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Injury severity grading in trauma patients: a simplified technique based upon ICD-9 coding
R Rutledge1, S Fakhry, C Baker
1North Carolina Trauma Registry, North Carolina Memorial Hospital, Wake Medical Center/Area Health Education Center, Chapel Hill.
The Journal of Trauma
|October 1, 1993
Summary
This study developed a simplified patient risk stratification using ICD-9 codes. The first diagnostic code (1st Dx) proved a better predictor of mortality than the Injury Severity Score (ISS).
Area of Science:
- Medical Informatics
- Trauma Surgery
- Public Health
Background:
- Accurate patient risk stratification is crucial for effective trauma care and resource allocation.
- Existing injury severity scoring systems, like the Injury Severity Score (ISS), have limitations in data acquisition and predictive power.
Purpose of the Study:
- To develop a simplified method for stratifying patient risk of death.
- To evaluate the predictive capability of International Classification of Diseases, Ninth Revision (ICD-9) codes for patient mortality.
Main Methods:
- Utilized data from a statewide trauma registry (n = 37,100).
- Derived a mortality risk ratio (MRR) from a training subset based on ICD-9 codes.
- Employed stepwise multivariate modeling with MRRs, ISS, and other variables.
Main Results:
- The MRR for the first diagnostic code (1st Dx) was the primary predictor in the multivariate model (partial R2 = 0.37).
- The ISS contributed significantly less to the model's predictive power (partial R2 = 0.02).
Conclusions:
- The 1st Dx is a superior predictor of patient outcome compared to the ISS.
- ICD-9 codes offer a more accessible and effective alternative for injury severity scoring, potentially replacing the ISS.