Department of Trauma Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
Int J Qual Health Care. 2021 Mar 11;33(1). doi: 10.1093/intqhc/mzab041.
Injury coding is well known for lack of completeness and accuracy. The objective of this study was to perform a nationwide assessment of accuracy and reliability on Abbreviated Injury Scale (AIS) coding by Dutch Trauma Registry (DTR) coders and to determine the effect on Injury Severity Score (ISS). Additionally, the coders' characteristics were surveyed.
Three fictional trauma cases were presented to all Dutch trauma coders in a nationwide survey (response rate 69%). The coders were asked to extract and code the cases' injuries according to the AIS manual (version 2005, update 2008). Reference standard was set by three highly experienced coders. Summary statistics were used to describe the registered AIS codes and ISS distribution. The primary outcome measures were accuracy of injury coding and inter-rater agreement on AIS codes. Secondary outcome measures were characteristics of coders: profession, work setting, experience in injury coding and training level in injury coding.
The total number of different AIS codes used to describe 14 separate injuries in the three cases was 89. Mean accuracy per AIS code was 42.2% (range 2.4-92.7%). Mean accuracy on number of AIS codes was 23%. Overall inter-rater agreement per AIS code was 49.1% (range 2.4-92.7%). The number of assigned AIS codes varied between 0 and 18 per injury. Twenty-seven percentage of injuries were overlooked. ISS was correctly scored in 42.4%. In 31.7%, the AIS coding of the two more complex cases led to incorrect classification of the patient as ISS < 16 or ISS ≥ 16. Half (47%) of the coders had no (para)medical degree, 26% were working in level I trauma centers, 37% had less than 2 years of experience and 40% had no training in AIS coding.
Accuracy of and inter-rater agreement on AIS injury scoring by DTR coders is limited. This may in part be due to the heterogeneous backgrounds and training levels of the coders. As a result of the inconsistent coding, the number of major trauma patients in the DTR may be over- or underestimated. Conclusions based on DTR data should therefore be drawn with caution.
损伤编码的完整性和准确性一直存在问题。本研究的目的是对荷兰创伤登记处（DTR）编码员的简明损伤定级（AIS）编码进行全国性评估，以确定其对损伤严重度评分（ISS）的影响。此外，还对编码员的特征进行了调查。
在一项全国性调查中，向所有荷兰创伤编码员展示了三个虚构的创伤病例（回应率为 69%）。要求编码员根据 AIS 手册（2005 年版，2008 年更新）提取和编码病例的损伤。参考标准由三名经验丰富的编码员确定。使用描述性统计方法描述登记的 AIS 代码和 ISS 分布。主要观察指标是损伤编码的准确性和 AIS 代码的组内一致性。次要观察指标是编码员的特征：职业、工作场所、损伤编码经验和损伤编码培训水平。
描述三个病例中 14 个单独损伤的不同 AIS 代码总数为 89 个。每个 AIS 代码的平均准确率为 42.2%（范围为 2.4%-92.7%）。AIS 代码数量的平均准确率为 23%。每个 AIS 代码的总体组内一致性为 49.1%（范围为 2.4%-92.7%）。每个损伤分配的 AIS 代码数量为 0 至 18 个。有 27%的损伤被忽略。ISS 正确评分的比例为 42.4%。在 31.7%的情况下，对两个更复杂病例的 AIS 编码导致患者的 ISS<16 或 ISS≥16 分类不正确。编码员中有一半（47%）没有（准）医学学位，26%在一级创伤中心工作，37%的经验少于 2 年，40%没有 AIS 编码培训。
DTR 编码员的 AIS 损伤评分的准确性和组内一致性有限。这在一定程度上可能是由于编码员的背景和培训水平不同所致。由于编码不一致，DTR 中严重创伤患者的数量可能被高估或低估。因此，应谨慎根据 DTR 数据得出结论。
