A Dutch regional trauma registry: quality check of the registered data

Olthof, Dominique C.; Luitse, Jan S. K.; Groot, F. M. J. de; Goslings, J. Carel

doi:10.1136/bmjqs-2013-001888

Cited by 16 publications

(24 citation statements)

References 16 publications

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“…All data related to the care and diagnostics were registered by the healthcare providers themselves during the consultation. This registration of diagnosis and treatment activities in the medical record was comparable to those of other medical records that are considered to be valid and reliable (Visscher et al 2012, Olthof et al 2013.…”

Section: Validity and Reliabilitysupporting

confidence: 68%

Substitution of general practitioners by nurse practitioners in out‐of‐hours primary care: a quasi‐experimental study

Biezen¹,

Schoonhoven

Wijers³

et al. 2016

Journal of Advanced Nursing

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Aim. To provide insight into the impact of substituting general practitioners with nurse practitioners in out-of-hours services on: (1) the number of patients; and (2) general practitioners' caseload (patient characteristics, urgency levels, types of complaints). Background. General practitioners' workload during out-of-hours care is high, and the number of hours they work out-of-hours has increased, which raises concerns about maintaining quality of care. One response to these challenges is shifting care to nurse practitioners. Design. Quasi-experimental study comparing differences between and within outof-hours teams: experimental, one nurse practitioner and four general practitioners; control, five general practitioners. Methods. Data of 12,092 patients from one general practitioners cooperative were extracted from medical records between April 2011 and July 2012. Results. The number of patients was similar in the two study arms. In the experimental arm, the nurse practitioner saw on average 16Á3% of the patients and each general practitioner on average 20Á9% of the patients. General practitioners treated more older patients; higher urgency levels; and digestive, cardiovascular and neurological complaints. Nurse practitioners treated more patients with skin and respiratory complaints. Substitution did not lead to a meaningful increase of general practitioners' caseload. Conclusion. The results show that nurse practitioners can make a valuable contribution to patient care during out-of-hours. The patients managed and care provided by them is roughly the same as general practitioners. In areas with a shortage of general practitioners, administrators could consider employing nurses who are competent to independently treat patients with a broad range of complaints to offer timely care to patients with acute problems.

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Section: Validity and Reliabilitysupporting

confidence: 68%

Substitution of general practitioners by nurse practitioners in out‐of‐hours primary care: a quasi‐experimental study

Biezen¹,

Schoonhoven

Wijers³

et al. 2016

Journal of Advanced Nursing

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“…The current findings are in concordance with previously published work on variability of trauma registry data and reflect the ongoing discussion about the need for improved data accuracy [ 14 , 17 , 18 , 20 , 21 ].…”

Section: Discussionsupporting

confidence: 91%

“…In another study recoding 120 cases in the Queensland Trauma Registry, on average 39% of the codes used by any two coders for each of the injured persons were identical [ 20 ]. In the Netherlands, two independent studies demonstrated substantial accuracy on the number of AIS codes in regional trauma registries [ 17 , 18 ]. In a subgroup analysis of severely injured patients (ISS ≥ 16), however, accuracy was fair (intraclass correlation coefficient = 0.33) [ 17 ], and the authors concluded that discrepancies in injury coding are more likely to occur in this population.…”

Section: Discussionmentioning

confidence: 99%

Accuracy and reliability of injury coding in the national Dutch Trauma Registry

Twiss

Krijnen

Schipper

2021

International Journal for Quality in Health Care

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Objective Injury coding is well known for lack of completeness and accuracy. The objective of this study was to perform a nationwide assessment of accuracy and reliability on Abbreviated Injury Scale (AIS) coding by Dutch Trauma Registry (DTR) coders and to determine the effect on Injury Severity Score (ISS). Additionally, the coders’ characteristics were surveyed. Methods Three fictional trauma cases were presented to all Dutch trauma coders in a nationwide survey (response rate 69%). The coders were asked to extract and code the cases’ injuries according to the AIS manual (version 2005, update 2008). Reference standard was set by three highly experienced coders. Summary statistics were used to describe the registered AIS codes and ISS distribution. The primary outcome measures were accuracy of injury coding and inter-rater agreement on AIS codes. Secondary outcome measures were characteristics of coders: profession, work setting, experience in injury coding and training level in injury coding. Results The total number of different AIS codes used to describe 14 separate injuries in the three cases was 89. Mean accuracy per AIS code was 42.2% (range 2.4–92.7%). Mean accuracy on number of AIS codes was 23%. Overall inter-rater agreement per AIS code was 49.1% (range 2.4–92.7%). The number of assigned AIS codes varied between 0 and 18 per injury. Twenty-seven percentage of injuries were overlooked. ISS was correctly scored in 42.4%. In 31.7%, the AIS coding of the two more complex cases led to incorrect classification of the patient as ISS < 16 or ISS ≥ 16. Half (47%) of the coders had no (para)medical degree, 26% were working in level I trauma centers, 37% had less than 2 years of experience and 40% had no training in AIS coding. Conclusions Accuracy of and inter-rater agreement on AIS injury scoring by DTR coders is limited. This may in part be due to the heterogeneous backgrounds and training levels of the coders. As a result of the inconsistent coding, the number of major trauma patients in the DTR may be over- or underestimated. Conclusions based on DTR data should therefore be drawn with caution.

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“…[21] The reliability of injury coding was found to be substantial and the reliability of the ISS almost perfect. [21,22] Only severely injured patients (ISS > 15) were included in this study, because an ISS of 16 is predictive of 10% mortality and defines major trauma based on anatomic injury. [23] Within the group severely injured patients a cut-off score of 25 is used, because a rapid increase in fatalities is seen when de ISS exceeds the value of 25.…”

Section: Instrumentsmentioning

confidence: 99%

“…Serious intracranial injury (AIS>3) was present in 52% of the cases. The median ISS was 21 (interquartile range [17][18][19][20][21][22][23][24][25][26][27], and 86% of the participants had received ICU treatment. Participant characteristics are presented in table 1.…”

Section: Participants' Characteristicsmentioning

confidence: 99%

A cross-sectional study of psychological complaints and quality of life in severely injured patients

Delft-Schreurs¹,

Bergen

Sande

et al. 2013

Qual Life Res

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A Dutch regional trauma registry: quality check of the registered data

Abstract: The reliability of injury coding in a regional trauma registry was 'substantial' and the reliability of the ISS and survival status was 'almost perfect'. The format and design of this study were feasible and could be used to investigate the quality of (trauma) registries.

Cited by 16 publications

References 16 publications

Substitution of general practitioners by nurse practitioners in out‐of‐hours primary care: a quasi‐experimental study

Substitution of general practitioners by nurse practitioners in out‐of‐hours primary care: a quasi‐experimental study

Accuracy and reliability of injury coding in the national Dutch Trauma Registry

A cross-sectional study of psychological complaints and quality of life in severely injured patients

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