IMP-ICDX: an injury mortality prediction based on ICD-10-CM codes

Abstract

Background The International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) Injury Severity Score (ICISS) is a risk adjustment model when injuries are recorded using ICD-9-CM coding. The trauma mortality prediction model (TMPM-ICD9) provides better calibration and discrimination compared with ICISS and injury severity score (ISS). Though TMPM-ICD9 is statistically rigorous, it is not precise enough mathematically and has the tendency to overestimate injury severity. The purpose of this study is to develop a new ICD-10-CM injury model which estimates injury severities for every injury in the ICD-10-CM lexicon by a combination of rigorous statistical probit models and mathematical properties and improves the prediction accuracy. Methods We developed an injury mortality prediction (IMP-ICDX) using data of 794,098 patients admitted to 738 hospitals in the National Trauma Data Bank from 2015 to 2016. Empiric measures of severity for each of the trauma ICD-10-CM codes were estimated using a weighted median death probability (WMDP) measurement and then used as the basis for IMP-ICDX. ISS (version 2005) and the single worst injury (SWI) model were re-estimated. The performance of each of these models was compared by using the area under the receiver operating characteristic (AUC), the Hosmer-Lemeshow (HL) statistic, and the Akaike information criterion statistic. Results IMP-ICDX exhibits significantly better discrimination (AUCIMP-ICDX, 0.893, and 95% confidence interval (CI), 0.887 to 0.898; AUCISS, 0.853, and 95% CI, 0.846 to 0.860; and AUCSWI, 0.886, and 95% CI, 0.881 to 0.892) and calibration (HLIMP-ICDX, 68, and 95% CI, 36 to 98; HLISS, 252, and 95% CI, 191 to 310; and HLSWI, 92, and 95% CI, 53 to 128) compared with ISS and SWI. All models were improved after the extension of age, gender, and injury mechanism, but the augmented IMP-ICDX still dominated ISS and SWI by every performance. Conclusions The IMP-ICDX has a better discrimination and calibration compared to ISS. Therefore, we believe that IMP-ICDX could be a new viable trauma research assessment method.

IMP-2005: an injury mortality prediction according to the Abbreviated Injury Scale 2005

“…Therefore, we aim to improve the accuracy of trauma results by conducting a digital assessment, so as to determine a quantitative diagnosis. Existing articles include: TMPM, IMP, IMP-ICDX, etc [6,7,12].…”

“…This may be caused by too many homogeneous AIS_05 trauma classification codes leading to non_obvious advantage. In this study, we evaluated the IMP-2005 model based on AIS_05 using statistical and mathematical approaches similar to IMP and IMP-ICDX [7,12]. The unique calculation method showed in this research can improve the ability to predict trauma death.…”

“…When the true mortality rate of a specific AIS predot code was 0, the TMR value was set according to the trend of population crude mortality of each age group in the United States between 2012 and 2014 [11]. The TMR and WMDP values were calculated similar to IMP and IMP-ICDX [7,12], and were displayed in the Additional files 1 and 2, respectively. 16.7% of the data (IMP-2005 development dataset) was used to evaluate IMP-2005.…”

A traumatic injury mortality prediction (TRIMP) based on a comprehensive assessment of abbreviated injury scale 2005 predot codes

“…A TMR value according to the trend of the crude death rates of each age group in the United States between 2012 and 2014 13 is adopted, when the true mortality rate of a specific AIS predot code was zero. The TMR and WMDP values were calculated similar to IMP and IMP-ICDX 6 , 14 , as displayed in Appendices A and B respectively, with their workflow shown in Fig. 2 .…”

IMP-2005: an injury mortality prediction according to the Abbreviated Injury Scale 2005

“…When the true mortality rate of a specific AIS predot code was 0, the TMR value was set according to the trend of population crude mortality of each age group in the United States between 2012 and 2014 [11]. The TMR and WMDP values were calculated similar to IMP and IMP-ICDX [7,12], and were displayed in the…”