4.8%

6.8%

7.5%

5.7%

5.3%

7.3%

Risk Ratio

1.17 ± 0.16

0.92 ± 0.17

1.09 ± 0.17

0.88 ± 0.13

1.19 ± 0.12

0.96 ± 0.18

0.99 ± 0.12


7.6% ± 1.1

6.1% ± 1.1

7.1% ± 1.1

5.8% ± 0.8

7.8% ± 0.8

6.2% ± 1.2

6.5% ± 0.8


5

10

15

20

Firearm Trauma: Risk Adjusted Case Fatality Rates by Region

Ris

k A

dju

ste

d F

ata

lity

Ra

te (

%)

CentralNewYork

HudsonValley

LongIslandNassau

LongIslandSuffolk

NewYorkCity

NorthernNewYork

WesternNY/

FingerLakes

13.3%

7.7%

13.6% 12.7%14.0%

12.7% 11.8%

Observed Statewide Firearm Fatality Rate: 12.9%

Region

Central New York

Hudson Valley

Long Island Nassau

Long Island Suffolk

New York City

Northern New York


Number of Patients

207

127

112

104

1,628

133

605


23.7%

6.3%

17.0%

17.3%

10.4%

12.0%

16.0%


23.0%

10.5%

16.1%

17.6%

9.7%

12.3%

17.6%

Risk Ratio

1.03 ± 0.25

0.60 ± 0.40

1.06 ± 0.43

0.98 ± 0.42

1.07 ± 0.15

0.98 ± 0.45

0.91 ± 0.17


13.3% ± 3.3

7.7% ± 5.2

13.6% ± 5.6

12.7% ± 5.4

14.0% ± 2.0

12.7% ± 5.9

11.8% ± 2.2

Comparison to National Trauma Data Bank

Comparison to National Trauma Data Bank - Case Fatality Rates By Injury Severity Score 63

9−15 16−24 >24

New York vs United States: 2013 Case Fatality Rates by Injury Severity Score


Ca

se F

ata

lity

Ra

te (

%)

0

5

10

15

20

25

30

35New York State Nation

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 ofgreater than or equal to 9 was considered.

Comparison to National Trauma Data Bank - Case Fatality Rates By Age 64

<1 1−4 5−9 10−14 15−19 20−24 25−34 35−44 45−54 55−64 65−74 75−84 >84

New York vs United States: 2013 Case Fatality Rates by Age Group for Trauma with Injury Severity Score 9−15

Age (years)

Ca

se F

ata

lity

Ra

te (

%)

0

2

4

6

New York State Nation



<1 1−4 5−9 10−14 15−19 20−24 25−34 35−44 45−54 55−64 65−74 75−84 >84


Age (years)

Ca

se F

ata

lity

Ra

te (

%)

0

2

4

6

8

10

12




<1 1−4 5−9 10−14 15−19 20−24 25−34 35−44 45−54 55−64 65−74 75−84 >84


Age (years)

Ca

se F

ata

lity

Ra

te (

%)

