# COMAR Title 30 — Maryland Institute for Emergency Medical Services Systems (MIEMSS)

## Subtitle 08 — Designation of Trauma and Specialty Referral Centers

### Chapter 05 — Trauma Center Designation and Verification Standards

#### Regulation .24 Injury Severity Criteria.

*COMAR 30.08.05.24*

For the purposes of Regulation .20D(2)—(3) of this chapter, a patient with severe injury shall have:

A. An injury severity score (ISS) greater than or equal to 13;

B. A penetrating injury with systolic blood pressure of less than or equal to 90 millimeters of mercury;

C. A thoracic injury classified as one or more of the following International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) codes:

  (1) 861.21 — Lung contusion, without open wound to thorax;

  (2) 861.31 — Lung contusion, with open wound into thorax; or

  (3) 807.4 — Flail chest;

D. A blunt injury to the abdomen with major solid visceral injury classified as one or more of the following ICD-9-CM codes:

  (1) 864.03 — Moderate laceration injury to liver without mention of open wound into cavity;

  (2) 864.04 — Major laceration injury to liver without mention of open wound into cavity;

  (3) 864.13 — Moderate laceration injury to liver with open wound into cavity;

  (4) 864.14 — Major laceration of liver with open wound into cavity;

  (5) 865.03 — Injury to spleen with laceration extending into parenchyma without mention of open wound into cavity;

  (6) 865.04 — Injury to spleen with massive parenchymal disruption without mention of open wound into cavity;

  (7) 865.13 — Injury to spleen with laceration extending into parenchyma and open wound into cavity;

  (8) 865.14 — Injury to spleen with massive parenchymal disruption and open wound into cavity;

  (9) 866.01 — Hematoma of kidney without rupture of capsule or mention of open wound into cavity;

  (10) 866.02 — Laceration of kidney without mention of open wound into cavity;

  (11) 866.11 — Hematoma of kidney without rupture of capsule but with open wound into cavity; or

  (12) 866.12 — Laceration of kidney with open wound into cavity;

E. A major surgical procedure in the cranial, thoracic, vascular, abdominal, or spinal body regions, classified as one or more of the following ICD-9-CM procedure codes:

  (1) Cranial:

    (a) 01.2X — Craniotomy and craniectomy;

    (b) 01.3X — Incision of brain and cerebral meninges;

    (c) 01.52 — Hemispherectomy;

    (d) 01.53 — Lobectomy of brain;

    (e) 02.0X — Cranioplasty;

    (f) 02.1X — Repair of cerebral meninges;

    (g) 02.3 — Extracranial ventricular shunt;

    (h) 02.92 — Repair of brain; or

    (i) 02.94 — Insertion of replacement of skull tongs or halo traction device;

  (2) Thoracic:

    (a) 34.02 — Exploratory thoracotomy;

    (b) 34.82 — Suture of laceration of diaphragm;

    (c) 34.84 — Other repair of diaphragm;

    (d) 37.1X — Cardiotomy and pericardiotomy; or

    (e) 37.91 — Open chest cardiac massage;

  (3) Vascular:

    (a) 38.3 — Resection of vessel with anastomosis (use 4th digits 2, 3, 4, 5, 6, 7, 8, 9);

    (b) 38.4 — Resection of vessel with replacement (use 4th digits 2, 3, 4, 5, 6, 7, 8, 9);

    (c) 38.8 — Other surgical occlusion of vessels (use 4th digits 2, 3, 4, 5, 6, 7, 8, 9);

    (d) 39.3 — Suture of vessel;

    (e) 39.56 <MD >Repair of blood vessel with tissue patch graft;

    (f) 39.57 — Repair of blood vessel with synthetic patch graft;

    (g) 39.58 — Other repair of vessel;

    (h) 39.6X — Extracorporeal circulation and procedures auxiliary to heart surgery; or

    (i) 39.98 — Control of hemorrhage, not otherwise specified;

  (4) Abdominal:

    (a) 41.43 — Partial splenectomy;

    (b) 41.5 — Total splenectomy;

    (c) 41.95 — Repair and plastic operations on spleen;

    (d) 42.82 — Suture of laceration of esophagus;

    (e) 42.89 — Other repair of esophagus;

    (f) 44.61 — Suture of laceration of stomach;

    (g) 44.69 — Other repair of stomach, not otherwise specified;

    (h) 45.0X — Enterotomy;

    (i) 45.5X — Isolation of intestinal segment;

    (j) 45.6X — Other excision of small intestine;

    (k) 45.7X — Partial excision of large intestine;

    (l) 45.8 — Total intra-abdominal colectomy;

    (m) 46.0 through 46.03 — Other operations on intestine;

    (n) 46.7X — Other repair of intestine;

    (o) 50.0 — Hepatotomy;

    (p) 50.22 — Partial hepatectomy;

    (q) 50.3 — Lobectomy of liver;

    (r) 50.4 — Total hepatectomy;

    (s) 50.6X — Repair of liver;

    (t) 52.5X — Partial pancreatectomy;

    (u) 52.6 — Total pancreatectomy;

    (v) 52.95 — Other repair of the pancreas;

    (w) 54.11 — Exploratory laparotomy;

    (x) 55.4 — Partial nephrectomy;

    (y) 55.5X — Complete nephrectomy;

    (z) 55.8X — Other repair of kidney;

    (aa) 56.8X — Repair of ureter; or

    (bb) 57.8X — Other repair of urinary bladder; or

  (5) Spinal:

    (a) 03.53 — Repair of vertebral fracture;

    (b) 81.00 — Spinal fusion, not otherwise specified;

    (c) 81.01 — Atlas-axis spinal fusion;

    (d) 81.02 — Other cervical fusion, anterior technique;

    (e) 81.03 — Other cervical fusion, posterior technique;

    (f) 81.04 — Dorsal and dorsolumbar fusion anterior technique;

    (g) 81.05 — Dorsal and dorsolumbar fusion, posterior technique; or

    (h) 81.06 — Lumbar and lumbosacral fusion, anterior technique;

F. A major pelvic fracture, classified as one or more of the following ICD-9-CM codes:

  (1) 808.43 — Multiple, closed, pelvic fractures with disruption of pelvic circle; or

  (2) 808.53 — Multiple, open, pelvic fractures with disruption of pelvic circle; or

G. Two or more long bone lower extremity fractures that can be either ipsilateral or contralateral, classified as one or more of the following ICD-9-CM codes:

  (1) 820.XX — Fractures of neck of femur;

  (2) 821.XX — Fractures of other and unspecified parts of femur; or

  (3) 823.X2 — Fractures of fibula with tibia.