Development and validation of an ICD-10-based disability predictive index for patients admitted to hospitals with trauma
Development and validation of an ICD-10-based disability predictive index for patients admitted to hospitals with trauma
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针对因创伤入院的患者开发和验证基于 ICD-10 的残疾预测指数
DOI：
10.1016/j.injury.2017.12.021
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发表时间：
2018
期刊：
影响因子：
2.5
通讯作者：
Morimura Naoto
中科院分区：
文献类型：
--
作者：
Wada Tomoki;Yasunaga Hideo;Yamana Hayato;Matsui Hiroki;Fushimi Kiyohide;Morimura Naoto
背景：在行政索赔数据库中，没有针对创伤患者的残疾预测测量方法。本研究的目的是利用国际疾病分类第10版（ICD-10）编码，开发和验证基于诊断的严重身体残疾出院时残疾预测指数。方法采用日本诊断程序组合数据库进行回顾性观察性研究。纳入了2010年4月1日至2015年3月31日期间因创伤入院并活着出院的患者。排除了15岁以下的儿科患者。2010年4月1日至2013年3月31日住院患者的数据用于制定残疾预测指数（衍生队列），而2013年4月1日至2015年3月31日住院患者的数据用于内部验证（验证队列）。研究结果为严重身体残疾，出院时Barthel指数评分<60。参照2013年全球疾病负担研究中使用的分类，将与创伤相关的ICD-10代码分为36个伤害组。在衍生队列中，使用损伤组和患者基线特征（包括患者年龄、性别和Charlson共病指数（CCI）评分）对结果进行多变量logistic回归分析。对每个损伤组进行相应的回归系数评分。每个患者的残疾预测指数定义为得分的总和。在验证队列中使用受试者工作特征曲线分析验证该指标的预测性能。结果衍生队列纳入1475,158例患者，验证队列纳入939,659例患者。939,659例患者中，235,382例（25.0%）出院时伴有严重肢体残疾。失能预测指数的c统计量为0.795(95%可信区间[CI] 0.794 ~ 0.795)，而采用失能预测指数和患者基线特征的模型的c统计量为0.856 （95% CI 0.855 ~ 0.857）。结论创伤住院患者的年龄、性别、CCI评分和基于诊断的残疾预测指数可以很好地预测出院时的严重肢体残疾。
BackgroundThere was no established disability predictive measurement for patients with trauma that could be used in administrative claims databases. The aim of the present study was to develop and validate a diagnosis-based disability predictive index for severe physical disability at discharge using the International Classification of Diseases, 10th revision (ICD-10) coding.MethodsThis retrospective observational study used the Diagnosis Procedure Combination database in Japan. Patients who were admitted to hospitals with trauma and discharged alive from 01 April 2010 to 31 March 2015 were included. Pediatric patients under 15 years old were excluded. Data for patients admitted to hospitals from 01 April 2010 to 31 March 2013 was used for development of a disability predictive index (derivation cohort), while data for patients admitted to hospitals from 01 April 2013 to 31 March 2015 was used for the internal validation (validation cohort). The outcome of interest was severe physical disability defined as the Barthel Index score of <60 at discharge. Trauma-related ICD-10 codes were categorized into 36 injury groups with reference to the categorization used in the Global Burden of Diseases study 2013. A multivariable logistic regression analysis was performed for the outcome using the injury groups and patient baseline characteristics including patient age, sex, and Charlson Comorbidity Index (CCI) score in the derivation cohort. A score corresponding to a regression coefficient was assigned to each injury group. The disability predictive index for each patient was defined as the sum of the scores. The predictive performance of the index was validated using the receiver operating characteristic curve analysis in the validation cohort.ResultsThe derivation cohort included 1,475,158 patients, while the validation cohort included 939,659 patients. Of the 939,659 patients, 235,382 (25.0%) were discharged with severe physical disability. The c-statistics of the disability predictive index was 0.795 (95% confidence interval [CI] 0.794–0.795), while that of a model using the disability predictive index and patient baseline characteristics was 0.856 (95% CI 0.855–0.857).ConclusionsSevere physical disability at discharge may be well predicted with patient age, sex, CCI score, and the diagnosis-based disability predictive index in patients admitted to hospitals with trauma.