Abstract
Objective—To determine the performance of the ICD/AIS MAP (© E J MacKenzie et al) as a method of classifying injury severity for children.
Methods—Data on all children less than 16 years of age admitted to all designated trauma centers in Pennsylvania from January 1994 through October 1996 were obtained from the state trauma registry. The ICD/AIS MAP was used to convert all injury related ICD-9-CM diagnosis codes into abbreviated injury scale (AIS) score and injury severity score (ISS). Agreement between trauma registry AIS and ISS scores and MAP generated scores was assessed using the weighted κ (κw) coefficient for ordered data and the intraclass correlation coefficient for continuous data.
Results—Agreement in ISS scores was excellent, both overall (intraclass correlation coefficient = 0.86, 95% confidence interval (CI) 0.84 to 0.89)), and when grouped into three levels of severity (κw= 0.86, 95% CI 0.85 to 0.87). Agreement in AIS scores across all body regions and ages was also excellent, (κw= 0.86 (95% CI 0.83 to 0.87). Agreement increased with age (κw= 0.78 for children <2 years; κw= 0.86 for older children) and varied by body region, though was excellent across all regions.
Conclusions—The performance of the ICD/AIS MAP in assessing severity of pediatric injuries was equal to or better than previous assessments of its performance on primarily adult patients. Its performance was excellent across the pediatric age range and across nearly all body regions of injury.
Full Text
The Full Text of this article is available as a PDF (158.8 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Baker S. P., O'Neill B., Haddon W., Jr, Long W. B. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974 Mar;14(3):187–196. [PubMed] [Google Scholar]
- Carpenter J., Bithell J. Bootstrap confidence intervals: when, which, what? A practical guide for medical statisticians. Stat Med. 2000 May 15;19(9):1141–1164. doi: 10.1002/(sici)1097-0258(20000515)19:9<1141::aid-sim479>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]
- Cooper A., Barlow B., DiScala C., String D., Ray K., Mottley L. Efficacy of pediatric trauma care: results of a population-based study. J Pediatr Surg. 1993 Mar;28(3):299–305. doi: 10.1016/0022-3468(93)90221-6. [DOI] [PubMed] [Google Scholar]
- Durbin D. R., Schwarz D. F., Localio A. R., MacKenzie E. J. Trends in incidence of pediatric injury hospitalizations in Pennsylvania. Am J Public Health. 2000 Nov;90(11):1782–1784. doi: 10.2105/ajph.90.11.1782. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Long W. B., Sacco W. J., Copes W. S., Lawnick M. M., Proctor S. M., Sacco J. B. An evaluation of expert human and automated Abbreviated Injury Scale and ICD-9-CM injury coding. J Trauma. 1994 Apr;36(4):499–503. doi: 10.1097/00005373-199404000-00007. [DOI] [PubMed] [Google Scholar]
- MacKenzie E. J., Steinwachs D. M., Ramzy A. I. Evaluating performance of statewide regionalized systems of trauma care. J Trauma. 1990 Jun;30(6):681–688. doi: 10.1097/00005373-199006000-00005. [DOI] [PubMed] [Google Scholar]
- MacKenzie E. J., Steinwachs D. M., Shankar B. Classifying trauma severity based on hospital discharge diagnoses. Validation of an ICD-9CM to AIS-85 conversion table. Med Care. 1989 Apr;27(4):412–422. doi: 10.1097/00005650-198904000-00008. [DOI] [PubMed] [Google Scholar]
- Mullins R. J., Veum-Stone J., Helfand M., Zimmer-Gembeck M., Hedges J. R., Southard P. A., Trunkey D. D. Outcome of hospitalized injured patients after institution of a trauma system in an urban area. JAMA. 1994 Jun 22;271(24):1919–1924. doi: 10.1001/jama.1994.03510480043032. [DOI] [PubMed] [Google Scholar]
- Seigel D. G., Podgor M. J., Remaley N. A. Acceptable values of kappa for comparison of two groups. Am J Epidemiol. 1992 Mar 1;135(5):571–578. doi: 10.1093/oxfordjournals.aje.a116324. [DOI] [PubMed] [Google Scholar]
- Thurman D., Guerrero J. Trends in hospitalization associated with traumatic brain injury. JAMA. 1999 Sep 8;282(10):954–957. doi: 10.1001/jama.282.10.954. [DOI] [PubMed] [Google Scholar]