Cara M. Christ, MD, Director
BUREAU OF EMERGENCY MEDICAL SERVICES AND TRAUMA SYSTEM
STATE TRAUMA ADVISORY BOARD 2019 ANNUAL REPORT
This Report is Provided as Required by A.R.S. § 36-2222(E)(4)
PREPARED BY
Bureau of Emergency Medical Services and Trauma System
Terry Mullins, MBA, MPH, Bureau Chief Gail Bradley, MD, Medical Director Benjamin Fisher, MPA, NRP, Services Section Chief Vatsal Chikani, MPH, BHMS, Epidemiological Data and Quality Assurance Manager
Sri Vidya Mahankali, MS,BDS, Senior Epidemiologist
Mary Benkert, Trauma Data Administrator
Anne Vossbrink, MS, EMS Data Administrator
Page 2
STATE TRAUMA ADVISORY BOARD MEMBERSHIP
Listed below are the dedicated professionals and citizens who serve the State of Arizona as members of the State Trauma Advisory Board and the Trauma and EMS Performance Improvement Standing Committee by giving their time, expertise, and invaluable guidance to the Arizona trauma system. On behalf of the Arizona Department of Health Services and the citizens of Arizona, we thank them for their many contributions.
Gail Bradley, MD, Chairperson Debbie Johnston, Vice President, Policy Development ADHS BEMSTS Medical Director Statewide Hospital Association Representative Phoenix, AZ Phoenix, AZ Shawn Bowker, RN , BSN Jennefer Kieran, MD, FACS Local Regional EMS Coordinating Council - Northern Region Federal Indian Health Services Organization Representative Representative Phoenix, AZ Flagstaff, AZ Mike Garcia Neil Williamson, NRP Fire Department in a County with a Population > 500,000 Department of Public Safety Representative Representative Phoenix, AZ Tucson, AZ
Judy Baum, PT, MSHA David Notrica, MD, FACS, FAAP Statewide Rehabilitation Facility Representative Statewide Pediatric Organization Representative Prescott Valley, AZ Phoenix, AZ Vicki Bennett, RN, MSN Nirav Patel, MD, FACS Society of Trauma Nurses Representative Statewide Organization Representing a National College of Phoenix, AZ Surgeons for Trauma Services Phoenix, AZ Herman Butler Rodney A. Reed, NREMT-P Tribal Health Organization Representative Local Regional EMS Coordinating Council - Western Region Representative Tuba City, AZ Yuma, AZ
Franco Castro-Marin, MD Roy Ryals, CEP National Organization of Emergency Physicians Representative Local Regional Coordinating EMS Council – Central Region Representative (PMD Liaison) - Scottsdale, AZ Phoenix, AZ
Brent Burgett, NRP Chris Salvino, MD, MS, FACS Statewide Ambulance Association Representative Trauma Center Representative Mesa, AZ Lake Havasu City, AZ
Jeff Farkas, CEP Melissa Anderson, RN, MSN Statewide Fire District Association Representative Local Regional EMS Coordinating Council - Southeastern Region Show Low, AZ Representative Tucson, AZ
Iman Feiz-Erfan, MD Clifford Jones, MD Statewide Neurosurgical Society Representative National Association of Orthopedic Trauma Representative Phoenix, AZ Phoenix, AZ
Garth Gemar, MD Andrew Tang, MD, FACS National Association of Retired Persons Representative Trauma Center Representative / Vice Chair Phoenix, AZ Tucson, AZ Philip Johnson, MD Tara Johnson, MSN, CCRN Rural ALS Base Hospital that is not a Trauma Center Representative Urban Advanced Life Support Base Hospital that is not a Trauma Center Show Low, AZ Representative Chandler, AZ
Page 3
TRAUMA & EMS PERFORMANCE IMPROVEMENT STANDING COMMITTEE MEMBERSHIP
Josh Gaither, MD Ralph Zane Kelly, DO EMS Researcher (AEMRC)/Chair State Designated Level III Trauma Center Program Manager Tucson, AZ Tuba City, AZ
Melissa Moyer, CSTR Carey Lewis, CPNP-AC/PC Representative of the Trauma Registry Users Group/Vice Chair Pediatric Representative (MD or RN) Phoenix, AZ Phoenix, AZ
Corbin King, FP-C Tom Flanagan, NRP Air Ambulance Premier EMS Agency Ground Ambulance or First Responder Premier EMS Agency – Quality Quality Improvement Officer Improvement Officer (NAEMS/WACEMS) Gilbert, AZ Prescott, AZ
Danielle Stello, RN Nirav Patel, MD, FACS Prehospital EMS Coordinator - Base Hospital (NAEMS/WACEMS) State Trauma Advisory Board Liaison Lake Havasu City, AZ Phoenix, AZ
Raymond Proa, NREMT-P James Cunningham, V, RN, NREMT –P EMS Registry Group Member Ground Ambulance or First Responder Premier EMS Agency, Quality Fort Mohave, AZ Improvement Officer (SAEMS/AEMS) Mesa, AZ
Paul Dabrowski, MD Heather Miller, BSN, RN, CEN, TCRN Trauma Surgeon Western Arizona Council of Emergency Services Phoenix, AZ Kingman, AZ
Candyce Williams, MD Tiffiny Strever, RN Rehabilitation Specialist State Designated Level I Trauma Center or Trauma Program Phoenix, AZ Representative Phoenix, AZ Dale Woolridge, MD Pam Noland, RN Injury Researcher (AEMRC) State Designated Level IV Trauma Center Program Manager Tucson, AZ Willcox, AZ
Garth Gemar, MD James Cesolini, CEP, EMT-T, DMT EMS Medical Director of a Premier EMS Agency Law Enforcement Representative with Active Involvement in EMS Phoenix, AZ Mesa, AZ
Pamela Goslar, PhD Julie Augenstein, MD IPAC Representative Medical Direction Commission Liaison Phoenix, AZ Phoenix,AZ
Michelle Guadnola, RN Laura Smith, DNP, RN, CEN State Designated Level I Trauma Center Trauma Program State Designated Level I Trauma Center Trauma Program Representative Representative Phoenix, AZ Glendale, AZ
Rebecca Haro, NREMT-P EMS Council Liaison Phoenix, AZ
Amber Prince, RN Prehospital EMS Coordinator (SAEMS/AEMS) Tucson, AZ
Page 4 BUREAU OF EMS AND TRAUMA SYSTEM REPORT
Director Christ:
We are honored to submit the State Trauma Advisory Board 2018 Annual Report. This report, required by A.R.S.§36-2222(E)(4), summarizes data collected by all Arizona trauma centers. This report has been reviewed and approved by the members of the State Trauma Advisory Board during the January 23, 2020 board meeting.
Several events of note occurred this year:
To assist injury prevention efforts of trauma centers, base hospitals and EMS providers, the Data and Quality Assurance Section now includes zip-code level injury and demographic information in new quality assurance reports. This enhancement will help providers with limited injury prevention resources to target specific communities of interest.
The Data and Quality Assurance Section created and launched an externally-facing dashboard allowing the public to review and create reports from injury data collected by Arizona’s 40+ trauma centers.
To improve access to quality improvement data for Arizona’s trauma centers, base hospitals and EMS agencies, the Bureau worked with ADHS IT to launch an agency-specific reports portal. This is a significant improvement from past practices, where Bureau staff individually sent secure emails to each hospital and EMS agency each time a report was created.
Using CMS grant funds supplied by AHCCCS, the Bureau was able to accomplish a key goal - linking the state’s EMS registry with the single state health information exchange. While this is not a trauma-specific activity, it will help to improve all EMS care, including the care provided by EMS for injured patients. In short, this linkage will provide EMS agencies with timely outcome and disposition data to drive their quality improvement initiatives and it will provide hospitals with a copy of the EMS report more quickly than before. More work needs to be done to improve system operation, but this step puts Arizona at the forefront of EMS quality improvement in the U.S.
Lancet Technology, the trauma registry vendor used by Arizona, experienced a significant work flow issue, delaying the import and download of trauma records into the Arizona State Trauma Registry, and subsequently, the development of this report by 4 months. In December, Lancet Technology and several other EMS and trauma registry vendors were acquired by ESO. The Bureau will monitor Lancet’s performance closely during this transition.
On behalf of the members of the State Trauma Advisory Board, we appreciate the opportunity to provide you with a summary of Arizona’s trauma activities this past year.
