AttachmentJ7_DraftCIRENCodingManual.pdf

CIREN Coding Manual – Phase Four RFP Draft Version 1

Crash Injury Research and Engineering Network

Process and Coding Manual

RFP Draft Version for CIREN Phase Four April, 2016

CIREN Coding Manual – Phase Four RFP Draft Version 2

Contents

Contents 2 Introduction 5 Purpose 5 Process 5 Target Schedule 6

CIREN CASE Form [Medical Center] 8 Overview 8 Case Tab 9 Demographics Tab 13 Admissions Tab 17 Injury Analysis Tab 23 Events Tab 25 Crash Summary Tab 29 Vehicle Tab 31 Scene Tab 32 Cause of Death Tab 34

Comorbidity [Medical Center] 35 Overview 35 Summary Tab 35 Detail Tab 36

Complications [Medical Center] 39 Overview 39 Summary Tab 39 Detail Tab 40

Clothing [Medical Center] 53 Overview 53 Clothing 53

Anthropomorphic Measurements [Medical Center] 55 Overview 55

Vital Signs [Medical Center] 57 Overview 57 Summary Tab 57 Detail Tab 58

Charges [Medical Center] 60 Overview 60 Admissions Tab 60 Summary Tab 61 Detail Tab 62

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Laboratory Results [Medical Center] 64 Overview 64 ABG Test 64 Summary Tab 64 Detail Tab 65 Other Test 67 Summary Tab 67 Detail Tab 68

Ventilation [Medical Center] 69 Overview 69 Summary Tab 70 Detail Tab 71

GCS Measurements [Medical Center] 73 Overview 73 Summary Tab 74 Detail Tab 75

Invasive Procedures [Medical Center] 78 Overview 78 Operations Tab 79 Procedure Tab 81

Radiological Tests [Medical Center] 83 Overview 83 Summary Tab 84 Detail Tab 86

Emergency Medical Services (EMS) [Medical Center] 88 Overview 88 Vehicles Tab 89 Vital Signs Tab 90

CIREN Crash Investigation [Medical Center] 91 Coding/Investigation Rules: 91

CIREN Injury Coding [Medical Center and Engineering Center] 99 Overview 99 Summary Tab 100 Codes Tab [Medical Center] 102 Biomechanics Tab [Engineering Center] 105 BioTab Coding Procedure [Engineering Center] 106 BioTab Summary [Engineering Center] 114 Injury Causation Scenario (ICS) [Engineering Center] 115 Involved Physical Component (IPC) [Engineering Center] 118 Regional Mechanism [Engineering Center] 121 BioTab Lite [Engineering Center] 137 Radiology Tab [Engineering Center] 138 Invasive Procedures Tab [Medical Center] 140 Images Tab [Medical Center] 142 Note Tab [Medical Center] 143

Sanitization [Medical Center] 144

CIREN Coding Manual – Phase Four RFP Draft Version 4

Overview 144 Discrete Identifiers 144 Visual Identifiers 144

CIREN Team Review Process and Web Meeting Case Review [Medical Center and Engineering Center] 145

Overview 145 Requirements 145

Quality Control [Medical Center and Engineering Center] 151 Overview 151

Abbreviations 152

CIREN Coding Manual – Phase Four RFP Draft Version 5

Introduction Purpose

This draft process and coding manual is an adaptation of the previously-used CIREN coding manual, and is only to be used as a guide for the preparation of proposals for CIREN Phase Four. The data elements described in this document and in the National Automotive Sampling System – Crashworthiness Data System 2014 Coding and Editing Manual are a representation of the type and extent of data collection for CIREN Phase Four, and should not be considered the actual process documents to be used in the conduct of actual Task Orders.

The CIREN-specific variables described in this manual are presented in a format consistent with the legacy electronic data entry software. The electronic data system to be used in CIREN Phase Four may differ from that presented in this manual. The intent of this manual is to show the scope and nature of the patient medical and injury data collected in CIREN and the general process of case completion and interaction among CIREN program participants.

Process The CIREN process involves data collection, analysis, and review by multiple entities as depicted in Figure 1. A CIREN Medical Center screens trauma center admissions and enrolls eligible subjects. The enrolling CIREN Medical Center then collects medical and crash data and prepares for the collaborative case review session. A CIREN Engineering Center reviews injury and crash data and establishes injury causation scenarios that are presented and discussed at the case review session. Case data are then prepared for review by a third-party quality control entity, which documents coding errors checks for conformance with data requirements. The CIREN Medical Center and Engineering Center then make required repairs prior to cases being approved by NHTSA for public release.

CIREN Coding Manual – Phase Four RFP Draft Version 6

Figure 1: CIREN process flow diagram (Medical Center functions shaded gray, Engineering Center functions shaded black, functions of NHTSA and other entities shaded white)

Target Schedule Many factors may affect the CIREN case completion schedule, though the general target is to complete cases within six months after the crash date. Case completion is achieved once repairs are made following the third-party quality control review.

• Within eight weeks of the crash date, the CIREN Medical Center shall collect and enter the required vehicle and scene data into the CIREN data system.

• Within eight weeks of the case occupant’s discharge date from the enrolling center, the CIREN Medical Center shall collect and enter the required medical documentation, including radiology and a complete injury list, into the CIREN data system.

