Diagnosis based injury severity scaling: investigation of a method using Australian and New Zealand hospitalisations

Abstract

(New Zealand). Interventions: None. Main outcome measures: The models were assessed in terms of their discrimination, measured by the concordance score, and calibration, measured using calibration curves and the Hosmer-Lemeshow statistic. Results: 523 633 Australian and 124 767 New Zealand hospitalisations were selected, including 7230 and 1565 deaths respectively. Discrimination was high in all the fitted models with concordance scores of 0.885 to 0.910. Calibration results were also promising with all calibration curves being close to linear, though ICISS appeared to underestimate mortality somewhat for cases with an ICISS score less than 0.6. Overall ICISS performed better when applied to the Australian than the New Zealand hospitalisations. Australian and New Zealand hospitalisations were very similar. ICISS was also only a little more successful when ICD-10-AM rather than mapped ICD-10 was used.Conclusions: ICISS appears to be a reasonable way to estimate severity for databases using ICD-10 or ICD-10-AM. It is also likely to work well for other clinical variants of ICD-10.

The impact of clinically undiagnosed injuries on survival estimates

“…Our focus on the effect of overlooked injuries on survival risk estimates in a population-based perspective stems from the good performance of hospital discharge data compared with trauma registers (15) and the excellent opportunity for injury severity adjustments that is offered by injury-specific survival risk estimates (3,4). Even a small number of misclassified hospital deaths can, however, substantially reduce the estimated survival.…”

“…The ICISS has been shown to perform well compared with other injury severity scores (3,4). It is calculated on the basis of survival risk ratios (SRRs) for individual injury ICD-10 codes (4).…”

“…Survival risk estimates for different injury categories and injury severity scores such as the International Classification of Diseases Injury Severity Score (ICISS) rely on accurate classification of patients based on their injury diagnoses (3)(4)(5). It is a well-known problem that injuries can be overlooked clinically and remain undetected unless autopsy is performed (6 -8).…”

Gravidade dos acidentes de trabalho atendidos em serviços de emergência

“…ISS scoring varies from 1 to 75, and the index is categorized as mild (1)(2)(3), moderate (4)(5)(6)(7)(8), serious (9-15), severe (16-24), and critical (25-75). 14 There are few studies on the severity of occupational injuries using standardized scales, none of which was carried out in Brazil. This makes it difficult to define priorities for planning and criteria for notification.…”

NZ Government's trend analysis of hospitalised self‐harm is misleading

“…2 The International Classification of Disease based Injury Severity Score (ICISS) was used to establish the threshold. 5,6 Additionally, the case had to be discharged alive.…”