title: Is the TMPM-ICD9 revolution in trauma risk-adjustment compatible with imperfect administrative coding?
abstract: BACKGROUND
  TMPM-ICD9 is the latest injury-severity measure based on empirical estimation from ICD-9-CM codes. It is candidate to replace expert-based AIS measures worldwide because of easier accessibility and better predictive performances. In Italy and other countries administrative ICD coding is generally less complete than dedicated AIS coding. We attempted to ascertain how this affects TMPM performances.
  
  
  METHODS
  Discrimination (c statistics) and calibration (calibration curves, Akaike's criterion) of hierarchical logistic regression models for hospital mortality comprising TMPM or ISS were compared using trauma-registry data on 3570 patients of years 2007-2009. The completeness of AIS vs. ICD-9-CM coding was also investigated through the ratio of the respective numbers of codes per patient. Model discrimination was further analyzed after stratification according to the above ratio (>1 and ≤ 1).
  
  
  RESULTS
  The models with TMPM showed worse performances. The differences, concerned calibration (graphical evidence) in univariate models and discrimination (-1.2% of area under the ROC curve, p<0.05) in models completed with age, gender, mechanism of injury, motor GCS and systolic pressure. In parallel, ICD coding was less complete than AIS, as expected: 68% of patients had a ratio >1. The discrimination of TMPM vs. ISS models improved when the ratio changed from >1 to ≤ 1.
  
  
  CONCLUSIONS
  The predictive performances of TMPM-ICD9 vs. ISS were lower than in the previous studies; the sub-optimal quality of ICD coding was a main cause. Imperfect administrative coding may hence hamper the TMPM-ICD9 revolution, although in our setting the negligible differences and the ready availability of administrative data may still give reason for adopting TMPM-ICD9.
authors.affiliation: Anaesthesia and ICU S.M.M. Hospital, Udine/Regional Health Agency of Emilia-Romagna, Viale Aldo Moro 21, 40127 Bologna, Italy. Electronic address: stefano.dibartolomeo@uniud.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Bartolomeo
authors.affiliation: Regional Health Agency of Emilia-Romagna, Bologna, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Ventura
authors.affiliation: Regional Health Agency of Emilia-Romagna, Bologna, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Marino
authors.affiliation: Anaesthesia and ICU, AUSL Cesena, Italy.
authors.forename: Arturo
authors.initials: A
authors.lastname: Chieregato
authors.affiliation: Anaesthesia and ICU, Ospedale "G.B. Morgagni-L. Pierantoni", AUSL di Forlì, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gambale
authors.affiliation: Emergency Medicine, Ospedale "G.B. Morgagni-L. Pierantoni", Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fabbri
authors.affiliation: Azienda Ospedaliero-Universitaria di Parma, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Volpi
authors.affiliation: Regional Health Agency of Emilia-Romagna, Bologna, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: De Palma
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D038801:International Classification of Diseases; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D020379:Risk Adjustment; D014947:Wounds and Injuries / Q000145:classification / Q000401:mortality