Should the IDC-9 Trauma Mortality Prediction Model become the new paradigm for benchmarking trauma outcomes?

Authors

Adil H. Haider, The Johns Hopkins University, BaltimoreFollow
Cassandra V. Villegas, The Johns Hopkins University, Baltimore
Taimur Saleem, The Johns Hopkins University, Baltimore
David T. Efron, The Johns Hopkins University, Baltimore
Kent A. Stevens, The Johns Hopkins University, Baltimore
Tolulope A. Oyetunji, Howard University, Washington
Edward E. Cornwell, Howard University, Washington
Stephen Bowman, The Johns Hopkins University, Baltimore
Sara Haack, The Johns Hopkins University, Baltimore
Susan P. Baker, The Johns Hopkins University, Biltmore

Document Type

Article

Department

General Surgery

Abstract

Background: Optimum quantification of injury severity remains an imprecise science with a need for improvement. The accuracy of the criterion standard Injury Severity Score (ISS) worsens as a patient's injury severity increases, especially among patients with penetrating trauma. The objective of this study was to comprehensively compare the mortality prediction ability of three anatomic injury severity indices: the ISS, the New ISS (NISS), and the DRG International Classification of Diseases-9th Rev.-Trauma Mortality Prediction Model (TMPM-ICD-9), a recently developed contemporary injury assessment model.
Methods: Retrospective analysis of patients in the National Trauma Data Bank from 2007 to 2008. The TMPM-ICD-9 values were computed and compared with the ISS and NISS for each patient using in-hospital mortality after trauma as the outcome measure. Discrimination and calibration were compared using the area under the receiver operator characteristic curve. Subgroup analysis was performed to compare each score across varying ranges of injury severity and across different types of injury.
Results: A total of 533,898 patients were identified with a crude mortality rate of 4.7%. The ISS and NISS performed equally in the groups with minor (ISS, 1-8) and moderate (ISS, 9-15) injuries, regardless of the injury type. However, in the populations with severe (ISS, 16-24) and very severe (ISS, ≥ 25) injuries for all injury types, the NISS predicted mortality better than the ISS did. The TMPM-ICD-9 outperformed both the NISS and ISS almost consistently.
Conclusion: The NISS and TMPM-ICD-9 are both superior predictors of mortality as compared with the ISS. The immediate adoption of NISS for evaluating trauma outcomes using trauma registry data is recommended. The TMPM-ICD-9 may be an even better measure of human injury, and its use in administrative or nonregistry data is suggested. Further research on its attributes is recommended because it has the potential to become the basis for benchmarking trauma outcomes.

Comments

This work was published before the author joined Aga Khan University

Publication (Name of Journal)

Journal of Trauma and Acute Care Surgery

Recommended Citation

Haider, A. H., Villegas, C. V., Saleem, T., Efron, D. T., Stevens, K. A., Oyetunji, T. A., Cornwell, E. E., Bowman, S., Haack, S., Baker, S. P. (2012). Should the IDC-9 Trauma Mortality Prediction Model become the new paradigm for benchmarking trauma outcomes?. Journal of Trauma and Acute Care Surgery, 72(6), 1695-1701.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_gen/231