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Gagné M, Moore L, Sirois MJ, Simard M, Beaudoin C, Kuimi BLB. Performance of International Classification of Diseases-based injury severity measures used to predict in-hospital mortality and intensive care admission among traumatic brain-injured patients. J Trauma Acute Care Surg 2017; 82:374-382. [PMID: 28107311 DOI: 10.1097/ta.0000000000001319] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The International Classification of Diseases (ICD) is the main classification system used for population-based traumatic brain injury (TBI) surveillance activities but does not contain direct information on injury severity. International Classification of Diseases-based injury severity measures can be empirically derived or mapped to the Abbreviated Injury Scale, but no single approach has been formally recommended for TBI. OBJECTIVE The aim of this study was to compare the accuracy of different ICD-based injury severity measures for predicting in-hospital mortality and intensive care unit (ICU) admission in TBI patients. METHODS We conducted a population-based retrospective cohort study. We identified all patients 16 years or older with a TBI diagnosis who received acute care between April 1, 2006, and March 31, 2013, from the Quebec Hospital Discharge Database. The accuracy of five ICD-based injury severity measures for predicting mortality and ICU admission was compared using measures of discrimination (area under the receiver operating characteristic curve [AUC]) and calibration (calibration plot and the Hosmer-Lemeshow goodness-of-fit statistic). RESULTS Of 31,087 traumatic brain-injured patients in the study population, 9.0% died in hospital, and 34.4% were admitted to the ICU. Among ICD-based severity measures that were assessed, the multiplied derivative of ICD-based Injury Severity Score (ICISS-Multiplicative) demonstrated the best discriminative ability for predicting in-hospital mortality (AUC, 0.858; 95% confidence interval, 0.852-0.864) and ICU admissions (AUC, 0.813; 95% confidence interval, 0.808-0.818). Calibration assessments showed good agreement between observed and predicted in-hospital mortality for ICISS measures. All severity measures presented high agreement between observed and expected probabilities of ICU admission for all deciles of risk. CONCLUSIONS The ICD-based injury severity measures can be used to accurately predict in-hospital mortality and ICU admission in TBI patients. The ICISS-Multiplicative generally outperformed other ICD-based injury severity measures and should be preferred to control for differences in baseline characteristics between TBI patients in surveillance activities or injury research when only ICD codes are available. LEVEL OF EVIDENCE Prognostic study, level III.
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Affiliation(s)
- Mathieu Gagné
- From the Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec, Canada (M.G., M.S., C.B.); Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec City, Québec, Canada (M.G., L.M., C.B., B.L.B.K.); Axe Santé des Populations et pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit, and Traumatologie-Urgence-Soins intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada (L.M., B.L.B.K.); Centre d'Excellence sur le Vieillissement de Québec; and Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec (Hépital de l'Enfant-Jésus); and the Département de réadaptation, Faculté de médecine, Université Laval, Québec City, Québec, Canada (M.-J.S.)
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Lim SW, Shiue YL, Ho CH, Yu SC, Kao PH, Wang JJ, Kuo JR. Anxiety and Depression in Patients with Traumatic Spinal Cord Injury: A Nationwide Population-Based Cohort Study. PLoS One 2017; 12:e0169623. [PMID: 28081205 PMCID: PMC5231351 DOI: 10.1371/journal.pone.0169623] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 12/20/2016] [Indexed: 12/25/2022] Open
Abstract
Background Traumatic spinal cord injury (tSCI) may involve new-onset anxiety and depression post-discharge. However, long-term population-based studies have lacked access to follow-up conditions in terms of new-onset anxiety and depression. The objective of this study was to estimate the long-term risk of new-onset anxiety and depression post-discharge. Methods The Longitudinal Health Insurance Database 2000 (LHID2000) from Taiwan’s National Health Insurance Research Database was used in this study. Individuals with tSCI were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes of 806 and 952 from 1999–2008. The comparison cohort (other health conditions group) was randomly selected from the LHID2000 and was 1:1 matched by age, sex, index year, and comorbidities to reduce the selection bias. All study participants were retrospectively followed for a maximum of 3 years until the end of follow-up, death, or new-onset anxiety (ICD-9-CM: 309.2–309.4) or depression (ICD-9-CM: 296.2, 296.5, 296.82, 300.4, 309.0–309.1, and 311). Persons who were issued a catastrophic illness card for tSCI were categorized as having a severe level of SCI (Injury Severity Score [ISS] ≥16). Poisson regression was used to estimate the incidence rate ratios of anxiety or depression between patients with tSCI and