Development of an expert derived ICD-AIS map for serious AIS3+ injury identification.

Objective: The objective of the mapping project was to develop an expert derived map between the International Statistical Classification of Diseases and Related Health Problems (ICD) clinical modifications (CM) and the Abbreviated Injury Scale (AIS) to be able to relate AIS severity to ICD coded data road traffic collision data in EU datasets. The maps were developed to enable the identification of serious AIS3+ injury and provide details of the mapping process for assumptions to be made about injury severity from mass datasets. This article describes in detail the mapping process of the International Classification of Diseases Ninth Revision, Clinical Modification (ICD-9-CM) and the International Classification of Diseases Tenth Revision, Clinical Modification (ICD-10-CM) codes to the Abbreviated Injury Scale 2005, Update 2008 (AIS08) codes to identify injury with an AIS severity of 3 or more (AIS3+ severity) to determine 'serious' (MAIS3+) road traffic injuries.Methods: Over 19,000 ICD codes were mapped from the following injury categories; injury ICD-9-CM (Chapter 17) codes between '800 and 999.9' and injury ICD-10-CM (Chapter 19) 'S' and 'T' prefixed codes were reviewed and mapped to an AIS08 category and then relate the severity to three groups; AIS3+, AIS < =2 and AIS 9 (no-map). The mapping was undertaken by ICD coding experts and certified AIS specialists from Europe, North America, Australia and Canada in face-to-face working groups and subsequent webinars between May 2014 and October 2015. During the process, the business rules were documented to define guidelines for the mapping process and enable inter-rater discrepancies to be resolved.Results: In total 2,504 ICD-9-CM codes were mapped to the AIS, of which 780 (31%) were assigned an AIS3+ severity. For the16,508 ICD-10-CM mapped codes a total of 2,323 (14%) were assigned an AIS3+ severity. Some 17% (n = 426) and 27% (n = 4,485) of ICD-9-CM and ICD-10-CM codes respectively were assigned to AIS9 (no-map) following the mapping process. It was evident there were 'problem' codes that could not be easily mapped to an AIS code to reflect severity. Problem maps affect the specificity of the map and severity when used to translate historical data in large datasets.Conclusions: The Association for the Advancement in Automotive Medicine, AAAM-endorsed expert-derived map offers a unique tool to road safety researchers to establish the number of MAIS3+ serious injuries occurring on the roads. The detailed process offered in this paper will enable researchers to understand the decision making and identify limitations when using the AIS08/ICD map on country-specific data. The results could inform protocols for dealing with problem codes to enable country comparisons of MAIS3+ serious injury rates.

Clinical practice guideline: red blood cell transfusion in adult trauma and critical care.

OBJECTIVE: To develop a clinical practice guideline for red blood cell transfusion in adult trauma and critical care. DESIGN: Meetings, teleconferences and electronic-based communication to achieve grading of the published evidence, discussion and consensus among the entire committee members. METHODS: This practice management guideline was developed by a joint taskforce of EAST (Eastern Association for Surgery of Trauma) and the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM). We performed a comprehensive literature review of the topic and graded the evidence using scientific assessment methods employed by the Canadian and U.S. Preventive Task Force (Grading of Evidence, Class I, II, III; Grading of Recommendations, Level I, II, III). A list of guideline recommendations was compiled by the members of the guidelines committees for the two societies. Following an extensive review process by external reviewers, the final guideline manuscript was reviewed and approved by the EAST Board of Directors, the Board of Regents of the ACCM and the Council of SCCM. RESULTS: Key recommendations are listed by category, including (A) Indications for RBC transfusion in the general critically ill patient; (B) RBC transfusion in sepsis; (C) RBC transfusion in patients at risk for or with acute lung injury and acute respiratory distress syndrome; (D) RBC transfusion in patients with neurologic injury and diseases; (E) RBC transfusion risks; (F) Alternatives to RBC transfusion; and (G) Strategies to reduce RBC transfusion. CONCLUSIONS: Evidence-based recommendations regarding the use of RBC transfusion in adult trauma and critical care will provide important information to critical care practitioners.

Development of an expert based ICD-9-CM and ICD-10-CM map to AIS 2005 update 2008.

