Domain
EHR, ICD-10, LOINC, SNOMED CT, patient care and clinical documentation
16,101 clinical terms
The facsimile number associated with a trauma care facility or trauma surgeon, used to transmit urgent injury-related records, imaging reports, and transfer documentation between emergency departments, trauma centers, and specialist providers.
The billed charge amount for trauma care services rendered to a patient following a physical injury event. Captured on institutional or professional claims to reflect costs associated with emergency stabilization, surgical intervention, and acute trauma management.
The given name of the patient or clinician associated with a trauma encounter record. Used to identify individuals involved in trauma cases within clinical documentation, emergency department registrations, and trauma registry data submissions.
A binary indicator applied to a patient encounter or claim record denoting that the case meets criteria for trauma classification. Used in trauma registry reporting, quality benchmarking, and triggering specialized trauma care protocols within clinical and billing systems.
The complete name of the patient or clinician associated with a trauma encounter, combining given and family name components. Used for identity verification, trauma registry enrollment, and accurate matching across emergency department and inpatient records.
The sex or gender identity classification of a patient involved in a trauma encounter. Used in trauma registry reporting, injury epidemiology analyses, and ensuring appropriate clinical documentation and demographic accuracy across trauma care records.
The blood glucose measurement recorded during a trauma encounter, reflecting the patient's metabolic status at or near the time of injury. Elevated or depressed values inform resuscitation decisions, operative risk assessment, and are captured in trauma registry clinical data fields.
The hemoglobin concentration measured during a trauma encounter, used to assess blood loss severity and guide transfusion decisions. Recorded in trauma registry and clinical documentation to support hemorrhagic shock classification and resuscitation outcome tracking.
The structured clinical narrative documenting the circumstances, mechanism, timeline, and progression of a patient's injury at the time of a trauma encounter. Captured in emergency department and trauma admission records to support diagnosis, triage, and trauma registry reporting.
The unique alphanumeric key assigned to a trauma encounter or trauma patient record within a clinical or registry system. Enables consistent tracking of injury cases across emergency department visits, inpatient admissions, operative reports, and trauma registry submissions.
A numeric position or ranking value assigned within a trauma record dataset, used to sequence multiple injury events, procedures, or diagnoses associated with a single encounter. Supports ordered retrieval and analysis of trauma case data across registry and clinical systems.
A coded value signifying whether an encounter, claim, or patient record meets defined trauma criteria. Used in trauma registry eligibility determination, hospital quality reporting, and identifying trauma-related cases for outcomes analysis and reimbursement classification.
Structured clinical guidance or care directives associated with a trauma encounter, including wound care, mobilization restrictions, or follow-up protocols. Documented in discharge summaries and care coordination records to support post-acute recovery and patient safety compliance.
A surrogate or natural key value used to uniquely reference a trauma record within a data warehouse or clinical registry. Supports relational joins across encounter, diagnosis, procedure, and outcome tables for trauma case reporting and longitudinal injury analysis.
A human-readable text descriptor applied to a trauma record, encounter classification, or injury category within clinical or registry systems. Used to render meaningful descriptions in reports, user interfaces, and trauma quality dashboards for operational and analytical purposes.
The preferred spoken or written language of a patient involved in a trauma encounter. Used to ensure appropriate interpreter services, informed consent documentation, and discharge instruction delivery within emergency department and inpatient trauma care settings.
The family surname of the patient or clinician associated with a trauma encounter record. Used in identity verification, trauma registry enrollment, and demographic matching across emergency department admissions, operative records, and follow-up care documentation.
The officially registered full name of a patient involved in a trauma encounter, as recorded on government-issued identification. Used for insurance verification, trauma registry enrollment, consent documentation, and ensuring accurate patient identity across clinical records.
A standardized I–V classification designating a trauma center's verified surgical, critical care, and specialty capabilities per ACS or state standards. Used in ADT, claims, and EHR systems to route trauma encounters, apply appropriate facility fees, and stratify outcomes data for trauma registry and quality benchmarking reporting.
The state-issued professional license number of a clinician providing trauma care services. Used to verify credentialing, support billing and claims adjudication, and fulfill regulatory reporting requirements for trauma surgeons and emergency medicine practitioners.