other health conditions. The relative risk of anxiety or depression was estimated using a Cox regression analysis, which was adjusted for potential confounding factors. Results Univariate analyses showed that the tSCI patients (n = 3556) had a 1.33 times greater incidence of new-onset anxiety or depression (95% confidence interval [CI]: 1.12–1.57) compared to the other health conditions group (n = 3556). After adjusting for potential risk factors, the tSCI patients had a significant 1.29-fold increased risk of anxiety or depression compared to the group with other health conditions (95% CI: 1.09–1.53). Individuals with tSCI, including patients who were under the age of 35, patients who were males, patients who had a low income, and patients without a Charlson Comorbidity Index score, all had a higher long-term risk of anxiety or depression than the other health conditions group (IRRs: 1.84, 1.63, 1.29, and 1.39, respectively). For all tSCI patients, those with an Injury Severity Score (ISS) ≥16 had an almost 2-fold higher risk of anxiety or depression (adjusted Hazard Ratio: 1.85; 95% CI: 1.17–2.92) compared to those with ISS <16. Conclusions Our findings indicated that tSCI patients have a high risk of anxiety or depression post-discharge, especially among the younger tSCI patients (age <50 years), compared with the other health conditions group. This information could help physicians understand the long-term risk of new-onset anxiety or depression in tSCI patients post-discharge.
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Affiliation(s)
- Sher-Wei Lim
- Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Shou-Chun Yu
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Medical Research, Chi-Mei Medical Center, Chiali, Tainan, Taiwan
| | - Pei-Hsin Kao
- Department of Psychiatry, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- * E-mail:
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Loftis KL, Price JP, Gillich PJ, Cookman KJ, Brammer AL, St Germain T, Barnes J, Graymire V, Nayduch DA, Read-Allsopp C, Baus K, Stanley PA, Brennan M. Development of an expert based ICD-9-CM and ICD-10-CM map to AIS 2005 update 2008. TRAFFIC INJURY PREVENTION 2016; 17 Suppl 1:1-5. [PMID: 27586094 DOI: 10.1080/15389588.2016.1191069] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This article describes how maps were developed from the clinical modifications of the 9th and 10th revisions of the International Classification of Diseases (ICD) to the Abbreviated Injury Scale 2005 Update 2008 (AIS08). The development of the mapping methodology is described, with discussion of the major assumptions used in the process to map ICD codes to AIS severities. There were many intricacies to developing the maps, because the 2 coding systems, ICD and AIS, were developed for different purposes and contain unique classification structures to meet these purposes. METHODS Experts in ICD and AIS analyzed the rules and coding guidelines of both injury coding schemes to develop rules for mapping ICD injury codes to the AIS08. This involved subject-matter expertise, detailed knowledge of anatomy, and an in-depth understanding of injury terms and definitions as applied in both taxonomies. The official ICD-9-CM and ICD-10-CM versions (injury sections) were mapped to the AIS08 codes and severities, following the rules outlined in each coding manual. The panel of experts was composed of coders certified in ICD and/or AIS from around the world. In the process of developing the map from ICD to AIS, the experts created rules to address issues with the differences in coding guidelines between the 2 schemas and assure a consistent approach to all codes. RESULTS Over 19,000 ICD codes were analyzed and maps were generated for each code to AIS08 chapters, AIS08 severities, and Injury Severity Score (ISS) body regions. After completion of the maps, 14,101 (74%) of the eligible 19,012 injury-related ICD-9-CM and ICD-10-CM codes were assigned valid AIS08 severity scores between 1 and 6. The remaining 4,911 codes were assigned an AIS08 of 9 (unknown) or were determined to be nonmappable because the ICD description lacked sufficient qualifying information for determining severity according to AIS rules. There were also 15,214 (80%) ICD codes mapped to AIS08 chapter and ISS body region, which allow for ISS calculations for patient data sets. CONCLUSION This mapping between ICD and AIS provides a comprehensive, expert-designed solution for analysts to bridge the data gap between the injury descriptions provided in hospital codes (ICD-9-CM, ICD-10-CM) and injury severity codes (AIS08). By applying consistent rules from both the ICD and AIS taxonomies, the expert panel created these definitive maps, which are the only ones endorsed by the Association for the Advancement of Automotive Medicine (AAAM). Initial validation upheld the quality of these maps for the estimation of AIS severity, but future work should include verification of these maps for MAIS and ISS estimations with large data sets. These ICD-AIS maps will support data analysis from databases with injury information classified in these 2 different systems and open new doors for the investigation of injury from traumatic events using large injury data sets.
