Risk adjustment for injured patients using administrative data.
BACKGROUND
Risk adjustment methods are needed for population-based studies of injured patients.


METHODS
Data were obtained from National Hospital Discharge Surveys, 1996 to 2000. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses were used to categorize Abbreviated Injury Scale score, Injury Severity Score, ICD-9-CM Injury Severity Score, injury mechanisms, and comorbidities. Regression models for weighted survey data were constructed from combinations of these classifications, plus age and sex, to predict mortality, length of stay (LOS), or discharge to long-term care (LTC).


RESULTS
Increased Abbreviated Injury Scale score, increased Injury Severity Score, or decreased ICD-9-CM Injury Severity Score were similarly associated with mortality, prolonged LOS, or more frequent LTC, as was increased age. Penetrating or burn mechanisms were associated with mortality and longer LOS; penetrating or vehicle mechanisms were associated with less frequent LTC. Different comorbidities affected LOS and LTC. Men had shorter LOS and less frequent LTC than women.


CONCLUSIONS
Hospital outcomes after injury are predictable from age, sex, and standard diagnosis groupings. Anatomic scales gave similar results when adjusted for other factors.
Clark
David E
DE
Department of Surgery, Maine Medical Center, Portland, Maine, USA. clarkd@mmc.org
Winchell
Robert J
RJ
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010351:Patient Discharge / Q000706:statistics & numerical data; D011336:Probability; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality*