After initial testing, we reclassified code Fleischman et al. Di Bartolomeo et al. For each ICD code, a measure of effect E for the corresponding injury diagnosis was derived as the mean score for subjects with this code. Different cutpoints for E were investigated to determine how this measure could best be translated into an AIS severity. For each combination of cutpoints, an ISS was calculated, and its ability to discriminate patients who survived from those who did not was determined using a C-statistic.
Among the combinations resulting in a maximum C-statistic to two decimal places , the combination was chosen that most closely approximated the ISS that had been calculated by hospital trauma registrars ISSAIS.
Otherwise, it is the maximum known severity 1 through 6 for that body region. Copes et al. Performance of the various ISS methods was further evaluated using a C-statistic Stata command roctab. The C-statistic, also known as the area under a receiver-operator characteristic ROC curve, ranges from 0.
However, cases 7. The GEM methods were unable to categorize cases 2. C-statistics were calculated for the ability of each form of ISS to distinguish NTDB patients with valid ICDCM diagnoses after excluding cases that could not be categorized who would subsequently die or not die in the hospital. Theoretically, ISSAIS in these cases should only be the square of a number from 1 to 5, but among these cases there were In the NIS data set for the Fourth Quarter of , a principal ICDCM diagnosis of trauma by the criteria described above was present in 66, patients, who had from 1 to 30 listed diagnoses plus up to 4 injury mechanism diagnoses.
For the GEMmax method, the C-statistic was 0. Further instructions and troubleshooting help are available at this website and elsewhere. Basic procedures for issuing commands in R are available in many locations, or may be obtained from a colleague already familiar with the program. The input data file must be in CSV comma-separated variables format with each row corresponding to one person.
There is no maximum number of diagnosis codes per person. The following command will load the data into R:. To use the GEM methods, the command should be modified as follows:. To export the resulting table in CSV format e. Users may wish to copy them for use with another program if they find that easier than working in R.
This implements the current version of ICDPIC-R using only a simple point-and-click interface, but is limited to datasets with fewer than approximately 10, records. However, the time and effort required to approach this ideal is only possible in specialized settings and for subjects who can be thoroughly evaluated. We therefore hope that these methods to derive approximate scoring using administrative data will be useful for population-based studies.
ISS coding among trauma registries contributing to the NTDB during the last quarter of was quite variable, even for patients with a single diagnosis Table 5. The imprecision is likely to improve as the new coding format becomes more familiar, but suggests that some standardized method of deriving a severity score from individual diagnoses may be preferable for large centralized registries. Version 0. Similarly, the AAAM mapping, or mappings developed in other countries, could be incorporated if they are made available in the public domain.
The additional data should allow additional precision, and perhaps enable a more robust algorithm to build on the ROCmax mapping strategy. Other reference databases may become available, and the GEM table can also be updated to the latest version published by CMS. However, these functions could be added in subsequent versions if there is sufficient demand. Accessed 12 Mar The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.
J Trauma. Article Google Scholar. An introduction to the Barell body region by nature of injury diagnosis matrix. Inj Prev. Recommended framework for presenting injury mortality data. Google Scholar. A new characterization of injury severity. Trauma risk assessment: review of severity scales.
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