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Affiliation(s)
| | | | | | - Kathy J Cookman
- a AAAM , Chicago , Illinois
- b KJ Trauma Consulting LLC , Fort Myers , Florida
| | | | | | - Jo Barnes
- a AAAM , Chicago , Illinois
- c Design School, Loughborough University , Loughborough , U.K
| | | | - Donna A Nayduch
- a AAAM , Chicago , Illinois
- d AVP Trauma, HCA North FL Division , Ocala , Florida
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Croft P, Altman DG, Deeks JJ, Dunn KM, Hay AD, Hemingway H, LeResche L, Peat G, Perel P, Petersen SE, Riley RD, Roberts I, Sharpe M, Stevens RJ, Van Der Windt DA, Von Korff M, Timmis A. The science of clinical practice: disease diagnosis or patient prognosis? Evidence about "what is likely to happen" should shape clinical practice. BMC Med 2015; 13:20. [PMID: 25637245 PMCID: PMC4311412 DOI: 10.1186/s12916-014-0265-4] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/24/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Diagnosis is the traditional basis for decision-making in clinical practice. Evidence is often lacking about future benefits and harms of these decisions for patients diagnosed with and without disease. We propose that a model of clinical practice focused on patient prognosis and predicting the likelihood of future outcomes may be more useful. DISCUSSION Disease diagnosis can provide crucial information for clinical decisions that influence outcome in serious acute illness. However, the central role of diagnosis in clinical practice is challenged by evidence that it does not always benefit patients and that factors other than disease are important in determining patient outcome. The concept of disease as a dichotomous 'yes' or 'no' is challenged by the frequent use of diagnostic indicators with continuous distributions, such as blood sugar, which are better understood as contributing information about the probability of a patient's future outcome. Moreover, many illnesses, such as chronic fatigue, cannot usefully be labelled from a disease-diagnosis perspective. In such cases, a prognostic model provides an alternative framework for clinical practice that extends beyond disease and diagnosis and incorporates a wide range of information to predict future patient outcomes and to guide decisions to improve them. Such information embraces non-disease factors and genetic and other biomarkers which influence outcome. SUMMARY Patient prognosis can provide the framework for modern clinical practice to integrate information from the expanding biological, social, and clinical database for more effective and efficient care.
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Affiliation(s)
- Peter Croft
- />Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Douglas G Altman
- />Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD UK
| | - Jonathan J Deeks
- />School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Kate M Dunn
- />Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Alastair D Hay
- />Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS UK
| | - Harry Hemingway
- />Farr Institute of Health Informatics Research, London, and UCL Institute of Health Informatics, London, NW1 2DA UK
| | - Linda LeResche
- />School of Dentistry Office of Research, Box 357480, University of Washington, Seattle, WA 98195 USA
| | - George Peat
- />Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Pablo Perel
- />Epidemiology & Population Health Faculty, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
| | - Steffen E Petersen
- />William Harvey Research Institute and NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, EC1M 6BQ UK
| | - Richard D Riley
- />Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
- />Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Ian Roberts
- />Epidemiology & Population Health Faculty, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
| | - Michael Sharpe
- />Oxford Psychological Medicine Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Richard J Stevens
- />Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG UK
| | - Danielle A Van Der Windt
- />Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Michael Von Korff
- />Group Health Research Institute, Group Health Cooperative, Seattle, WA 98101 USA
| | - Adam Timmis
- />NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, EC1M 6BQ UK
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Pal R, Agarwal A, Galwankar S, Swaroop M, Stawicki SP, Rajaram L, Paladino L, Aggarwal P, Bhoi S, Dwivedi S, Menon G, Misra M, Kalra O, Singh A, Radjou AN, Joshi A. The 2014 Academic College of Emergency Experts in India's INDO-US Joint Working Group (JWG) White Paper on "Developing Trauma Sciences and Injury Care in India". Int J Crit Illn Inj Sci 2014; 4:114-30. [PMID: 25024939 PMCID: PMC4093962 DOI: 10.4103/2229-5151.134151] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
It is encouraging to see the much needed shift in the understanding and recognition of the concept of “burden of disease” in the context of traumatic injury. Equally important is understanding that the impact of trauma burden rivals that of nontraumatic morbidities. Subsequently, this paradigm shift reinstates the appeal for timely interventions as the standard for management of traumatic emergencies. Emergency trauma care in India has been disorganized due to inadequate sensitivity toward patients affected by trauma as well as the haphazard, nonuniform acceptance of standardization as the norm. Some of the major hospitals across various regions in the country do have trauma care units, but even those lack protocols to ensure that all trauma cases are handled by those units, largely owing to lack of structured referral system. As a first step to reform the state of trauma care in the country, a detailed overview is needed to gain insight into the prevailing reality. The objectives of this paper are to thus weave a foundation based on the statistical and qualitative burden of trauma in the country; the available infrastructure of trauma care centers equipped to deal with trauma; the need and scope of standardized protocols for intervention; and most importantly, the application of these in shaping educational initiatives in advancing emergency trauma care in the country.