• A CIREN Medical Center shall schedule case review sessions, in collaboration with NHTSA and the assigned CIREN Engineering Center, to occur no later than sixteen weeks after the crash date. The case review session cannot occur earlier than ten weeks after the case occupant’s discharge date from the enrolling center. Case review dates must be scheduled such that the assigned Engineering Center has no

CIREN Coding Manual – Phase Four RFP Draft Version 7 less than two weeks after the Medical Center data are entered to establish injury causation scenarios and prepare case review materials.

In cases of extended hospital stays, the CIREN Medical Center shall consult with NHTSA regarding scheduling of case reviews to ensure adequate review time by the assigned Engineering Center.

• Following the case review session, the CIREN Medical Center shall make any required revisions to crash, scene, and medical data identified in the case review session within two weeks of the case review session date (achieves IN REVIEW status – no later than eighteen weeks after the crash date).

• Following the case review session, the CIREN Engineering Center shall finalize the injury causation scenarios and enter the causation data into the CIREN data system within two weeks of the case review session date (achieves IN REVIEW status – no later than eighteen weeks after the crash date).

• The third-party quality control contractor returns the case with comments for required and suggested changes (achieves QC COMPLETE status) within four weeks of a case being marked IN REVIEW (no later than twenty-two weeks after the crash date).

• The CIREN Medical Center shall complete repairs (achieve COMPLETE status) based on the quality control feedback within two weeks of the case achieving QC COMPLETE status.

• The CIREN Engineering Center shall complete repairs (achieve BIO COMPLETE status) based on the quality control feedback within four weeks of the case of achieving QC COMPLETE status.

CIREN Coding Manual – Phase Four RFP Draft Version 8

CIREN CASE Form [Medical Center] Overview

The CIREN CASE form is the main “entrance” window to a case. The window contains the case number and summary information. The window consists of the tabs:

• Case

Contains the case number, crash date and study criteria.

• Demographics

Lists the demographic information for the patient.

• Admissions

Lists the Admissions, Discharges, and Discharge summary for the patient.

• Injury Analysis

Typed analysis of injuries and causation for patient.

• Events

Summarizes and Details the event sequence during the crash.

• Crash Summary

Typed summary of events of the crash.

• Vehicle

Lists the vehicles involved in the crash.

• Scene

A graphical representation of the scene of the crash.

• Cause of Death

Lists the causes of death for the patient.

• Component Notes

Contains the list of annotations in a case and provides the table/column name annotated.

• Completeness

Supplies a checklist for each feature of the Medical and Crash submenu.

Required: All tabs are required

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Case Tab

Variable Pick List Description / Guidelines CIREN Case # Site Specific Site assigned number to identify one unique CIREN case… - Note:

One CIREN case equals one patient

Required

Center Number

N/A Number identifier assigned to enrolling site

Not Required RETIRED

Center Text name of enrolling site Crash Date Date of crash

Note: This date is sanitized to the first of the month in the archived dataset.

Required – Self generated from entry into NASSMAIN. Use the PAR, EMS documentation or case occupant interview.

Crash Time Time of crash

Required - If UNKNOWN enter 99:99 - – Self generated from entry into NASSMAIN. Use the PAR, EMS documentation or case occupant interview as source. Use best judgment when documented time is in error. UNKNOWN RARE IF PAR IS OBVIOUSLY WRONG, USE

ANOTHER CREDIBLE SOURCE FOR CRASH TIME.

Date Opened

Date case is opened in CIREN DB – Automated by system This date should occur on or before 7 days post primary admission to a CIREN center. If a case is opened then it is decided the case is not to continue, purge the case via VOLPE.

CRASH Status Current status of NASS data element Required – Self generated from entry into NASSMAIN

Fatality Not Fatal

This field could require updating during the CIREN data cycle.

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Fatal

Fatal – ruled disease (specify)

During case review code the fatality status of the case occupant documented at that point in time. During the course of follow-up, if the fatality status changes then re-coding of this field is required.

EXAMPLE: If an adult case occupant is discharged to a rehabilitation center, but dies 2 weeks after their crash from complications related to their injuries the following would result – At the discharge and the site review of the case the occupant would be classified as “NOT FATAL”. During follow-up for the SF-36 your site learns of the death – then the case is re-opened and the fatality status is re-coded “FATAL” and the “Cause Of Death” tab is completed.

If it is determined by the medical investigator that this fatality was directly caused by injury resulting from the crash, then the field should be coded

“FATAL”.

If it is determined by the medical investigator that the case occupant expired secondary to complication(s) directly resulting from injury or injuries suffered in the accident within 30 days of the crash date, the field should be coded “FATAL”.

If it is determined by the medical investigator that the case occupant expired secondary to factors not related to the injuries originally suffered or to complications related to the injuries greater than 30 days post crash then the field should be coded “FATAL – RULED DISEASE (SPECIFY)”. Use the specify option and “Cause Of Death” tab to detail the cause.

Case occupants that do not expire are coded as “NOT FATAL”.

NASS 30-day fatality rule shall be utilized

ALL FATAL and FATAL – RULED DISEASE occupants must have the “CAUSE OF DEATH TAB” completed.

Required – Use PAR, EMS, autopsy report, hospital documentation and interview as source.

Location AT CRASH SITE

EMS VEHICLE

EMERGENCY

DEPARTMENT

FLOOR

INTENSIVE CARE

UNIT

INTERMEDIATE CARE

UNIT

OPERATING ROOM

OTHER (Specify)

OTHER HOSPITAL

PRE-HOSPITAL, NOT

SPECIFIED

RADIOLOGY

RESUS. ROOM – not in

ED

UNKNOWN

DEAD ON SCENE

Location of death - If Fatality = “Not Fatal”, then Location = “Not Fatal”. This will automatically populate once the original designation is made.

