Turner M Osler1, Laurent G Glance, Alan Cook, Jeffrey S Buzas, David W Hosmer. 1. From the Department of Surgery (T.M.O.), University of Vermont, Colchester, Vermont; Department of Anesthesiology (L.G.G.), University of Rochester, Rochester, New York; Trauma Research Program (A.C.), Chandler Regional Medical Center, Chandler, Arizona; and Department of Mathematics and Statistics (J.S.B., D.W.H.), University of Vermont, Colchester, Vermont.
Abstract
BACKGROUND: Outcome prediction models allow risk adjustment required for trauma research and the evaluation of outcomes. The advent of ICD-10-CM has rendered risk adjustment based on ICD-9-CM codes moot, but as yet no risk adjustment model based on ICD-10-CM codes has been described. METHODS: The National Trauma Data Bank provided data from 773,388 injured patients who presented to one of 747 trauma centers in 2016 with traumatic injuries ICD-10-CM codes and Injury Severity Score (ISS). We constructed an outcome prediction model using only ICD-10-CM acute injury codes and compared its performance with that of the ISS. RESULTS: Compared with ISS, the TMPM-ICD-10 discriminated survivors from non-survivors better (ROC TMPM-ICD-10 = 0.861 [0.860-0.872], ROC [reviever operating curve] ISS = 0.830 [0.823-0.836]), was better calibrated (HL [Hosmer-Lemeshow statistic] TMPM-ICD-10 = 49.01, HL ISS = 788.79), and had a lower Akaike information criteria (AIC TMPM-ICD10 = 30579.49; AIC ISS = 31802.18). CONCLUSIONS: Because TMPM-ICD10 provides better discrimination and calibration than the ISS and can be computed without recourse to Abbreviated Injury Scale coding, the TMPM-ICD10 should replace the ISS as the standard measure of overall injury severity for data coded in the ICD-10-CM lexicon. LEVEL OF EVIDENCE: Prognostic/Epidemiologic, level II.
BACKGROUND: Outcome prediction models allow risk adjustment required for trauma research and the evaluation of outcomes. The advent of ICD-10-CM has rendered risk adjustment based on ICD-9-CM codes moot, but as yet no risk adjustment model based on ICD-10-CM codes has been described. METHODS: The National Trauma Data Bank provided data from 773,388 injured patients who presented to one of 747 trauma centers in 2016 with traumatic injuries ICD-10-CM codes and Injury Severity Score (ISS). We constructed an outcome prediction model using only ICD-10-CM acute injury codes and compared its performance with that of the ISS. RESULTS: Compared with ISS, the TMPM-ICD-10 discriminated survivors from non-survivors better (ROC TMPM-ICD-10 = 0.861 [0.860-0.872], ROC [reviever operating curve] ISS = 0.830 [0.823-0.836]), was better calibrated (HL [Hosmer-Lemeshow statistic] TMPM-ICD-10 = 49.01, HL ISS = 788.79), and had a lower Akaike information criteria (AIC TMPM-ICD10 = 30579.49; AIC ISS = 31802.18). CONCLUSIONS: Because TMPM-ICD10 provides better discrimination and calibration than the ISS and can be computed without recourse to Abbreviated Injury Scale coding, the TMPM-ICD10 should replace the ISS as the standard measure of overall injury severity for data coded in the ICD-10-CM lexicon. LEVEL OF EVIDENCE: Prognostic/Epidemiologic, level II.