Evaluation of injury databases as a preliminary step to developing a triage decision rule

Purpose: To evaluate accessibility and appropriateness of the Crash Outcomes Data Evaluation Systems (CODES) databases for prehospital trauma triage decision-rule development for people age 65 years and older. Design and Methods: This informatics feasibility study included five steps for evaluating the accessibility of CODES databases. Eight criteria were used to evaluate the appropriateness of these databases for older person prehospital trauma triage decision-rule development. Findings: Only 4 of the 33 states funded for CODES database development released their data to the study team during the 13-month data-acquisition period. Potential predictor variables (of life-threatening injury) and outcome variables (need for trauma center care) were identified for each database. Several databases had large amounts of missing data. Codebooks were available but descriptions of data validation procedures were unavailable. Conclusions: At this time, limited access to and development of CODES databases and missing data preclude the usefulness of these databases for older person triage decision rule development. Although adequate funding must be appropriated for continued CODES development, and commitment from individual states is essential, these databases offer great promise as a mechanism for decision-rule development to guide triage decision-making. Investigators should systematically evaluate large databases before using them in secondary analyses for clinical decision rule development. Clinical Relevance: Nurses participate in the planning, development, and implementation of health information systems in various settings. They also assume important roles in prehospital care as direct care providers, EMS administrators, participants of local and state EMS councils where emergency care problems are discussed and policies are formulated, and through use at state and federal levels.