#	Complication	Description
Pulmonary
20	Acute respiratory distress syndrome (ARDS)* *(maps to NTD B definition)	Adult (Acute) respiratory distress syndrome: ARDS occurs in conjunction with catastrophic medical conditions, such as pneumonia, shock, sepsis (or severe infection throughout the body, sometimes also referred to as systemic infection, and may include or also be called a blood or blood-borne infection), and trauma. It is a form of sudden and often severe lung failure characterized by PaO2/FiO2 ≤200, decreased compliance, and diffuse bilateral pulmonary infiltrates without associated clinical evidence of CHF. The process must persist beyond 36 hours and require mechanical ventilation.
21	Acute respiratory failure	Need for prolonged ventilatory support after a period of normal non-assisted breathing (minimum of 48 hrs) or reintubation.  a.Planned—do not report (i.e., taken to OR)  b.Unplanned––report
22	Aspiration/aspiration pneumonia	Documented inhalation of gastric contents or other materials followed by clinical and new radiological findings of pneumonitis which requires treatment within 48 h.
24	Fat embolus syndrome	Documented diagnosis by an attending physician in a patient w/pelvic or extremity fractures and a decreased PO2. One of the following must also be present: change in mental status; petechial signs; tachypnea; fat in urine; decreased platelets.
26	Pneumonia* *(maps to NTDB definition)	Patients with evidence of pneumonia that develops during the hospitalization. Patients with pneumonia must meet at least one of the following two criteria:  Criterion 1. Rales or dullness to percussion on physical examination of chest AND any of the following:   a. New onset of purulent sputum or change in character of sputum  b. Organism isolated from blood culture  c. Isolation of pathogen from specimen obtained by transtracheal aspirate, bronchial brushing, or biopsy  Criterion 2. Chest radiographic examination shows new or progressive infiltrate, consolidation, cavitation, or pleural effusion AND any of the following:   a. New onset of purulent sputum or change in character of sputum   b. Organism isolated from the blood   c. Isolation of pathogen from specimen obtained by transtracheal aspirate, bronchial brushing, or biopsy   d. Isolation of virus or detection of viral antigen in respiratory secretions   e. Diagnostic single antibody titer (IgM) or fourfold increase in paired serum samples (IgG) for pathogen   f. Histopathologic evidence of pneumonia
27	Pneumothorax	Presence of intrapleural air not present on admission radiograph, resulting from treatment or intervention.
28	Pulmonary embolus* *(maps to NTDB definition)	Defined as a lodging of a blood clot in a pulmonary artery with subsequent obstruction of blood supply to the lung parenchyma. The blood clots usually originate from the deep veins or the pelvic venous system. Consider the condition present if the patient has a VQ scan interpreted as high probability of pulmonary embolism or a positive pulmonary arteriogram or positive CT angiogram.
48	Cardiopulmonary arrest (unexpected, not resulting in death)	Documented by a physician.
Cardiovascular
30	Acute arterial occlusion (not present on admission)	Caused by embolism or thrombosis, documented by arteriography, duplex scanning, pulse volume recording, segmental pressures, clinical exam, or autopsy.
34	Major dysrhythmia (not resulting in death)	Dysrhythmia requiring drugs or defibrillation (e.g., supraventricular tachycardia, rapid atrial fibrillation, sustained ventricular tachycardia, bradycardia requiring pacing).
32	Extremity compartment syndrome (not present on admission)* *(maps to NTDB definition)	Defined as a condition in which there is swelling and an increase in pressure within a limited space (a fascial compartment) that presses on and compromises blood vessels, nerves, and/or tendons that run through that compartment. Compartment syndromes usually involve the leg but can also occur in the forearm, arm, thigh, and shoulder.
33	Deep vein thrombosis (DVT)* *(maps to NTDB definition)	The formation, development, or existence of a blood clot or thrombus within the vascular system, which may be coupled with inflammation. This diagnosis may be confirmed by a venogram, ultrasound, or CT. The patient must be treated with anticoagulation therapy and/or placement of a vena cava filter or clipping of the vena cava.
35	Myocardial infarction (MI)* *(maps to NTDB definition)	A new acute myocardial infarction occurring during hospitalization (within 30 days of injury).
Hematologic/coagulopathy
40	Blood transfusion reaction	Transfusion reaction as documented by the institution’s reaction protocol
41	Coagulopathy (excluding anticoagulation therapy, coumadin therapy, or underlying hematologic disorders, e.g., hemophilia)	Uncontrolled diffuse bleeding in the presence of coagulation abnormalities, e.g., increased prothrombin time, increased partial thromboplastin time, decreased platelet count, or disseminated intravascular coagulation (DIC) requiring treatment, i.e., transfusion components such as platelets, clotting factors, FFP.
