Background The study objective was to compare the ISS manually assigned by hospital personnel and those generated by the ICDPIC software for value agreement and predictive power of length of stay (LOS) and mortality.
Methods We used data from the 2010–2016 trauma registry of a paediatric trauma centre (PTC) and 2014 National Trauma Data Bank (NTDB) hospitals that reported manually coded ISS. Agreement analysis was performed between manually and computer assigned ISS with severity groupings of 1–8, 9–15, 16–25 and 25–75. The prediction of LOS was compared using coefficients of determination (R2) from linear regression models. Mortality predictive power was compared using receiver operating characteristic (ROC) curves from logistic regression models.
Results The proportion of agreement between manually and computer assigned ISS in PTC data was 0.84 and for NTDB was 0.75. Analysing predictive power for LOS in the PTC sample, the R2=0.19 for manually assigned scores, and the R2=0.15 for computer assigned scores (p=0.0009). The areas under the ROC curve indicated a mortality predictive power of 0.95 for manually assigned scores and 0.86 for computer assigned scores in the PTC data (p=0.0011).
Conclusions Manually and computer assigned ISS had strong comparative agreement for minor injuries but did not correlate well for critical injuries (ISS=25–75). The LOS and mortality predictive power were significantly higher for manually assigned ISS when compared with computer assigned ISS in both PTC and NTDB data sets. Thus, hospitals should be cautious about transitioning to computer assigned ISS, specifically for patients who are critically injured.
- injury severity score
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Contributors AW and LO participated in the literature search. HX and KW participated in study design. JS conducted the data analysis. All authors participated in data interpretation and manuscript editing. AW and LO participated in writing the first draft. All authors participated in the critical revision of the manuscript and gave the final approval. AW contributed to the study while conducting her summer research at the Center for Pediatric Trauma Research and the Center for Injury Research and Policy, the Abigail Wexner Research Institute at Nationwide Children’s Hospital, during the summer of 2017.
Funding This research was supported with funding from the Agency for Healthcare Research and Quality (grant 1R01 HS24263-01) and the Health Resources and Services Administration (grant R40MC30759).
Disclaimer The funders had no involvement in the study design; collection, analysis and interpretation of data; writing of the report; or decision to submit the paper for publication.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This research was approved by the Institutional Review Board of Abigail Wexner Research Institute at Nationwide Children's Hospital
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available.
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