Abstract
The Injury Severity Score (ISS) is a measure of injury severity widely used for research and quality assurance in trauma. Calculation of ISS requires chart abstraction, so it is often unavailable for patients cared for in nontrauma centers. Whether ISS can be accurately calculated from International Classification of Diseases, Ninth Revision (ICD-9) codes remains unclear. Our objective was to compare ISS derived from ICD-9 codes with those coded by trauma registrars. This was a retrospective study of patients entered into 9 U.S. trauma registries from January 2006 through December 2008. Two computer programs, ICDPIC and ICDMAP, were used to derive ISS from the ICD-9 codes in the registries. We compared derived ISS with ISS hand-coded by trained coders. There were 24,804 cases with a mortality rate of 3.9%. The median ISS derived by both ICDPIC (ISS-ICDPIC) and ICDMAP (ISS-ICDMAP) was 8 (interquartile range [IQR] = 4'13). The median ISS in the registry (ISS-registry) was 9 (IQR = 4'14). The median difference between either of the derived scores and ISS-registry was zero. However, the mean ISS derived by ICD-9 code mapping was lower than the hand-coded ISS in the registries (1.7 lower for ICDPIC, 95% CI [1.7, 1.8], Bland'Altman limits of agreement = - 10.5 to 13.9; 1.8 lower for ICDMAP, 95% CI [1.7, 1.9], limits of agreement = - 9.6 to 13.3). ICD-9-derived ISS slightly underestimated ISS compared with hand-coded scores. The 2 methods showed moderate to substantial agreement. Although hand-coded scores should be used when possible, ICD-9-derived scores may be useful in quality assurance and research when hand-coded scores are unavailable.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 4-14 |
| Number of pages | 11 |
| Journal | Journal of Trauma Nursing |
| Volume | 24 |
| Issue number | 1 |
| DOIs | |
| State | Published - 2017 |
Fingerprint
Keywords
- ICD-9
- Injury severity
- Injury Severity Score
- Methodologyresearch concepts
- Trauma
ASJC Scopus subject areas
- Emergency
- Critical Care
- Advanced and Specialized Nursing
Cite this
Validating the use of ICD-9 code mapping to generate injury severity scores. / Fleischman, Ross J.; Mann, N. Clay; Dai, Mengtao; Holmes Jr, James F; Wang, N. Ewen; Haukoos, Jason; Hsia, Renee Y.; Rea, Thomas; Newgard, Craig D.
In: Journal of Trauma Nursing, Vol. 24, No. 1, 2017, p. 4-14.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Validating the use of ICD-9 code mapping to generate injury severity scores
AU - Fleischman, Ross J.
AU - Mann, N. Clay
AU - Dai, Mengtao
AU - Holmes Jr, James F
AU - Wang, N. Ewen
AU - Haukoos, Jason
AU - Hsia, Renee Y.
AU - Rea, Thomas
AU - Newgard, Craig D.
PY - 2017
Y1 - 2017
N2 - The Injury Severity Score (ISS) is a measure of injury severity widely used for research and quality assurance in trauma. Calculation of ISS requires chart abstraction, so it is often unavailable for patients cared for in nontrauma centers. Whether ISS can be accurately calculated from International Classification of Diseases, Ninth Revision (ICD-9) codes remains unclear. Our objective was to compare ISS derived from ICD-9 codes with those coded by trauma registrars. This was a retrospective study of patients entered into 9 U.S. trauma registries from January 2006 through December 2008. Two computer programs, ICDPIC and ICDMAP, were used to derive ISS from the ICD-9 codes in the registries. We compared derived ISS with ISS hand-coded by trained coders. There were 24,804 cases with a mortality rate of 3.9%. The median ISS derived by both ICDPIC (ISS-ICDPIC) and ICDMAP (ISS-ICDMAP) was 8 (interquartile range [IQR] = 4'13). The median ISS in the registry (ISS-registry) was 9 (IQR = 4'14). The median difference between either of the derived scores and ISS-registry was zero. However, the mean ISS derived by ICD-9 code mapping was lower than the hand-coded ISS in the registries (1.7 lower for ICDPIC, 95% CI [1.7, 1.8], Bland'Altman limits of agreement = - 10.5 to 13.9; 1.8 lower for ICDMAP, 95% CI [1.7, 1.9], limits of agreement = - 9.6 to 13.3). ICD-9-derived ISS slightly underestimated ISS compared with hand-coded scores. The 2 methods showed moderate to substantial agreement. Although hand-coded scores should be used when possible, ICD-9-derived scores may be useful in quality assurance and research when hand-coded scores are unavailable.
AB - The Injury Severity Score (ISS) is a measure of injury severity widely used for research and quality assurance in trauma. Calculation of ISS requires chart abstraction, so it is often unavailable for patients cared for in nontrauma centers. Whether ISS can be accurately calculated from International Classification of Diseases, Ninth Revision (ICD-9) codes remains unclear. Our objective was to compare ISS derived from ICD-9 codes with those coded by trauma registrars. This was a retrospective study of patients entered into 9 U.S. trauma registries from January 2006 through December 2008. Two computer programs, ICDPIC and ICDMAP, were used to derive ISS from the ICD-9 codes in the registries. We compared derived ISS with ISS hand-coded by trained coders. There were 24,804 cases with a mortality rate of 3.9%. The median ISS derived by both ICDPIC (ISS-ICDPIC) and ICDMAP (ISS-ICDMAP) was 8 (interquartile range [IQR] = 4'13). The median ISS in the registry (ISS-registry) was 9 (IQR = 4'14). The median difference between either of the derived scores and ISS-registry was zero. However, the mean ISS derived by ICD-9 code mapping was lower than the hand-coded ISS in the registries (1.7 lower for ICDPIC, 95% CI [1.7, 1.8], Bland'Altman limits of agreement = - 10.5 to 13.9; 1.8 lower for ICDMAP, 95% CI [1.7, 1.9], limits of agreement = - 9.6 to 13.3). ICD-9-derived ISS slightly underestimated ISS compared with hand-coded scores. The 2 methods showed moderate to substantial agreement. Although hand-coded scores should be used when possible, ICD-9-derived scores may be useful in quality assurance and research when hand-coded scores are unavailable.
KW - ICD-9
KW - Injury severity
KW - Injury Severity Score
KW - Methodologyresearch concepts
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=85015791535&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85015791535&partnerID=8YFLogxK
U2 - 10.1097/JTN.0000000000000255
DO - 10.1097/JTN.0000000000000255
M3 - Article
C2 - 28033134
AN - SCOPUS:85015791535
VL - 24
SP - 4
EP - 14
JO - Journal of trauma nursing : the official journal of the Society of Trauma Nurses
JF - Journal of trauma nursing : the official journal of the Society of Trauma Nurses
SN - 1078-7496
IS - 1
ER -