Otherwise, Location is a list of locations excluding “Not Fatal”.

Required - Use PAR, EMS, hospital documentation and interviews as source.

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(DOS)

*Patient Name

Name of patient – site only

Not Required

*Date of Birth

Birth date of case occupant

Required – Use PAR, EMS or hospital documentation as source.

Case Status See Below Current status of CIREN case (see below) Criteria Inclusion criteria met by case – ONLY 1 can be selected.

Select the PRIMARY inclusion reason.

If the case is a PI Special Interest – then that Criteria must be selected.

Required

NASS Crash Case #

NASS crash case # this CIREN case is linked to.

Required – Self generated from entry into NASSMAIN.

Consent Obtained

Was an IRB approved consent obtained? If patient is expired with consent waived by local jurisdiction, then complete.

Required

Photo Released

Indicates if photograph was sanitized and released – complete on all cases

Required

ISS Injury Severity Score – Calculated by the system.

If any injury is AIS coded with a severity level of 7 then ISS will be

UNKNOWN

MAIS Maximum AIS severity score – Automatically completed by the system after AIS injury coding is entered

CIREN ID Case specific identifier generated by the system NASS ID Case specific identifier generated by the system Total ICU Days

Manual count of total days during the primary admission that the case occupant was on a critical care or ICU unit (and/or) receiving ICU level of care (O.R. resuscitation). Documentation of any amount of time the case occupant is housed on a qualifying unit* for medical support during a 24-hour cycle will be counted as 1 complete calendar day. See VENTILATION TAB for detail capture of the initial event.

* - Any unit that has the capability/resource to maintain on-going care for a patient on mechanical ventilation support is classified as an ICU in CIREN even if the occupant is not vented.

Required –Use hospital documentation as source.

Total Ventilation Days

Manual count of the total number of days the case occupant received mechanical respiratory support (ventilator) for the primary admission.

Duration of time of any length with ventilator support for the case occupant will be recorded as 1 complete day. Only record mechanical vent support (tracheostomy, oral tracheal tube, naso-tracheal tube or cricothyroidotomy) SEE VENTILATION TAB for detail of initial ventilation support.

NOTE: - By definition ventilation days must always be equal to or less than Total ICU days.

Required - Use hospital documentation as source.

* - Sanitized Variables

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CIREN Case Status Definitions:

PENDING – The case is applicable to CIREN and has been opened in the database – but consent has not been obtained. This status should be used rarely. This status should not be queried for research.

OPEN – The case is in the data collection process at an enrolling CIREN Medical Center and consent has been obtained. This status should not be queried for research.

BIO OPEN – The case is in the injury biomechanics coding process at a CIREN Engineering Center. This status should not be queried for research.

IN REVIEW – The case has undergone collaborative review with crash, occupant, and injury causation data completed. The case has been subjected to internal quality control at the enrolling Medical Center and assigned Engineering Center – the internal QC process shall verify completion of all relevant fields, adherence with coding guidelines, internal consistency, and grammatical and editorial quality of the narrative descriptions.

This status should be coded for cases waiting to be sent to the third-party quality control contractor. This status is acceptable for research queries, though case coding may not be final. It is expected that CIREN cases will be marked “IN REVIEW” by the enrolling CIREN center generally within 18 weeks after the crash date. The CIREN Medical Center or CIREN Engineering Center shall notify NHTSA when this goal cannot be met.

QC REVIEW – The case is currently being reviewed by the third-party quality control contractor. This status is acceptable for research queries, though case coding may not be final.

QC COMPLETE – The case has been reviewed by the third-party quality control contractor and includes documentation of findings for Medical Center and Engineering Center corrective action. The CIREN Medical Center and Engineering Center are now responsible for correcting any errors and reporting their findings prior to marking the case COMPLETE. This status is acceptable for research queries, though case coding may not be final.

QC INCOMPLETE – This status is assigned only by the third-party quality control contractor. The case fails to meet IN REVIEW case completion requirements and/or contains fundamental errors. This case has undergone little or no quality control by the third-party contractor and must be returned to the Medical Center or Engineering Center responsible for its completion. The Medical Center and Engineering Center must work together to address the shortcomings in the case and expedite its return to IN REVIEW status. This status should not be queried for research.

COMPLETE – The CIREN Medical Center has addressed the QC findings on the crash and occupant content and has documented its actions. This status is acceptable for research queries, though injury causation coding may not be final.

BIO COMPLETE – The CIREN Engineering Center has addressed the QC findings on the injury causation content and has documented its actions. This case is acceptable for research queries. It is expected that CIREN cases will be marked “BIO COMPLETE” by the CIREN Engineering Center generally within 26 weeks after the crash date.

RESTRICTED – The case is restricted from publication to the Internet case viewer and data tables. This status should be applied after achieving BIO COMPLETE status if the enrolling CIREN Medical Center or NHTSA determines a case to be ineligible for public release. This case is acceptable for research queries.

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Demographics Tab

*SEE EDIT RULES BELOW

DATE OF BIRTH N/A Will roll from previous input

Required

AGE N/A Automatically calculated – Children under 1 year of age are recorded in months

Required

SEX Male Female – not reported pregnant Female – pregnant – 1st trimester (1st-3rd month) Female – pregnant – 2nd trimester (4th-6th month) Female – pregnant – 3rd trimester (7th-9th month) Unknown

Gender of case occupant

If female and pregnant, then CoMorbidity Tab coding required

Required – Use PAR, EMS hospital documentation or interview as source.

