National Emergency Medical Center, National Medical Center, Seoul, Republic of Korea.
National Emergency Medical Center, National Medical Center, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Am J Emerg Med. 2024 Dec;86:62-69. doi: 10.1016/j.ajem.2024.09.056. Epub 2024 Sep 29.
Various scoring systems are utilized to assess severe trauma patients, with one of the most commonly used tools being the International Classification of Diseases Injury Severity Score (ICISS) criteria derived from the Survival Risk Ratio (SRR) calculated using diagnostic codes. This study aimed to redefine the severe trauma scoring system in Korea based on the SRR for diagnostic codes, and subsequently evaluate its performance in predicting survival outcomes for trauma patients.
This study included trauma patients who visited Level 1 and 2 emergency departments (EDs) between January 2016 and December 2019, utilizing the Korean National Emergency Department Information System (NEDIS) database. The primary outcome of this study was in-hospital mortality. The new SRR-2020 value was calculated for each of the 865 trauma diagnosis codes (Korean Standard Classification of Diseases [KCD-7] codes, 4-digit format), and the patient-specific ICISS-2020 value was derived by multiplying the corresponding SRR-2020 value based on patient diagnosis. We compared the predictive performance for in-hospital mortality between severe trauma patients with an ICISS <0.9 based on the newly developed ICISS-2020 version and those defined by the previously used ICISS-2015 version.
A total of 3,841,122 patients were enrolled, with an in-hospital mortality rate of 0.5 %. Severe trauma patients with ICISS-2020 < 0.9 accounted for 5.3 % (204,897 cases) that was lower than ICISS-2015 < 0.9 accounting for 15.3 % (587,801 cases). Among the 20,619 in-hospital mortality cases, 81.4 % had ICISS-2020 < 0.9, and 88.6 % had ICISS-2015 < 0.9. When comparing predictive performance for in-hospital mortality between the two ICISS versions, ICISS-2020 showed higher accuracy (0.95), specificity (0.95), positive predictive value (PPV) (0.08), positive likelihood ratio (LR+) (16.53), and area under the receiver operating characteristic curve (AUROC) (0.96) than ICISS-2015 for accuracy (0.85), sensitivity (0.88), specificity (0.85), PPV (0.03), LR+ (5.94), and AUROC (0.94). However, regarding sensitivity, ICISS-2020 < 0.9 showed a lower value of 0.81 compared to ICISS-2015 < 0.9, which was 0.88. The negative predictive value (NPV) was 1.00 for both versions.
The newly developed ICISS-2020, utilizing a nationwide emergency patient database, demonstrated relatively good performance (accuracy, specificity, PPV, LR+, and AUROC) in predicting survival outcomes for patients with trauma.
各种评分系统被用于评估严重创伤患者，其中最常用的工具之一是国际疾病损伤严重度评分（ICISS）标准，该标准源自使用诊断代码计算的生存风险比（SRR）。本研究旨在基于诊断代码的 SRR 重新定义韩国严重创伤评分系统，并随后评估其在预测创伤患者生存结局方面的性能。
本研究纳入了 2016 年 1 月至 2019 年 12 月期间在一级和二级急诊科就诊的创伤患者，使用韩国国家急诊部信息系统（NEDIS）数据库。本研究的主要结局为院内死亡率。为每个 865 个创伤诊断代码（韩国标准疾病分类[KCD-7]代码，4 位数字格式）计算了新的 SRR-2020 值，并根据患者的诊断计算出相应的患者特异性 ICISS-2020 值。我们比较了基于新开发的 ICISS-2020 版本的严重创伤患者 ICISS<0.9 与基于先前使用的 ICISS-2015 版本的严重创伤患者 ICISS<0.9 预测院内死亡率的性能。
共纳入 3841122 例患者，院内死亡率为 0.5%。ICISS-2020<0.9 的严重创伤患者占 5.3%（204897 例），低于 ICISS-2015<0.9 的 15.3%（587801 例）。在 20619 例院内死亡病例中，81.4%的患者 ICISS-2020<0.9，88.6%的患者 ICISS-2015<0.9。比较两种 ICISS 版本预测院内死亡率的性能时，ICISS-2020 具有更高的准确性（0.95）、特异性（0.95）、阳性预测值（PPV）（0.08）、阳性似然比（LR+）（16.53）和受试者工作特征曲线下面积（AUROC）（0.96），而 ICISS-2015 的准确性（0.85）、敏感性（0.88）、特异性（0.85）、PPV（0.03）、LR+（5.94）和 AUROC（0.94）。然而，在敏感性方面，ICISS-2020<0.9 的值为 0.81，低于 ICISS-2015<0.9 的 0.88。阴性预测值（NPV）在两个版本中均为 1.00。
利用全国急诊患者数据库开发的新 ICISS-2020 对创伤患者的生存结局预测具有相对较好的性能（准确性、特异性、PPV、LR+和 AUROC）。
