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
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
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DOI：
10.1097/ta.0000000000001319
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发表时间：
2017-02-01
影响因子：
3.4
通讯作者：
Kuimi, Brice Lionel Batomen
中科院分区：
文献类型：
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作者：
Gagne, Mathieu;Moore, Lynne;Kuimi, Brice Lionel Batomen
背景：国际疾病分类（ICD）是用于基于人群的创伤性脑损伤（TBI）监测活动的主要分类系统，但不包含损伤严重程度的直接信息。基于国际疾病分类的损伤严重程度措施可以根据经验推导或映射到简略损伤量表，但没有一种方法被正式推荐用于TBI。目的：本研究的目的是比较不同的基于icd的损伤严重程度指标在预测TBI患者住院死亡率和重症监护病房（ICU）入院率方面的准确性。方法：我们进行了一项基于人群的回顾性队列研究。我们从魁北克医院出院数据库中确定了2006年4月1日至2013年3月31日期间接受急性治疗的所有16岁或以上TBI诊断患者。采用区分指标（受试者工作特征曲线下面积[AUC]）和校准指标（校准图和Hosmer-Lemeshow拟合优度统计）比较基于icd的5种损伤严重程度指标预测死亡率和ICU入院率的准确性。结果：研究人群31,087例外伤性脑损伤患者中，9.0%在医院死亡，34.4%住院。在评估的基于icd的严重程度指标中，基于icd的损伤严重程度评分（iciss - multiplative）的乘导数在预测住院死亡率（AUC, 0.858； 95%可信区间，0.852-0.864）和ICU入院率（AUC, 0.813； 95%可信区间，0.808-0.818）方面表现出最佳的判别能力。校准评估显示，ICISS测量的观察到的住院死亡率和预测的住院死亡率之间存在良好的一致性。所有严重程度指标在观察到的和预期的ICU入院概率之间都显示出高度的一致性。结论：基于icd的损伤严重程度指标可准确预测TBI患者住院死亡率和ICU入院率。iciss - multiplative通常优于其他基于ICD的损伤严重程度测量，当只有ICD代码可用时，应优先用于控制TBI患者在监测活动或损伤研究中的基线特征差异。（版权所有）2016威科集团健康有限公司版权所有。)
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-hospitalmortality 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. (Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.)