RACE

(ROLL-UP)

White Black or African American Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Other (specify):

[No driver present] Unknown

Required – See REMARKS below.

Entered in NASSMAIN

ETHNICITY

(ROLL-UP)

Hispanic or Latino Not Hispanic or Latino [No driver present] Unknown

Entered in NASSMAIN

LEVEL OF

EDUCATION

Preschool K thru 4 5 thru 8

Number of education years completed by the case occupant.

CIREN Coding Manual 14

9 thru 12 HS or GED Vocational Training Some College College Degree Post Graduate Training No Schooling Other – specify:

Required – Use hospital documentation or interview as source.

ALCOHOL

CONSUMPTION

Don’t Drink Occasional, Not > 3 Drinks/Month Moderate, Not > 3 Drinks 4 Days/Month Heavy, Not > 5 Drinks 4 Days/Month Problem, > 5 Drinks 4 Days/Month Unknown

Amount of alcohol consumed by occupant on average per month.

Required – Use hospital documentation or interview as source.

SMOKING

HABITS

Don’t Smoke 1 Pack Per Day More Than 1 Pack Per Day Unknown

Number of packs of cigarettes consumed by occupant on average per day

Required - Use hospital documentation or

MARITAL

STATUS

Currently Married (Including Common Law) Living Together Currently Married (Including Common Law) Not Living Together Never Married Widowed and Not Remarried Divorced and Not Remarried Separated Unknown

Marital status of the occupant at the time of the crash

LIVING

ARRANGEMENTS

Alone With Spouse or Unrelated Partner With Children With Parent or Guardian With Relatives, Other Than Spouse, Children or Parents With Non-relatives Unknown

Living arrangement of the occupant at the time of the crash

INDUSTRY Pick list is too extensive for this forum – please refer to the CIREN system or data dictionary.

Industry under which the occupant’s vocation/occupation falls

OCCUPATION Pick list is too extensive for this forum – please refer to the CIREN system or data dictionary.

Means by which the occupant earns a living

Required - Use hospital documentation or interview as source.

HOUSEHOLD

INCOME

* Increments in U.S dollars Per-annual total household income of case occupant

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EDIT RULES:

Child <12 yrs old

- marital = never married

- alcohol = don’t drink

- smoking = don’t smoke

- industry = student

- occupation = student

Child <3 yrs old

- industry = not applicable

- occupation = not applicable

Child <30 months (2.5 yrs)

-level of education – no schooling

Remarks:

Note: This variable is a “self-identification” by the occupant. This information can be obtained from any of the above sources, however is not always an “official record”. When using secondary sources, the ethnicity must be specifically mentioned in the document.

The concept of race as used by the U.S. Census Bureau reflects self-identification; it does not denote any clear-cut scientific definition of biological stock. Self-identification represents self-classification by people according to the race with which they identify themselves. For drivers with parents of different races who cannot provide a single response, use the race of the driver's mother; however, if a single response cannot be provided for the driver's mother, the first race reported by the driver is encoded.

Hispanic is not a race but rather an ethnic origin. Persons of Spanish origin may be of any race. For the purpose of this variable, race and Hispanic origin have been combined using the elements listed above.

Prioritization of data sources:

First, use interviewee data. Ask the interviewee what the driver considers their race and ethnic origin to be. If the response does not clearly fit into one of the race and ethnic origin categories, then use the information provided by the interviewee concerning the driver's nationality/ethnic origin to select the correct element value.

Second, use the PAR. If race is given on the PAR and the PAR scheme is compatible with this variable, then use the PAR information.

In addition, the driver's name is not a reliable indicator of race and cannot be used when selecting the applicable element value for this variable.

Third, use official records (e.g., medical). If the data needed cannot be obtained from the interviewee and is not available or usable from the PAR, then use official records, if available, to determine the correct element attribute.

White is selected for drivers who consider themselves a person having origins in any of the original peoples of Europe, the Middle East or North Africa.

Black or African American is for drivers who consider themselves a person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American."

Asian is selected for drivers who consider themselves a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Native Hawaiian or Other Pacific Islander is selected for drivers who consider themselves a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

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American Indian or Alaska Native is selected for drivers who consider themselves a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

Other is selected for drivers who consider themselves to be of a race not described above. Use this attribute for descriptions such as: Eurasian, Cosmopolitan, inter-racial, etc.

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Admissions Tab

Hospital admission will only use one row of data entry per admission. Multiple admissions for an occupant (more than one row entered) will only be coded if any of the following scenarios occur-

1. The case occupant is initially admitted to an outside medical facility (not part of your CIREN center) then subsequently transferred to your CIREN center.

2. The case occupant is admitted to your CIREN center treated and discharged. The case occupant is then admitted to a rehab or other medical facility that is associated with your CIREN center enabling your team to continue follow-up data collection on the case occupant.

3. The case occupant is admitted to your CIREN center treated and discharged. The case occupant is re-admitted to the same CIREN center for follow-up surgery or complication.

Case occupants who expire prior to significant medical intervention (Dead On Scene) require special coding procedures (see Detail Tab below).

CIREN records hospital days on a calendar basis. Example- If a CIREN occupant is admitted at 11:50 PM and then expires the following day at 6:00AM the total number of hospital days would equal two.

Summary SubTab:

Type Column Code for the type of transfer.

