Should the IDC-9 Trauma Mortality Prediction Model become the new paradigm for benchmarking trauma outcomes?
BACKGROUND
Optimum quantification of injury severity remains an imprecise science with a need for improvement. The accuracy of the criterion standard Injury Severity Score (ISS) worsens as a patient's injury severity increases, especially among patients with penetrating trauma. The objective of this study was to comprehensively compare the mortality prediction ability of three anatomic injury severity indices: the ISS, the New ISS (NISS), and the DRG International Classification of Diseases-9th Rev.-Trauma Mortality Prediction Model (TMPM-ICD-9), a recently developed contemporary injury assessment model.


METHODS
Retrospective analysis of patients in the National Trauma Data Bank from 2007 to 2008. The TMPM-ICD-9 values were computed and compared with the ISS and NISS for each patient using in-hospital mortality after trauma as the outcome measure. Discrimination and calibration were compared using the area under the receiver operator characteristic curve. Subgroup analysis was performed to compare each score across varying ranges of injury severity and across different types of injury.


RESULTS
A total of 533,898 patients were identified with a crude mortality rate of 4.7%. The ISS and NISS performed equally in the groups with minor (ISS, 1-8) and moderate (ISS, 9-15) injuries, regardless of the injury type. However, in the populations with severe (ISS, 16-24) and very severe (ISS, ≥ 25) injuries for all injury types, the NISS predicted mortality better than the ISS did. The TMPM-ICD-9 outperformed both the NISS and ISS almost consistently.


CONCLUSIONS
The NISS and TMPM-ICD-9 are both superior predictors of mortality as compared with the ISS. The immediate adoption of NISS for evaluating trauma outcomes using trauma registry data is recommended. The TMPM-ICD-9 may be an even better measure of human injury, and its use in administrative or nonregistry data is suggested. Further research on its attributes is recommended because it has the potential to become the basis for benchmarking trauma outcomes.


METHODS
Prognostic study, level III.
Center for Surgery Trials and Outcomes Research, Department of Surgery, School of Medicine, The Johns Hopkins University, Baltimore, Maryland 21212, USA. ahaider1@jhmi.edu
Adil H
AH
Haider
Cassandra V
CV
Villegas
Taimur
T
Saleem
David T
DT
Efron
Kent A
KA
Stevens
Tolulope A
TA
Oyetunji
Edward E
EE
Cornwell
Stephen
S
Bowman
Sara
S
Haack
Susan P
SP
Baker
Eric B
EB
Schneider
D000328:Adult; D000368:Aged; D019985:Benchmarking; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014481:United States; D014947:Wounds and Injuries / Q000145:classification* / Q000401:mortality* / Q000628:therapy; D055815:Young Adult