创伤国际疾病分类编码向简明损伤定级分值转换规则的研究

目的　寻找一种创伤国际疾病分类 (ICD - 9CM)编码向简明损伤定级 (AIS)编码的转换方法 ,为建立简便快捷的创伤评分方法提供思路。　方法　创伤病种中 ,ICD - 9CM编码与AIS- 90编码含义基本相同者 ,在成对的两类编码间建立固定对应关系 ;依据专业理论提出 8项与创伤严重度密切相关的病案首页指标 ,利用病案首页数据库中的创伤患者数据计算出每条创伤ICD- 9CM编码的相应指标值 ;运用判别分析方法建立所有创伤ICD - 9CM编码与AIS 6个严重度分值的对应关系。　结果　 7项指标被选入判别分析模型 ,通过非参数判别分析建立了创伤ICD - 9CM编码与AIS分值的对应关系。经临床创伤专家的修正和完善 ,最终建立了创伤ICD - 9CM编码向AIS分值的转换规则。对检验样本国际疾病分类创伤评分 (ICISS)分值和损伤严重度评分 (ISS)分值的一致性分析结果表明 ,ISS分值与Ln(2 -ICISS)值高度相关 (r=0 .8311,P <0 .0 0 0 1)。两种方法得到的分值在反映患者伤情方面具有很高的一致性。　结论　建立创伤ICD - 9CM编码向AIS分值的转换规则是可行的 ;在不增加额外人力物力支出的情况下 ,结合ISS或TRISS法 ,这种转换规则可被用来对创伤患者进行快速的创伤严重度评分。

Converting rules from international classification of disease codes of trauma to abbreviated injury scale values

Objective To develop converting rule from international classification of disease (ICD) codes of trauma to abbreviated injury scale (AIS) values so as to provide clues for a simple and convenient trauma scoring way. Methods The corresponding set relations were made for ICD-9CM codes and AIS-90 codes with similar code meanings in the trauma diseases. Based on medical theories and knowledge, 8 indeces closely associated with injury severity were worked out for each ICD-9CM code of trauma diseases by using the database of discharge abstracts of trauma patients. Discriminant analysis was used to set up corresponding relations of ICD-9CM codes with AIS values. Results Seven indices were selected for discriminant function. Corresponding relations of all ICD-9CM codes of trauma diseases with AIS values was made through nonparametric discriminant method. Under deliberation and revision by several clinical experts on traumatology, the converting rule was established eventually. Consistency analysis between the sample's international classification of disease injury severity score (ICISS) values and injury severity score (ISS) values showed that ICISS values were closely correlated with 2-ICISS (Y=Ln), with correlation coefficient of 0.831 1 ( P <0.000 1). There was high consistency between the two methods of scoring upon reflecting the severity in most cases. Conclusions Converting rule is doable for ICD-9CM codes of trauma diseases converting to AIS values. Together with ISS or trauma score injury severity score methods, the converting rule can be used to evaluate the severity of trauma patients more easily and rapidly conditioned that no extra expense increases.