Sincerely,
______Gail Bradley, MD FACEP FAEMS, Medical Director Terry Mullins, MBA, MPH, Bureau Chief
Page 5 EXECUTIVE SUMMARY
Traumatic injury is a tremendous health concern in the United States. In the last decade, trauma deaths increased by 22.8%,1 making them the leading cause of years of potential life lost.1,2 For those who survive, trauma can lead to lifelong physical suffering and places a substantial economic burden on the health system. In Arizona, the rate of traumatic injury continues to increase. In 2018, Arizona’s trauma centers treated 54,273 people, of whom 1,227 (2.26%) died. In 2017, Arizona’s age-adjusted injury mortality rate was 81 per 100,000, while the national rate was 72 per 100,000, putting Arizona at 32nd place compared to other states.2
Traumatic injury exacts a significant financial burden on the state. In Arizona for the year 2018, trauma centers charges totaled $2.6 billion, with a median charge per patient of $28,068. Falls resulted in over one trillion dollars in charges in 2018. Hospital reimbursement has remained consistently low, around 14.3%.
Unintentional injuries account for the majority of all traumas in Arizona and nationally.4 The top three mechanisms were Falls (43.28%), Motor Vehicle Traffic, MVT (21.7%), and Struck by/Against (6.92%), which made up 72% of all traumas in Arizona.
Firearms and MVT-Pedestrian accounted for less than 2.5% of trauma individually but both had a disproportionately higher mortality of 17.62% and 11.51% respectively as compared to other traumas.
Although trauma affects all people, males and individuals over the age of 65 years are disproportionately affected, as are American Indian/Alaskan Natives (AI/AN). Males are involved in three times as many assault-related traumas as females, and have a mortality rate over two times higher. Adults 65 years and older had the highest trauma rate as compared to any other age group. AI/AN continue to have the highest rate of trauma and trauma-related deaths when compared to other racial/ethnic groups.
Alcohol and drug use are well known risk factors for trauma. In Arizona, 23% of patients were suspected or confirmed of being under the influence of drugs or alcohol when involved in a trauma. Drug and alcohol use were more prevalent among intentional trauma including assaults and self-inflicted injuries. Alcohol and drug involvement varies by age and race. Among the younger population, especially 15-17 year olds, there were more traumas involving drugs than alcohol.
Overall, 67% of motor vehicle occupants were using some form of passenger restraint when involved in a trauma. Although seatbelt use has been shown to save lives, it was least practiced among those between 15 and 17 years of age (53%). In the trauma patient population, 57% of motorcyclists, and less than a third of pedal-cyclists and off- road vehicle occupants were wearing a helmet when involved in a trauma.
Greater than 31% of trauma patients suffered from Traumatic Brain Injury (TBI). Among trauma patients, the incidence of TBI was highest in infants < 1 year of age (60%). TBIs were prevalent among trauma patients whose mechanism of injury indicated MVT - Other (57%) , Child/Adult abuse (54%), MVT-Pedestrian (49%) and Struck By/ Against (43%). 1 in 10 patients with a major head injury died.
Geographically, incident location influences trauma rate and patients’ access to care. Arizona’s Northern region had the highest rate of traumatic injury, almost double that of the Central region. Importantly, the median injury-to-ED arrival time for patients with Injury Severity Score > 15 was 46 minutes for urban locations vs. 85 minutes for rural locations.
1. Rhee P, Joseph B, Pandit V, et al. Increasing Trauma Deaths in the United States. Ann Surg. 2014;00(00):1-9. doi:10.1097/SLA.0000000000000600. 2. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2005) [cited 2017 Sep.]. Available from URL: www.cdc.gov/injury/wisqars 3. State Health Facts: Kaiser Family foundation. Available from URL: http://www.kff.org/other/state-indicator/total-population
Page 6 BACKGROUND & METHODS
BACKGROUND
The Bureau of Emergency Medical Services and Trauma System (BEMSTS) is responsible for collecting, analyzing and reporting on data obtained from designated trauma centers and participating EMS agencies to enhance the EMS and Trauma System in Arizona. In 2018, there were 49 hospitals submitting data to the Arizona State Trauma Registry (ASTR) including thirteen (13) Level I trauma centers, seven (7) Level III trauma centers, twenty -six (26) Level IV trauma centers, and three (3) non-designated hospitals. Appendix A contains a list of trauma centers reporting to ASTR as of 12/30/2019.
All trauma centers are required to report any injuries meeting the ASTR inclusion criteria (Appendix B). Level I , II and III trauma centers are required to submit the full ASTR data set while Level IV trauma centers and non- designated facilities have the option to submit either the full or reduced data set. The data in the ASTR is validated to meet more than 800 state and national rules. Validation is run at both the hospital and state levels. Any inconsistencies are flagged and returned to the hospitals for review or correction before the data is accepted.
All the Level I trauma centers in Arizona are located in urban areas of the state, including 10 in Maricopa County, one in Coconino County and one in Pima County. Due to Arizona’s unique geography, the BEMSTS has divided the system into four distinct regions based on Arizona’s 15 counties: Western (Mohave, La Paz and Yuma Counties), Northern (Yavapai, Coconino, Navajo and Apache Counties), Southeastern (Pima, Santa Cruz, Graham, Cochise and Greenlee Counties) and Central (Maricopa, Gila and Pinal Counties). Each region has its own community- based, non-profit organization dedicated to improving EMS and trauma care in the state.
Regional EMS Coordinating Systems
Arizona Emergency Medical Services, Inc. (AEMS) - https://www.aems.org/ Northern Arizona Emergency Medical Services (NAEMS) - http://www.naems.org/ Southeastern Arizona EMS Council (SAEMS) - http://saemscouncil.com/ Western Arizona Council of EMS (WACEMS) - http://wacems.org/prod/ METHODS
This report analyzed incidents of traumatic injury reported to the ASTR with an Emergency Department/ Hospital Arrival Date between January 1, 2018 and December 31, 2018. The report gives an overview of trauma in the state by describing patient demographics, injury characteristics, trauma risk factors, regional differences and comparisons with national trauma data.
Descriptive statistics were used to depict the distribution of traumatic injury in Arizona as well as differences over time. When appropriate, rates and 95% confidence intervals (CIs) were calculated per 100,000 Arizona residents using 2017 population denominators from the Arizona Health Status and Vital Statistics database.5 If the CIs of two rates do not overlap, the difference between the rates is considered statistically significant (alpha 0.05). The 2018 data was compared with the 2016 and 2017 two-year median. The Vital Statistics Information Management System‘s Database Applications for Vital Events (DAVE) was used in order to show the complete picture of trauma mortality, including deaths that occurred outside of designated trauma centers.
Note: The 2018 National Trauma Data Bank (NTDB) Annual Report had not been released at the time this report was created; therefore, the section comparing ASTR to NTDB was removed.