0

10

20

30

40

50



Appendix

Appendix - Incidence By Trauma Mechanism and County 68

albany

allegany

bronx

broomecattaraugus

cayuga

chautauquachemung

chenango

clinton

columbia

cortland

delaware

dutchess

erie

essex

franklin

fultongenesee

greene

hamilton

herkimer

jefferson

kings

lewis

livingston

madison

monroe

montgomery

nassaunew york

niagara oneida

onondaga

ontario

orange

orleans

oswego

otsego

putnam

queens

rensselaer

richmond

rockland

st lawrence

saratoga

schenectady

schoharie

schuyler

seneca

steuben

suffolk

sullivan

tioga

tompkins

ulster

warren

washington

wayne

westchester

wyomingyates

franklinchemungschuyler

tompkinsst lawrence

essexsteuben

chautauquaschenectady

kingsorangebronx

new yorkwayne

tiogaputnamwarren

westchestermonroesullivan

washingtonwyoming

niagaraerie

lewisrichmond

senecaonondaga

oneidaalleganysaratogamadison

cayugaulster

schohariedutchessjeffersongenesee

rensselaerlivingston

albanyorleansoswegocortlandclintonqueens

cattaraugusontario

hamiltonherkimercolumbia

yatesfulton

chenangorockland

greenemontgomery

otsegobroomenassau

delawaresuffolk


0 1 2 3 4 5 6 7

Fall Trauma: Average Annual Incidence by County of Residence


albany

allegany

bronx

broomecattaraugus

cayuga

chautauquachemung

chenango

clinton

columbia

cortland

delaware

dutchess

erie

essex

franklin

fultongenesee

greene

hamilton

herkimer

jefferson

kings

lewis

livingston

madison

monroe

montgomery

nassaunew york

niagara oneida

onondaga

ontario

orange

orleans

oswego

otsego

putnam

queens

rensselaer

richmond

rockland

st lawrence

saratoga

schenectady

schoharie

schuyler

seneca

steuben

suffolk

sullivan

tioga

tompkins

ulster

warren

washington

wayne

westchester

wyomingyates

franklinchemungnew york

st lawrencechautauqua

tompkinskings

clintonrichmond

essexbronx

queensrockland

westchestersteubenwarrenputnamotsego

eriehamilton

tiogaalbany

schenectadyjeffersonschuyler

orangemonroe

onondagasenecaoneida

rensselaerfulton

saratogalewis

broomeherkimer

nassaucortlandniagara

columbiawashington

alleganymadison

schoharieontario

wyomingcattaraugus

geneseedutchess

cayugadelawaresullivan

livingstonyatesulster

oswegomontgomery

suffolkwayne

orleanschenango

greene


0 1 2 3 4 5

Motor Vehicle Traffic Trauma: Average Annual Incidence by County of Residence


albany

allegany

bronx

broomecattaraugus

cayuga

chautauquachemung

chenango

clinton

columbia

cortland

delaware

dutchess

erie

essex

franklin

fultongenesee

greene

hamilton

herkimer

jefferson

kings

lewis

livingston

madison

monroe

montgomery

nassaunew york

niagara oneida

onondaga

ontario

orange

orleans

oswego

otsego

putnam

queens

rensselaer

richmond

rockland

st lawrence

saratoga

schenectady

schoharie

schuyler

seneca

steuben

suffolk

sullivan

tioga

tompkins

ulster

warren

washington

wayne

westchester

wyomingyates

columbiafranklin

lewisputnam

schoharieschuyler

chemungmadison

warrenwashington

fultontompkinsallegany

essexsaratogarockland

chautauquaherkimer

otsegooswegobroome

st lawrenceclinton

cattarauguschenango

steubengreene

delawarewyoming

cayugaseneca

tiogamontgomerywestchester

ontariosullivanoneidaulster

jeffersonsuffolknassau

livingstonyates

cortlandgeneseequeensorleans

richmondwayne

new yorkorange

schenectadyniagara

rensselaerdutchess

albanyhamilton

kingserie

onondagamonroe

bronx


0.0 0.2 0.4 0.6 0.8

Firearm Trauma: Average Annual Incidence by County of Residence


albany

allegany

bronx

broomecattaraugus

cayuga

chautauquachemung

chenango

clinton

columbia

cortland

delaware

dutchess

erie

essex

franklin

fultongenesee

greene

hamilton

herkimer

jefferson

kings

lewis

livingston

madison

monroe

montgomery

nassaunew york

niagara oneida

onondaga

ontario

orange

orleans

oswego

otsego

putnam

queens

rensselaer

richmond

rockland

st lawrence

saratoga

schenectady

schoharie

schuyler

seneca

steuben

suffolk

sullivan

tioga

tompkins

ulster

warren

washington

wayne

westchester

wyomingyates

steubentompkins

washingtonwayneyates

chemungalleganyhamilton

oneidaorleans

st lawrenceschuyler

senecaoswego

jeffersonmonroe

onondagacayugaotsego

geneseeontario

cortlandessex

madisonrocklandputnamwarren

herkimerrichmond

lewisfranklin

tiogachenangosaratoga

livingstonsullivanorange

cattaraugusdelawarenew york

westchesterclinton

chautauquaulster

greenequeens

schoharienassaufulton

columbiasuffolk

kingswyomingdutchess

schenectadymontgomery

erieniagara

rensselaerbronx

broomealbany


0.0 0.2 0.4 0.6

Cut / Pierce Trauma: Average Annual Incidence by County of Residence


albany

allegany

bronx

broomecattaraugus

cayuga

chautauquachemung

chenango

clinton

columbia

cortland

delaware

dutchess

erie

essex

franklin

fultongenesee

greene

hamilton

herkimer

jefferson

kings

lewis

livingston

madison

monroe

montgomery

nassaunew york

niagara oneida

onondaga

ontario

orange

orleans

oswego

otsego

putnam

queens

rensselaer

richmond

rockland

st lawrence

saratoga

schenectady

schoharie

schuyler

seneca

steuben

suffolk

sullivan

tioga

tompkins

ulster

warren

washington

wayne

westchester

wyomingyates

chemungfranklin

fultonhamiltonschuyler

new yorkwestchester

bronxkingsulster

queensrichmond

nassaumonroeputnamsullivanorange

chautauquarocklandjefferson

eriest lawrence

tompkinstioga

saratogasuffolkbroome

essexschenectady

dutchesssenecaalbany

onondagasteuben

washingtononeida

chenangocortland

greeneniagara

rensselaerwarren

livingstonherkimer

otsegoclintonoswego

madisonontario

columbiawayne

geneseewyoming

lewismontgomery

cattaraugusschoharie

orleansyates

alleganycayuga

delaware


0.0 0.1 0.2 0.3 0.4

Machinery Trauma: Average Annual Incidence by County of Residence

Appendix - Mortality By Trauma Mechanism and County 73

albany

allegany

bronx

broomecattaraugus

cayuga

chautauquachemung

chenango

clinton

columbia

cortland

delaware

dutchess

erie

essex

franklin

fultongenesee

greene

hamilton

herkimer

jefferson

kings

lewis

livingston

madison

monroe

montgomery

nassaunew york

niagara oneida

onondaga

ontario

orange

orleans

oswego

otsego

putnam

queens

rensselaer

richmond

rockland

st lawrence

saratoga

schenectady

schoharie

schuyler

seneca

steuben

suffolk

sullivan

tioga

tompkins

ulster

warren

washington

wayne

westchester

wyomingyates

steubenchemungfranklin

essexst lawrence

lewisorangeorleans

wyomingtompkinsnew york

bronxschuylerputnam

schohariekings

chautauquaniagara

schenectadymonroewarren

eriedutchess

senecasaratoga

richmondsullivanwayneoneida

alleganyfulton

rocklandgeneseeclinton

onondagaherkimer

westchesterqueens

washingtonontario

ulstermadison

rensselaercayuga

tiogalivingston

albanyjeffersoncortland

cattaraugusgreene

montgomeryoswego

delawaresuffolknassau

columbiahamilton

otsegochenango

broomeyates


0.0 0.2 0.4 0.6

Fall Trauma: Average Annual Mortality by County of Residence


albany

allegany

bronx

broomecattaraugus

cayuga

chautauquachemung

chenango

clinton

columbia

cortland

delaware

dutchess

erie

essex

franklin

fultongenesee

greene

hamilton

herkimer

jefferson

kings

lewis

livingston

madison

monroe

montgomery

nassaunew york

niagara oneida

onondaga

ontario

orange

orleans

oswego

otsego

putnam

queens

rensselaer

richmond

rockland

st lawrence

saratoga

schenectady

schoharie

schuyler

seneca

steuben

suffolk

sullivan

tioga

tompkins

ulster

warren

washington

wayne

westchester

wyomingyates

cortlandputnam

jeffersonst lawrence

franklinsteuben

chemungnew yorkschoharierocklandallegany

kingsontariobronx

orleanswestchester

orangeotsego

tompkinsclintonalbany

schenectadychautauqua

queensdutchesssaratoga

eriemontgomery

chenangowarrengreene

richmondsullivan

ulsterrensselaer

niagarafulton

washingtonyates

delawarecolumbia

nassauessex

livingstonschuylermadisonmonroecayuga

cattaraugussuffolk

geneseetioga

wyomingherkimerbroome

onondagaoneidasenecawayne

oswegohamilton

lewis


0.0 0.2 0.4 0.6

Motor Vehicle Traffic Trauma: Average Annual Mortality by County of Residence


albany

allegany

bronx

broomecattaraugus

cayuga

chautauquachemung

chenango

clinton

columbia

cortland

delaware

dutchess

erie

essex

franklin

fultongenesee

greene

hamilton

herkimer

jefferson

kings

lewis

livingston

madison

monroe

montgomery

nassaunew york

niagara oneida

onondaga

ontario

orange

orleans

oswego

otsego

putnam

queens

rensselaer

richmond

rockland

st lawrence

saratoga

schenectady

schoharie

schuyler

seneca

steuben

suffolk

sullivan

tioga

tompkins

ulster

warren

washington

wayne

westchester

wyomingyates

tiogatompkins

warrenwyoming

yateschemungchenangocolumbiadelaware

essexfranklin

fultongreene

hamiltonherkimer

lewisotsego

putnamcattaraugus

schoharieschuyler

westchesterbroomeorange

rocklandchautauquast lawrence

saratoganiagara

dutchesssteuben

ulsterclinton

new yorkrensselaer

cayugasuffolkqueens

schenectadynassau

madisonwashington

albanyoswegoontario

richmondmontgomery

alleganyoneida

sullivansenecakings

waynegenesee

jeffersonerie

cortlandbronx

livingstonorleans

onondagamonroe


0.00 0.10 0.20

Firearm Trauma: Average Annual Mortality by County of Residence

Appendix - Injury Statistics 76

Rank 0<1 1-4 5-9 10-14 15-19 20-24 25-44 45-64 65+ Total

Suffocation Homicide Homicide Suicide Homicide Homicide Poisoning Poisoning Fall Suicide

27 (32%) 16 (28%) 6 (23%) 10 (19%) 96 (31%) 159 (26%) 613 (30%) 684 (29%) 1,013 (45%) 1,581 (20%)

Homicide Suffocation MVT^, Unspecified MVT^, Pedestrian Suicide Poisoning Suicide Suicide Suicide Poisoning

14 (17%) 7 (12%) 5 (20%) 8 (16%) 73 (23%) 123 (20%) 492 (24%) 633 (27%) 254 (11%) 1,518 (20%)

MVT^, Pedestrian Fire / Flame Homicide MVT^, Occupant Suicide Homicide Fall 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 MVT^, Unspecified MVT^, Unspecified MVT^, Unspecified MVT^, Unspecified Homicide Suffocation Homicide

* 4 ( 7%) 4 (14%) 4 ( 8%) 29 ( 9%) 52 ( 8%) 82 ( 4%) 126 ( 5%) 136 ( 6%) 790 (10%)

MVT^, Unspecified Fire / Flame Poisoning MVT^, Occupant MVT^, Motorcyclist MVT^, Pedestrian MVT^, Pedestrian MVT^, Unspecified

* 3 ( 5%) * 3 ( 6%) 23 ( 8%) 43 ( 7%) 76 ( 4%) 93 ( 4%) 102 ( 5%) 354 ( 5%)

Transport, Non-

Traffic MVT^, Pedestrian MVT^, Motorcyclist MVT^, Occupant MVT^, Unspecified MVT^, Occupant MVT^, Occupant

* * * 3 ( 6%) 13 ( 4%) 21 ( 3%) 76 ( 4%) 85 ( 4%) 94 ( 4%) 313 ( 4%)

MVT^, Pedal Cyclist MVT^, Motorcyclist MVT^, Pedestrian MVT^, Pedestrian MVT^, Occupant MVT^, Unspecified MVT^, Pedestrian

* * * 2 ( 4%) 7 ( 2%) 19 ( 3%) 67 ( 3%) 65 ( 3%) 92 ( 4%) 311 ( 4%)

MVT^, Pedal Cyclist Fall Fall Suffocation Poisoning Unspecified

* * * * 4 ( 1%) 8 ( 1%) 49 ( 2%) 51 ( 2%) 70 ( 3%) 265 ( 3%)

Fall

Pedestrian, Non-

Traffic Suffocation MVT^, Motorcyclist Fire / Flame Suffocation

* * * * 4 ( 1%) 6 ( 1%) 21 ( 1%) 45 ( 2%) 55 ( 2%) 249 ( 3%)

Pedestrian, Non-

Traffic MVT^, Pedal Cyclist Unspecified Unspecified Homicide MVT^, Motorcyclist

* * * 4 ( 1%) 5 ( 1%) 18 ( 1%) 42 ( 2%) 36 ( 2%) 155 ( 2%)

MVT^ = Motor Vehicle Traffic

*Data based on three year total frequencies of less than six are not reportable

Intentional Injury Source: NYSDOH, Bureau of Occupational Health and Injury Prevention

Unintentional Injury www.health.ny.gov/prevention/injury_prevention/

Deaths Due to Injury

Leading Causes by Age GroupNew York State Residents, 2010-2012

7

8

9

10

Age Group

Yearly Average (percent of age group)

1

2

3

4

5

6


Rank 0<1 1-4 5-9 10-14 15-19 20-24 25-44 45-64 65+ Total

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%) 17,734 (20%) 27,152 (24%) 22,481 (17%) 16,882 (12%) 45,004 (11%) 27,973 ( 9%) 11,674 ( 7%) 184771 (13%)

Unspecified

Natural /

Environmental

Natural /

Environmental Overexertion Overexertion Assault Struck By, Against Cut / Pierce Struck By, Against Overexertion

864 ( 6%) 8,784 ( 8%) 6,500 ( 7%) 10,826 (10%) 14,196 (11%) 15,436 (11%) 44,109 (11%) 27,445 ( 9%) 8,864 ( 6%) 124504 ( 9%)

Natural /

Environmental 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%)

MVT^, Occupant Cut / Pierce Unspecified Unspecified MVT^, Occupant Cut / Pierce MVT^, Occupant Unspecified 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%) 4,720 ( 4%) 9,592 ( 7%) 13,014 ( 9%) 33,618 ( 8%) 24,778 ( 8%) 6,469 ( 4%) 104289 ( 7%)

Poisoning Poisoning MVT^, Occupant

Natural /

Environmental Unspecified Unspecified Assault

Natural /

Environmental

Natural /

Environmental Assault

365 ( 3%) 3,123 ( 3%) 2,705 ( 3%) 4,149 ( 4%) 7,910 ( 6%) 9,990 ( 7%) 32,793 ( 8%) 13,420 ( 5%) 5,220 ( 3%) 81,464 ( 6%)

Cut / Pierce Hot Object / Scald

Pedal Cyclist, Non-

Traffic

Pedal Cyclist, Non-

Traffic

Natural /

Environmental

Natural /

Environmental

Natural /

Environmental Assault Poisoning Poisoning

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%) 15,844 ( 1%)

Overexertion MVT^, Occupant Assault MVT^, Occupant Self-Inflicted Self-Inflicted Hot Object / Scald Poisoning Assault

Pedal Cyclist, Non-

Traffic

237 ( 2%) 1,976 ( 2%) 1,136 ( 1%) 2,943 ( 3%) 2,117 ( 2%) 1,614 ( 1%) 3,995 ( 1%) 3,007 ( 1%) 1,204 ( 1%) 14,578 ( 1%)

Suffocation Suffocation Hot Object / Scald

Transport, Non-

Traffic

Pedal Cyclist, Non-

Traffic 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%)

†The incidence of ED visits does not include those that were subsequently admitted into the hospital




SPARCS December 2013

Emergency Department (ED)† Visits Due to Injury


7

8

9

10

Age Group


1

2

3

4

5

6


Rank 0<1 1-4 5-9 10-14 15-19 20-24 25-44 45-64 65+ Total

Fall Fall Fall Fall Self-Inflicted Assault Fall Fall Fall Fall

406 (39%) 938 (31%) 881 (42%) 764 (27%) 1,422 (22%) 1,627 (20%) 5,076 (19%) 14,397 (38%) 52,640 (73%) 76,790 (48%)

Hot Object / Scald Poisoning

Natural /

Environmental Self-Inflicted Assault Self-Inflicted Self-Inflicted Poisoning Unspecified Self-Inflicted

117 (11%) 434 (14%) 153 ( 7%) 296 (11%) 1,204 (18%) 1,454 (18%) 4,208 (16%) 3,893 (10%) 4,659 ( 6%) 10,896 ( 7%)

Assault Hot Object / Scald MVT^, Pedestrian Struck By, Against Fall Fall Assault Self-Inflicted Poisoning Poisoning

87 ( 8%) 426 (14%) 137 ( 7%) 271 (10%) 783 (12%) 904 (11%) 3,403 (13%) 2,907 ( 8%) 2,069 ( 3%) 9,987 ( 6%)

Unspecified

Natural /

Environmental Struck By, Against MVT^, Pedestrian MVT^, Occupant MVT^, Occupant Poisoning Unspecified MVT^, Occupant Unspecified

77 ( 7%) 258 ( 8%) 133 ( 6%) 200 ( 7%) 636 (10%) 884 (11%) 2,503 ( 9%) 2,543 ( 7%) 1,566 ( 2%) 9,075 ( 6%)

Suffocation Struck By, Against Hot Object / Scald Assault Struck By, Against Poisoning MVT^, Occupant MVT^, Occupant

Natural /

Environmental Assault

56 ( 5%) 127 ( 4%) 87 ( 4%) 178 ( 6%) 364 ( 6%) 545 ( 7%) 1,861 ( 7%) 1,774 ( 5%) 1,132 ( 2%) 8,482 ( 5%)

Poisoning Unspecified Poisoning

Pedal Cyclist, Non-

Traffic Poisoning MVT^, Motorcyclist Unspecified Assault Struck By, Against MVT^, Occupant

56 ( 5%) 83 ( 3%) 74 ( 4%) 134 ( 5%) 329 ( 5%) 246 ( 3%) 1,221 ( 5%) 1,604 ( 4%) 971 ( 1%) 6,917 ( 4%)

Natural /

Environmental MVT^, Pedestrian

Pedal Cyclist, Non-

Traffic

Natural /

Environmental MVT^, Pedestrian MVT^, Pedestrian

Natural /

Environmental

Natural /

Environmental Suffocation Struck By, Against

42 ( 4%) 65 ( 2%) 73 ( 3%) 114 ( 4%) 215 ( 3%) 224 ( 3%) 843 ( 3%) 1,271 ( 3%) 742 ( 1%) 3,668 ( 2%)

Struck By, Against Assault MVT^, Occupant

Transport, Non-

Traffic

Natural /

Environmental 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

10 ( 1%) 61 ( 2%) 61 ( 3%) 84 ( 3%) 143 ( 2%) 214 ( 3%) 696 ( 3%) 813 ( 2%) 598 ( 1%) 1,955 ( 1%)