(H = Hospital, S = Service) Use “H” only

Facility Column Lists facilities to which the patient was admitted prior to and including admission to the trauma center, as well as during recovery

Admission Date Column Date Patient was admitted to facility

Time Column Time at which patient was admitted to facility

Admission Location Location where patient was admitted

Discharge Date Column Date Patient was discharged from facility

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Disposition Column Disposition of patient at discharge

Required: At least one admission and one discharge referral per case.

Detail SubTab:

Case occupants that have expired prior to the arrival or upon arrival of first responders – code the following: For Dead On Scene: code the date of death as Admission Date (usually the crash date) and code 99:99 for Admission Time (unless an actual time is documented by the medical examiner). Now code “DOS” for Location - then code ”Scene” for Transferred From – then code “DOS” for Discharge Location and finally code “Death” for Disposition

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HOSPITAL

NAME

CIREN Center, Other Hospital

Center specific list of hospitals and institutions related to that site for occupant transport and treatment (prior to 6/1/10).

Admissions from other hospitals do not require specific location data – “Other Hospital” will be coded for location fields (admit/discharge).

ADMISSION

DATE

N/A Date of admission for the occupant’s currently coded hospital admission (admitted to the building).

Required for each admission recorded – Use hospital documentation as source.

For Dead On Scene (DOS) record date of crash

INCLUDES RE-ADMISSIONS FOR SURGERY RELATED

TO INITIAL INJURY/COMPLICATION – EVEN IF AS

OUTPATIENT ALSO REFER TO PROCEDURE TABS

ADMISSION

TIME

N/A Time of admission for the occupant’s current coded hospital admission. If admission time is not unique at a site – use the estimated time that medical care is transferred from the EMS to the hospital staff.

Required for each date of admission entered – Use EMS and/or hospital documentation as source.

If UNKNOWN then enter 99:99 For Dead On Scene enter 99:99

ADMISSION

LOCATION

Not Available or None DOS (Dead On Scene) Resus. Room - not in ED Other Hospital EMS Vehicle At Crash Site Emergency Department Operating Room Radiology Intensive Care Unit Intermediate Care Unit Floor Unknown Pre-Hospital, not specified Other (specify)

Initial location in the hospital where the patient is admitted and evaluated when transferred from the scene. If the patient is a transfer from an outside hospital then enter “Other Hospital”.

Required for each admission date entered – Use hospital documentation as source.

TRANSFERRED

FROM

Pick list is constructed at each center and is unique to that center

Name or description of hospital that the occupant was transferred from Not Required

DISCHARGE

DATE

N/A Date of discharge from the hospital currently being coded Required for each admission date entered – Use hospital documentation as source.

DISCHARGE

TIME

N/A Time of discharge from hospital currently being coded. If UNKNOWN enter 99:99 Required for each admission date entered – Use hospital

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DISCHARGE

LOCATION

Not Available or None DOS (Dead On Scene) Resus. Room - not in ED Other Hospital EMS Vehicle At Crash Site Emergency Department Operating Room Radiology Intensive Care Unit Intermediate Care Unit Floor Unknown Pre-Hospital, not specified Other (specify) Not Fatal

Location, section or department from which the occupant was discharged from, in relation to the current hospital stay being coded

For Dead On Scene – enter DOS

Required for each admission date entered – Use hospital documentation as source.

DISPOSITION Home Trauma Center Rehabilitation Facility Discharged SNF (Extended Care Facility) Death Death (DOA) Home Health Hospital Transfer (not trauma or peds) Unable to Complete Treatment /

AMA

Nursing Home Burn Center Pediatric Center Jail Other Foster Care Psychological Unit Not Documented

Location or status of the occupant upon discharge from the current admission data being coded

Required for each admission date entered – Use hospital documentation as source.

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ALL injuries will be ICD-CM coded to the maximum level. Entry of ICD-CM codes into the Discharge Dx Sub-Tab is optional. All ICD-CM codes must be coded and entered into the INJURY TAB (See Injury Form).

Discharge Dx SubTab:

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CIREN Summary:

This tab can be used for several purposes related to the data capture of each CIREN case.

The primary role of this tab is for the capture of the dictated hospital discharge summary. This may be scanned, sanitized and entered or possibly cut, pasted and sanitized if the facility has such online documentation capabilities.

This tab may also be used to communicate additional information to quality control or NHTSA concerning the course of the case.

If this tab is used for multiple purposes each distinct text field should be appropriately titled for usability. The following headings can be used to diversify the areas under the Discharge Summary Tab:

• Discharge Summary Primary:

This heading should be used to identify the discharge summary for the hospital course related to the initial CIREN center admission after the crash

• Discharge Summary Secondary:

This heading should be used to identify the discharge summary for any follow-up admissions that are documented at the CIREN center for the case occupant (readmissions for follow-up surgery or complications). This should be done in conjunction with coding an additional admission on the Admissions Tab.

• Outcome Results: This section is mandatory when describing the reasons for not being able to capture outcome data on a CIREN occupant that was not fatal (i.e. Severe brain injury, unable to locate at last known address, etc.)

• QC Alert: Use this section to notify QC about any issues or conflicts that may arise during the QC process.

• Additional Information: This would be a “catch all” for any relevant information that cannot be coded anywhere else in the CIREN database.

** This tab will only appear if a Hospital Admission is selected on the Summary tab.

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Injury Analysis Tab

The Injury Analysis (IA) should provide the reader with a summary of the CIREN teams’ account of how the occupant sustained his/her injuries. The narrative should include relevant occupant kinematics, intrusions, contact points, and injury sources in a format and language, which can be understood by the general public.

Simultaneously, the narrative should provide sufficient technical information to be beneficial to the crash research community.