OBJECTIVE: This article describes how maps were developed from the clinical modifications of the 9th and 10th revisions of the International Classification of Diseases (ICD) to the Abbreviated Injury Scale 2005 Update 2008 (AIS08). The development of the mapping methodology is described, with discussion of the major assumptions used in the process to map ICD codes to AIS severities. There were many intricacies to developing the maps, because the 2 coding systems, ICD and AIS, were developed for different purposes and contain unique classification structures to meet these purposes. METHODS: Experts in ICD and AIS analyzed the rules and coding guidelines of both injury coding schemes to develop rules for mapping ICD injury codes to the AIS08. This involved subject-matter expertise, detailed knowledge of anatomy, and an in-depth understanding of injury terms and definitions as applied in both taxonomies. The official ICD-9-CM and ICD-10-CM versions (injury sections) were mapped to the AIS08 codes and severities, following the rules outlined in each coding manual. The panel of experts was composed of coders certified in ICD and/or AIS from around the world. In the process of developing the map from ICD to AIS, the experts created rules to address issues with the differences in coding guidelines between the 2 schemas and assure a consistent approach to all codes. RESULTS: Over 19,000 ICD codes were analyzed and maps were generated for each code to AIS08 chapters, AIS08 severities, and Injury Severity Score (ISS) body regions. After completion of the maps, 14,101 (74%) of the eligible 19,012 injury-related ICD-9-CM and ICD-10-CM codes were assigned valid AIS08 severity scores between 1 and 6. The remaining 4,911 codes were assigned an AIS08 of 9 (unknown) or were determined to be nonmappable because the ICD description lacked sufficient qualifying information for determining severity according to AIS rules. There were also 15,214 (80%) ICD codes mapped to AIS08 chapter and ISS body region, which allow for ISS calculations for patient data sets. CONCLUSION: This mapping between ICD and AIS provides a comprehensive, expert-designed solution for analysts to bridge the data gap between the injury descriptions provided in hospital codes (ICD-9-CM, ICD-10-CM) and injury severity codes (AIS08). By applying consistent rules from both the ICD and AIS taxonomies, the expert panel created these definitive maps, which are the only ones endorsed by the Association for the Advancement of Automotive Medicine (AAAM). Initial validation upheld the quality of these maps for the estimation of AIS severity, but future work should include verification of these maps for MAIS and ISS estimations with large data sets. These ICD-AIS maps will support data analysis from databases with injury information classified in these 2 different systems and open new doors for the investigation of injury from traumatic events using large injury data sets.

Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline.

BACKGROUND: Diagnosing blunt cardiac injury (BCI) can be difficult. Many patients with mechanism for BCI are admitted to the critical care setting based on associated injuries; however, debate surrounds those patients who are hemodynamically stable and do not otherwise require a higher level of care. To allow safe discharge home or admission to a nonmonitored setting, BCI should be definitively ruled out in those at risk. METHODS: This Eastern Association for the Surgery of Trauma (EAST) practice management guideline (PMG) updates the original from 1998. English-language citations were queried for BCI from March 1997 through December 2011, using the PubMed Entrez interface. Of 599 articles identified, prospective or retrospective studies examining BCI were selected. Each article was reviewed by two members of the EAST BCI PMG workgroup. Data were collated, and a consensus was obtained for the recommendations. RESULTS: We identified 35 institutional studies evaluating the diagnosis of adult patients with suspected BCI. This PMG has 10 total recommendations, including two Level 2 updates, two upgrades from Level 3 to Level 2, and three new recommendations. CONCLUSION: Electrocardiogram (ECG) alone is not sufficient to rule out BCI. Based on four studies showing that the addition of troponin I to ECG improved the negative predictive value to 100%, we recommend obtaining an admission ECG and troponin I from all patients in whom BCI is suspected. BCI can be ruled out only if both ECG result and troponin I level are normal, a significant change from the previous guideline. Patients with new ECG changes and/or elevated troponin I should be admitted for monitoring. Echocardiogram is not beneficial as a screening tool for BCI and should be reserved for patients with hypotension and/or arrhythmias. The presence of a sternal fracture alone does not predict BCI. Cardiac computed tomography or magnetic resonance imaging can be used to differentiate acute myocardial infarction from BCI in trauma patients.