A traumatic injury mortality prediction (TRIMP) based on a comprehensive assessment of abbreviated injury scale 2005 predot codes

AbstractAbbreviated Injury Scale (AIS)-based systems such as injury severity score (ISS), exponential injury severity score (EISS), trauma mortality prediction model (TMPM), and injury mortality prediction (IMP), classify anatomical injuries with limited accuracy. The widely accepted alternative, trauma and injury severity score (TRISS), improves the prediction rate by combining an anatomical index of ISS, physiological index (the Revised Trauma Score, RTS), and the age of patients. The study introduced the traumatic injury mortality prediction (TRIMP) with the inclusion of extra clinical information and aimed to compare the ability against the TRISS as predictors of survival. The hypothesis was that TRIMP would outperform TRISS in prediction power by incorporating clinically available data. This was a retrospective cohort study where a total of 1,198,885 injured patients hospitalized between 2012 and 2014 were subset from the National Trauma Data Bank (NTDB) in the United States. A TRIMP model was computed that uses AIS 2005 (AIS_05), physiological reserve and physiological response indicators. The results were analysed by examining the area under the receiver operating characteristic curve (AUC), the Hosmer–Lemeshow (HL) statistic, and the Akaike information criterion. TRIMP gave both significantly better discrimination (AUCTRIMP, 0.964; 95% confidence interval (CI), 0.962 to 0.966 and AUCTRISS, 0.923; 95% CI, 0.919 to 0.926) and calibration (HLTRIMP, 14.0; 95% CI, 7.7 to 18.8 and HLTRISS, 411; 95% CI, 332 to 492) than TRISS. Similar results were found in statistical comparisons among different body regions. TRIMP was superior to TRISS in terms of accurate of mortality prediction, TRIMP is a new and feasible scoring method in trauma research and should replace the TRISS.

Download Full-text

IMP-ICDX: an injury mortality prediction based on ICD-10-CM codes

World Journal of Emergency Surgery ◽

10.1186/s13017-019-0265-y ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Muding Wang ◽

Wusi Qiu ◽

Yunji Zeng ◽

Wenhui Fan ◽

Xiao Lian ◽

...

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Assessment Method ◽

Mortality Prediction ◽

Research Assessment ◽

Injury Mortality ◽

Risk Adjustment Model ◽

Death Probability ◽

Icd 10

Abstract Background The International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) Injury Severity Score (ICISS) is a risk adjustment model when injuries are recorded using ICD-9-CM coding. The trauma mortality prediction model (TMPM-ICD9) provides better calibration and discrimination compared with ICISS and injury severity score (ISS). Though TMPM-ICD9 is statistically rigorous, it is not precise enough mathematically and has the tendency to overestimate injury severity. The purpose of this study is to develop a new ICD-10-CM injury model which estimates injury severities for every injury in the ICD-10-CM lexicon by a combination of rigorous statistical probit models and mathematical properties and improves the prediction accuracy. Methods We developed an injury mortality prediction (IMP-ICDX) using data of 794,098 patients admitted to 738 hospitals in the National Trauma Data Bank from 2015 to 2016. Empiric measures of severity for each of the trauma ICD-10-CM codes were estimated using a weighted median death probability (WMDP) measurement and then used as the basis for IMP-ICDX. ISS (version 2005) and the single worst injury (SWI) model were re-estimated. The performance of each of these models was compared by using the area under the receiver operating characteristic (AUC), the Hosmer-Lemeshow (HL) statistic, and the Akaike information criterion statistic. Results IMP-ICDX exhibits significantly better discrimination (AUCIMP-ICDX, 0.893, and 95% confidence interval (CI), 0.887 to 0.898; AUCISS, 0.853, and 95% CI, 0.846 to 0.860; and AUCSWI, 0.886, and 95% CI, 0.881 to 0.892) and calibration (HLIMP-ICDX, 68, and 95% CI, 36 to 98; HLISS, 252, and 95% CI, 191 to 310; and HLSWI, 92, and 95% CI, 53 to 128) compared with ISS and SWI. All models were improved after the extension of age, gender, and injury mechanism, but the augmented IMP-ICDX still dominated ISS and SWI by every performance. Conclusions The IMP-ICDX has a better discrimination and calibration compared to ISS. Therefore, we believe that IMP-ICDX could be a new viable trauma research assessment method.

