Utility of the international classification of diseases injury severity score: detecting preventable deaths and comparing the performance of emergency medical centers.

Abstract

The purpose of this study was to assess the ability of the International Classification of Diseases-based Injury Severity Score (ICISS) to detect preventable deaths, and to compare the performance of trauma care facilities. For 2 years, from 1997 to 1998, 131 trauma deaths and 1,087 blunt trauma inpatients from 6 emergency medical centers (EMCs) in Korea were reviewed. Trauma deaths were reviewed and the preventability of those deaths was judged by two professional panels. For both trauma deaths and trauma inpatients, the survival probability of each trauma patient was assessed using the ICISS full model. The degree of agreement in the preventability of trauma death between survival probability on the basis of the ICISS and judgment rendered by professional panels was determined, and the correlation between the W-score and the preventable death rate in each EMC was also assessed. The overall agreement rate between ICISS survival probability and preventable deaths judged by professional panels was 66.4% (kappa statistic, 0.36), and the positive predictive value of the ICISS in detecting preventable trauma deaths was 54.1% and the negative predictive value was 84.8%. The Spearman correlation coefficient between the W-score and the preventable death rate by each EMC was -0.77 (p = 0.07). The degree of agreement in the preventability of trauma death derived from the ICISS with a professional judgment on preventability was similar to that derived from the Trauma and Injury Severity Score. The W-scores of EMCs correlated well with their preventable death rates, with marginal statistical significance. This study has demonstrated that the ICISS is useful in detecting preventable deaths and in comparing the performance of trauma care facilities.