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ICE 2004 update: M ultiple I njury P rofiles

ICE 2004 update: M ultiple I njury P rofiles. A summary of what we have done and learnt since Paris ICE meeting 2003 Limor Aharonson-Daniel. Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Israel.

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ICE 2004 update: M ultiple I njury P rofiles

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  1. ICE 2004 update: Multiple Injury Profiles A summary of what we have done and learnt since Paris ICE meeting 2003 Limor Aharonson-Daniel Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Israel

  2. 2003 agreements Multiple Injury Profiles are • a step forward in the application of the Barell Matrix • an injury descriptor, not a severity measure • A tool for • presenting and reporting injury statistics • comparing injury patterns in populations

  3. 2003 agreements Choice of groups “We always remain loyal to the full matrix (36 rows) as the basic, most descriptive unit.” Further collapsing and grouping can be tailor-made by researchers based on study needs, frequency, clinical reasoning etc. Too much detail obscures presentation Body region is usually a good indicator See “poster” file for excmples of different levels of detail

  4. 2003 agreements Excluding AIS=1 injuries The number of combinations may be inflated by a large number of superficial injuries that make no difference in terms of outcome or significant care provided. In order to reduce the number of combinations, exclude AIS=1 injuries from profile and see the effect

  5. Homework Excluding AIS=1 injuries Check on Israeli data – what effect would excluding these injuries have on the overall results.

  6. 2004: Plan A Excluding AIS=1 injuries In Theory: Specific ICD codes corresponding to AIS=1 have to be selected and excluded from profile. In practice: It is not straight forward to assign specific ICD codes to correspond to AIS=1.

  7. 2004:The problem Excluding AIS=1 injuries Excluding ICD diagnoses with AIS=1 was not possible.

  8. 2004: New Plan Excluding AIS=1 injuries Build an AIS based matrix. Use for building multiple injury profiles. AIS=1 codes can be excluded and results compared.

  9. 2004: Current status Excluding AIS=1 injuries AIS matrix is built but needs validation. We preferred to use an accepted method. AIS six body regions were used to build multiple injury profiles. A comparison of these profiles with and without AIS=1 injuries was done.

  10. Multiple Injury Profiles using AIS regions Building a profile using AIS six body regions: Head, Face, Chest, Abdomen, Extremities, External A patient has an injury to the Head and Chest His profile would be: H _ C _ _ _ The following are results of the analysis of road traffic casualties from 1998-2002, a total of 23848 patients using AIS body regions

  11. Distribution of body regions injured All injuries All patients: 23848,

  12. Distribution of body regions injured All injuries (red) and when excluding AIS=1 (yellow) All patients: 23848, Excluding AIS=1, 19014 patients

  13. Distribution of MIP for patients with Head injuries All injuries (red) and when excluding AIS=1 (yellow) All patients: 9226, Excluding AIS=1, 8541 patients

  14. Distribution of critical injuries (ISS 25+) All injuries (red) and when excluding AIS=1 (yellow) All patients: 23848, Excluding AIS=1, 19014 patients

  15. Distribution of inpatient mortality rate All injuries (red) and when excluding AIS=1 (yellow) All patients: 23848, Excluding AIS=1, 19014 patients

  16. What do you think? Should we exclude AIS=1?

  17. Proposed directions to proceed to • Put efforts into associating individual ICD diagnoses with AIS severity so that this will be checked on the original matrix based MIP. • AIS matrix needs to be experimented and validated on different populations

  18. Thanks for your attention

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