Alice Claeson1, Mattias Sterner2, Jonathan Attergrim2, Monty Khajanchi3, Vineet Kumar4, Makhan Lal Saha5, Martin Gerdin Wärnberg2. 1. System and Policy Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. Electronic address: alice.claeson@stud.ki.se. 2. System and Policy Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 3. Department of General Surgery, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India. 4. Department of Surgery, College Building First Floor, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India. 5. Department of General Surgery, Institute of Post-Graduate Medical Education and Research, Kolkata, India.
Abstract
BACKGROUND: Trauma is the cause of 1.2 million deaths in India annually. Injury severity scores play an important role in trauma research and care because these scores enable the adjustment of trauma severity when comparing mortality outcomes. The generalizability of the International Classification of Diseases Injury Severity Score (ICISS) between different populations is not fully known, and the validity of the ICISS has not been assessed in the Indian context. The aim of this study was to assess the predictive performances of three international versions of the ICISS, derived from data from Australia, New Zealand and pooled data from seven different high-income countries, in trauma patients admitted to four public hospitals in urban India. MATERIAL AND METHODS: We used patient data from an Indian cohort of 16,047 trauma patients. The patients were assigned an ICISS based on International Classification of Diseases codes using survival risk ratios from publicly available data sets from Australia and New Zealand and with pooled data from seven different high-income countries. Predicted mortality based on the ICISS was compared with observed patient mortality, and the predictive performance was assessed in terms of discrimination and calibration. RESULTS: Discrimination and calibration did not reach the threshold for predictive performance in any of the ICISS versions used. The threshold value used was 0.8 for discrimination, which was not significantly different from one for the calibration slope and not significantly different from zero for the calibration intercept. CONCLUSIONS: None of the international versions of the ICISS adequately predicted mortality within the study population, indicating the need for an ICISS version specifically adapted to the Indian context.
BACKGROUND:Trauma is the cause of 1.2 million deaths in India annually. Injury severity scores play an important role in trauma research and care because these scores enable the adjustment of trauma severity when comparing mortality outcomes. The generalizability of the International Classification of Diseases Injury Severity Score (ICISS) between different populations is not fully known, and the validity of the ICISS has not been assessed in the Indian context. The aim of this study was to assess the predictive performances of three international versions of the ICISS, derived from data from Australia, New Zealand and pooled data from seven different high-income countries, in traumapatients admitted to four public hospitals in urban India. MATERIAL AND METHODS: We used patient data from an Indian cohort of 16,047 traumapatients. The patients were assigned an ICISS based on International Classification of Diseases codes using survival risk ratios from publicly available data sets from Australia and New Zealand and with pooled data from seven different high-income countries. Predicted mortality based on the ICISS was compared with observed patient mortality, and the predictive performance was assessed in terms of discrimination and calibration. RESULTS: Discrimination and calibration did not reach the threshold for predictive performance in any of the ICISS versions used. The threshold value used was 0.8 for discrimination, which was not significantly different from one for the calibration slope and not significantly different from zero for the calibration intercept. CONCLUSIONS: None of the international versions of the ICISS adequately predicted mortality within the study population, indicating the need for an ICISS version specifically adapted to the Indian context.
Keywords:
ICISS; India; International classification of diseases injury severity score; Mortality prediction; Public university hospitals; Trauma; Trauma mortality