5. Arizona Department of Health Services, Population Health and Vital Statistics. Population Denominators: 2016. http://pub.azdhs.gov/health-stats/menu/info/pop/index.php
Page 7 MAP OF ARIZONA DESIGNATED TRAUMA CENTERS
Page 8 LIST OF TABLES & FIGURES
Trauma Demographics ...... 11 Figure 1/ Table 1: Trauma incidence and rate per 100,000 by year ...... 11 Figure 2/ Table 2: Age and gender-specific trauma rate per 100,000 ...... 11 Figure 3/ Table 3: Race-specific trauma rate per 100,000 ...... 11 Mechanism of Injury ...... 12 Table 4: Trauma incidence and mortality proportion by mechanism of injury...... 12 Table 5: Trauma incidence and mortality proportion by mechanism of injury among severely injured patients (ISS>15) ...... 13 Figure 4/ Table 6: Trauma rate per 100,000 by top six mechanisms and year ...... 14 Figure 5: Gender-specific trauma proportion by top six mechanisms ...... 14 Intent of Injury ...... 15 Table 7: Trauma incidence and mortality proportion by intent of injury ...... 15 Figure 6/ Table 8: Trauma rate per 100,000 by intent and year ...... 15 Figure 7: Gender-specific trauma proportion by intent ...... 15 Figure 8: Top six mechanisms of unintentional trauma ...... 16 Figure 9: Top six mechanisms of homicide/assault trauma ...... 16 Figure 10: Top six mechanisms of suicide/self-inflicted trauma ...... 16 Injury Severity Score ...... 16 Figure 11: Trauma proportion by Injury Severity Score ...... 16 Table 9: Trauma incidence and mortality proportion by Injury Severity Score ...... 16 Trauma Mortality ...... 17 Table 10: Age-specific trauma incidence and mortality proportion...... 17 Figure 12/ Table 11: Age-specific trauma mortality rate per 100,000 ...... 17 Figure 13/ Table 12: Gender-specific trauma mortality rate per 100,000 ...... 18 Figure 14/ Table 13: Race-specific trauma mortality rate per 100,000 ...... 18 Figure 15/ Table 14: Age-adjusted trauma mortality rate per 100,000 by year: Trauma center vs. Statewide ...... 18 Trauma Charges ...... 19 Table 15: Total trauma charges and reimbursement by year ...... 19 Figure 16: Primary payment source of traumatic injury by year ...... 19 Table 16: Total trauma charges and reimbursement by primary payer ...... 19 Table 17: Total trauma charges and reimbursement by mechanism of injury ...... 20 Drugs & Alcohol ...... 21 Figure 17: Age-specific trauma proportion by drug and alcohol use ...... 21 Figure 18: Race-specific trauma proportion by drug and alcohol use ...... 21 Figure 19: Intent-specific trauma proportion by drug and alcohol use ...... 21 Figure 20: Mechanism-specific trauma proportion by drug and alcohol use ...... 21 Protective Devices ...... 22 Figure 21: Age-specific proportion of restraint use among motor vehicle traffic occupants ...... 22 Figure 22: Age-specific proportion of helmet use among pedal-cyclists ...... 22 Figure 23: Age-specific proportion of helmet use among motorcyclists ...... 22 Figure 24: Age-specific proportion of helmet use among -off road vehicle occupants ...... 22
Page 9 LIST OF TABLES & FIGURES
Access to Care ...... 23 Table 18: Injury to ED arrival time for patient with an Injury Severity Score > 15 by injury location ...... 23 Table 19: Injury to ED arrival time for transferred patients with an Injury Severity Score > 15 by injury location ...... 23 Figure 25: Mode of transport to trauma center by Injury Severity Score ...... 23 Injury Region ...... 24 Figure 26a/ Table 20: Region-specific trauma rate per 100,000 ...... 24 Figure 26b/ Table 20: Region-specific Severe (ISS>15) trauma rate per 100,000 ...... 24 Figure 27/ Table 21: Region-specific trauma mortality rate per 100,000 ...... 24 Figure 28: Region-specific trauma proportion by Injury Severity Score ...... 24 Figure 29/ Table 22: Region-specific trauma rate per 100,000 by the top six mechanisms of injury ...... 25 Figure 30/ Table 23: Region-specific trauma rate per 100,000 by intent of injury ...... 26 Trauma Center Designation ...... 27 Table 24: Trauma incidence and mortality proportion by trauma center designation ...... 27 Figure 31: Injury Severity Score by trauma center designation ...... 27
Table 25: Trauma charges and reimbursement by trauma center designation………………………………………………………………………..27 Traumatic Brain Injury ...... 28 Table 26: Traumatic Brain Injury incidence and mortality proportion by age and brain injury severity ...... 28 Figure 38: Proportion of Traumatic Brain Injury by mechanism ...... 28 Table 27: Traumatic Brain Injury incidence and mortality proportion by age and Glasgow Coma Score ...... 29 Rehab ...... 30 Table 28: Discharged to rehab by primary payer and Injury Severity Score ...... 30 Table 29: Discharge to rehab by region of injury ...... 30 Appendix A. List of trauma centers by level of designation ...... 31 Appendix B. Arizona State Trauma Registry inclusion criteria ...... 33
Page 10 TRAUMA DEMOGRAPHICS (N = 54,273 )
INCIDENCE & RATE Figure 1: Trauma rate per 100,000 by year 800 Table 1: Trauma incidence and rate per 100,000 by year Year Total Trauma cases Rate per 100,000 (95%CI) 600 2010 26,688 418 [413, 423] 2011 28,721 446 [441, 451] 2012 31,246 481 [475, 486] 400 2013 34,275 521 [515, 526] 2014 39,373 591 [585, 596] Rate per 100,000per Rate 200 2015 42,351 627 [621, 633] 2016 46,842 685 [679, 691] 2017 51,666 742 [735, 748] 0 2010 2011 2012 2013 2014 2015 2016 2017 2018 2018 54,273 767 [761, 773] Data source: Arizona State Trauma Registry 2010-2018 CI = Confidence interval AGE & GENDER
Figure 2: Age and gender-specific trauma rate per 100,000 Table 2: Age and gender-specific trauma rate per 100,000 Female Male Gender Age Total Trauma Cases Rate per 100,000 (95%CI) Female Total 23,315 655 [647, 664] 1,500 <15 2,086 52 [50, 54] 15-19 1,233 535 [505, 565] 1,000 20-44 5,299 471 [458, 483] 45-64 4,115 469 [454, 483] 500 65+ 10,582 1,618 [1,587, 1,649]
Rate per 100,000per Rate Male Total 30,952 880 [870, 889] <15 3,023 72 [69, 74] 0 15-19 2,151 892 [855, 930] <15 15-19 20-44 45-64 65+ <15 15-19 20-44 45-64 65+ 20-44 10,735 901 [884, 918] 45-64 6,854 826 [807, 846] 2018 Median 2016-2017 Data source: Arizona State Trauma Registry 2016-2018 65+ 8,189 1,462 [1,430, 1,493] CI = Confidence interval
RACE & ETHNICITY
Figure 3: Race-specific trauma rate per 100,000
1,500 2018 Median 2016-2017 Table 3: Race-specific trauma rate per 100,000 1,250 Race/ethnicity Total Trauma Cases Rate per 100,000 (95%CI) 1,000 AA/Black 2,256 663 [636, 691]
750 AI/AN 4,357 1,459 [1,416, 1,502] Asian/PI 717 273 [253, 293] 500
Rate per 100,000per Rate Hispanic 10,250 460 [451, 469] 250 White 35,706 905 [895, 914] 0 CI= Confidence interval, PI=Pacific Islander, AI/AN=American Indian/Alaska Asian/PI AA/Black AI/AN Hispanic White Native, AA=African American Data source: Arizona State Trauma Registry 2016-2018, PI=Pacific Islander, AI/AN=American Indian/Alaska Native, AA=African American
Page 11 MECHANISM OF INJURY
INCIDENCE & MORTALITY
