基于 ICD-10-CM 词典的创伤死亡率预测模型：TMPM-ICD10。
A trauma mortality prediction model based on the ICD-10-CM lexicon: TMPM-ICD10.
机构信息
From the Department of Surgery (T.M.O.), University of Vermont, Colchester, Vermont; Department of Anesthesiology (L.G.G.), University of Rochester, Rochester, New York; Trauma Research Program (A.C.), Chandler Regional Medical Center, Chandler, Arizona; and Department of Mathematics and Statistics (J.S.B., D.W.H.), University of Vermont, Colchester, Vermont.
出版信息
J Trauma Acute Care Surg. 2019 May;86(5):891-895. doi: 10.1097/TA.0000000000002194.
BACKGROUND
Outcome prediction models allow risk adjustment required for trauma research and the evaluation of outcomes. The advent of ICD-10-CM has rendered risk adjustment based on ICD-9-CM codes moot, but as yet no risk adjustment model based on ICD-10-CM codes has been described.
METHODS
The National Trauma Data Bank provided data from 773,388 injured patients who presented to one of 747 trauma centers in 2016 with traumatic injuries ICD-10-CM codes and Injury Severity Score (ISS). We constructed an outcome prediction model using only ICD-10-CM acute injury codes and compared its performance with that of the ISS.
RESULTS
Compared with ISS, the TMPM-ICD-10 discriminated survivors from non-survivors better (ROC TMPM-ICD-10 = 0.861 [0.860-0.872], ROC [reviever operating curve] ISS = 0.830 [0.823-0.836]), was better calibrated (HL [Hosmer-Lemeshow statistic] TMPM-ICD-10 = 49.01, HL ISS = 788.79), and had a lower Akaike information criteria (AIC TMPM-ICD10 = 30579.49; AIC ISS = 31802.18).
CONCLUSIONS
Because TMPM-ICD10 provides better discrimination and calibration than the ISS and can be computed without recourse to Abbreviated Injury Scale coding, the TMPM-ICD10 should replace the ISS as the standard measure of overall injury severity for data coded in the ICD-10-CM lexicon.
LEVEL OF EVIDENCE
Prognostic/Epidemiologic, level II.
背景
预后预测模型允许对创伤研究和结果评估进行风险调整。ICD-10-CM 的出现使得基于 ICD-9-CM 编码的风险调整变得毫无意义，但迄今为止，尚未描述基于 ICD-10-CM 编码的风险调整模型。
方法
国家创伤数据库提供了 2016 年来自 773388 名创伤患者的数据，这些患者在 747 个创伤中心就诊，创伤损伤 ICD-10-CM 编码和损伤严重程度评分（ISS）。我们仅使用 ICD-10-CM 急性损伤编码构建了一个预后预测模型，并将其性能与 ISS 进行了比较。
结果
与 ISS 相比，TMPM-ICD-10 更好地区分了幸存者和非幸存者（TMPM-ICD-10 的 ROC = 0.861 [0.860-0.872]，ROC ISS = 0.830 [0.823-0.836]），校准更好（HL [Hosmer-Lemeshow 统计量] TMPM-ICD-10 = 49.01，HL ISS = 788.79），Akaike 信息准则（AIC TMPM-ICD10 = 30579.49；AIC ISS = 31802.18）较低。
结论
由于 TMPM-ICD10 提供了比 ISS 更好的区分度和校准度，并且可以在不依赖损伤严重程度评分编码的情况下计算，因此 TMPM-ICD10 应该取代 ISS 作为 ICD-10-CM 词汇表中编码数据的整体损伤严重程度的标准衡量标准。
证据水平
预后/流行病学，II 级。
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