Mannaerts G H, Sawor J H, Menovsky T, Springer L, Patka P, Haarman H J
Academisch Ziekenhuis Vrije Universiteit, afd. Heelkunde/Traumatologie, Amsterdam.
Ned Tijdschr Geneeskd. 1994 Nov 12;138(46):2290-4.
Evaluation of the reliability of diagnostic codification by the Medical Codification Department (MCD) as a method of national hospital identification of multiple injury patients and description of epidemiology and mortality among the multiple injury group studied.
Prospective/retrospective and descriptive.
Free University Hospital, Amsterdam.
The injuries of 207 severely injured patients presented at the Accident and Emergency department during the year 1992, were coded as an Injury Severity Score (ISS). Those having an ISS > or = 18 were reviewed on cause and outcome of the injury. The diagnose for codification (International Classification of Diseases-9 Clinical Modification) of the MCD, from which an Abbreviated Injury Score (AIS) and the ISS can be calculated, was evaluated.
24 out of the 207 severely injured patients were transferred to other hospitals after stabilisation because of lack of room. Of the remaining 183 patients 124 had an ISS > or = 18.44 (35%) patients died during their stay in hospital. 21 (48%) of them died within 2 hours. 28 (64%) multiple injury patients died during the first 24 hours after admission. Neurological damage was the main cause of death (59%), followed by exsanguination (30%). A traffic accident was the cause of the injuries in 61% and a fall or jump in 27%. The mean ISS of these patients was 29 and the maximum score was 66. Head and neck injuries were present in 80% of the patients. The codification of brain damage by the MCD resulted in several mistakes. Brain damage in multiple injury cases results in a high AIS. Since the ISS is calculated by multiplication of AIS values, small differences in AIS create considerable variations in ISS.
Multiple injury patients need fast and adequate help because of the high mortality, especially in the first 24 hours. The diagnostic codification of the MCD was found not reliable enough to be used for a hospital identification and registration of multiple injury patients.
评估医学编码部门（MCD）诊断编码的可靠性，以此作为全国医院识别多发伤患者的一种方法，并描述所研究的多发伤群体的流行病学特征和死亡率。
前瞻性/回顾性和描述性研究。
阿姆斯特丹自由大学医院。
对1992年期间在急诊科就诊的207例重伤患者的损伤情况进行编码，得出损伤严重程度评分（ISS）。对ISS≥18的患者的损伤原因和结果进行回顾。评估了MCD用于编码的诊断（国际疾病分类第9版临床修订本），从中可计算出简明损伤评分（AIS）和ISS。
207例重伤患者中有24例因空间不足在病情稳定后转至其他医院。其余183例患者中，124例ISS≥18。44例（35%）患者在住院期间死亡。其中21例（48%）在2小时内死亡。28例（64%）多发伤患者在入院后24小时内死亡。神经损伤是主要死因（59%），其次是失血（30%）。61%的损伤由交通事故所致，27%由跌倒或坠落所致。这些患者的平均ISS为29，最高分为66。80%的患者存在头颈部损伤。MCD对脑损伤的编码出现了一些错误。多发伤病例中的脑损伤导致较高的AIS。由于ISS是通过AIS值相乘计算得出的，AIS的微小差异会导致ISS出现相当大的变化。
由于死亡率高，尤其是在最初24小时内，多发伤患者需要快速且充分的救治。发现MCD的诊断编码不够可靠，无法用于医院对多发伤患者的识别和登记。
