Agenzia Regionale della Sanità del Friuli Venezia Giulia, Udine, Italy.
Scand J Trauma Resusc Emerg Med. 2010 Mar 31;18:17. doi: 10.1186/1757-7241-18-17.
Injury severity measures are based either on the Abbreviated Injury Scale (AIS) or the International Classification of diseases (ICD). The latter is more convenient because routinely collected by clinicians for administrative reasons. To exploit this advantage, a proprietary program that maps ICD-9-CM into AIS codes has been used for many years. Recently, a program called ICDPIC trauma and developed in the USA has become available free of charge for registered STATA users. We compared the ICDPIC calculated Injury Severity Score (ISS) with the one from direct, prospective AIS coding by expert trauma registrars (dAIS).
The administrative records of the 289 major trauma cases admitted to the hospital of Udine-Italy from 1 July 2004 to 30 June 2005 and enrolled in the Italian Trauma Registry were retrieved and ICDPIC-ISS was calculated. The agreement between ICDPIC-ISS and dAIS-ISS was assessed by Cohen's Kappa and Bland-Altman charts. We then plotted the differences between the 2 scores against the ratio between the number of traumatic ICD-9-CM codes and the number of dAIS codes for each patient (DIARATIO). We also compared the absolute differences in ISS among 3 groups identified by DIARATIO. The discriminative power for survival of both scores was finally calculated by ROC curves.
The scores matched in 33/272 patients (12.1%, k 0.07) and, when categorized, in 80/272 (22.4%, k 0.09). The Bland-Altman average difference was 6.36 (limits: minus 22.0 to plus 34.7). ICDPIC-ISS of 75 was particularly unreliable. The differences increased (p < 0.01) as DIARATIO increased indicating incomplete administrative coding as a cause of the differences. The area under the curve of ICDPIC-ISS was lower (0.63 vs. 0.76, p = 0.02).
Despite its great potential convenience, ICPIC-ISS agreed poorly with its conventionally calculated counterpart. Its discriminative power for survival was also significantly lower. Incomplete ICD-9-CM coding was a main cause of these findings. Because this quality of coding is standard in Italy and probably in other European countries, its effects on the performances of other trauma scores based on ICD administrative data deserve further research. Mapping ICD-9-CM code 862.8 to AIS of 6 is an overestimation.
伤害严重程度的衡量标准基于简略损伤量表（AIS）或国际疾病分类（ICD）。后者更方便，因为出于管理原因，由临床医生常规收集。为了利用这一优势，多年来一直使用一种专有的程序将 ICD-9-CM 映射到 AIS 代码。最近，一个名为 ICDPIC trauma 的程序在美国开发并免费提供给注册的 STATA 用户。我们比较了由意大利创伤登记处的专家创伤登记员直接、前瞻性 AIS 编码计算的 ICDPIC 损伤严重度评分（ISS）与 dAIS。
检索 2004 年 7 月 1 日至 2005 年 6 月 30 日期间入住意大利乌迪内医院的 289 例重大创伤病例的行政记录，并纳入意大利创伤登记处，计算 ICDPIC-ISS。通过 Cohen 的 Kappa 和 Bland-Altman 图表评估 ICDPIC-ISS 与 dAIS-ISS 的一致性。然后，我们将这两个分数之间的差异与每位患者的创伤性 ICD-9-CM 代码数量与 dAIS 代码数量的比值（DIARATIO）进行了比较。我们还比较了 DIARATIO 确定的 3 组之间 ISS 的绝对差异。最后，通过 ROC 曲线计算了这两个评分的生存判别能力。
在 33/272 例患者（12.1%，k=0.07）和 80/272 例患者（22.4%，k=0.09）中评分匹配。Bland-Altman 平均差值为 6.36（限值：-22.0 至+34.7）。ICDPIC-ISS 为 75 时特别不可靠。差异随着 DIARATIO 的增加而增加（p<0.01），表明行政编码不完整是差异的原因。ICDPIC-ISS 的曲线下面积较低（0.63 对 0.76，p=0.02）。
尽管具有很大的便利性，但 ICDPIC-ISS 与传统计算的对应物一致性较差。其生存判别能力也明显较低。ICD-9-CM 编码不完整是造成这些发现的主要原因。由于这种编码质量在意大利和其他欧洲国家可能是标准的，因此基于 ICD 行政数据的其他创伤评分的性能值得进一步研究。将 ICD-9-CM 代码 862.8 映射到 AIS 为 6 是一种高估。