Download Full-text

Non-Selective Thoracic Computed Tomography in Trauma Patients Results in Injury Severity Score Inflation

The American Surgeon ◽

10.1177/00031348211024973 ◽

2021 ◽

pp. 000313482110249

Author(s):

Leonardo Alaniz ◽

Omaer Muttalib ◽

Juan Hoyos ◽

Cesar Figueroa ◽

Cristobal Barrios

Keyword(s):

Computed Tomography ◽

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Treatment Plan ◽

Mortality Prediction ◽

Trauma Patients ◽

Mortality Benefit ◽

Severity Scores ◽

Score Inflation

Introduction Extensive research relying on Injury Severity Scores (ISS) reports a mortality benefit from routine non-selective thoracic CTs (an integral part of pan-computed tomography (pan-CT)s). Recent research suggests this mortality benefit may be artifact. We hypothesized that the use of pan-CTs inflates ISS categorization in patients, artificially affecting admission rates and apparent mortality benefit. Methods Eight hundred and eleven patients were identified with an ISS >15 with significant findings in the chest area. Patient charts were reviewed and scores were adjusted to exclude only occult injuries that did not affect treatment plan. Pearson chi-square tests and multivariable logistic regression were used to compare adjusted cases vs non-adjusted cases. Results After adjusting for inflation, 388 (47.8%) patients remained in the same ISS category, 378 (46.6%) were reclassified into 1 lower ISS category, and 45 (5.6%) patients were reclassified into 2 lower ISS categories. Patients reclassified by 1 category had a lower rate of mortality ( P < 0.001), lower median total hospital LOS ( P < .001), ICU days ( P < .001), and ventilator days ( P = 0.008), compared to those that remained in the same ISS category. Conclusion Injury Severity Score inflation artificially increases survival rate, perpetuating the increased use of pan-CTs. This artifact has been propagated by outdated mortality prediction calculation methods. Thus, prospective evaluations of algorithms for more selective CT scanning are warranted.

Download Full-text

Economical treatment-related burden assessment of maxillofacial trauma among Ukrainians patients

Brazilian Journal of Oral Sciences ◽

10.20396/bjos.v19i0.8659930 ◽

2020 ◽

Vol 19 ◽

pp. e209930

Author(s):

Pavlo Brekhlichuk ◽

Myroslav Goncharuk-Khomyn

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Treatment Cost ◽

Injury Severity ◽

Traumatic Injury ◽

Maxillofacial Trauma ◽

Facial Injury ◽

Maxillofacial Injury ◽

Duration Of Hospitalization ◽

Dental Rehabilitation

Aim: Quantitative evaluation of prognostic correspondence between initial maxillofacial traumatic injury assessed by facial injury severity score and maxillofacial injury severity score, treatment cost and duration of hospitalization among Ukrainian patients. Methods: Design of present study was retrospective and based on the medical data of patients hospitalized with signs of maxillofacial trauma. Quantitative assessment of maxillofacial trauma was held with the use of facial injury severity score (FISS) and maxillofacial injury severity score (MFISS). Average treatment cost and hospitalization duration were used as coordinative criteria for economical treatmentrelated burden verification. Results: Levels of correlation between FISS, treatment charges and hospitalization duration were r=0.69 (р<0.05) and r=0.67 (р<0.05) respectively, while analogical correlations for MFISS were 0.74 (р<0.05) and 0.69 respectively (р<0.05). Statistical correspondence between FISS and MFISS scores among study sample reached r=0.71 (р<0.05). Cases with milder maxillofacial trauma types, characterized with initial lower levels of FISS and MFISS scores, demonstrated greater degree of FISS-to-MFISS inter-relation compare to cases with severe maxillofacial trauma. Conclusion: Even though FISS and MFISS scores both demonstrated reliable levels of correlation with hospitalization duration and cost of dental rehabilitation after maxillofacial trauma injury, but MFISS approach characterized by prognostically greater level of statistical relationship with economically related treatment derivates. Moreover, differentiation capabilities of MFISS is relative greater than FISS, since independent grading of separate functional disabilities becomes possible.

Download Full-text

Measuring trauma severity using the 1998 and 2005 revisions of the Abbreviated Injury Scale

Revista da Escola de Enfermagem da USP ◽

10.1590/s0080-623420140000400010 ◽

2014 ◽

Vol 48 (4) ◽

pp. 641-648 ◽

Cited By ~ 3

Author(s):

Maria Carolina Barbosa Teixeira Lopes ◽

Iveth Yamaguchi Whitaker

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Sao Paulo ◽

São Paulo ◽

Abbreviated Injury Scale ◽

New Injury Severity Score ◽

Trauma Severity

Objetivo: Comparar a gravidade das lesões e do trauma mensurada pelas versões da Abbreviated Injury Scale 1998 e 2005 e verificar a mortalidade nos escores Injury Severity Score e New Injury Severity Score nas duas versões.Método: Estudo transversal e retrospectivo analisou lesões de pacientes de trauma, de três hospitais universitários do município de São Paulo, Brasil. Cada lesão foi codificada com Abbreviated Injury Scale 1998 e 2005. Os testes estatísticos aplicados foram Wilcoxon, McNemar-Bowker, Kappa e teste Z.Resultados: A comparação das duas versões resultou em discordância significante de escores em algumas regiões corpóreas. Com a versão 2005 os níveis de gravidade da lesão e do trauma foram significantemente reduzidos e a mortalidade foi mais elevada em escores mais baixos. Conclusão: Houve redução da gravidade da lesão e do trauma e alteração no percentual de mortalidade com o uso da Abbreviated Injury Scale 2005.    

