J Korean Neurotraumatol Soc.  2005 Oct;1(1):34-45. 10.13004/jknts.2005.1.1.34.

Development of Severity-Adjusted Mortality Model and Its Validity Evaluation in Trauma Patients

• Sohn MJ

• KMID: 2192307
• DOI: http://doi.org/10.13004/jknts.2005.1.1.34

Abstract

OBJECTIVE
Quality evaluation is the most important factor in trauma care and emergency care system to maintain and improve the quality level. It is necessary to provide the alternative methodology that is easily applicable and highly valid in the country, which has lack of the data related to traumatic care and emergency care, The aim of this study was to assess the validation of ICISS that was an evaluation tool of the probability of mortality in traumatic patients. Providing the applicable and high valid evaluation tool for the probability of severity-adjusted mortality in traumatic patients, ultimately we are to contribute to improve the quality of emergency care in traumatic patient,
METHODS
With collecting the computerized patient's data from 35 emergency care centers, expected survival rate on each ICD code and modeling of ICISS were established. The model was applied on total 1087 trauma patients who treated at 6 emergency care centers during two years. In addition, physiologic evaluating tool, RTS and ICISS were established and evaluated. The statistical performance of the developed model was evaluated by c-statistic, R2, and Hosmer-Lemeshow statistic. Hospital performance was evaluated by severity-adjusted mortalities.
RESULTS
ICISS expected survival rate and preventable death judged by specialist panel groups was 38.9% and kappa statics was 0.027 (p<0.001). The c-statistic and R2 were 0.942 and 0.218, respectively. Hosmer-Lemeshow statistic was 9.987 (p=0.265). Comparing the quality of emergency care centers by ICISS severity adjusted mortality rates, there were no significant differences in emergency care performance.
CONCLUSION
The severity adjusted mortality rate using ICD-10 based ICISS and RTS is relatively useful tool for evaluating the results of emergency care as a quality indicator. However, further study is mandated to establish the standard tool for evaluating overall hospital performance of emergency care.

Keyword

Severity-adjusted Mortality; RTS (Revised Trauma Score); ICISS (ICD-10 based Injury Severity Score); Emergency care; Quality evaluating tool

MeSH Terms

Emergency Medical Services
Humans
International Classification of Diseases
Mortality*
Quality Indicators, Health Care
Specialization
Survival Rate