Renal
50	Acute renal failure* *(maps to NTDB definition)	A patient who did not require dialysis prior to injury, and who has worsening renal dysfunction after an injury requiring hemodialysis, ultrafiltration, or peritoneal dialysis. If the patient refuses treatment (e.g., dialysis), the condition is still considered present.
Hepatic
63	Liver failure	Documented by a physician. Increased serum ammonium or decreased synthetic or metabolic function (e.g., PT, TTP, or fibrinogen).
Infection/sepsis
70	Empyema	Infection documented by purulent material or positive culture from the pleural space, requiring thoracostomy tube drainage.
76	Sepsis	Documented by a physician with at least two or more of the following conditions (which occur at the same time): core temperature of >38 or ≤36°C; white blood cell count >12,000 or <4,000 or >10% immature bands; positive blood cultures (excluding contaminants); clinically obvious source of infection; heart rate >90 beats/min or respiratory rate >20 breaths/min.
77	Septicemia	(+) blood cx, excluding isolates thought to be contaminates.
78	Acute sinusitis	Opacification on XRAY or CT with fever and/or positive purulent drainage requiring treatment.
79	Soft tissue infection	Documentation by a physician of cellulitis, gas gangrene, necrotizing fasciitis, or streptococcal myositis requiring treatment.
97	Urinary tract infection (UTI) (not present on admission) (CDC guidelines used as reference)	Clean voided or other catheter urine specimen with ≥100,000 organisms/ml on C/S.
99	Wound infection	(Traumatic or incisional) drainage of purulent material from wound; active treatment of wound, or administration of antibiotics for wound. *An abdominal abscess would not be considered a wound infection and is not applicable as an occurrence.
Airway management
80	Esophageal intubation	Endotracheal tube in esophagus and not immediately repositioned. Esophageal location determined by physical exam, X-ray, capnography, or endoscopy.
69	Unrecognized main stem bronchus intubation	Any endotracheal intubation procedure resulting in definitive placement of the tube in either the right or left main stem bronchus.  a.Recognized and treated immediately—not reportable  b.Unrecognized on two successive chest xrays––reportable
Gastrointestinal
83	GI bleeding	Blood loss from anywhere in GI tract, grossly positive nasogastric (NG) aspirate, or grossly positive stool which requires treatment.
86	Small bowel obstruction (SBO) (excluding ileus)	Radiographic evidence of dilated loop of bowel with multiple air-fluid levels and confirmed by a surgeon; requiring treatment (surgery or NG tube).
Neurological
64	CNS infection	CSF aspirate with positive culture and increased white blood cell count.
66	Progression of original neurologic insult	Documentation by a physician of deterioration or additional loss of function from that noted on ED arrival, i.e., paralysis, paresis, or other neurologic sequelae.
96	Seizures	Two or more seizures after a head injury which are witnessed or attested to by hospital personnel (e.g., focal, grand mal, conscious or unconscious (one seizure after a head injury is not a complication; 10–15% are expected).
Procedure-related
91	Organ, nerve, vessel injury	Perforation or injury resulting from treatment or intervention.
Decubitus
65	Dehiscence/evisceration	Breakdown of fascial closure confirmed by discharge of peritoneal fluid, evisceration, or palpable fascial defect. *THIS OCCURRENCE PERTAINS TO THE ABDOMINAL AREA ONLY*
94	Decubitus* *(maps to NTDB definition)	Defined as a “pressure sore” resulting from pressure exerted on the skin, soft tissue, muscle, or bone by the weight of an individual against a surface beneath. Individuals unable to avoid long periods of uninterrupted pressure over bony prominences are at increased risk for the development of necrosis and ulceration.
Hypothermia
46	Hypothermia	(Non-therapeutic) rectal or core temperature ≤34 °C or 93.2 °F. If the patient presents to the hospital with hypothermia, the hypothermia is considered a diagnosis. If the hypothermia presents during the hospital stay and is unexpected, the hypothermia is considered an occurrence.
47	Postoperative hemorrhage	Requiring operative intervention—procedures done in angio to control hemorrhage should be considered operative interventions and the hemorrhage should be included as an occurrence.
49	Adverse drug reaction	Documented by a physician, plus one of the following: adversely affects patient care; increases length of stay; increases morbidity and mortality.