A Perozziello1, T Gauss2, A Diop3, M Frank-Soltysiak4, P Rufat5, M Raux6, S Hamada7, B Riou8. 1. Département d'informations médicales, groupe hospitalier Paris Nord Val-de-Seine, Assistance publique-Hôpitaux de Paris (AP-HP), Paris et Clichy, 92118 Clichy, France. Electronic address: anne.perozziello@aphp.fr. 2. Département d'anesthésie-réanimation, hôpital Beaujon, groupe hospitalier Paris Nord Val-de-Seine, AP-HP, 92118 Clichy, France. 3. Département d'informations médicales, groupe hospitalier Paris Nord Val-de-Seine, Assistance publique-Hôpitaux de Paris (AP-HP), Paris et Clichy, 92118 Clichy, France. 4. Département d'informations médicales, hôpital Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France. 5. Département d'informations médicales, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France. 6. Département d'anesthésie-réanimation, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; UMRS Inserm 1166 et 1158, IHU ICAN, Sorbonne université, Paris, France. 7. Département d'anesthésie-réanimation, hôpital Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France. 8. UMRS Inserm 1166 et 1158, IHU ICAN, Sorbonne université, Paris, France; Service d'accueil des urgences, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
Abstract
BACKGROUND: Resource allocation to hospitals is highly dependent on appropriate case coding. For trauma victims, the major diagnosis-coding category (DCC) is multiple trauma (DCC26), which triggers higher funding. We hypothesized that DCC26 has limited capacity for appropriate identification of severe trauma victims. METHODS: We studied Injury Severity Score (ISS), Trauma Related Injury Severity Score (TRISS) and in-hospital mortality using data recorded in three level 1 trauma centers over a 2-year period. Patients were divided into two groups: DCC26 and non-DCC26. For non-DCC26 patients, two subgroups were identified: patients with severe head trauma and patients with spinal trauma. Clinical endpoints were mortality, ISS>15 and TRISS, IGS II. Use of hospital resources was estimated using funding and expenditures associated with each patient. RESULTS: During the study period, 2570 trauma victims were included in the analysis. These patients were 39±18 years old, with median ISS=14, and observed mortality=10 %. Group DCC26 had 811 (31 %) patients, group non-DCC26 1855 (69 %) patients. DCC26 coding identified a more severely injured group of patients. However, in the group non-DCC26, there was a high proportion of severe trauma (ISS>15: 35 %; TRISS<0.95: 9 %). CONCLUSION: DCC26 is not an appropriate coding for severe trauma patients. For these patients, expenditures will include intensive care and rare and costly resources. We propose to take into account the TRISS score to improve trauma coding.
BACKGROUND: Resource allocation to hospitals is highly dependent on appropriate case coding. For trauma victims, the major diagnosis-coding category (DCC) is multiple trauma (DCC26), which triggers higher funding. We hypothesized that DCC26 has limited capacity for appropriate identification of severe trauma victims. METHODS: We studied Injury Severity Score (ISS), Trauma Related Injury Severity Score (TRISS) and in-hospital mortality using data recorded in three level 1 trauma centers over a 2-year period. Patients were divided into two groups: DCC26 and non-DCC26. For non-DCC26patients, two subgroups were identified: patients with severe head trauma and patients with spinal trauma. Clinical endpoints were mortality, ISS>15 and TRISS, IGS II. Use of hospital resources was estimated using funding and expenditures associated with each patient. RESULTS: During the study period, 2570 trauma victims were included in the analysis. These patients were 39±18 years old, with median ISS=14, and observed mortality=10 %. Group DCC26 had 811 (31 %) patients, group non-DCC26 1855 (69 %) patients. DCC26 coding identified a more severely injured group of patients. However, in the group non-DCC26, there was a high proportion of severe trauma (ISS>15: 35 %; TRISS<0.95: 9 %). CONCLUSION:DCC26 is not an appropriate coding for severe traumapatients. For these patients, expenditures will include intensive care and rare and costly resources. We propose to take into account the TRISS score to improve trauma coding.