Drowning /

Submersion MVT^, Occupant Unspecified Unspecified

Transport, Non-

Traffic

Natural /

Environmental MVT^, Motorcyclist Cut / Pierce Overexertion Hot Object / Scald

7 ( 1%) 45 ( 1%) 53 ( 3%) 83 ( 3%) 138 ( 2%) 195 ( 2%) 649 ( 2%) 596 ( 2%) 543 ( 1%) 1,806 ( 1%)





10

Age Group


1

2

3

4

5

6

Hospitalizations Due to Injury


7

8

9


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 39.8 161,270 825.4 1,447,251 7,407.50<1 84 34.9 1,038 431.8 13,998 5,820.71-4 55 5.8 3,035 320.8 104,854 11,082.95-9 27 2.3 2,089 178.4 87,310 7,454.210-14 53 4.4 2,810 235.6 111,210 9,323.115-19 311 23.4 6,531 492.5 133,457 10,062.820-24 619 43.6 8,013 564.7 139,113 9,803.325-44 2,048 38.7 26,946 509.6 402,900 7,620.145-64 2,344 44.6 38,242 726.9 298,196 5,668.265+ 2,236 83 72,565 2693.9 156,213 5,799.4Male 5,372 56.6 79,928 841.2 764,718 8,061.6Female 2,412 24 81,340 810.3 682,502 6,789.9Unknown * n/a * n/a 31 n/a

6

Source: NYSDOH, Bureau of Occupational Health and Injury Prevention www.health.ny.gov/prevention/injury_prevention


Vital Statistics Death File February 2014

†The incidence of ED visits does not include patients who were subsequently admitted into the hospital

Rate = Frequency / Population * 100,000

n/a

Mean One Year Total

Hospitalization or ED Visit

Charges

*Data based on frequencies less than six not reported

$6,889,633,188$17,969,649,941

n/a

n/a

Three Year Total


Charges

Average Length of

Hospital Stay (Days)

Characteristics of Injury IncidenceDeaths, Hospitalizations, and Emergency Department† (ED) Visits

New York State Residents, 2010-2012

Percent Traumatic Brain

Injury

Mean Charge per


Age

Gro

upG

ende

r

Total

$37,142

Deaths

29%

$2,296,544,396

$1,587

Hospitalizations ED Visits

12% 8%

n/a

$5,989,883,314n/a

Appendix - Materials and Methods 80

Materials and Methods

1. Data Sources

Trauma Registry - Established in 1993, the New York State Trauma Registry(NYSTR) receives reports from designated trauma centers on patients iden-tified and treated as being moderately to severely traumatically injured (In-clusion Criteria in Appendix Inclusion Criteria in Appendix). The reportscontains variables specified by the New York State Trauma Registry includ-ing patients’ demographic information, diagnoses and treatments. A verysmall portion of the trauma reports in the NYSTR were submitted fromseveral non-trauma centers/hospitals.

Statewide Planning and Research Cooperative System (SPARCS) - Imple-mented by the New York State Department of Health (NYSDOH) in 1979,SPARCS is a comprehensive, integrated information system available to as-sist hospitals and organizations in the health care industry with healthcareresource planning, financial analysis, decision making, and surveillance ofNew York State. SPARCS receives, processes, stores, and analyzes the inpa-tient and emergency department from data from all hospitals in New York.Each health care provider submits its SPARCS data, as mandated, in theuniform, computer-readable format described in the Universal Data Set.

Surveillance, Epidemiology, and End Results Program (SEER) - The pop-ulation estimates used to calculate trauma incidence and mortality werefrom Surveillance, Epidemiology, and End Results Program (SEER) of theNational Cancer Institute. These data were produced by the US CensusBureau’s Population Estimates Program, in collaboration with the NationalCenter for Health Statistics and with support from the National CancerInstitute.[3]

National Trauma Data Bank (NTDB) - NTDB collects trauma registry datafrom participating trauma centers across the U.S. on an annual basis. Thecase fatality rates calculated using NYSTR 2013 data were compared withthat published on NTDB 2014 Annual Report.[4]

2. The Cohort

A cohort used for generating the NYSTR Summary Report was constructedwith NYSTR data from 2010 through 2013 submitted from the certifiedtrauma centers. Trauma records submitted by non-trauma centers wereexcluded in the data analyses.

3. Data Matching

A dataset containing all patients diagnosed with traumatic injuries andwere treated in New York State trauma centers for discharge years 2010 -2013 was created from SPARCS hospital inpatients and emergency depart-ment (ED) discharge files. This data file was matched to Trauma Registryrecords for the same discharge year period by using identifying variablessuch as hospital’s Permanent Facility Identifier, admission dates, dischargedates, hospital’s medical record numbers, Patients’ date of birth, etc. Thematches were conducted without using patient’s name and address, be-cause SPARCS does not contain patient name and SAPRCS ED data do nothave patient’s address information. The records found in the SPARCS hos-pital data files or ED data files but not in the Trauma Registry databasewere defined as unmatched/missed reports and were sent to hospitals foraudits. After checking their own unmatched/missed reports, hospitals re-submit the missing trauma cases and corrected trauma cases to TraumaRegistry.

