Utter Garth H, Miller Preston R, Mowery Nathan T, Tominaga Gail T, Gunter Oliver, Osler Turner M, Ciesla David J, Agarwal Suresh K, Inaba Kenji, Aboutanos Michel B, Brown Carlos V R, Ross Steven E, Crandall Marie L, Shafi Shahid
From the Department of Surgery (G.H.U.), University of California, Davis, Medical Center, Sacramento, California; Department of General Surgery (P.R.M, N.T.M.), Wake Forest Baptist Health, Winston-Salem, North Carolina; Department of Surgery (G.T.T.), Scripps Memorial Hospital, San Diego, California; Department of Surgery (O.G.), Vanderbilt University Medical Center, Nashville, Tennessee; Department of Surgery (T.M.O.), University of Vermont, Colchester, Vermont; Department of Surgery (D.J.C.), Morsani College of Medicine, University of South Florida, Tampa, Florida; Department of Surgery (S.K.A.J.), University of Wisconsin, Madison, Wisconsin; Department of Surgery (K.I.), Keck School of Medicine of University of Southern California Medical Center, Los Angeles, California; Department of Surgery (M.B.A.), Virginia Commonwealth University Medical Center, Richmond, Virginia; Department of Trauma Service (C.V.R.B.), University Medical Center Brackenridge, Austin, Texas; Department of Surgery (S.E.R.), Cooper University Hospital, Camden, New Jersey; Departments of Surgery-Trauma/Critical Care and Preventive Medicine (M.L.C.), Northwestern University Feinberg School of Medicine, Chicago, Illinois; and Institute for Health Care Research and Improvement (S.S.), Baylor Health Care System, Dallas, Texas.
J Trauma Acute Care Surg. 2015 May;78(5):1059-65. doi: 10.1097/TA.0000000000000608.
The American Association for the Surgery of Trauma (AAST) recently established a grading system for uniform reporting of anatomic severity of several emergency general surgery (EGS) diseases. There are five grades of severity for each disease, ranging from I (lowest severity) to V (highest severity). However, the grading process requires manual chart review. We sought to evaluate whether International Classification of Diseases, 9th and 10th Revisions, Clinical Modification (ICD-9-CM, ICD-10-CM) codes might allow estimation of AAST grades for EGS diseases. The Patient Assessment and Outcomes Committee of the AAST reviewed all available ICD-9-CM and ICD-10-CM diagnosis codes relevant to 16 EGS diseases with available AAST grades. We then matched grades for each EGS disease with one or more ICD codes. We used the Official Coding Guidelines for ICD-9-CM and ICD-10-CM and the American Hospital Association's "Coding Clinic for ICD-9-CM" for coding guidance. The ICD codes did not allow for matching all five AAST grades of severity for each of the 16 diseases. With ICD-9-CM, six diseases mapped into four categories of severity (instead of five), another six diseases into three categories of severity, and four diseases into only two categories of severity. With ICD-10-CM, five diseases mapped into four categories of severity, seven diseases into three categories, and four diseases into two categories. Two diseases mapped into discontinuous categories of grades (two in ICD-9-CM and one in ICD-10-CM). Although resolution is limited, ICD-9-CM and ICD-10-CM diagnosis codes might have some utility in roughly approximating the severity of the AAST grades in the absence of more precise information. These ICD mappings should be validated and refined before widespread use to characterize EGS disease severity. In the long-term, it may be desirable to develop alternatives to ICD-9-CM and ICD-10-CM codes for routine collection of disease severity characteristics.
美国创伤外科学会（AAST）最近建立了一个分级系统，用于统一报告几种急诊普通外科（EGS）疾病的解剖学严重程度。每种疾病有五个严重程度等级，从I级（最低严重程度）到V级（最高严重程度）。然而，分级过程需要人工查阅病历。我们试图评估国际疾病分类第9版和第10版临床修订本（ICD - 9 - CM、ICD - 10 - CM）编码是否可用于估计EGS疾病的AAST等级。AAST的患者评估与结果委员会审查了与16种有可用AAST等级的EGS疾病相关的所有可用ICD - 9 - CM和ICD - 10 - CM诊断编码。然后，我们将每种EGS疾病的等级与一个或多个ICD编码进行匹配。我们使用ICD - 9 - CM和ICD - 10 - CM的官方编码指南以及美国医院协会的《ICD - 9 - CM编码诊所》进行编码指导。ICD编码无法将16种疾病中的每一种都与AAST的所有五个严重程度等级相匹配。对于ICD - 9 - CM，六种疾病映射到四个严重程度类别（而非五个），另外六种疾病映射到三个严重程度类别，四种疾病仅映射到两个严重程度类别。对于ICD - 10 - CM，五种疾病映射到四个严重程度类别，七种疾病映射到三个类别，四种疾病映射到两个类别。两种疾病映射到不连续的等级类别（ICD - 9 - CM中有两种，ICD - 10 - CM中有一种）。尽管分辨率有限，但在缺乏更精确信息的情况下，ICD - 9 - CM和ICD - 10 - CM诊断编码在大致估算AAST等级的严重程度方面可能具有一定作用。在广泛使用以描述EGS疾病严重程度之前，这些ICD映射应进行验证和完善。从长远来看，可能需要开发替代ICD - 9 - CM和ICD - 10 - CM编码的方法来常规收集疾病严重程度特征。
