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Trauma Measure #5 Documentation of Glasgow Coma Score at Time of Initial Evaluation in TBI

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Trauma Measure #5 Documentation of Glasgow Coma Score at Time of Initial Evaluation in TBI Trauma Measure #5 Documentation of Glasgow Coma Score at Time of Initial Evaluation in TBI National Quality Strategy Domain: Communication and Care Coordination Measure Type (Process/Outcome): Process 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY DESCRIPTION: Percentage of trauma activations for patients aged 18 years or older evaluated as part of a trauma activation or trauma consultation who have a traumatic intracranial hemorrhage on initial head CT for which a Glasgow Coma Score (GCS) at the time of initial evaluation is documented in the medical record within 1 hour of hospital arrival. INSTRUCTIONS: This measure is to be reported each time a patient is evaluated as part of a trauma activation or trauma consultation and is found to have a traumatic intracranial hemorrhage on initial head CT. It is anticipated that clinicians who are responsible for the initial trauma evaluation of TBI patients as specified in the denominator coding will submit this measure. Measure Reporting via Registry: Abbreviated Injury Scale (AIS) codes, patient demographics, and the medical record are used to identify patients who are included in the measure’s denominator. The listed numerator options are used to report the numerator of the measure. DENOMINATOR: All patients aged 18 years or older evaluated by an eligible professional as part of a trauma activation or trauma consultation who have a traumatic intracranial hemorrhage on initial head CT). Denominator Criteria: Patients aged 18 years or older AND Patients evaluated as part of a trauma activation or trauma consultation AND Patients meeting or more of the following two criteria: 1) Patients diagnosed with traumatic intracranial hemorrhage on initial head CT 2) One of the following abbreviated injury scale codes (AIS 98 and/or AIS 05): Listed below are AIS 98 and AIS 05 predot codes that represent traumatic intracranial hemorrhage Intracranial Lesion AIS 98 Predot Codes Epidural Hematoma 140630, 140632, 140634, 140636 Subdural Hematoma 140650, 140652, 140654, 140656 1 Traumatic Subarachnoid Hemorrhage 140684 140608, 140610, 140616, 140618, 140624, Intracerebral Mass Lesion 140626, 140648 140204, 140206, 140208, 140210, 140212, 140214, 140218, 14218, 140299, 140402, 140403, 140404, 140405, 140406, 140410, Brainstem/Cerebellar Lesion 140414, 140418, 140422, 140426, 140430, 140434, 140438, 140442, 140446, 1404450, 140458, 140462, 140466, 140470, 140474, 140499 Intracranial Lesion AIS 05 Predot Codes Epidural Hematoma 140630, 140631, 140632, 140634, 140636 140651, 140651, 140652, 140654, 140655, Subdural Hematoma 140656 Traumatic Subarachnoid Hemorrhage 140693, 140694, 140695 140608, 140610, 140616, 140618, 140624, Intracerebral Mass Lesion 140626, 140641, 140648 140204, 140208, 140210, 140212, 140214, 140218, 140299, 140402, 140403, 140404, 140405, 140407, 140410, 140414, 140416, Brainstem/Cerebellar Lesion 140418, 140422, 140426, 140428, 140430, 140434, 140438, 140440, 140442, 140446, 140450, 140458, 140462, 140466, 140470, 140472, 140473, 140474 NUMERATOR: All patients aged 18 years or older evaluated by an eligible professional as part of a trauma activation or trauma consultation who are diagnosed with a traumatic intracranial hemorrhage on initial head CT for whom an eligible professional attests to documenting a Glasgow Coma Score (GCS) at the time of initial evaluation in the medical record within 1 hour of hospital arrival. Definitions: Glasgow Coma Scale: A 15-point scale used to assess mental status following trauma. The components of GCS include motor response, verbal response, and eye opening. The highest score from each component is used to calculate the GCS. If full assessment of a patient’s GCS is not possible due to endotracheal intubation, this should be noted by the addition of a “t” modifier to the end of the score. If full assessment of a patient’s GCS is not possible due to paralysis, this should be noted by the addition of a “p” modifier to the end of the score. • Eye Response: o 4 – Eyes open spontaneously o 3 – Eyes open to verbal command o 2 – Eyes open to painful stimuli o 1 – Eyes do not open • Verbal Response: o 5 – Oriented o 4 – Confused o 3 – Inappropriate words o 2 – Incomprehensible sounds o 1 – No verbal response 2 • Motor Response: o 6 – Obeys commands o 5 – Localizes to pain o 4 – Withdraws from pain o 3 – Flexion to pain o 2 – Extension to pain o 1 – No motor response Numerator Quality-Data Coding Options for Reporting Satisfactorily: Documentation in the medical record within hour of hospital arrival of the Glasgow Coma Score (GCS) at the time of initial trauma evaluation. Performance Met: Documentation in the medical record within 1 hour of hospital arrival of the GCS at the time of initial trauma evaluation. OR Documentation in the medical record within 1 hour of hospital arrival that the Glasgow Coma Score (GCS) at the time of initial trauma evaluation was not assigned due to the risk of harm to the patient by delaying definitive care by formally assessing GCS. Medical Performance Exclusion: Eligible professional attests to documenting in the medical record that the patient did not have a GCS score assigned during their initial trauma evaluation due to risk of harm to the patient by delaying definitive care by formally assessing GCS. OR No documentation in the medical record within 1 hour of hospital arrival of the Glasgow Coma Score (GCS) at the time of initial trauma evaluation or no documentation that it was not assigned due to the risk of harm to the patient by delaying definitive care by formally assessing GCS. Performance Not Met: No documentation in the medical record within 1 hour of hospital arrival of the GCS at the time of initial trauma evaluation or no documentation of a medical performance exclusion. RATIONALE Assigning and documenting an injured patient’s GCS is an important component of the initial evaluation. The American College of Surgeons’ Advanced Trauma Life Support (ACS ATLS) Manual describes GCS as a “quick, simple method for determining the level of consciousness” in trauma patients. Assigning and documenting this baseline GCS level facilitates multi-disciplinary communication and care coordination between the multiple teams of healthcare providers participating in the care of injured patients. CLINICAL RECOMMENDATION STATEMENTS 3 • ACS ATLS Manual: Recommends that a GCS be assigned to all trauma patients as a part of the primary survey portion of their initial evaluation. It is recommended that it be assessed immediately following the assessment of the airway, breathing, and circulation of an injured patient. 4 .
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