Table 4: Trauma incidence and mortality proportion by mechanism of injury Mechanism Count Percent Deaths Mortality Proportion Overall 54,273 100.00% 1,227 2.26% Fall 23,492 43.28% 343 1.46% MVT-Occupant 11,793 21.72% 208 1.76% Struck By/Against 3,757 6.92% 18 0.47% Cut/Pierce 1,951 3.59% 24 1.23% MVT-Motorcyclist 1,921 3.53% 84 4.37% MV Non-Traffic 1,510 2.78% 18 1.19% Firearm 1,367 2.51% 241 17.62% MVT-Pedestrian 1,198 2.20% 138 11.51% Other Land Transport 945 1.74% 5 0.52% Pedalcyclist,Other 936 1.72% 7 0.74% Not Documented 822 1.51% 8 0.97% Other Specified,Classifiable 766 1.41% 12 1.56% MVT-Pedalcyclist 661 1.21% 16 2.42% Bite And Stings-Nonvenomous 458 0.84% 1 0.21% Other Specified,Not Elsewhere Classifiable 359 0.66% 31 8.63% Pedestrian,Other 356 0.65% 26 7.30% Unspecified 290 0.53% 3 1.03% Other Transport 245 0.45% 5 2.04% Machinery 230 0.42% 2 0.86% Natural/Environmental, Other 221 0.40% 1 0.45% MVT-Unspecified 213 0.39% 1 0.46% Other Specified,Child/Adult Abuse 197 0.36% 7 3.55% Overexertion 186 0.34% 0 0.00% Hot Object/Substance 156 0.28% 1 0.64% Fire/Flame 107 0.19% 2 1.86% Suffocation 65 0.11% 22 33.84% MVT-Other 26 0.04% 1 3.84% Drowning/Submersion 20 0.03% 2 10.00% Bite And Stings-Venomous 15 0.02% 0 0.00% Other Specified,Foreign Body 5 0.00% 0 0.00% Poisoning:Non-Drug 4 0.00% 0 0.00% Poisoning:Drug 1 0.00% 0 0.00%
MVT = Motor Vehicle Traffic
Page 12 MECHANISM OF INJURY
INCIDENCE & MORTALITY: INJURY SEVERITY SCORE (ISS) > 15
Table 5: Trauma incidence and mortality proportion by mechanism of injury among severely injured patients (ISS>15) Mechanism Count Percent Deaths Mortality Proportion Overall 5,767 100.00% 725 12.57% Fall 2,531 43.88% 146 5.76% MVT-Occupant 1,175 20.37% 142 12.08% MVT-Motorcyclist 341 5.91% 66 19.35% MVT-Pedestrian 324 5.61% 103 31.79% Struck By/Against 297 5.14% 15 5.05% Firearm 247 4.28% 145 58.70% MV Non-Traffic 118 2.04% 10 8.47% MVT-Pedalcyclist 98 1.69% 15 15.30% Other Land Transport 97 1.68% 4 4.12% Pedalcyclist,Other 86 1.49% 5 5.81% Other Specified,Not Elsewhere Classifiable 63 1.09% 15 23.80% Other Specified,Child/Adult Abuse 61 1.05% 7 11.47% Not Documented 58 1.00% 4 6.89% Pedestrian,Other 57 0.98% 19 33.33% Cut/Pierce 54 0.93% 8 14.81% Unspecified 37 0.64% 2 5.40% Other Specified,Classifiable 33 0.57% 9 27.27% Other Transport 26 0.45% 4 15.38% MVT-Unspecified 22 0.38% 1 4.54% Natural/Environmental, Other 17 0.29% 0 0.00% MVT-Other 7 0.12% 1 14.28% Suffocation 6 0.10% 4 66.66% Overexertion 4 0.06% 0 0.00% Fire/Flame 3 0.05% 0 0.00% Bite And Stings-Nonvenomous 3 0.05% 0 0.00% Machinery 2 0.03% 0 0.00%
Page 13 MECHANISM OF INJURY
RATE BY YEAR
Table 6: Trauma rate per 100,000 by top 6 mechanisms and year Total Trauma Rate per 100,000 Figure 4: Trauma rate per 100,000 by top 6 mechanisms of Year Mechanism of injury Cases (95%CI) injury 2016 2017 2018 2016 Fall 18,042 264 [260, 268] MVT-Occupant 10,213 149 [147, 152] 300 Struck By/Against 3,547 52 [50, 54] 200 Cut/Pierce 1,766 26 [25, 27]
Rate MVT-Motorcyclist 1,863 27 [26, 28] 100 MV Non-Traffic 1,961 29 [27, 30] 0 2017 Fall 21,137 303 [299, 308] Fall MVT-OccupantStruck By/AgainstCut/Pierce MVT-MotorcyclistMV Non-Traffic MVT-Occupant 10,768 155 [152, 158] Struck By/Against 3,711 53 [52, 55] Cut/Pierce 2,024 29 [28, 30] Data source: Arizona State Trauma Registry 2016-2018 MVT-Motorcyclist 1,884 27 [26, 28] MV Non-Traffic 1,657 24 [23, 25] 2018 Fall 23,492 332 [328, 336] MVT-Occupant 11,793 167 [164, 170] Struck By/Against 3,757 53 [51, 55] Cut/Pierce 1,951 28 [26, 29] MVT-Motorcyclist 1,921 27 [26, 28] MV Non-Traffic 1,510 21 [20, 22]
GENDER
Figure 5: Gender-specific trauma proportion by top 6 mechanisms of injury Male Female 53% 50% 40% 35% 30% 25% 19% 20% Percent 8% 10% 5% 5% 4% 3% 1% 1% 2% 0% Fall Fall Cut/Pierce Cut/Pierce MVT-Occupant MVT-Occupant MV Non-Traffic MV Non-Traffic MV MVT-Motorcyclist MVT-Motorcyclist Struck By/Against Struck By/Against Struck Data source: Arizona State Trauma Registry 2018
Page 14 INTENT* OF INJURY
INCIDENCE & MORTALITY Table 7: Trauma incidence and mortality proportion by intent of injury Intent Count Percent Deaths Mortality Proportion Overall 54,273 100.00% 1,227 2.26% Unintentional 46,498 85.67% 864 1.85% Assault 4,663 8.59% 158 3.38% Self-harm 749 1.38% 133 17.75% Undetermined 392 0.72% 35 8.92% Legal/war 144 0.26% 19 13.19% Not documented 1,827 3.36% 18 0.98%
INTENT RATE BY YEAR
Table 8: Trauma rate per 100,000 by intent and year Total Trauma Rate per 100,000 Year Intent of injury Figure 6: Trauma rate per 100,000 by intent of injury and Cases (95%CI) year 2016 Unintentional 40,900 598 [593, 604] 2016 2017 2018 Assault 4,341 64 [62, 65]
600 Self-harm 744 11 [10, 12] Legal Intervention 114 2 [1, 2]
400 2017 Unintentional 44,878 644 [638, 650]
Rate Assault 4,627 66 [65, 68] 200 Self-harm 706 10 [9, 11] Legal Intervention 108 2 [1, 2] 0 2018 Unintentional 46,498 657 [651, 663] Unintentional Assault Self-harm Legal Intervention Assault 4,663 66 [64, 68] Data source: Arizona State Trauma Registry 2016-2018 Self-harm 749 11 [10, 11]
Legal Intervention 144 2 [2, 2] CI= Confidence Interval
INTENT RATE BY GENDER
Figure 7: Gender-specific trauma proportion by intent Female Male 91% 81% 80% 60% 40%
Percent 20% 11% 4% 0% 0% 0% 1% 0% 0% 0% Assault Assault Self-harm Self-harm Unintentional Unintentional Undetermined Undetermined Legal Intervention Legal Intervention Legal Data source: Arizona State Trauma Registry 2018
*Intent of Injury: Whether an injury was caused by an act carried out on purpose by oneself (Self-Harm) or by another person(s) (Assault), with the goal of injuring or killing; the injury was not inflicted by deliberate means (Unintentional) or; the injury was inflicted by the police or other legal authorities during law enforcement activities (Legal/War). Centers for Disease Control and Prevention. Definitions for WISQARS Nonfatal. https://www.cdc.gov/ncipc/wisqars/nonfatal/definitions.htmnnonfatalnjury
Page 15 INTENT OF INJURY
INTENT BY MECHANISM
Figure 8: Top six mechanisms of Unintentional trauma Figure 9: Top six mechanisms of Assault trauma 50% 50%
40% 40%
30% 30%
20% 20% Percent Percent
10% 10%
0% 0% Fall MVT-OccupantMVT-MotorcyclistMV Non-TrafficStruck By/AgainstMVT-Pedestrian Struck By/AgainstCut/PierceFirearm UnspecifiedChild/AdultOther, Abuse Classifiable
Data source: Arizona State Trauma Registry 2018 Data source: Arizona State Trauma Registry 2018
Figure 10: Top six mechanisms of Self-harm trauma
40%
30%
20% Percent 10%
0% Cut/Pierce Firearm Not ClassifiableSuffocation Fall MVT-Other
Data source: Arizona State Trauma Registry 2018
INJURY SEVERITY SCORE
INCIDENCE & MORTALITY
Figure 11: Trauma proportion by injury severity score Table 9: Trauma incidence and mortality proportion by 60% injury severity score Injury Severity Mortality 40% Count Percent Deaths Score Proportion Percent 20% 1-8 36,367 67.00% 207 0.56% 9-15 10,653 19.62% 260 2.44% 0% 1-8 9-15 16-24 25-75 Missing/NA/ND 16-24 4,334 7.98% 197 4.54% 25-75 1,433 2.64% 528 36.84% Missing/NA/ND 1,486 2.73% 35 2.35% Data source: Arizona State Trauma Registry 2018
Page 16 TRAUMA MORTALITY
AGE-SPECIFIC MORTALITY
