ICISS: An International Classsfication of Disease-9 based Injury Severity Score
ICISS: An International Classsfication of Disease-9 based Injury Severity Score
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DOI：
10.1097/00005373-199609000-00002
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发表时间：
1996-09-01
影响因子：
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通讯作者：
Bedrick, E
中科院分区：
文献类型：
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作者：
Osler, T;Rutledge, R;Bedrick, E
背景：20年来，损伤严重程度评分(ISS)一直被用作人类创伤的标准汇总衡量标准，尽管其服务坚定不移，但ISS有两个弱点：它依赖于对每个简化损伤等级(AIS)损伤的严重程度估计的共识，并且最多只考虑单个患者的三个伤害，这三个伤害通常甚至不是患者最严重的伤害。此外，国际空间站要求所有患者在AIS词典中描述他们的受伤情况，这是一个昂贵的步骤，目前只有热衷于创伤护理的医院才会采取这一步骤。我们假设，使用经验性得出的损伤严重程度并考虑单个患者的所有伤害的数据驱动替代方案将更准确地预测生存。方法：使用北卡罗来纳州出院数据库经验得出每种国际疾病分类第9版(ICD-9)伤害类别(800-959.9)的生存风险比，这些患者在5年内有300,000名创伤患者。ICD-9创伤严重程度评分(ICISS)UAS被定义为单个患者创伤ICD-9编码的所有生存风险比的乘积，我们比较了新墨西哥大学创伤中心4年来积累的3,142名患者的ISS和ICISS的表现，这些患者都有指定的创伤数据库人员精心分配的AIS和ICD-9描述符。结果：ICISS的误分率为7.67%，ISS受试者特征曲线面积为0.872；ICISS误分率为5.95%，ICISS受试者特征曲线面积为0.921。此外，当ICISS用于包括年龄、机制和修订的创伤评分的生存概率模型时，这些改善基本保持不变，ICISS预测能力的改善约有一半是因为它使用了单个患者最严重的三个损伤，而不考虑身体部位，其余的是因为对单个损伤的更好的建模，并允许所有损伤对最终评分做出贡献。结论：我们得出结论：ICISS是比ISS更好地预测受伤患者生存的因素。使用ICD-9词典可以避免对AIS编码的需要，从而可以增加ICISS的统计吸引力的经济诱因。使用AIS词汇表对ISS进行类似的数据驱动修订可能会与ICISS一样好或更好，事实上，只要考虑到所有伤害，并使用经验得出的SRR来计算最终的伤害测量，用于将伤害“景观”划分为个别伤害的实际词典可能没有什么影响。
Background: The Injury Severity Score (ISS) has served as the standard summary measure of human trauma for 20 years, Despite its stalwart service, the ISS has two weaknesses: it relies upon the consensus derived severity estimates for each Abbreviated Injury Scale (AIS) Injury and considers, at most, only three of an individual patient's injuries, three injuries that often are not even the patient's most severe injuries. Additionally, the ISS requires that all patients have their injuries described in the AIS lexicon, an expensive step that is currently taken only at hospitals with a zealous commitment to trauma care. We hypothesized that a data driven alternative to ISS that used empirically derived injury severities and considered all of an individual patient's injuries would more accurately predict survival.Methods: Survival risk ratios were derived for every International Classification of Disease 9th Edition (ICD-9) injury category (800-959.9) using the North Carolina State Discharge Database experience with 300,000 trauma patients over 5 years. An ICD-9 Injury Severity Score (ICISS) uas then defined as the product of all survival risk ratios for an individual patient's traumatic ICD-9 codes, We compared the performance of ISS and ICISS in a group of 3,142 patients accrued at the University of New Mexico Trauma Center over 4 years, These patients had both AIS and ICD-9 descriptors meticulously assigned prospectively by designated trauma data base personnel. Results: ICISS outperformed ISS at a level that was highly statistically significant (p < 0.0001) and may be clinically important: ISS misclassification rate 7.67%, ISS Receiver Operator Characteristic Curve area = 0.872; ICISS misclassification rate 5.95%, ICISS Receiver Operator Characteristic Curve area = 0.921. Moreover, these improvements are largely preserved when ICISS is used in a probability of survival model that includes age, mechanism, and revised trauma score, About half of ICISS's improvement in predictive power is because of its use of an individual patient's worst three injuries regardless of body region, The remainder is because of better modeling of individual injuries and allowing all injuries to contribute to the final score.Conclusions: We conclude that ICISS is a much better predictor of survival than ISS in injured patients. The use of the ICD-9 lexicon may avoid the need for AIS coding, and thus may add an economic incentive to the statistical appeal of ICISS. It is possible that a similar data driven revision of ISS using the AIS vocabulary might perform as well or better than ICISS, Indeed, the actual lexicon used to divide up the injury ''landscape'' into individual injuries may be of little consequence so long as all injuries are considered and empirically derived SRRs are used to calculate the final injury measure.