Appendix - Materials and Methods 81

4. Statistical Analysis

Descriptive Analysis. Standard linear and weighted loess regression tech-niques were used. All confidence intervals shown represent a 95% confi-dence interval of the sample population. Box plots omits outliers, defenedas 1.5 times the interquartile range.

Predictive Analysis. Predictive analysis of risk of mortality was per-formed to develop a risk adjusted model that provides unbiased estimatesof trauma case fatality rates. The detailed description of the risk adjustmentmethodology was provided in the Risk Adjustment Methodology section inAppendix.

5. Specific Notes

EMS Time Variables. Many omissions were present in the EMS time vari-ables, approximately 47% of the cohort. Therefore, when time variableswere 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 Codefor cause. In this analysis, only the primary E code cause was used, in theMechanism of Injury section, page 28

Payer and total charges. Primary payer and total charges used for the PayerTypes section, page 24 and the Cost of Trauma section, page 51 were ob-tained from SPARCS data.

Pediatric patents. In this report, the pediatric patients were defined asthose aged 14 years or younger.

Comparison to the Nation. Since different inclusion criteria is used by theNYSTR and NTBD, only trauma with an injury severity score of greaterthan or equal to 9 was considered.

6. Software

All figures, tables, maps, and calculations were created with R statisticalsoftware[5]. This document was typeset with LATEX. The two scripts werecombined into a single program with Sweave[7].

Appendix - Risk Adjustment Methodology 82

Risk Adjustment Methodology

1. Introduction

This section describes the risk adjustment methodology developed by theNew York State Trauma Registry. The goal of the risk adjustment was toprovide unbiased estimates of trauma fatality rate after controlling con-tributing risk factors. The risk adjustment model was developed using theNew York Trauma Registry data submitted by the trauma centers acrossthe state.

2. Trauma data

Trauma case reports submitted by the New York State certified trauma cen-ters for patients discharged in 2010 through 2013 were included. About 5%of the patients were excluded from the analysis due to the missing valuesin the variables used for risk-adjustment model development.

3. Selection of factors

The contributing fatality risk factors among trauma patients include thefollowing categories:

I Patient demographic variables: age, gender, race, ethnicity,health insurance/payer, body mass index, and comorbidities;

I Patient condition upon arrival: Glasgow coma score, systolicblood pressure, pulse, respiratory rate, and oxygen saturationlevel;

I Required pre-hospital and emergency room treatments: CPR,intubation, and ventilation

I Mechanism of injury;

I Transferring/referring; and

I Severity of injury: Abbreviated Injury Scale (AIS).

4. Risk-adjustment model

We choose to use a logistic regression to model trauma patient fatality riskwith trauma death as the dependent variable and the potential risks factors(listed in 3, Selection of factors) as the independent variables. The final riskadjustment model contains 25 variables, all of which are highly significantwith greater than 95% confidence (Table 1).

5. Calculation of the risk-adjusted fatality rate andconfidence intervals

I Expected fatality rate: calculated using the developed riskadjustment model adjusting for the differences among groups.

I Observed fatality rate: calculated using the number of patientdeaths observed in the group divided by the number ofpatients in the group.

I Rate ratio: calculated using the observed fatality rate dividedby the expected fatality rate. If the ratio is larger than one, thegroup has a higher fatality rate than expected on the basis ofits patient mix.

I Risk-adjusted fatality rate: calculated using the fatality rateratio multiplied by the overall statewide observed fatality rate.

I Confidence intervals: The 95% confidence intervals for therisk-adjusted fatality rate were calculated using the standarderror of the observed fatality rate[1]. A confidence interval isabove the statewide rate indicating a statistically significantlyhigher than expected fatality rate after adjusting for risk.