Download Full-text

Clinical Outcome and Management for Geriatric Traumatic Injury: Analysis of 2688 Cases in the Emergency Department of a Teaching Hospital in Taiwan

Journal of Clinical Medicine ◽

10.3390/jcm7090255 ◽

2018 ◽

Vol 7 (9) ◽

pp. 255 ◽

Cited By ~ 1

Author(s):

Meng-Yu Wu ◽

Yu-Long Chen ◽

Giou-Teng Yiang ◽

Chia-Jung Li ◽

Amy Lin

Keyword(s):

Clinical Outcome ◽

Injury Severity Score ◽

Clinical Outcomes ◽

Severity Score ◽

Injury Severity ◽

Strong Predictor ◽

Traumatic Injury ◽

Geriatric Trauma ◽

Shock Index ◽

New Injury Severity Score

Geriatric traumatic injuries in emergency departments are frequent and associated with higher mortality rates and catastrophic functional outcomes. Several prediction scores have been established to manage traumatic patients, including the shock index (SI), revised trauma score (RTS), injury severity score (ISS), trauma injury severity score (TRISS), and new injury severity score (NISS). However, it was necessary to investigate the effectiveness and efficiency of care for the geriatric traumatic population. In addition, image studies such as computed tomography and magnetic resonance imaging play an important role in early diagnosis and timely intervention. However, few studies focus on this aspect. The association between the benefit of carrying out more image studies and clinical outcomes remains unclear. In this study, we included a total of 2688 traumatic patients and analyzed the clinical outcomes and predicting factors in terms of geriatric trauma via pre-hospital and in-hospital analysis. Our evaluation revealed that a shock index ≥1 may be not a strong predictor of geriatric trauma due to the poor physical response in the aging population. This should be modified in geriatric patients. Other systems, like RTS, ISS, TRISS, and NISS, were significant in terms of predicting the clinical outcome.

Download Full-text

Epidemiology of Traumatic Esophageal Injury: An Analysis of the National Trauma Data Bank

The American Surgeon ◽

10.1177/000313481908500422 ◽

2019 ◽

Vol 85 (4) ◽

pp. 342-349 ◽

Cited By ~ 1

Author(s):

Alexander A. Xu ◽

Janis L. Breeze ◽

Jessica K. Paulus ◽

Nikolay Bugaev

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Traumatic Injury ◽

Data Bank ◽

Esophageal Injury ◽

Trauma Patients ◽

Adult Age ◽

National Trauma ◽

National Trauma Data Bank

Existing literature on traumatic injury of the esophagus (TIE) is limited. We aimed to describe the clinical characteristics and outcomes of TIE. We reviewed the National Trauma Data Bank for the years 2010–2015. We described the demographics, characteristics, and outcomes of adult (age ≥16 years) TIE patients and also compared those factors in blunt versus penetrating TIE. The association between TIE and mortality was analyzed using multivariable logistic regression. Thousand four hundred eleven adult TIE patients were identified (37 per 100,000 trauma patients, 95% confidence intervals (CI): 35, 39). TIE patients were younger (38 vs 52 years), more likely to be male (81% vs 62%), and more severely injured (Injury Severity Score ≥ 25: 45% vs 7%) than patients without TIE (all P < 0.001). TIE was observed 16 times more frequently with penetrating injuries (257 per 100,000, 95% CI: 240, 270) than with blunt injuries (16 per 100,000, 95% CI: 15, 18). Inhospital TIE mortality was 19 per cent. TIE patients had greater risk of mortality than other trauma patients, after adjusting for age, gender, and Injury Severity Score (odds ratio = 1.4, 95% CI: 1.1, 1.7). Mortality in blunt and penetrating TIE did not differ. Although extremely rare, TIE is independently associated with a marked increase in mortality, even after adjusting for other risk factors.