The information contained in the IA should be presented in a consistent method across all CIREN Centers. The information in the IA should be consistent with (and build on) data found in the Crash Summary. No personal identifiers or Tier 2 data (unique medical information or combinations of data) should be provided in the IA.

FORMAT:

The following format should be maintained for all cases in CIREN. Although a few cases may require slight alterations, this format should be followed on a regular basis.

Section 1

• Case occupant age, gender, height, weight and seating position (HT and WT format as metric with English in parenthesis)

• Vehicle body type, model year, make, model

• Crash damage severity, general crash type and impact direction via o’clock method

• Restraint system, use / misuse

• Air bag availability (if relevant to crash type) and all deployments

• Fatality status (if fatal)

• Other occupants in the case may be detailed if injury causation of the case occupant is related or if the other occupant is fatal (see data elements table)

Section 2

• Occupant posture / out-of-position (if relevant)

• Hand and Foot positions (if relevant)

• Vehicle seat position on track (if relevant)

• Avoidance maneuvers (if relevant)

• Injury description for all AIS 2+ injuries (AIS 1 as needed)

• Kinematics

• Injuries

• Contact Points with Coded Confidence Levels (if relevant)

EXAMPLE:

This case involves a 25 year old male driver 173 cms (68 inches) tall and weighing 68 kilograms (150 pounds). The case occupant was driving a 2005 four door Dodge Neon involved in a moderate severity frontal crash with a 2003 two door Ford Mustang. The principal direction of force was 12 o’clock. The case occupant was properly restrained with a 3-point manual belt and had a steering wheel mounted air bag available to him, which deployed as a result of the crash.

On impact the case occupant moved forward in relationship to the vehicle contacting the deploying air bag as evidenced by his nasal abrasion and the scuff contact evidence on the airbag. The case occupant also contacted the right side of the knee bolster with his right knee as evidenced by his right knee hematoma and the deformed knee bolster. The knee contact with knee bolster resulted in a right acetabular fracture and right posterior hip dislocation. All three injury causations and contacts were coded with a confidence level of certain.

**This is public data and no personal identifiers, or live dates/times may be used**.

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CHILD SAFETY SEAT DETAIL STANDARDS FOR THE IA

The following should be included in the IA when describing child restraint systems utilized by the case occupant.

• Type of Child Restraint o If the infant car seat was designed with a detachable base, indicate whether base was used at the time of the crash. If the infant car seat was not designed with a detachable base describe as such.

• For convertible seats indicate whether the seat was installed FF or RF

• For FF seats, were harness straps in top slots? If not, indicate in analysis.

Combination Seats

• Indicate whether seat was used as a FFCSS using the 5-point harness or whether it was used as a belt positioning booster seat

Booster Seats:

• High-back Belt-positioning Booster Seat

• Backless Belt-positioning seat

• Make note of any seat belt misuses (i.e. shoulder belt behind back)

Belt System Used with CRS:

• 3-point manual lap and shoulder belt with switchable retractor o Note whether retractor was in ELR mode, ALR mode, or unknown.

• 3-point manual lap and shoulder belt with ELR retractor only o Requires a locking clip – note whether locking clip was used

• 3-point manual lap and shoulder belt with lightweight cinching latch plate o Locking clip usually not needed, but still note if one was used.

• 2-point ALR lap belt

• 2-point lap belt with heavy duty latch plate

*Always make note of after-market products attached to the seat belt (i.e., a device like the “Mighty Tight”)

Installation:

• Note if the seat belt was not routed through the proper belt path

• Note if the child seat was unanchored

• Note if the child restraint was modified in any way

• Note if the child was not restrained by the harness or shield

• Note if the LATCH system was used

• Note if the seat was tethered

This case involves a 3 year old male occupant 71 cms (26 inches) tall and weighing 11 kilograms (25 pounds). The case occupant was the center rear passenger in a 2009 four door Honda Accord involved in a severe offset frontal crash with a 2005 Nissan Altima. The PDOF for the case vehicle was 11 o’clock.

The case occupant was restrained in a convertible child safety seat with a 5 point harness. The safety seat was anchored to the vehicle by the 3-point manual lap and shoulder belt with an emergency locking retractor in a forward facing orientation. No locking clip was used. In addition, the harness straps were incorrectly threaded through the middle slots.

Strain and tearing was noted in the plastic shell at the harness slots due to occupant loading.

The occupant moved forward and left sustaining a frontal skull fracture due to contact with the rear side of the driver’s seat. The injury causation and contacts were coded as probable.

CIREN Coding Manual 25

Events Tab

The Events Tab lists all the events associated with the crash. The Summary Tab will list all the events and the Detail Tab allows for a more descriptive view of each event.

Data are automatically populated from NASSMAIN upon linking the CIREN case to the NASS case.

This tab is Read Only.

Reference: NASS-CDS 2014 Coding and Editing Manual

Summary Sub-Tab

Event # Column Sequential number assigned to an individual event in the crash

Vehicle # Column Number identifying the vehicle involved in this event

Area of Damage Column Area to which vehicle sustained damage

Contacted Column Entity the vehicle contacted in this event

Class Column If another vehicle was struck in this event, the class of that vehicle

Area of Damage Column If another vehicle was struck in this event, the area to which that vehicle sustained damage

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Detail Sub-Tab

Event No. N/A Sequential number assigned to an individual event in the crash sequence Total Events N/A Total Number of events in this crash sequence Vehicle # N/A Number identifying the vehicle involved in this event. The CIREN case vehicle is always number 1.