Table 10: Age-specific trauma incidence and mortality proportion Percent of Arizona Trauma Age Trauma Count Trauma Percent Trauma Mortality Proportion Population (n=7,076,199)* Deaths Total 54,273 100.00% 100.00% 1,227 2.26%
<1 531 0.97% 1.22% 10 1.88%
1-4 1,369 2.52% 5.01% 17 1.24%
5-9 1,480 2.72% 6.43% 3 0.20%
10-14 1,729 3.18% 6.64% 14 0.80%
15-19 3,384 6.23% 6.66% 62 1.83%
20-24 3,925 7.23% 7.00% 100 2.54%
25-34 6,964 12.83% 14.00% 163 2.34%
35-44 5,148 9.48% 12.22% 118 2.29%
45-54 5,065 9.33% 12.07% 126 2.48%
55-64 5,904 10.87% 12.06% 170 2.87%
65-74 6,643 12.23% 10.01% 170 2.55%
75-84 6,789 12.50% 5.2% 154 2.26%
85+ 5,342 9.84% 1.95% 120 2.24%
* Source: Arizona Department of Health Services, Population Health and Vital Statistics. Population Denominators: 2016. http://pub.azdhs.gov/health-stats/ menu/info/pop/index.php
AGE-SPECIFIC MORTALITY RATE
Figure 12: Age-specific trauma mortality rate per 100,000
2018 Table 11: Age-specific trauma mortality rate Median 2016-2017 30 Age Total Trauma Deaths Rate per 100,000 (95%CI) <15 44 3 [2, 4] 20 15-19 62 13 [10, 16] 20-44 381 16 [15, 18] 10 45-64 296 17 [15, 19]
Mortality rate 100,000per Mortality 65+ 444 37 [33, 40] 0 <15 15-19 20-44 45-64 65+ Overall Overall 1,227 17 [16, 18] Data source: Arizona State Trauma Registry 2016-2018 CI= Confidence interval
Page 17 TRAUMA MORTALITY
GENDER-SPECIFIC MORTALITY RATE
Figure 13: Gender-specific trauma mortality rate per 100,000 25
20 Table 12: Gender-specific trauma mortality rate per 100,000
15 Gender Total Trauma Deaths Rate per 100,000 (95%CI)
10 Female 351 10 [9, 11]
5 Male 876 25 [23, 27]
Mortality rate 100,000per Mortality CI= Confidence interval 0 Female Male Data source: Arizona State Trauma Registry 2018
RACE-SPECIFIC MORTALITY RATE
Figure 14: Race-specific trauma mortality rate per 100,000
25 Table 13: Race-specific trauma mortality rate per 100,000 20 Race/ethnicity Total Trauma Deaths Rate per 100,000 (95%CI) 15 AA/Black 59 17 [13, 22]
10 AI/AN 79 26 [21, 32]
5 Asian/PI 16 6 [3, 9]
Mortality rate 100,000per Mortality Hispanic 227 10 [9, 12] 0 AA/Black AI/AN Asian/PI Hispanic White White 773 20 [18, 21] Data source: Arizona State Trauma Registry 2016-2018, PI=Pacific Islander, AI/AN=American Indian/Alaska Native, AA=African American CI= Confidence interval
ASTR VS. STATEWIDE
Figure 15: Age-adjusted trauma mortality rate per 100,000: Trauma center deaths vs. Statewide trauma deaths Table 14: Age-adjusted trauma mortality rate per 100,000 by year: Trauma Center vs. Statewide* 2016 2017 2018 Total Trauma Rate per 100,000 48.9 49.7 Data source Year 50 48.2 Deaths (95%CI) ASTR 2016 1,111 15.5 [14.6, 16.4] 40 2017 1,220 16.4 [15.5, 17.3] 30 2018 1,227 16.1 [15.2, 17.0] DAVE 2016 3,602 48.9 [47.3, 50.5] 20 16.4 16.1 15.5 2017 3,742 49.7 [48.1, 51.3] 10 CI= Confidence interval2018 3,723 48.2 [46.7, 49.8] Mortality rate 100,000per Mortality 0 CI= Confidence interval ASTR DAVE *Statewide data obtained from the Database Application for Vital Events (DAVE). Data sources: Arizona State Trauma Registry 2016-2018, Database Includes all trauma deaths including those that occurred outside of trauma Application for Vital Events, 2016-2018 centers.
Page 18 TRAUMA CHARGES
CHARGES & REIMBURSEMENT Table 15: Total trauma charges and reimbursement by year
Year Total Charges Median Charges Total Reimbursement Reimbursement Percent
2015 $1,667,301,074 $22,026 $274,959,253 16.4%
2016 $1,923,007,348 $22,418 $302,128,477 15.7%
2017 $2,187,732,051 $23,752 $317,620,953 14.5%
2018 $2,611,324,694 $28,068 $375,754,016 14.3%
PRIMARY PAYER BY YEAR
Figure 16: Primary payment source of traumatic injuries by year 2015 2016 2017 2018 31% 31% 31% 30% 30% 30% 29%
30% 28% 27% 27% 25% 22%
20%
10% 8% 7% 6% 6% 2% 2% 2% 2% 2% 1% 1% 1% 0% AHCCCS/Govt Private Medicare Self pay Other Workers Comp Data source: Arizona State Trauma Registry 2015-2018, Other includes: No fault auto, Not billed, and Other insurance
CHARGES & REIMBURSEMENT BY PAYER
Table 16: Total trauma charges and reimbursement by primary payer Primary payer Total Charges Median Charges Total Reimbursement Reimbursement Percent AHCCCS/Govt $864,412,608 $27,464 $78,241,893 9.0%
Medicare $803,228,659 $30,397 $106,460,143 13.2% Not documented $290,926 $5,415 $56,910 19.5% Other $47,876,537 $19,418 $4,585,377 9.5%
Private $725,886,720 $28,371 $169,653,890 23.3%
Self pay $117,290,963 $24,619 $5,230,458 4.4%
Workers Comp $52,338,281 $31,863 $11,525,345 22.0%
Total $2,611,324,694 $28,068 $375,754,016 14.3%
Page 19 TRAUMA CHARGES
CHARGES & REIMBURSEMENT BY MECHANISM
Table 17: Total trauma charges and reimbursement by mechanism of injury
Total Reimbursement Mechanism Total Charges Median Charges Reimbursement Percent MVT-Other $2,375,918 $48,610 $125,570 5.20% MVT-Pedestrian $128,731,479 $45,192 $16,707,406 12.90% Suffocation $4,102,544 $41,656 $617,560 15.00% Other Specified,Not Elsewhere Classifiable $21,469,760 $37,309 $2,259,021 10.50% MVT-Motorcyclist $163,907,844 $37,176 $25,468,633 15.50% Pedestrian,Other $25,374,287 $34,113 $2,567,767 10.10% Firearm $106,664,426 $32,685 $13,165,341 12.30% MVT-Pedalcyclist $40,992,214 $31,269 $5,044,556 12.30% Fall $1,044,885,448 $28,510 $154,245,204 14.70% Other Specified,Child/Adult Abuse $11,025,737 $28,209 $2,282,271 20.60% Total $2,611,324,694 $28,068 $375,754,016 14.30% MVT-Occupant $593,671,441 $28,035 $84,513,508 14.20% Cut/Pierce $72,807,394 $27,873 $8,735,417 11.90% Overexertion $6,268,295 $27,103 $1,150,836 18.30% Pedalcyclist,Other $36,176,439 $26,156 $6,047,561 16.70% MV Non-Traffic $66,367,491 $25,858 $9,574,973 14.40% Other Transport $14,854,211 $25,832 $2,018,156 13.50% Other Specified,Classifiable $31,550,658 $25,623 $5,519,002 17.40% Machinery $6,609,221 $24,220 $956,906 14.40% Other Land Transport $41,217,772 $24,100 $6,939,977 16.80% Unspecified $13,856,658 $23,957 $1,474,380 10.60% Bite And Stings-Nonvenomous $13,966,308 $23,614 $1,985,742 14.20% Struck By/Against $123,635,710 $22,891 $16,383,364 13.20% Natural/Environmental, Other $7,739,721 $21,864 $1,828,432 23.60% Poisoning:Drug $20,611 $20,611 $3,208 15.50% Poisoning:Non-Drug $62,182 $16,595 $12,296 19.70% Not Documented $20,407,605 $15,125 $4,275,995 20.90% MVT-Unspecified $7,508,556 $14,525 $973,747 12.90% Other Specified,Foreign Body $98,316 $13,713 $1,466 1.40% Drowning/Submersion $383,829 $10,923 $57,623 15.00% Fire/Flame $1,787,109 $10,045 $362,142 20.20% Hot Object/Substance $2,153,525 $6,241 $316,545 14.60% Bite And Stings-Venomous $651,984 $6,005 $139,409 21.30%
Page 20 DRUGS & ALCOHOL (SUSPECTED OR CONFIRMED USE) (N = 12,536 , 23%)
AGE-SPECIFIC RACE-SPECIFIC
Figure 17: Age-specific trauma proportion by alcohol and Figure 18: Race-specific trauma proportion by alcohol and drug use drug use Drug Alcohol Drug Alcohol
25% 43% 25% 25% 25% 40% 20% 20% 19% 30% 16% 23% 15% 14% 20% 19% Percent
Percent 14% 13% 10% 12% 11% 10% 8% 6% 5% 10% 7% 5% 3% 2% 0% 0% 0% 0% Hispanic White AI/AN AA/Black Asian/PI <10 10-14 15-17 18-24 25-44 45-64 65+ Data source: Arizona State Trauma Registry 2018, PI=Pacific Islander, Data source: Arizona State Trauma Registry 2018 AI/AN=American Indian/Alaska Native, AA=African American
