Citation

Wang M, Qiu W, Zeng Y, Fan W, Lian X, Shen Y. World J. Emerg. Surg. 2019; 14: e46.

Affiliation

Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Hangzhou, 310058 Zhejiang People's Republic of China.

Copyright

(Copyright © 2019, Holtzbrinck Springer Nature Publishing Group - BMC)

DOI

10.1186/s13017-019-0265-y

PMID

31632453

PMCID

PMC6787998

Abstract

BACKGROUND: The International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) Injury Severity Score (ICISS) is a risk adjustment model when injuries are recorded using ICD-9-CM coding. The trauma mortality prediction model (TMPM-ICD9) provides better calibration and discrimination compared with ICISS and injury severity score (ISS). Though TMPM-ICD9 is statistically rigorous, it is not precise enough mathematically and has the tendency to overestimate injury severity. The purpose of this study is to develop a new ICD-10-CM injury model which estimates injury severities for every injury in the ICD-10-CM lexicon by a combination of rigorous statistical probit models and mathematical properties and improves the prediction accuracy.

METHODS: We developed an injury mortality prediction (IMP-ICDX) using data of 794,098 patients admitted to 738 hospitals in the National Trauma Data Bank from 2015 to 2016. Empiric measures of severity for each of the trauma ICD-10-CM codes were estimated using a weighted median death probability (WMDP) measurement and then used as the basis for IMP-ICDX. ISS (version 2005) and the single worst injury (SWI) model were re-estimated. The performance of each of these models was compared by using the area under the receiver operating characteristic (AUC), the Hosmer-Lemeshow (HL) statistic, and the Akaike information criterion statistic.

RESULTS: IMP-ICDX exhibits significantly better discrimination (AUC_IMP-ICDX, 0.893, and 95% confidence interval (CI), 0.887 to 0.898; AUC_ISS, 0.853, and 95% CI, 0.846 to 0.860; and AUC_SWI, 0.886, and 95% CI, 0.881 to 0.892) and calibration (HL_IMP-ICDX, 68, and 95% CI, 36 to 98; HL_ISS, 252, and 95% CI, 191 to 310; and HL_SWI, 92, and 95% CI, 53 to 128) compared with ISS and SWI. All models were improved after the extension of age, gender, and injury mechanism, but the augmented IMP-ICDX still dominated ISS and SWI by every performance.

CONCLUSIONS: The IMP-ICDX has a better discrimination and calibration compared to ISS. Therefore, we believe that IMP-ICDX could be a new viable trauma research assessment method.

© The Author(s). 2019.

Language: en

Keywords

Injury mortality prediction for ICD-10-CM (IMP-ICDX); Injury severity score (ISS); International Classification of Diseases Tenth Edition (ICD-10-CM); Mortality prediction