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Vehicle Class Subcompact/mini (wheelbase < 254 cm)

Compact (wheelbase > 254 but < 265 cm) Intermediate (wheelbase > 265 but < 278 cm) Full size (wheelbase > 278 but < 291 cm) Largest (wheelbase - 291 cm) Unknown passenger car size Compact utility vehicle Large utility vehicle (< 4,536 kgs GVWR) Utility station wagon (< 4,536 kgs GVWR) Unknown utility type Minivan (< 4,536 kgs GVWR) Large van (< 4,536 kgs GVWR) Van based school bus (< 4,536 kgs GVWR) Other van type (< 4,536 kgs GVWR) Unknown van type (< 4,536 kgs GVWR) Compact pickup truck (< 4,536 kgs GVWR) Large pickup truck (< 4,536 kgs GVWR) Other pickup truck (< 4,536 kgs GVWR) Unknown pickup truck type (< 4,536 kgs

GVWR)

Other light truck (< 4,536 kgs GVWR) Unknown light truck type (< 4,536 kgs

GVWR)

Unknown light vehicle type School bus (excludes van based) (> 4,536 kgs

GVWR)

Other bus (> 4,536 kgs GVWR) Unknown bus type Truck (> 4,536 kgs GVWR) Tractor without trailer Tractor - trailer(s) Unknown medium/heavy truck type Unknown light/medium/heavy truck type Motored cycle Other vehicle Unknown Not a motor vehicle

Class of this vehicle

GAD – General Area of Damage

Noncollision Unknown Front Right side Left side Back Top Undercarriage

Area in which this vehicle sustained damage

STRUCK OBJECT

Object Category Noncollision

Collision With Fixed Object Nonbreakaway Pole or Post Collision with Nonfixed Object Vehicle UNK Event or Object Other Event (specify)

Category of object struck in this event

Vehicle Class **SEE ABOVE** If another vehicle was struck in this event, the class of that vehicle

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GAD – General Area of Damage

Noncollision Unknown Front Right side Left side Back Top Undercarriage

If another vehicle was struck in this event, the area to which that vehicle sustained damage

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Crash Summary Tab

Through the summary, the researcher is able to provide an end-user a quick reference of crash particulars by providing a non-jargon account of the crash. The summary should provide a brief synopsis of the crash sequence as reconstructed by the researcher. Do not identify vehicle/driver culpability.

For example, suppose vehicle #1 ran a stop sign and struck vehicle #2 in its left side. This situation should be described as follows:

Vehicle #1 was going north and vehicle # 2 was going east on an intersecting roadway. The front of vehicle #1 impacted the right side of vehicle #2.

Thus, the impact configuration is emphasized rather than who was at fault. Any particulars concerning vehicle crashworthiness should be highlighted. Include any abnormal crash occurrences that may be of interest to quality control or the data user. Make sure personal identifiers are not used (i.e highway/road/street names or names of persons). Items that are listed on the vehicle and person summary screens should not be included unless unusual circumstances are involved.

FORMAT:

The following format shall be maintained for all cases in CIREN. Although a few cases may require slight alterations this format should be followed on a regular basis.

Section 1

Occupant and Crash Summary This summary should be one or two sentences and provide a quick synopsis of the crash and occupant information. This is for quick reference purposes only.

Mandatory Generic crash type (frontal/nearside/farside/rollover/rear impact/multiple event) Gender of case occupant Age of case occupant Restraint Use (restrained/unrestrained/air bag deployed) Injury severity (AIS verbiage – minor/moderate/serious/severe/critical/fatal)

Section 2

Vehicle and Environment Pre-crash Mandatory

Case Vehicle (CV) and Other Vehicle (OV) make, model, year and body type CV and OV pre-crash travel directions Lighting and weather conditions Roadway description for CV and OV (if different) CV and OV pre-crash dynamics Traffic controls and Intersection status

Optional

• Posted speed

Section 3 Vehicle and Environment Crash/Post-crash Mandatory

CV and OV crash dynamics with final rest detail

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CV and OV damage planes CV and OV tow status

Section 4

Occupant(s) Mandatory

Case Occupant (CO) and Other Case Vehicle Occupant (OCVO) o Age o Gender o Seating position (driver/front right passenger/row 3 center) o Belt restraint type and status o Air bag availability and deployment status

CO and OCVO injury severity status o Minor (MAIS 1) o Moderate (MAIS 2) o Serious (MAIS 3) o Severe (MAIS 4) o Critical (MAIS 5) o Fatal o Unknown

CO and OCVO transport mode/status

Optional (placed in appropriate section to relate to crash dynamics) Seat track position Driver distraction Avoidance maneuvers Pre-impact posture or out of position status

*Information or facts must be consistent with NASS/CIREN

This frontal crash case involves a 25 year old restrained male with deployed air bag who sustained serious injury.

The crash occurred during daylight hours in dry and clear weather. The collision occurred on a two lane bituminous rural roadway basically straight in origin and without any intersection or traffic control device involvement. The roadway is level and divided by a solid double line. The case vehicle (V1) a 2005 four-door Dodge Neon was being driven northbound and vehicle two (V2) a 2003 two door Ford Mustang was being driven southbound.

The crash occurred when V2, for unknown reasons, crossed over directly into the path of V1 resulting in a full frontal crash configuration for both vehicles. Both vehicles rotated counterclockwise with V1 coming to rest partially in the northbound lane and off the shoulder of the road and V2 coming to rest in the middle of the roadway. Both vehicles were towed from the scene due to damage

V1 was driven by the 25 year old male case occupant who was restrained by the available 3-point manual belt. The available steering wheel mounted air bag deployed as a result of the impact. The case occupant was seriously injured and transported to a CIREN center by a combination of ground ambulance and helicopter.

