Citation

Osler T, Glance LG, Cook A, Buzas JS, Hosmer DW. J. Trauma Acute Care Surg. 2019; 86(5): 891-895.

Affiliation

Emeritus Professor, Department of Surgery, University of Vermont, 789 Orchard Shore Road, Colchester, VT 05446 Department of Anesthesiology, University of Rochester Trauma Research Program, Chandler Regional Medical Center Department of Mathematics and Statistics, University of Vermont Department of Mathematics and Statistics, University of Vermont.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002194

PMID

30633101

Abstract

BACKGROUND: Outcome prediction models allow risk adjustment required for trauma research and the evaluation of outcomes. The advent of ICD-10-CM has rendered risk adjustment based on ICD-9-CM codes moot, but as yet no risk adjustment model based on ICD-10-CM codes has been described.

METHODS: The National Trauma Data Bank provided data from 773,388 injured patients who presented to one of 747 trauma centers in 2016 with traumatic injuries ICD-10-CM codes and ISS. We constructed an outcome prediction model using only ICD-10-CM acute injury codes and compared its performance to that of the ISS.

RESULTS: Compared to ISS, the TMPM-ICD-10 discriminated survivors from non-survivors better, [ROC TMPM-ICD-10 = 0.861 (0.860 - 0.872), ROC ISS = 0.830 (0.823 - 0.836)], was better calibrated [HL TMPM-ICD-10 = 49.01, HL ISS = 788.79] and had a lower Akaike information criteria (AIC TMPM-ICD10 = 30579.49; AIC ISS = 31802.18).

CONCLUSIONS: Because TMPM-ICD10 provides better discrimination and calibration than the ISS and can be computed without recourse to AIS coding the TMPM-ICD10 should replace the ISS as the standard measure of overall injury severity for data coded in the ICD-10-CM lexicon. LEVEL OF EVIDENCE: Level II.

Language: en