INTENT-SPECIFIC MECHANISM-SPECIFIC
Figure 19: Intent-specific trauma proportion by alcohol and Figure 20: Mechanism-specific trauma proportion by drug use alcohol and drug use Drug Alcohol Drug Alcohol
39% 31% 31% 40% 28% 35% 30% 32% 21% 21% 30% 20% 26% 25% 16% 16% 13% 22% Percent 8% 20% 10% 6% Percent
10% 10% 0% 10% Fall MVT-Occupant Struck By/AgainstCut/Pierce MVT-Motorcyclist
0% Unintentional Assault Self-harm Legal Intervention Data source: Arizona State Trauma Registry 2018 Data source: Arizona State Trauma Registry 2018
Page 21 PROTECTIVE DEVICES
MVT-OCCUPANT (N = 11,793) PEDAL CYCLIST (N = 1,597)
Figure 21: Age-specific proportion of restraint use among Figure 22: Age-specific proportion of helmet use among Motor Vehicle Traffic occupants pedal-cyclists
100 Age specific 100 Age specific Overall Overall 78 80 80 75 80 71 64 61 60 54 53 60 42
Percent 40 Percent 40 33 28 23 18 18 20 20 11
0 0 <5 5-8 9-14 15-17 18-24 25-44 45-64 65+ 5-8 9-14 15-17 18-24 25-44 45-64 65+ Data source: Arizona State Trauma Registry 2018 Data source: Arizona State Trauma Registry 2018
MOTORCYCLIST (N = 1,921) OFF-ROAD VEHICLE OCCUPANT (N = 1,573)
Figure 23: Age-specific proportion of helmet use among Figure 24: Age-specific proportion of helmet use among Motorcyclists off-road vehicle occupants
100 Age specific 100 Age specific Overall Overall 77 80 73 80
59 59 60 57 60 46 49 42 44
Percent 40 Percent 40 33 31 32 33
20 20 16 5 0 0 5-8 9-14 15-17 18-24 25-44 45-64 65+ <5 5-8 9-14 15-17 18-24 25-44 45-64 65+ Data source: Arizona State Trauma Registry 2018 Data source: Arizona State Trauma Registry 2018
Page 22 ACCESS TO CARE
INJURY TO ED ARRIVAL TIME
Table 18: Injury to ED arrival time for patient with an injury severity score > 15 by injury location ISS>15: Injury to ED Arrival Time (Minutes) Injury location Injury time N Median time 25th percentile* 75th percentile** missing (n)
Rural 637 85 51 129 143 Urban 2,184 46 34 70 1,173 Statewide 2,821 50 35 86 1,316 *25% of the cohort had a median transport time at or below this value ** 75% of the cohort had a median transport time at or below this value
Table 19: Injury to ED arrival time for transferred patients with an injury severity score > 15 by injury location ISS>15 and transferred to Level 1: Injury to ED Arrival Time (Minutes)
Injury location Injury time N Median time 25th percentile* 75th percentile** missing (n)
Rural 308 368 262 597 94 Urban 619 311 236 471 398 Statewide 927 331 243 512 492 *25% of the cohort had a median transport time at or below this value ** 75% of the cohort had a median transport time at or below this value
MODE OF TRANSPORT
Figure 25: Mode of transport to trauma center by Injury Severity Score Air Ground POV
80% 75% 75% 72% 67%
60%
40%
Percent 28% 21% 20% 16% 13% 13% 8% 4% 2% 0% 1-8 9-15 16-24 25-75 Data source: Arizona State Trauma Registry 2018
POV - Privately owned vehicle
Page 23 INJURY REGION
TRAUMA RATE
Figure 26a: Region-specific trauma rate per 100,000 Figure 26b: Region-specific severe trauma (ISS>15) rate per 100,000 By region 1,300 1,250 Statewide By region 130 125 Statewide 1,000 947 100 720 76 750 71 75 66 517 500 50 Rate per 100,000per Rate 250 100,000per Rate 25
0 0 Southeastern Central Western Northern Southeastern Western Central Northern Data source: Arizona State Trauma Registry 2018 Data source: Arizona State Trauma Registry 2018
Table 20: Region-specific trauma rate per 100,000 All Trauma Patients Severe Trauma Patients (ISS >15) Injury Region Total Trauma Cases Rate per 100,000 (95%CI) Total Trauma Cases Rate per 100,000 (95%CI) Western 4,357 947 [919, 975] 327 71 [63, 79] Southeastern 6,549 517 [505, 530] 840 66 [62, 71] Northern 7,290 1,300 [1,271, 1,330] 731 130 [121, 140] Central 34,483 720 [712, 727] 3,661 76 [74, 79] CI= Confidence interval MORTALITY RATE MORTALITY BY ISS
Figure 27: Region-specific trauma mortality rate per Figure 28: Region-specific trauma proportion by Injury 100,000 Severity Score By region Central Region Western Region Statewide Northern Region Southeastern Region
20 72% 20 69% 69% 17 68% 16 16 15 60%
10 40%
5 Percent
Rate per 100,000per Rate 20% 19% 20% 20% 16% 0 8% 8% 8% 6% 4% Western Southeastern Central Northern 2% 1% 2% 0% Data source: Arizona State Trauma Registry 2018 1-8 9-15 16-24 25-75 Data source: Arizona State Trauma Registry 2018
Table 21: Region-specific trauma mortality rate per 100,000 Total Trauma Rate per 100,000 Injury Region deaths (95%CI) Western 73 16 [12, 20] Northern 111 20 [16, 23] Southeastern 204 16 [14, 18] Central 820 17 [16, 18] CI= Confidence interval
Page 24 INJURY REGION
MECHANISM OF INJURY
Figure 29: Region-specific trauma rate per 100,000 by top 6 mechanisms
500 Central Northern 400 Southeastern Western 300 Statewide
200
Rate per 100,000per Rate 100
0 Fall MVT-Occupant Struck By/AgainstCut/Pierce MVT-MotorcyclistMV Non-Traffic
Data source: Arizona State Trauma Registry 2018 Table 22: Region-specific trauma rate per 100,000 by the top 6 mechanism of injury Region Mechanisms Total Trauma Cases Rate per 100,000 (95%CI) Central Fall 16,084 336 [331, 341] MVT-Occupant 7,116 149 [145, 152] Struck By/Against 2,270 47 [45, 49] Cut/Pierce 1,284 27 [25, 28] MVT-Motorcyclist 1,237 26 [24, 27] MV Non-Traffic 756 16 [15, 17] Northern Fall 2,739 489 [470, 507] MVT-Occupant 1,680 300 [285, 314] Struck By/Against 655 117 [108, 126] Cut/Pierce 201 36 [31, 41] MVT-Motorcyclist 193 34 [30, 39] MV Non-Traffic 266 47 [42, 53] Southeastern Fall 1,976 156 [149, 163] MVT-Occupant 1,806 143 [136, 149] Struck By/Against 499 39 [36, 43] Cut/Pierce 327 26 [23, 29] MVT-Motorcyclist 322 25 [23, 28] MV Non-Traffic 132 10 [9, 12] Western Fall 2,145 466 [447, 486] MVT-Occupant 799 174 [162, 186] Struck By/Against 180 39 [33, 45] Cut/Pierce 84 18 [14, 22] MVT-Motorcyclist 124 27 [22, 32] MV Non-Traffic 313 68 [60, 76] Statewide Fall 23,492 332[328, 336] MVT-Occupant 11,793 167 [164, 170] Struck By/Against 3,757 53 [51,55] Cut/Pierce 1,951 28[26, 29] MVT-Motorcyclist 1,921 27 [26, 28] CI = Confidence interval MV Non-Traffic 1,510 21 [20, 22]
Page 25 INJURY REGION
INTENT OF INJURY
Figure 30: Region-specific trauma rate per 100,000 by intent
1,000 Central Region Western Region Northern Region Southeastern Region 800 Statewide
600
400 Rate per 100,000per Rate
200
0 Unintentional Assault Self-harm Data source: Arizona State Trauma Registry 2018
Table 23: Region-specific trauma rate per 100,000 by intent of injury Region Intent Total Trauma Cases Rate per 100,000 (95%CI) Central Region Unintentional 30,232 631 [624, 638] Assault 2,800 58 [56, 61] Self-harm 472 10 [9, 11] Northern Region Unintentional 5,747 1,025 [999, 1,052] Assault 759 135 [126, 145] Self-harm 88 16 [12, 19] Southeastern Region Unintentional 5,372 424 [413, 436] Assault 734 58 [54, 62] Self-harm 127 10 [8, 12] Western Region Unintentional 3,882 844 [817, 870] Assault 213 46 [40, 53] Self-harm 54 12 [9, 15] Statewide Unintentional 45,233 639 [633, 645] Assault 4,506 64 [62, 66] Self-harm 741 10 [10, 11] CI= Confidence interval
Page 26 TRAUMA CENTER DESIGNATION
INCIDENCE & MORTALITY
