Wisconsin State Trauma
Registry
Data
Elements/Definitions
Level I, II, III &
IV Hospitals
Revised June 13, 2005
Demographics
Facility submitting data
State Trauma Registry Number
First, Last and Middle Initial of Name
Medical Record #
Account #
Race
Gender
Date of Birth/Age
Home Zip Code
Injury
Date of Injury
Time of Injury
Zip Code/County/Township of Injury or GPS Latitude and Longitude
Injury Type
Injury Site E-Code
Mechanism E-Code
Primary E-Code: Select primary E-Code as cause for injury.
Add free text in “specify” field to further
define mechanism.
Secondary E-Code: Select secondary E-Code as cause for injury if applicable.
Work-Related
Protective/Safety Devices
Position of Patient in MV
Pre-Hospital
Initial EMS at Scene
1st Responder Service at Scene
1st
Responder Service
Run Sheet-1st Responder
Primary EMS Provider and/or Mode of Transport From Scene
Ambulance/Flight Service Number-Primary
.
Run Sheet Present-Primary
Ambulance/Flight Run Number-Primary
Secondary Transport from Scene, or Intercept
Ambulance/Flight Service-Secondary
Run Sheet Present-Secondary
Ambulance/Flight Run Number-Secondary
Extrication Required
Extrication Time
Run Times-1st Responder
Ambulance/Flight Run Times-Primary
Ambulance/Flight Run Times-Secondary
Scene Vital Signs
Scene GCS Qualifier
Primary Ambulance/Flight Vital Signs
Glasgow Coma Score-Scene by Primary Ambulance/Flight Service
.
Adults and Children Infants Points
Eye Spontaneous Spontaneous 4
Opening To voice To
voice 3
To pain To pain 2
None None 1
Verbal Oriented Coos,
babbles 5
Response Confused Irritable
cry 4
Inappropriate
words Cries to
pain 3
Incomprehensible Moans to pain 2
None None 1
Motor Obeys
commands Normal
spontaneous movement 6
Response Localizes pain Withdraws
to touch 5
Withdraws
to pain Withdraws
to pain 4
Flexor
response Flexor
response 3
Extensor response Extensor
response 2
None None
_1_
Auto-calculated Total
GCS-Scene = sum
of integers in each category
Revised Trauma Score-Scene
RTS
Points
Glasgow Coma Scale total
points
13-15
4
9-12
3
6-8
2
4-5
1
3
0
Respiratory
Rate (unassisted)
10-29 4
>
29 3
6-9
2
1-5
1
0
0
Systolic
Blood Pressure
>
89 4
76-89
3
50-
75 2
1-49
1
0 0____
Auto-calculated
Total Revised Trauma Score-Scene = sum of integers in each category
Referring Hospital
Hospital Transfer
Referring Hospital
Arrival Date
Arrival Time
Discharge Date
Discharge Time
Referring Hospital GCS Qualifier
Were
paralytic agents in effect?
Pop-up
list options:
Yes
No
Unknown
Was patient intubated?
Pop-up
list options:
Yes
No
Referring Hospital Vital Signs
Glasgow Coma Score-Referring Hospital
Adults and Children Infants Points
Eye Spontaneous Spontaneous 4
Opening To voice To
voice 3
To pain To pain 2
None None 1
Verbal Oriented Coos,
babbles 5
Response Confused Irritable 4
Inappropriate
words Cries to
pain 3
Incomprehensible Moans to pain 2
None None 1
Motor Obeys
commands Normal
spontaneous movement 6
Response Localizes pain Withdraws
to touch 5
Withdraws
to pain Withdraws
to pain 4
Flexor
response Flexor
response 3
Extensor response Extensor
response 2
None None
_1_
Auto-calculated Total
GCS-Scene = sum
of integers in each category
Revised Trauma Score-Referring Hospital
Coded Value Weight
Glasgow Coma Scale total
points
13-15
4 0.9368
9-12
3
6-8
2
4-5
1
3
0
Respiratory
Rate (unassisted)
10-29 4 0.7326
>
29 3
6-9
2
1-5
1
0
0
Systolic Blood Pressure
>
89 4 0.2908
76-89
3
50-
75 2
1-49
1
0 0____
Total Revised
Trauma Score Referring Hospital: Auto-calculated = sum of products of
multiplication in each category
ETOH Level
Drug Screen
Cocaine
PCP
Valium
Barbiturates
Narcotics
Amphetamines
Benzodiazepines
Inappropriate
or “Not Tested”
Other –specify in free text
field
Unknown
Transport from Referring Hospital
ED/Admission-Receiving Hospital
Direct Admission or DOA
ED Admission
Arrival Date (Will probably be on first
screen)
Arrival Time (Will probably be on first
screen)
ED Discharge Date (Will default to same as
arrival date)
ED Discharge Time
Receiving Hospital GCS Qualifier
ED/Admission Vital Signs
Glasgow Coma Score-Receiving Hospital
Adults and Children Infants Points
Eye Spontaneous Spontaneous 4
Opening To voice To
voice 3
To pain To pain 2
None None 1
Verbal Oriented Coos,
babbles 5
Response Confused Irritable 4
Inappropriate
words Cries to
pain 3
Incomprehensible Moans to pain 2
None None 1
Motor Obeys
commands Normal
spontaneous movement 6
Response Localizes pain Withdraws
to touch 5
Withdraws
to pain Withdraws
to pain 4
Flexor
response Flexor
response 3
Extensor response Extensor
response 2
None None ____1____
Auto-calculated
Total GCS-Receiving Hospital = sum of integers in each category
Revised Trauma Score-Receiving Hospital
Coded Value Weight
Glasgow Coma Scale total
points
13-15
4 0.9368
9-12
3
6-8
2
4-5
1
3
0
Respiratory
Rate (unassisted)
10-29 4 0.7326
>
29 3
6-9
2
1-5
1
0
0
Systolic
Blood Pressure
>
89 4 0.2908
76-89
3
50-75
2
1-49
1
0 0____
Total Revised
Trauma Score Receiving Hospital: Auto-calculated = sum of products of
multiplication in each category
ETOH Level at Receiving Hospital
Drug Screen at Receiving Hospital
Hospital Course
Post-ED or Direct Admission Destination
Admitting Service
Hospital Discharge Date
Hospital Discharge Time
Total Hospital Days
Total ICU Days
Outcomes
Hospital Disposition
Discharge Status
Organ/Tissue/Eye Donation
Autopsy
Diagnoses
ICD-9 Diagnosis Code
AIS Code
Calculated ISS-Injury Severity Score
Calculated Probability of Survival