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Validation of the ICD/AIS MAP for pediatric use
D R Durbin1, A R Localio, E J MacKenzie
1Department of Pediatrics, The Children's Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, USA. ddurbin@cceb.med.upenn.edu
Insights
The ICD/AIS MAP effectively classifies pediatric injury severity, showing excellent agreement in Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) for children across various ages and body regions.
Area of Science:
- Trauma research
- Medical informatics
- Pediatric emergency medicine
Background:
- Accurate injury severity classification is crucial for trauma care and research.
- Existing methods for classifying pediatric injury severity require validation.
- The ICD/AIS MAP offers a potential automated solution for injury coding.
Purpose of the Study:
- To evaluate the performance of the ICD/AIS MAP in classifying pediatric injury severity.
- To compare ICD/AIS MAP scores with existing trauma registry data for children.
Main Methods:
- Utilized data from Pennsylvania trauma centers (1994-1996) for children under 16.
- Converted ICD-9-CM codes to Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) using the ICD/AIS MAP.
- Assessed agreement using weighted kappa and intraclass correlation coefficients.
Main Results:
- Excellent agreement was found for Injury Severity Scores (ISS), both overall and by severity level.
- Excellent agreement was observed for Abbreviated Injury Scale (AIS) scores across body regions and age groups.
- Agreement improved with age and was consistently high across all body regions.
Conclusions:
- The ICD/AIS MAP demonstrates excellent performance in assessing pediatric injury severity.
- Its accuracy in children is comparable to or exceeds performance in adult populations.
- The tool is reliable across the pediatric age spectrum and most body regions.
Objective:
To determine the performance of the ICD/AIS MAP (EJ MacKenzie et al) as a method of classifying injury severity for children.
Methods:
Data on all children less than 16 years of age admitted to all designated trauma centers in Pennsylvania from January 1994 through October 1996 were obtained from the state trauma registry. The ICD/AIS MAP was used to convert all injury related ICD-9-CM diagnosis codes into abbreviated injury scale (AIS) score and injury severity score (ISS). Agreement between trauma registry AIS and ISS scores and MAP generated scores was assessed using the weighted kappa (kappaw) coefficient for ordered data and the intraclass correlation coefficient for continuous data.
Results:
Agreement in ISS scores was excellent, both overall (intraclass correlation coefficient = 0.86, 95% confidence interval (CI) 0.84 to 0.89)), and when grouped into three levels of severity (kappaw= 0.86, 95% CI 0.85 to 0.87). Agreement in AIS scores across all body regions and ages was also excellent, (kappaw= 0.86 (95% CI 0.83 to 0.87). Agreement increased with age (kappaw= 0.78 for children <2 years; kappaw= 0.86 for older children) and varied by body region, though was excellent across all regions.
Conclusions:
The performance of the ICD/AIS MAP in assessing severity of pediatric injuries was equal to or better than previous assessments of its performance on primarily adult patients. Its performance was excellent across the pediatric age range and across nearly all body regions of injury.