Table 24: Trauma incidence and mortality proportion by trauma center designation
Trauma Center Designation Count Percent Deaths Mortality Proportion
Level I 36,100 66.88% 1,065 2.95%
Level III 6,150 11.39% 54 0.87%
Level IV 11,726 21.72% 108 0.92%
INJURY SEVERITY
Figure 31: Injury Severity Score by trauma center designation Level I Level III Level IV
79% 80% 76%
64% 60%
40% Percent
22% 17% 20% 15% 10% 4% 4% 3% 0% 0% 0% 1-8 9-15 16-24 25-75 Data source: Arizona State Trauma Registry 2018
CHARGES & REIMBURSEMENT
Table 25: Trauma charges and reimbursement by trauma center designation
Trauma Center Designation Total Charges Median Charges Total Reimbursement Reimbursement Percent
Level I $1,687,485,464 $30,598 $247,984,737 14.6%
Level III $295,040,453 $21,626 $41,173,199 13.9%
Level IV $192,646,592 $13,450 $26,372,727 13.6%
Total $2,175,172,510 $24,000 $315,530,663 14.5%
Page 27 TRAUMATIC BRAIN INJURY
INCIDENCE & MORTALITY
Table 26: Traumatic brain injury incidence and mortality proportion by age and brain injury severity
Total Major TBI Minor TBI Age Trauma Mortality Mortality N Percent Mortality N Percent Mortality Cases Percent Percent Total 54,273 6,334 11.67% 603 9.52% 10,625 19.57% 127 1.19% <1 531 183 34.46% 10 5.46% 125 23.54% 0 . 1-4 1,369 165 12.05% 15 9.09% 211 15.41% 1 0.47% 5-9 1,480 90 6.08% 1 1.11% 203 13.71% 0 . 10-14 1,729 111 6.41% 6 5.40% 354 20.47% 3 0.84% 15-19 3,384 261 7.71% 31 11.87% 815 24.08% 7 0.85% 20-24 3,925 299 7.61% 54 18.06% 857 21.83% 4 0.46% 25-34 6,964 585 8.40% 87 14.87% 1,433 20.57% 14 0.97% 35-44 5,148 501 9.73% 55 10.97% 1,078 20.94% 11 1.02% 45-54 5,065 570 11.25% 54 9.47% 1,053 20.78% 21 1.99% 55-64 5,904 732 12.39% 90 12.29% 1,118 18.93% 16 1.43% 65-74 6,643 951 14.31% 89 9.35% 1,148 17.28% 18 1.56% 75-84 6,789 1,078 15.87% 67 6.21% 1,211 17.83% 19 1.56% 85+ 5,342 808 15.12% 44 5.44% 1,019 19.07% 13 1.27%
MECHANISM OF INJURY (TOP 10)
Figure 32: Proportion of Traumatic Brain Injury by mechanism
57% 60% 54% 50% 49% 43% 43% 40% 40% 40% 33% 33% 33% 30%
Percent 20% 10% 0% MVT-OtherChild/AdultMVT-Pedestrian AbuseStruck By/AgainstUnspecifiedNot ClassifiableMVT-PedalcyclistPedalcyclist,OtherPedestrian,OtherFall
Data source: Arizona State Trauma Registry 2018
Page 28 TRAUMATIC BRAIN INJURY
GLASGOW COMA SCORE (GCS)
Table 27: Traumatic brain injury incidence and mortality proportion by age and GCS
Total TBI- GCS<9 TBI- GCS 9-12 TBI- GCS 12-15 Age Trauma Mortality Mortality Mortality N Percent Mortality N Percent Mortality N Percent Mortality Cases Percent Percent Percent Total 54,273 1,283 2.36% 550 42.86% 536 0.98% 37 6.90% 14,781 27.23% 128 0.86% <1 531 11 2.07% 6 54.54% 6 1.12% 1 16.66% 267 50.28% 0 . 1-4 1,369 40 2.92% 15 37.50% 13 0.94% 1 7.69% 310 22.64% 0 . 5-9 1,480 13 0.87% 1 7.69% 9 0.60% 0 . 265 17.90% 0 . 10-14 1,729 21 1.21% 8 38.09% 15 0.86% 0 . 424 24.52% 1 0.23% 15-19 3,384 110 3.25% 36 32.72% 32 0.94% 1 3.12% 916 27.06% 0 . 20-24 3,925 140 3.56% 58 41.42% 24 0.61% 0 . 979 24.94% 0 . 25-34 6,964 242 3.47% 99 40.90% 77 1.10% 2 2.59% 1,674 24.03% 0 . 35-44 5,148 156 3.03% 61 39.10% 76 1.47% 3 3.94% 1,325 25.73% 2 0.15% 45-54 5,065 151 2.98% 60 39.73% 59 1.16% 2 3.38% 1,388 27.40% 11 0.79% 55-64 5,904 161 2.72% 77 47.82% 67 1.13% 6 8.95% 1,590 26.93% 21 1.32% 65-74 6,643 111 1.67% 63 56.75% 63 0.94% 8 12.69% 1,875 28.22% 35 1.86% 75-84 6,789 79 1.16% 41 51.89% 49 0.72% 8 16.32% 2,092 30.81% 35 1.67% 85+ 5,342 48 0.89% 25 52.08% 46 0.86% 5 10.86% 1,676 31.37% 23 1.37%
Page 29 REHAB
DISCHARGED TO REHAB BY PAYER
Table 28: Discharged to rehab by primary payer and Injury Severity Score ISS <=15 and ISS >15 and Primary Payer Total Patient admitted Discharged to Rehab Discharged to Rehab Discharged to Rehab N % N % N % N % AHCCCS 9,445 30.42% 475 5.02% 227 2.96% 244 16.08% Medicare 10,678 34.39% 1,251 11.71% 993 11.12% 247 15.63% Not Documented 36 0.11% 2 5.55% 1 3.12% 1 25.00% Other 522 1.68% 13 2.49% 5 1.16% 8 10.52% Private 8,832 28.45% 813 9.20% 505 6.88% 305 22.54% Self pay 1,529 4.92% 18 1.17% 8 0.61% 10 5.15% Total 31,042 100.00% 2,572 8.28% 1,739 6.76% 815 17.25%
DISCHARGED TO REHAB BY REGION
Table 29: Discharged to rehab by region of injury
Total Patient Admitted Discharged to Rehab Region N % N % N %
Missing Region 939 3.0% 870 92.6% 69 7.3%
Central Region 22,403 72.1% 20,647 92.1% 1,756 7.8%
Western Region 1,703 5.4% 1,537 90.2% 166 9.7%
Northern Region 3,083 9.9% 2,799 90.7% 284 9.2%
Southeastern Region 2,914 9.3% 2,617 89.8% 297 10.1%
Statewide 31,042 100.0% 28,470 91.7% 2,572 8.2%
Page 30 APPENDIX A. LIST OF TRAUMA CENTERS BY LEVEL OF DESIGNATION
Effective Expiration Health Care Institution Address Date Date Level I Trauma Centers
Abrazo West Campus 13677 W. McDowell Road, Goodyear, AZ 85395 06/30/18 06/30/21
Banner - University Medical Center Phoenix 1111 E. McDowell Rd., Phoenix, AZ 85006 11/19/17 11/19/20
Banner Desert Medical Center 1400 South Dobson Rd., Meza, AZ 85202 04/23/19 04/23/22
Banner Thunderbird Medical Center 5555 W. Thunderbird Rd, Glendale, AZ 85306 09/30/19 09/30/22
Banner University Medical Center – Tucson 1501 N. Campbell Ave., Tucson, AZ 85724 11/11/18 11/11/20 Campus Dignity Health, dba Chandler Regional Medical 1955 W. Frye Rd., Chandler, AZ 85224 07/01/18 07/01/21 Center Flagstaff Medical Center 1200 N. Beaver St., Flagstaff, AZ 86001 05/27/17 05/27/20
HonorHealth Deer Valley Medical Center 19829 N. 27th Ave., Phoenix, AZ 85027 06/01/19 06/01/22
HonorHealth John C. Lincoln Medical Center 250 E. Dunlap Ave., Phoenix, AZ 85020 04/24/17 04/24/20 HonorHealth Scottsdale Osborn Medical 7400 E. Osborn, Scottsdale, AZ 85251 10/27/18 10/27/20 Center Maricopa Medical Center 2601 E. Roosevelt, Phoenix, AZ 85008 12/19/17 12/19/20
St. Joseph’s Hospital & Medical Center 350 W. Thomas Rd., Phoenix, AZ 85013 11/20/17 11/20/19
Level I Pediatric Trauma Centers **
Phoenix Children’s Hospital 1919 E. Thomas Rd., Phoenix, AZ 85016 08/31/18 08/31/21
Level III Trauma Centers
Abrazo Scottsdale Campus 3929 E. Bell Rd., Phoenix, AZ 85032 07/15/19 06/25/22
Banner Baywood Medical Center 6644 E. Baywood Ave., Mesa, AZ 85206 08/21/17 * 02/25/20
Banner Del E. Webb Medical Center 14502 W. Meeker Blvd, Sun City West, AZ 85375 01/25/19 01/25/21
Canyon Vista Medical Center 5700 E. Highway 90, Sierra Vista, AZ 85635 04/03/17 04/03/20
Havasu Regional Medical Center 101 Civic Center Ln., Lake Havasu City, AZ 86403 02/28/17 * 02/28/20
Mountain Vista Medical Center 1301 S. Crismon Rd., Mesa, AZ 85209 07/26/19 07/26/20
Tuba City Regional Health Care Corp. P.O. Box 600, 167 Main St., Tuba City, AZ 86045 12/10/18 12/10/20
*Application Pending: In accordance with R9-25-1307D – If an owner submits for renewal of designation, the designation does not expire until the Department has made a final determination. ** Pediatric Level I Trauma Centers: All Arizona Designated Trauma Centers are required to have the capabilities necessary to resuscitate, stabilize, and transfer pediatric patients. Pediatric Trauma Centers have a trauma service specifically intended to meet the needs of children requiring trauma care.
