Abstract
AbstractObjectiveOur study aimed to identify the superior predictor of mortality from International Classification of Diseases 10 (ICD-10) codes among pediatric trauma patients in the German hospital database (GHD), a nationwide database comprising all hospitalizations in the country.Study design and settingHospital admissions of patients aged < 18 years with injury-related ICD-10 codes were selected. The maximum abbreviated injury scale (MAIS) and injury severity score (ISS) were calculated using the ICD-AIS map provided by the Association for the Advancement of Automotive Medicine, which we adjusted to the German modification of the ICD-10 classification. The survival risk ratio was used to calculate the single worst ICD-derived injury (single ICISS) and a multiplicative injury severity score (multiplicative ICISS). The ability to predict mortality of the four above mentioned scores were compared in the selected trauma population and within four clinically relevant subgroups using discrimination and calibration.ResultsOut of 13,992,596 cases < 18 years of age hospitalized between 2014 and 2020, 1,720,802 were trauma patients and ICD-AIS mapping was possible in 1,328,377 cases. Mortality was highest in patients with only one coded injury. Cases with mapping failure (n = 392,425; 22.8 %) were younger and had a higher mortality rate. SRR-derived scores had a better discrimination calibration than ICD-AIS based scores in the overall cohort and all four subgroups (AUC ranges between 0.985 and 0.998 versus 0.886 and 0.972 respectively).ConclusionEmpirically derived measures of injury severity were superior to ICD-AIS mapped scores in the GHD to predict mortality in pediatric trauma patients. Given the high percentage of mapping failure and high mortality among cases with single coded injury, the single ICISS may be the most suitable measure of injury severity in this group of patients.
Publisher
Cold Spring Harbor Laboratory