TY  - JOUR
PY  - 2015//
TI  - Performance of ICD-based injury severity measures used to predict in-hospital mortality: a systematic review and meta-analysis
JO  - Journal of trauma and acute care surgery
A1  - Gagné, Mathieu
A1  - Moore, Lynne
A1  - Beaudoin, Claudia
A1  - Batomen Kuimi, Brice Lionel
A1  - Sirois, Marie-Josée
SP  - 419
EP  - 426
VL  - 80
IS  - 3
N2  - BACKGROUND: The International Classification of Diseases (ICD) is the main classification system used for population-based injury surveillance activities but does not contain information on injury severity. ICD-based injury severity measures can be empirically-derived or mapped, but no single approach has been formally recommended. <br><br>OBJECTIVE: To compare performance of ICD-based injury severity measures to predict in-hospital mortality among injury-related admissions. <br><br>METHODS: A systematic review and a meta-analysis were conducted. MEDLINE, EMBASE and Global Health databases were searched from their inception through September 2014. Observational studies that assessed the performance of ICD-based injury severity measures to predict in-hospital mortality and reported discriminative ability using the area under a receiver operating characteristic curve (AUC) were included. Metrics of model performance were extracted. Pooled AUC were estimated under random-effects models. <br><br>RESULTS: 22 eligible studies reported 72 assessments of discrimination on ICD-based injury severity measures. Reported AUC ranged from 0.681 to 0.958. Forty-six of the 72 assessments showed excellent (0.80≤AUC<0.90) and six outstanding (AUC≥0.90) discriminative ability. Pooled AUC for ICD-Injury Severity Score (ICISS) based on the product of traditional survival proportions was significantly higher than measures based on ICD mapped to AIS scores (0.863 versus 0.825 for ICDMAP-ISS (p=0.005) and ICDMAP-NISS (p=0.016). Similar results were observed when studies were stratified by the type of data used (trauma registry or hospital discharge) or the provenance of survival proportions (internally or externally-derived). However, among studies published after 2003 the Trauma Mortality Prediction Model based on ICD-9 codes (TMPM-9) demonstrated superior discriminative ability than ICISS using the product of traditional survival proportions (0.850 versus 0.802, p=0.002). Models generally showed poor calibration. <br><br>CONCLUSIONS: ICISS using the product of traditional survival proportions and TMPM-9 predict mortality more accurately than those mapped to AIS codes and should be preferred for describing injury severity when ICD is used to record injury diagnoses. LEVEL OF EVIDENCE: level VI.<p />  <p>Language: en</p>
LA  - en
SN  - 2163-0755
UR  - http://dx.doi.org/10.1097/TA.0000000000000944
ID  - ref1
ER  -