Development and validation of the excess mortality ratio-adjusted injury severity score using the international classification of diseases 10th edition

Abstract

Objectives:This study aimed to develop and validate a new method for measuring injury severity, the excess mortality ratio-adjusted Injury Severity Score (EMR-ISS), using the International Classification of Diseases 10th Edition (ICD-10).Methods: An injury severity grade similar to the Abbreviated Injury Scale (AIS) was converted from them ICD-10 codes on the basis of quintiles of the EMR for each ICD-10 code. Like the New Injury Severity Score (NISS), the EMR-ISS was calculated from three maximum severity grades using data from theKorean National Injury Database. The EMR-ISS was then validated using the Hosmer-Lemeshow goodness- of-fit chi-square (HL chi-square, with lower values preferable), the area under the receiver operating characteristic curve (AUC-ROC), and the Pearson correlation coefficient to compare it with the International Classification of Diseases 9th Edition-based Injury Severity Score (ICISS). Nationwide hospital discharge abstract data (DAD) from stratified-sample general hospitals (n = 150) in 2004 were used for an external validation. © 2009 by the Society for Academic Emergency Medicine.