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Combat injury coding: a review and reconfiguration
Mary M Lawnick1, Howard R Champion, Thomas Gennarelli
1From Department of Surgery, SimQuest Solutions Inc. (M.M.L., H.R.C., E.J.K.), Annapolis; and Uniformed Services University of the Health Sciences (H.R.C.), Bestheda, Maryland; Medical College of Wisconsin (T.G.), Milwaukee, Wisconsin; Naval Health Research Center (M.R.G., E.D., R.R.V., V.W., J.D.), San Diego, California; University of Texas (B.J.E.); US Army Institute of Surgical Research (M.A.S., L.H.B.); University of Texas Health Science Center (J.H.); and Brooke Army Medical Center (J.R.F.), Fort Sam Houston, San Antonio, Texas; Applied Research Associates (L.A.Y.), Albuquerque, New Mexico; Mayo Clinic (D.H.J.), Rochester, Minnesota; and Walter Reed Army Medical Center, Washington, DC (S.F.).
The Military Combat Injury Scale (MCIS) and Military Functional Incapacity Scale (MFIS) offer a more accurate way to classify combat injuries than current civilian scales. These new scales better describe the unique and complex wounds sustained in modern warfare.
Area of Science:
- Military medicine
- Trauma surgery
- Injury scaling
Background:
- Current civilian Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are inadequate for combat injuries.
- Existing systems fail to adequately describe penetrating and multi-mechanistic injuries from improvised explosive devices (IEDs).
Purpose of the Study:
- To develop and validate new injury coding systems for combat trauma.
- Introduce the Military Combat Injury Scale (MCIS) and Military Functional Incapacity Scale (MFIS).
Main Methods:
- Developed MCIS and MFIS with military and civilian combat trauma experts.
- Assigned MCIS severity based on urgency, care needs, and mortality risk.
- Developed MFIS based on casualty's ability to shoot, move, and communicate.
- Evaluated MCIS on 992 combat-injured patients.
Main Results:
- MCIS is a simpler, comprehensive scale with 269 codes, outperforming AIS.
- MCIS integrates with MFIS to associate functional impairment with injury severity.
- MCIS demonstrates improved validity and reliability for military applications.
Conclusions:
- MCIS and MFIS were developed, tested, and validated over several years by experts.
- MCIS shows significant promise for documenting the nature, severity, and complexity of modern combat injuries.
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