Download Full-text

Avaliação da gravidade do traumatismo crânio-encefálico por índices anatômicos e fisiológicos

Revista da Escola de Enfermagem da USP ◽

10.1590/s0080-62341996000100010 ◽

1996 ◽

Vol 30 (1) ◽

pp. 116-137 ◽

Cited By ~ 1

Author(s):

Maria de Fátima Paiva Imai ◽

Maria Sumie Koizumi

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Abbreviated Injury Scale ◽

Terapia Intensiva

Este estudo analisou prospectivamente a gravidade do Traumatismo Crânio-Encefálico (TCE) a partir de índices anatômicos e fisiológicos em pacientes internados em Unidade de Terapia Intensiva. Teve por objetivo caracterizar a população quanto a idade, sexo, tempo de permanência na UTI e causa externa. Caracterizar a gravidade das lesões pela Abbreviated Injury Scale (AIS), do trauma pelo Injury Severity Score (ISS) e do TCE pela Escala de Coma de Glasgow (ECGl), além de verificar a possível associação entre os índices. Os resultados apontam a predominância de adultos jovens e do sexo masculino com causa externa mais freqüente em acidentes de trânsito de veículo a motor e média de permanência na UTI de 6,28 dias. Quanto a gravidade das lesões constatou-se que os pacientes apresentaram lesões graves, que não ameaçam a vida (AIS3) e lesões graves, que ameaçam a vida (AIS4) e que a região corpórea mais atingida foi a cabeça e pescoço. Em relação a gravidade do trauma constatou-se que a maioria dos pacientes obteve ISS 3 16. Pela gravidade do TCE, a maioria dos pacientes apresentou TCE grave ou ECGl de 3 a 8. Através da associação entre os índices analisados por grupos de gravidade constatou-se que há associação estatisticamente significativa entre a ECGl-1 e a AIS da região cabeça, ou seja ECGl 3 a 8 e AIS- cabeça 4 e 5 e ECGl 9 a 12 e AIS- cabeça 2 e 3. Não houve associação estatisticamente significativa entre a ECGl-1 e o ISS, TCE isolado ou TCE associado a outras lesões e o ISS ou a ECGl.

Download Full-text

Comparison of Injury Severity Score, New Injury Severity Score, Revised Trauma Score and Trauma and Injury Severity Score for Mortality Prediction in Elderly Trauma Patients

Indian Journal of Critical Care Medicine ◽

10.5005/jp-journals-10071-23120 ◽

2019 ◽

Vol 23 (2) ◽

pp. 73-77 ◽

Cited By ~ 7

Author(s):

Akkamahadevi Patil ◽

Madhu Srinivasarangan ◽

Rameshbabu Homanna Javali ◽

Krishnamoorthy LNU ◽

Suraj LNU ◽

...

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Mortality Prediction ◽

Trauma Patients ◽

New Injury Severity Score ◽

Revised Trauma Score ◽

Elderly Trauma Patients ◽

Trauma Score ◽

Trauma And Injury

Download Full-text

Emergency Trauma Providers as Equal Partners: From “Proof of Concept” to “Outcome Parity”

The American Surgeon ◽

10.1177/000313481908500936 ◽

2019 ◽

Vol 85 (9) ◽

pp. 961-964

Author(s):

Kathryn C. Kelley ◽

Alex Alers ◽

Charles Bendas ◽

Peter G. Thomas ◽

James Cipolla ◽

...

Keyword(s):

United States ◽

Injury Severity Score ◽

Severity Score ◽

Functional Outcomes ◽

Injury Severity ◽

The United States ◽

Patient Age ◽

Lengths Of Stay ◽

Patient Âgé ◽

Surgical Critical Care

Enmeshment of emergency trauma providers (ETPs) into the United States health-care fabric resulted in the establishment of a formalized surgical critical care fellowship and certification for emergency medicine trainees. The aim of this study was to compare trauma outcomes for surgery-trained providers (STPs) and ETPs at our institution, hypothesizing patient outcome equivalency. We performed an institutional review board–exempt institutional registry review (January 1, 2004 to August 1, 2018), comparing 74 STPs and 6 ETPs. Comparator variables included all-cause mortality, all-cause morbidity, CTimaging studies per provider, time in ED (min), hospital/ICU lengths of stay, ICU admissions, and functional outcomes on discharge. Statistical comparisons included chi-square test for categorical data and analysis of covariance for continuous data (adjustments made for patient age, Injury Severity Score, and trauma mechanism; all P < 0.20). Statistical significance was set at P < 0.05, with an equivalence study design. A total of 33,577 trauma resuscitations were reviewed (32,299 STP-led and 1,278 ETP-led). Except for patient age (STP 50.2 ± 25.9 vs ETP 54.9 ± 25.3 years), Injury Severity Score (8.47 ± 8.14 vs 9.22 ± 8.40), and ICU admissions (16.1% vs 18.8%), we noted no significant intergroup differences. ETPs’ performance was equivalent to that of STPs for all primary comparator variables (mortality, morbidity, CT utilization, time in the ED, lengths of stay, and functional outcomes). Incorporation of ETPs into our trauma center resulted in outcome parity between ETPs and STPs, while simultaneously expanding the expertise and experiential diversity within our multidisciplinary team. This study provides support for further incorporation of ETPs as equal partners across the growing network of United States regional trauma centers.

Download Full-text