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Vehicle Tab

The Vehicle Tab contains coded data on all the vehicles directly involved in the crash. Other vehicles may be located in the area, but unless they have a direct involvement with the case vehicle these other vehicles do not need to be coded.

The CIREN case vehicle should always be vehicle number 1.

Data is automatically populated from NASSMAIN upon linking the CIREN case to the NASS case.

Reference: NASS-CDS 2014 Coding and Editing Manual

Vehicle # N/A Identifying number of this vehicle Model Year N/A Year this vehicle was manufactured Make List is too extensive for this format

Manufacturer of this vehicle

Model List is too extensive for this format

Model of this vehicle

Damage Plane Front Left Right Back Top Undercarriage Unknown

One of 6 planes on which the damage occurred.

The research team must determine the most severe impact and choose the associated damage plane.

All efforts should be made to determine the plane of damage. The vehicle inspection, occupant interview, police report, tow operator, damage to other vehicles or objects should be considered.

If there is absolutely no information available, then “Unknown” may be used.

However, it should rarely be selected.

Severity Light Moderate Severe Unknown

Rating of severity assigned to the damage sustained by this vehicle The research team must determine the damage severity for the most severe Damage Plane.

All efforts should be made to determine the damage severity when a vehicle inspection is obtained. If pictures or damaged parts are available, examine and photograph them in an effort to document a “rough” Damage Severity for this vehicle. If there is absolutely no information available, or no vehicle inspection, then “Unknown” may be used.

FSN

(Field Safety Notification)

N/A Check of box indicates that a FSN was submitted for the selected vehicle.

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Scene Tab This tab contains a detailed drawing of the crash scene. The scene diagram is read only and is imported from

NASSMAIN.

Mandatory Inclusion

• CIREN case study vehicle always labeled as V1 and RED in color

• Include all vehicles that contact the case vehicle to scale

• All vehicle approaches in dashed lines

• All contact vehicles POIs (Primary rank 1 V2 must be BLUE in color)

• All vehicle final rests in solid lines

• Evidence (i.e., gouges, skids, etc.) that is related to the trajectory of the case vehicle

• Roadway delineation – curbs, lane markings, medians, traffic controls

• Roadside/ roadway objects contacted – trees, poles, etc.

• North arrow is up

• Callout RP/RL

• All involved vehicles’ make, model, and model year

Optional/ As Relevant

• Speed limit - If put in, put KMPH value first, followed by MPH value in parentheses

• Roadway profile- uphill, downhill if relevant

• Roadway defects- potholes, etc as relevant

• Label medians and shoulders as paved, grass, raised, etc as relevant

• Scale- Only say when scene is not to scale

• Callout of anything unusual on the scene or in vehicle movement if relevant

• Color layout

• Primary tree impacts should use “pole” object as the tree object has foliage that obscures vehicle dynamics

Not Included

• Culpability

• CIREN case number (05-166-1-1)

• CDC/ PDOF/ Delta V

• Roadway surface i.e.- bituminous, concrete

• Weather conditions- light, weather

• Surface condition

Other

• Researchers can use police reported evidence when it is deemed reliable and it aids a case

Every COMPLETE CIREN case must contain a scene diagram that is properly documented and detailed.

NOTE: Scene measurement tab is to be completed on all CIREN cases.

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Image SubTab

• Scene images of high relevance to the case should be linked.

• Basic examples may include the approach and look back for the case vehicle.

• Multiple relevant views should be linked when applicable to aid in describing the crash and related injuries.

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Cause of Death Tab This tab must be completed for every CIREN case occupant that expires during the crash, treatment, or follow-up phase of data collection (30 days from date of crash).

The availability of this tab is dependent on the FATAL field on the Case Form. If the case is “Not Fatal”, then the tab is not available; otherwise, the tab is available.

Cause

*-Fatal-ruled disease coding

Entered AIS code Complication from injury (specify) Unknown

*Cause of death given but not linked to injuries (specify) *Unknown

When Fatality (on the Case Form) is coded “Fatal” on the case form the occupant will have died from injury sustained in the crash or complications related to the injury(s)

When Fatality (on the Case Form) is coded “Fatal – ruled disease” then the occupant will have died from issues not related to the crash

Specify N/A Text field for added detail input Complication See Complication Tab Complications previously entered will be available for selection.

If multiple complications contributed then the “Multiple Complications” attribute is available for selection.

Associated with See coded injury list AIS codes and descriptions previously entered will be available for selection. If multiple injuries contributed then the “Multiple Injuries” attribute is available for selection.

TIME OF DEATH

***Date and Time of Death – When the date and time of death are known these should be entered in NASSMAIN on the OCCUPANT Form Injury/Zone. The time of death entered in NASSMAIN should be the best known time according to all available documentation for the point in time the case occupant expired. The discharge time may or may not be the same due to differences in admission and discharge protocols at trauma facilities.

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Comorbidity [Medical Center] Overview The Comorbidity Form contains the patient’s previous medical history data.

Summary Tab

Capture all documented comorbidities related to the case occupant described in the following pick list. If a case occupant has a comorbidity not listed that is determined to be significant, use the factor “Other” and detail the significance in the comment section.

EMS, hospital documentation and interviews can be used for source.

Documentation at the time of case review can be achieved by the enrolling team’s medical…