Appendix - Risk Adjustment Methodology 83

Category Independent variable Coefficient Std. Error z value Pr(>|z|)(Intercept) -4.274 0.117 -36.634 0.000

DemographicsAge 0.040 0.001 29.525 0.000

Male 0.117 0.048 2.441 0.015White 0.120 0.051 2.341 0.019

ComorbidityBleeding disorder 0.347 0.073 4.777 0.000

Advanced directive 1.792 0.086 20.871 0.000Disseminated cancer 0.717 0.204 3.510 0.000

Prior renal failure 0.961 0.136 7.045 0.000Prehospital cardiac arrest 1.608 0.435 3.697 0.000

Patient condition on arrivalGlasgow Comma Score Motor -0.344 0.012 -29.781 0.000

Systolic Blood Pressure -0.008 0.001 -15.058 0.000Required treatment

CPR administered in field or ED 3.588 0.236 15.233 0.000Ventilator required 1.472 0.053 27.727 0.000

Intubation occurred in the ED 0.854 0.056 15.359 0.000Severe injuries (AIS = 5 or 6)

Severe head or neck trauma 2.253 0.052 43.454 0.000Severe face trauma 2.345 0.641 3.659 0.000

Severe chest trauma 1.849 0.107 17.215 0.000Severe abdomen trauma 1.415 0.136 10.401 0.000

Severe extremities trauma 1.942 0.272 7.151 0.000Severe external trauma 4.816 0.673 7.156 0.000

Mechanism of InjuryPedestrian hit by car 0.438 0.083 5.301 0.000

Firearm trauma 1.316 0.097 13.598 0.000Low fall 0.169 0.060 2.794 0.005

Insurance/payerSelf Pay 1.040 0.079 13.170 0.000

Medicare 0.378 0.065 5.864 0.000Transfer status

Referring Hospital -0.267 0.057 -4.664 0.000

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 .99801 .00-.06 .09-.16 .19-.26 .29-.36 .39-.46 .49-.56 .59-.66 .69-.76 .79-.86 .89-.96 .99802 .7803 .00-.01 .03-.05 .12-.15 .20-.25 .33-.35 .43-.45 .52-.55 .62-.65 .72-.75 .82-.85 .92-.95804 .03-.05 .10-.16 .19-.26 .29-.36 .39-.46 .49-.56 .59-.66 .69-.76 .79-.86 .89-.96 .99805 .01-.08 .10-.18 .3 .5 .6 .7 .8806 .00-.39 .4 .5 . 60-.62 .69-.72 .79 .8 .9807 .04-.19 .4 .5 .6808 .1 .3 .43 .51-.53 .59 .9819 .0 .1821 .00-.01 .10-.11 .20-.23 .29-.33 .39823 .10 .12 .30 .32 .90 .92824 .1 .3 .5 .7 .9828 .0 .1836 .51-.52 .61-.64 .69839 .01-.08 .11-.18 .20-.21 .30-.31 .40-.42 .51-.52 .59 .8850 .2 .3 .4851 .00-.06 .09-.16 .19-.26 .29-.36 .39-.46 .49-.56 .59-.66 .69-.76 .79-.86 .89-.96 .99852 .00-.06 .09-.16 .19-.26 .29-.36 .39-.46 .49-.56 .59853 .00-.06 .09-.16 .19854 .03-.05 .10-.16 .19860 .0 .1 .2 .3 .4 .5861 .00-.03 .10-.13 .20-.22 .30-.32862 .0 .1 .21-.22 .29 .31-.32 .39 .8 .9863 .0 .1 .20-.21 .29-.31 .39-.46 .49-.56 .59 .80-.85 .89-.95 .99

864 .02-.05 .10-.15 .19865 .01-.04 .09 .11-.14 .19866 .02-.03 .11-.13867 .1 .2 .3 .4 .5868 .01-.04 .09-.14 .19874 .00-.02 .10-.12 .4 .5887 .0 .1 .2 .3 .4 .5 .6 .7896 .0 .1 .2 .3897 .0 .1 . 2.3 .4 .5 .6 .7900 .00-.03 .1 .81-.82 .89 .9901 .0 .1 .2 .3. 40-.42 .81-.83 .89 .9902 .0 .10-.11 .19-.27 .29 .31-.34 .39-.42 .49-.56 .59 .81-.82 .87 .89 .9903 .01-.02904 .0 .1925 .1 .2927 .00-.03 .09-.11 .21 .8 .9928 .00-.01 .10-.11 .20-.21 .8 .9950 .0 .1 .2 .3 .9952 .00-.19 .2 .3 .4 .8 .9953 .0 .1 .2 .4954 .8 .9955 .8956 .0. 8958 .4 .9 .91 .92 .93 .99

Appendix - References 85

References

[1] Hosmer D. and Lemeshow S. Confidence Interval Estimates of an Index of Quality Performance Based onLogistic 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 withMultiple 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 StatisticalComputing, 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 byThomas P Minka <[email protected]> (2014). maps: Draw Geographical Maps. R package version2.3-9. http://CRAN.R-project.org

[7] Friedrich Leisch. Sweave: Dynamic generation of statistical reports using literate data analysis. In WolfgangHärdle and Bernd Rönz, editors, Compstat 2002 - Proceedings in Computational Statistics, pages 575-580.Physica Verlag, Heidelberg, 2002. ISBN 3-7908-1517-9.

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