External validation of International Classification of Injury Severity Score to predict mortality in a Greek adult trauma population |
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| Affiliation: | 1. Division of Trauma & Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan;2. Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan;1. Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea;2. Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea;1. Department of Global Public Health and Primary Care, University of Bergen, Norway;2. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States;3. Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia;1. Trauma Service, Royal Brisbane and Women''s Hospital, Herston, Queensland, Australia;2. Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia;3. Jamieson Trauma Institute, Royal Brisbane and Women''s Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia;4. Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia;1. Department of Pharmacy, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States;2. Department of Surgery, 3147 SW Sam Jackson Park Rd, Portland OR 97239, United States;1. Department of Legal Medicine, University of Sao Paulo Medical School, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo SP 01246-903, Brazil;2. Department of Forensic Sciences, Oslo University Hospital, Oslo, P.O. Box 4950 Nydalen, NO-0424, Norway;3. Department of Preventive Medicine, University of Sao Paulo Medical School, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo SP 01246-903, Brazil;4. Department of Surgery, Clinical Hospital of the University of Sao Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255 - Cerqueira César, São Paulo SP 05403-000, Brazil;5. Department of Traumatology and Orthopedics, Clinical Hospital of the University of Sao Paulo Medical School, R. Dr. Ovídio Pires de Campos, 333 - Cerqueira César, São Paulo SP 05403-010, Brazil |
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| Abstract: | IntroductionThe International Classification of diseases- based Injury Severity Score (ICISS) obtained by empirically derived diagnosis-specific survival probabilities (DSPs) is the best-known risk-adjustment measure to predict mortality. Recently, a new set of pooled DSPs has been proposed by the International Collaborative Effort on Injury Statistics but it remains to be externally validated in other cohorts. The aim of this study was to externally validate the ICISS using international DSPs and compare its prognostic performance with local DSPs derived from Greek adult trauma population.Materials and methodsThis retrospective single-center cohort study enrolled adult trauma patients (≥ 16 years) hospitalized between January 2015 and December 2019 and temporally divided into derivation (n = 21,614) and validation cohorts (n = 14,889). Two different ICISS values were calculated for each patient using two different sets of DSPs: international (ICISSint) and local (ICISSgr). The primary outcome was in-hospital mortality. Models’ prediction was performed using discrimination and calibration statistics.ResultsICISSint displayed good discrimination in derivation (AUC = 0.836 CI 95% 0.819–0.852) and validation cohort (AUC = 0.817 CI 95% 0.797–0.836). Calibration using visual analysis showed accurate prediction at patients with low mortality risk, especially below 30%. ICISSgr yielded better discrimination (AUC = 0.834 CI 95% 0.814–0.854 vs 0.817 CI 95% 0.797–0.836, p ? .05) and marginally improved overall accuracy (Brier score = 0.0216 vs 0.0223) compared with the ICISSint in the validation cohort. Incorporation of age and sex in both models enhanced further their performance as reflected by superior discrimination (p ? .05) and closer calibration curve to the identity line in the validation cohort.ConclusionThis study supports the use of international DSPs for the ICISS to predict mortality in contemporary trauma patients and provides evidence regarding the potential benefit of applying local DSPs. Further research is warranted to confirm our findings and recommend the widespread use of ICISS as a valid measure that is easily obtained from administrative data based on ICD-10 codes. |
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