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Influence of Autopsy Reports on Trauma Registry Accuracy

Santos, Adora Tricia, DO; Sang, Whiyie, MD; Nugent, William, MD

doi: 10.1097/JTN.0000000000000428

The trauma registry is a locally maintained database with information on all trauma patients, including patient demographics and injury data. One essential field is the injury severity score (ISS). Patients who expire on arrival, either in the emergency department or soon after, often cannot undergo a complete evaluation of their injuries. As a result, many injuries remain undiagnosed, resulting in an erroneously low ISS, and autopsies can identify these unrecognized injuries. The objective of this study was to determine whether and how autopsy data improve the accuracy of the trauma registry data. The population included in the study was seen in the emergency department between January 2014 and August 2017 after a traumatic injury who expired on arrival, while in the ED, or within 48 hr of arrival. The ISS of each case was calculated prior to autopsy report and then adjusted according to autopsy data. The magnitude of this change was then compared. The mean ISS of these cases without autopsy data was 13, whereas the mean ISS of these cases including autopsy data was 49 (p ≤ .001). The mean ISS without autopsy data in those who died before and after 15 min was 7 and 23, respectively. In comparison, the mean autopsy-adjusted ISS in those who died before and after 15 min was 50 and 39, respectively (p ≤ .001). Our study identified the importance of obtaining autopsies in trauma patients. Having accurate registry data for trauma deaths further guides the development of performance improvement, injury prevention, and trauma research.

Department of Acute, Trauma and Critical Care, NewYork-Presbyterian-Queens, Flushing, New York.

Correspondence: Adora Tricia Santos, DO, c/o Department of Acute, Trauma and Critical Care, 56-45 Main St, NewYorkPresbyterian-Queens, Flushing, NY 11355 (

The authors have no conflict of interests to declare.

Copyright © 2019 by the Society of Trauma Nurses.