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Affiliation(s)
- Ranabir Pal
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Amit Agarwal
- Department of Neuro Surgery, Narayana Medical College and Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
| | - Sagar Galwankar
- Department of Emergency Medicine, Winter Haven Hospital, University of Florida, Florida, USA
| | - Mamta Swaroop
- Department of Trauma Surgery and Critical Care, Northwestern University, Chicago, USA
| | - Stanislaw P Stawicki
- Department of Surgery, Division of Trauma, Critical care, and Burns, The Ohio State University College of Medicine, Ohio, USA
| | - Laxminarayan Rajaram
- Department of Epidemiology and Biostatistics, University of South Florida, Florida, USA
| | - Lorenzo Paladino
- Department of Emergency Medicine, Suny Downstate Medical Center, Long Island College Hospital, New York, USA
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sankalp Dwivedi
- Department of Surgery, M M Institute of Medical Sciences and Research, Mullana, Punjab, India
| | - Geetha Menon
- Department of Health Research (Ministry of Health and Family welfare), Division of Non-Communicable Diseases, Indian Council Of Medical Research, New Delhi, India
| | - Mc Misra
- Director of The All India Institute of Medical Sciences, New Delhi, India
| | - Op Kalra
- University College of Medical Sciences, New Delhi, India
| | - Ajai Singh
- Department of Orthopedics, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Angeline Neetha Radjou
- Department of Surgery, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - Anuja Joshi
- Department of Medical Administration, Deenanath Mangeshkar Hospital, Pune, India
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Gabbe BJ, Simpson PM, Lyons RA, Polinder S, Rivara FP, Ameratunga S, Derrett S, Haagsma J, Harrison JE. How well do principal diagnosis classifications predict disability 12 months postinjury? Inj Prev 2014; 21:e120-6. [DOI: 10.1136/injuryprev-2013-041037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lloyd BA, Weintrob AC, Hinkle MK, Fortuna GR, Murray CK, Bradley W, Millar EV, Shaikh F, Vanderzant K, Gregg S, Lloyd G, Stevens J, Carson ML, Aggarwal D, Tribble DR. Adherence to published antimicrobial prophylaxis guidelines for wounded service members in the ongoing conflicts in Southwest Asia. Mil Med 2014; 179:324-8. [PMID: 24594469 PMCID: PMC4070846 DOI: 10.7205/milmed-d-13-00424] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
In 2008, a clinical practice guideline (CPG) was developed for the prevention of infections among military personnel with combat-related injuries. Our analysis expands on a prior 6-month evaluation and assesses CPG adherence with respect to antimicrobial prophylaxis for U.S. combat casualties medically evacuated to Landstuhl Regional Medical Center over a 1-year period (June 2009 through May 2010), with an eventual goal of continuously monitoring CPG adherence and measuring outcomes as a function of compliance. We classified adherence to the CPG as receipt of recommended antimicrobials within 48 hours of injury. A total of 1106 military personnel eligible for CPG assessment were identified and 74% received antimicrobial prophylaxis. Overall, CPG compliance within 48 hours of injury was 75%. Lack of antimicrobial prophylaxis contributed 2 to 22% to noncompliance varying by injury category, whereas receipt of antibiotics other than preferred was 11 to 30%. For extremity injuries, antimicrobial prophylaxis adherence was 60 to 83%, whereas it was 80% for closed injuries and 68% for penetrating abdominal injuries. Overall, the results of our analysis suggest an ongoing need to improve adherence, monitor CPG compliance, and assess effectiveness.