Page 31 APPENDIX A. LIST OF TRAUMA CENTERS BY LEVEL OF DESIGNATION
Level IV Trauma Centers
Banner Boswell Medical Center 10401 W. Thunderbird Blvd., Sun City, AZ 85351 12/17/18 12/17/21
Banner Casa Grande Medical Center 1800 E. Florence Blvd., Casa Grande, AZ 85122 10/01/19 10/01/21
Banner Estrella Medical Center 9201 W. Thomas Road, Phoenix, AZ 85037 08/30/18 08/30/21
Banner Gateway Medical Center 1900 N. Higley Road, Gilbert, AZ 85234 01/02/19 01/02/22
Banner Ironwood Medical Center 37000 N. Gantzel Rd., San Tan Valley, AZ 85140 10/11/18 10/11/21
Banner Page Hospital 501 N. Navajo, Page, AZ 86040 11/05/17 11/05/20
Banner Payson Medical Center 807 S. Ponderosa Street, Payson, AZ 85541 11/22/16 *11/22/19 Banner University Medical Center – 2800 E. Ajo Way, Tucson, AZ 85713 08/13/19 08/13/20 South Campus Benson Hospital 450 S. Ocotillo Ave., Benson, AZ 85602 09/18/19 09/18/21
Cobre Valley Regional Medical Center 5880 S. Hospital Dr., Globe, AZ 85501 11/26/18 11/26/21
Copper Queen Community Hospital 101 Cole Ave., Bisbee, AZ 85603 12/01/19 12/01/21 Copper Queen Community Hospital – Douglas 100 E. 5th Street, Douglas, AZ 85607 06/25/19 06/25/22 Emergency Department Kingman Regional Medical Center 3269 Stockton Hill Rd., Kingman, AZ 86409 10/15/18 10/15/21
La Paz Regional Hospital 1200 W. Mohave Rd., Parker, AZ 85344 06/02/18 06/02/21
Little Colorado Medical Center 1501 N. Williamson Ave, Winslow, AZ 86047 06/22/18 06/22/21
Mt. Graham Regional Medical Center 1600 S. 20th Ave., Safford, AZ 85546 03/20/17 03/20/20
Northern Cochise Community Hospital 901 W. Rex Allen Dr., Willcox, AZ 85643 12/04/17 12/04/20
San Carlos Apache Health Care Corporation 103 Medicine Way Road, Peridot, AZ 85542 05/09/18 05/09/21
Summit Healthcare Regional Medical Center 2200 Show Low Lake Rd., Show Low, AZ 85901 08/12/17 08/12/20
Verde Valley Medical Center 269 S. Candy Ln., Cottonwood, AZ 86326 08/18/17 08/18/20
Verde Valley Medical Center – Sedona Campus 3700 W. Hwy 89A, Sedona, AZ 86336 05/08/19 05/08/22
Western Arizona Regional Medical Center 2735 Silver Creek Road, Bullhead City, AZ 86442 10/28/19 10/28/22
White Mountain Regional Medical Center 118 S. Mountain Ave., Springerville, AZ 85938 06/18/18 06/18/21
Wickenburg Community Hospital 520 Rose Ln., Wickenburg, AZ 85390 08/08/17 08/08/20 Yavapai Regional Medical Center – 1003 Willow Creek Road, Prescott, AZ 86301 01/10/17 * 01/10/20 West Campus Yavapai Regional Medical Center – East 7700 E. Florentine, Prescott Valley, AZ 86314 06/24/17 06/24/20 Campus Yuma Regional Medical Center 2400 South Avenue A, Yuma, AZ 85364 10/28/19 10/28/20 *Application Pending: In accordance with R9-25-1307D – If an owner submits for renewal of designation, the designation does not expire until the Department has made a final determination. ** Pediatric Level I Trauma Centers: All Arizona Designated Trauma Centers are required to have the capabilities necessary to resuscitate, stabilize, and transfer pediatric patients. Pediatric Trauma Centers have a trauma service specifically intended to meet the needs of children requiring trauma care.
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ARIZONA STATE TRAUMA REGISTRY INCLUSION CRITERIA TRAUMA PATIENT INCLUSION DEFINITION ARIZONA STATE TRAUMA REGISTRY (ASTR) Effective for records with ED/Hospital Arrival Dates January 1, 2018** – Current
The owner of a trauma center shall ensure that: 1. The trauma registry, established according to subsection (B)(1), includes the information required in R9- 25-1309 for each patient with whom the trauma center had contact who meets one or more of the following criteria: a. A patient with injury or suspected injury who is: i. Transported from a scene to a trauma center or an emergency department based on the responding emergency medical services provider’s or ambulance service’s triage protocol required in R9-25- 201(E)(2)(b), or ii. Transferred from one health care institution to another health care institution by an emergency medical services provider or ambulance service; b. A patient with injury or suspected injury for whom a trauma team activation occurs; or c. A patient with injury, who is admitted as a result of the injury or who dies as a result of the injury, and whose medical record includes one or more of specific ICD-codes indicating that: i. At the initial encounter with the patient, the patient had: (1) An injury or injuries to specific body parts - S00-S99 with 7th character modifiers of A, B, or C ONLY. (Injuries to specific body parts –initial encounter)
(2) Unspecified multiple injuries - T07 (unspecified multiple injuries)
(3) Injury of an unspecified body region - T14 (injury of unspecified body region)
(4) A burn or burns to specific body parts - T20-T28 with 7th character modifier of A ONLY (burns by specific body parts – initial encounter)
(5) Burns assessed through Total Body Surface Area percentages - T30-T32 (burn by TBSA percentages) or
(6) Traumatic Compartment Syndrome - T79.A1-T79.A9 with 7th character modifier of A ONLY (Traumatic Compartment Syndrome – initial encounter); and
Page 33 APPENDIX B.
ARIZONA STATE TRAUMA REGISTRY INCLUSION CRITERIA ii. The patient’s injuries or burns were not only: (1) An isolated distal extremity fracture from a same-level fall, (2) An isolated femoral neck fracture from a same-level fall, (3) Effects resulting from an injury or burn that developed after the initial encounter – (Late effect codes, which are represented using the same range of injury diagnosis codes but with the 7th digit modifier code of D through S), (4) A superficial injury or contusion – S00 (Superficial injuries of the head) S10 (Superficial injuries of the neck) S20 (Superficial injuries of the thorax) S30 (Superficial injuries of the abdomen, pelvis, lower back and external genitals) S40 (Superficial injuries of shoulder and upper arm) S50 (Superficial injuries of elbow and forearm) S60 (Superficial injuries of wrist, hand and fingers) S70 (Superficial injuries of hip and thigh) S80 (Superficial injuries of knee and lower leg) S90 (Superficial injuries of ankle, foot and toes)), or (5) A foreign body entering through an orifice; (6) *The inclusion criteria are in the trauma rules. This document is a guide and does not supercede the rules.
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