Should the IDC-9 Trauma Mortality Prediction Model become the new paradigm for benchmarking trauma outcomes?

Adil H. Haider, Cassandra V. Villegas, Taimur Saleem, David Thomas Efron, Kent A Stevens, Tolulope A. Oyetunji, Edward E. Cornwell, Stephen Bowman, Sara Haack, Susan P. Baker, Eric B. Schneider

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Optimum quantification of injury severity remains an imprecise science with a need for improvement. The accuracy of the criterion standard Injury Severity Score (ISS) worsens as a patient's injury severity increases, especially among patients with penetrating trauma. The objective of this study was to comprehensively compare the mortality prediction ability of three anatomic injury severity indices: the ISS, the New ISS (NISS), and the DRG International Classification of Diseases-9th Rev.-Trauma Mortality Prediction Model (TMPM-ICD-9), a recently developed contemporary injury assessment model. METHODS: Retrospective analysis of patients in the National Trauma Data Bank from 2007 to 2008. The TMPM-ICD-9 values were computed and compared with the ISS and NISS for each patient using in-hospital mortality after trauma as the outcome measure. Discrimination and calibration were compared using the area under the receiver operator characteristic curve. Subgroup analysis was performed to compare each score across varying ranges of injury severity and across different types of injury. RESULTS: A total of 533,898 patients were identified with a crude mortality rate of 4.7%. The ISS and NISS performed equally in the groups with minor (ISS, 1-8) and moderate (ISS, 9-15) injuries, regardless of the injury type. However, in the populations with severe (ISS, 16-24) and very severe (ISS, ≥25) injuries for all injury types, the NISS predicted mortality better than the ISS did. The TMPM-ICD-9 outperformed both the NISS and ISS almost consistently. CONCLUSION: The NISS and TMPM-ICD-9 are both superior predictors of mortality as compared with the ISS. The immediate adoption of NISS for evaluating trauma outcomes using trauma registry data is recommended. The TMPM-ICD-9 may be an even better measure of human injury, and its use in administrative or nonregistry data is suggested. Further research on its attributes is recommended because it has the potential to become the basis for benchmarking trauma outcomes.

Original languageEnglish (US)
Pages (from-to)1695-1701
Number of pages7
JournalThe journal of trauma and acute care surgery
Volume72
Issue number6
DOIs
StatePublished - Jun 2012

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Benchmarking
Injury Severity Score
Mortality
Wounds and Injuries
International Classification of Diseases

Keywords

  • Benchmarking
  • Scoring
  • Trauma outcomes

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Should the IDC-9 Trauma Mortality Prediction Model become the new paradigm for benchmarking trauma outcomes? / Haider, Adil H.; Villegas, Cassandra V.; Saleem, Taimur; Efron, David Thomas; Stevens, Kent A; Oyetunji, Tolulope A.; Cornwell, Edward E.; Bowman, Stephen; Haack, Sara; Baker, Susan P.; Schneider, Eric B.

In: The journal of trauma and acute care surgery, Vol. 72, No. 6, 06.2012, p. 1695-1701.

Research output: Contribution to journalArticle

Haider, AH, Villegas, CV, Saleem, T, Efron, DT, Stevens, KA, Oyetunji, TA, Cornwell, EE, Bowman, S, Haack, S, Baker, SP & Schneider, EB 2012, 'Should the IDC-9 Trauma Mortality Prediction Model become the new paradigm for benchmarking trauma outcomes?', The journal of trauma and acute care surgery, vol. 72, no. 6, pp. 1695-1701. https://doi.org/10.1097/TA.0b013e318256a010
Haider, Adil H. ; Villegas, Cassandra V. ; Saleem, Taimur ; Efron, David Thomas ; Stevens, Kent A ; Oyetunji, Tolulope A. ; Cornwell, Edward E. ; Bowman, Stephen ; Haack, Sara ; Baker, Susan P. ; Schneider, Eric B. / Should the IDC-9 Trauma Mortality Prediction Model become the new paradigm for benchmarking trauma outcomes?. In: The journal of trauma and acute care surgery. 2012 ; Vol. 72, No. 6. pp. 1695-1701.
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AU - Villegas, Cassandra V.

AU - Saleem, Taimur

AU - Efron, David Thomas

AU - Stevens, Kent A

AU - Oyetunji, Tolulope A.

AU - Cornwell, Edward E.

AU - Bowman, Stephen

AU - Haack, Sara

AU - Baker, Susan P.

AU - Schneider, Eric B.

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N2 - BACKGROUND: Optimum quantification of injury severity remains an imprecise science with a need for improvement. The accuracy of the criterion standard Injury Severity Score (ISS) worsens as a patient's injury severity increases, especially among patients with penetrating trauma. The objective of this study was to comprehensively compare the mortality prediction ability of three anatomic injury severity indices: the ISS, the New ISS (NISS), and the DRG International Classification of Diseases-9th Rev.-Trauma Mortality Prediction Model (TMPM-ICD-9), a recently developed contemporary injury assessment model. METHODS: Retrospective analysis of patients in the National Trauma Data Bank from 2007 to 2008. The TMPM-ICD-9 values were computed and compared with the ISS and NISS for each patient using in-hospital mortality after trauma as the outcome measure. Discrimination and calibration were compared using the area under the receiver operator characteristic curve. Subgroup analysis was performed to compare each score across varying ranges of injury severity and across different types of injury. RESULTS: A total of 533,898 patients were identified with a crude mortality rate of 4.7%. The ISS and NISS performed equally in the groups with minor (ISS, 1-8) and moderate (ISS, 9-15) injuries, regardless of the injury type. However, in the populations with severe (ISS, 16-24) and very severe (ISS, ≥25) injuries for all injury types, the NISS predicted mortality better than the ISS did. The TMPM-ICD-9 outperformed both the NISS and ISS almost consistently. CONCLUSION: The NISS and TMPM-ICD-9 are both superior predictors of mortality as compared with the ISS. The immediate adoption of NISS for evaluating trauma outcomes using trauma registry data is recommended. The TMPM-ICD-9 may be an even better measure of human injury, and its use in administrative or nonregistry data is suggested. Further research on its attributes is recommended because it has the potential to become the basis for benchmarking trauma outcomes.

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