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Affiliation(s)
- Bradley A Lloyd
- Landstuhl Regional Medical Center, CMR 402, Box 1559, APO AE 09180, Landstuhl, Germany
| | - Amy C Weintrob
- Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Mary K Hinkle
- Landstuhl Regional Medical Center, CMR 402, Box 1559, APO AE 09180, Landstuhl, Germany
| | - Gerald R Fortuna
- Landstuhl Regional Medical Center, CMR 402, Box 1559, APO AE 09180, Landstuhl, Germany
| | - Clinton K Murray
- San Antonio Military Medical Center, 3551 Roger Brooke Drive #3600, Fort Sam Houston, TX 78234
| | - William Bradley
- Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Eugene V Millar
- Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Faraz Shaikh
- Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Kristen Vanderzant
- Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Stacie Gregg
- Landstuhl Regional Medical Center, CMR 402, Box 1559, APO AE 09180, Landstuhl, Germany
| | - Gina Lloyd
- Landstuhl Regional Medical Center, CMR 402, Box 1559, APO AE 09180, Landstuhl, Germany
| | - Julie Stevens
- Landstuhl Regional Medical Center, CMR 402, Box 1559, APO AE 09180, Landstuhl, Germany
| | - M Leigh Carson
- Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Deepak Aggarwal
- Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - David R Tribble
- Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
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Nakahara S, Uchida Y, Oda J, Yokota J. Bridging classification for injury diagnoses that can be converted to both the International Classification of Diseases and the Abbreviated Injury Scale. Acute Med Surg 2013; 1:10-16. [PMID: 29930816 DOI: 10.1002/ams2.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/29/2013] [Indexed: 11/10/2022] Open
Abstract
Background The International Statistical Classification of Diseases and Related Health Problems (ICD) is currently undergoing a revision process to develop the Eleventh Revision (ICD-11), but substantial modification of chapter 19 has not been proposed despite its known problems in describing injury severity and multiple injuries. Many facilities treating trauma patients perform duplicate coding for trauma diagnoses using two different classification systems, the ICD for administrative purposes and the Abbreviated Injury Scale (AIS) for trauma registry, because unambiguous conversion of codes between the ICD and AIS is not always possible due to structural differences. Aim We developed a new bridging classification system which can be unambiguously converted to both ICD and AIS. Methods and Results The bridging classification adopted multidimensional coding and addressed differences in granularity and classification boundaries by adopting the more detailed categorizations whenever the granularity and classification boundaries differed between the ICD and AIS. Then we showed that the bridging classification codes could unambiguously converted to both ICD and AIS. Conclusion Once injuries are coded using the bridging classification, the ICD and AIS codes are readily available. Integrating the new bridging classification into the ICD-11, possibly as a clinical modification, would eliminate the necessity of complicated procedures for code conversion and duplicate coding, and benefit users by building on the strengths of both the ICD and AIS.
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Affiliation(s)
| | - Yasuyuki Uchida
- Department of Emergency Medicine Teikyo University School of Medicine Tokyo Japan
| | - Jun Oda
- Department of Emergency Tokyo Medical University Tokyo Japan
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Ringdal KG, Skaga NO, Hestnes M, Steen PA, Røislien J, Rehn M, Røise O, Krüger AJ, Lossius HM. Abbreviated Injury Scale: not a reliable basis for summation of injury severity in trauma facilities? Injury 2013; 44:691-9. [PMID: 22831922 DOI: 10.1016/j.injury.2012.06.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 05/13/2012] [Accepted: 06/30/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Injury severity is most frequently classified using the Abbreviated Injury Scale (AIS) as a basis for the Injury Severity Score (ISS) and the New Injury Severity Score (NISS), which are used for assessment of overall injury severity in the multiply injured patient and in outcome prediction. European trauma registries recommended the AIS 2008 edition, but the levels of inter-rater agreement and reliability of ISS and NISS, associated with its use, have not been reported. METHODS Nineteen Norwegian AIS-certified trauma registry coders were invited to score 50 real, anonymised patient medical records using AIS 2008. Rater agreements for ISS and NISS were analysed using Bland-Altman plots with 95% limits of agreement (LoA). A clinically acceptable LoA range was set at ± 9 units. Reliability was analysed using a two-way mixed model intraclass correlation coefficient (ICC) statistics with corresponding 95% confidence intervals (CI) and hierarchical agglomerative clustering. RESULTS Ten coders submitted their coding results. Of their AIS codes, 2189 (61.5%) agreed with a reference standard, 1187 (31.1%) real injuries were missed, and 392 non-existing injuries were recorded. All LoAs were wider than the predefined, clinically acceptable limit of ± 9, for both ISS and NISS. The joint ICC (range) between each rater and the reference standard was 0.51 (0.29,0.86) for ISS and 0.51 (0.27,0.78) for NISS. The joint ICC (range) for inter-rater reliability was 0.49 (0.19,0.85) for ISS and 0.49 (0.16,0.82) for NISS. Univariate linear regression analyses indicated a significant relationship between the number of correctly AIS-coded injuries and total number of cases coded during the rater's career, but no significant relationship between the rater-against-reference ISS and NISS ICC values and total number of cases coded during the rater's career. CONCLUSIONS Based on AIS 2008, ISS and NISS were not reliable for summarising anatomic injury severity in this study. This result indicates a limitation in their use as benchmarking tools for trauma system performance.
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Affiliation(s)
- Kjetil G Ringdal
- Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway.
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Crandall M, Sharp D, Unger E, Straus D, Brasel K, Hsia R, Esposito T. Trauma deserts: distance from a trauma center, transport times, and mortality from gunshot wounds in Chicago. Am J Public Health 2013; 103:1103-9. [PMID: 23597339 DOI: 10.2105/ajph.2013.301223] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether urban patients who suffered gunshot wounds (GSWs) farther from a trauma center would have longer transport times and higher mortality. METHODS We used the Illinois State Trauma Registry (1999-2009). Scene address data for Chicago-area GSWs was geocoded to calculate distance to the nearest trauma center and compare prehospital transport times. We used multivariate regression to calculate the effect on mortality of being shot more than 5 miles from a trauma center. RESULTS Of 11,744 GSW patients during the study period, 4782 were shot more than 5 miles from a trauma center. Mean transport time and unadjusted mortality were higher for these patients (P < .001 for both). In a multivariate model, suffering a GSW more than 5 miles from a trauma center was associated with an increased risk of death (odds ratio = 1.23; 95% confidence interval = 1.02, 1.47; P = .03). CONCLUSIONS Relative "trauma deserts" with decreased access to immediate care were found in certain areas of Chicago and adversely affected mortality from GSWs. These results may inform decisions about trauma systems planning and funding.
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Affiliation(s)
- Marie Crandall
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Chung CH, Lai CH, Chu CM, Pai L, Kao S, Chien WC. A nationwide, population-based, long-term follow-up study of repeated self-harm in Taiwan. BMC Public Health 2012; 12:744. [PMID: 22950416 PMCID: PMC3488309 DOI: 10.1186/1471-2458-12-744] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 08/31/2012] [Indexed: 11/10/2022] Open
Abstract
Background Previous follow-up studies of repeated self-harm show that the cumulative risk of repeated self-harm within one year is 5.7%–15%, with females at greatest risk. However, relatively few studies have focused on the Far East. The objective of this study was to calculate the cumulative risk of repeated self-harm over different lengths of follow-up time (3 months, 6 months, and 1–8 years), to determine factors influencing repeated self-harm and to explore the interaction between gender and self-harm methods. Methods We used self-harm patient who hospitalized due to first-time self-harm between 2000 and 2007 from 1,230 hospitals in Taiwan. Hospitalization for repeated self-harm among members of this cohort was tracked after 3 months, 6 months, and 1–8 years. Tracking continued until December 31, 2008. We analyzed the cumulative risk and risk factors of repeated self-harm by using negative binomial regression. Results Of the 39,875 individual study samples, 3,388 individuals (8.50%) were found to have repeatedly self-harmed. The cumulative risk of repeated self-harm within three months was 7.19% and within one year was 8%. Within 8 years, it was 8.70%. Females were more likely to repeatedly self-harm than males (RR = 1.21, 95% CI = 1.15–1.76). The main method of self-harm was solid or liquid substances (RR = 1.88, 95% CI = 1.23–2.04) or cutting or piercing (RR = 1.36, 95% CI = 1.02–1.82), and in patients with psychiatric disorders were more likely to self-harm (RR = 1.61, 95% CI = 1.48–1.75). Conclusions The key time for intervention for repeated self-harm is within three months. Appropriate prevention programs should be developed based on gender differences.
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Affiliation(s)
- Chi-Hsiang Chung
- Graduate Institute of Life Sciences, National Defense Medical Center, No. 161, Section 6, Min-Chuan East Road, Neihu District, Taipei City 11490, Taiwan, Republic of China
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