help for icdpic -------------------------------------------------------------------------------

Title

icdpic -- International Classification of Diseases Programs for Injury Categorization

Version

Version 3.0.

ICDPIC Version 3.0 requires STATA 8.0 or higher. ICDPIC Version 3.0 has been tested in STATA 10 and STATA 11, but the authors believe it should also work without incident in STATA 8 and STATA 9. If you have any problems using ICDPIC Version 3.0 in STATA 8 or STATA 9, please inform the authors.

ICDPIC Version 3.0 may be installed from within STATA using the ssc command. If you installed a previous version of ICDPIC from the SSC archives website using the ssc command, we suggest that you first delete it by typing ssc uninstall icdpic followed by ssc install icdpic. Alternatively, you may use ssc install icdpic, replace. See help for ssc.

If you installed any previous ICDPIC files obtained directly from the authors, please delete them ALL (.ado, .hlp and .dta files) to avoid any conflicts with ICDPIC 3.0 files.

Please enter complete variable names in the ICDPIC Version 3.0 dialog boxes. Do not use abbreviations.

New to Version 3.0 is the addition of a dialog box (.dlg) file associated with each individual ICDPIC Version 3.0 program (.ado) file. To access the ICDPIC dialog box, and all the ICDPIC programs, type: db icdpic. Typing icdpic, as in earlier versions, will still work, but ONLY with icdpic. Forgetting to precede any other individual program name with db will produce an error.

Fixed in ICDPIC Version 3.0 is the ability to use path\file names containing spaces.

Fixed in ICDPIC Version 3.0 is the ability to run in STATA 11.0.

Fixed in ICDPIC Version 3.0 is a bug that caused the triss program to crash if the rts variable was named anything other than "rts".

New in ICDPIC Version 3.0 (trauma program only) is the ability to choose whether an AIS value of 6 automatically forces an ISS of 75 or to automatically have all AIS values of 6 changed to an AIS value of 5 and then have the ISS calculated normally.

All dialog boxes in ICDPIC Version 3.0 have memory. Each time a dialog box is opened within the same STATA session, it will remember the values last entered.

All dialog boxes in ICDPIC Version 3.0 have the following buttons:

OK executes the program and removes the dialog box from the screen.

SUBMIT executes the program and leaves the dialog box on the screen. Note that if an error message is generated the dialog box may be minimized.

CANCEL removes the dialog box from the screen and does nothing. Clicking on the close icon of the dialog box does the same thing.

HELP leaves the dialog box on the screen and presents the program help file. The HELP button has a question mark on it.

COPY leaves the dialog box on the screen and copies the program command to the clipboard.

RESET resets the values of the controls in the dialog box to their initial state, just as if the dialog box were invoked for the first time. Each time a user invokes a dialog box, its controls will be filled in with the values the user last entered. RESET restores the control values to their defaults. The RESET button has an R on it.

Syntax

db icdpic

The ICDPIC dialog box will open. Click on the radio button next to the desired program and then click OK or Submit.

Description

The db icdpic command presents to the user the master dialog box used to access the International Classification of Diseases Programs for Injury Categorization (IDCPIC). ICDPIC programs, and their associated lookup tables, were developed using Stata (Version 7, StataCorp, College Station TX) for records containing ICD-9-CM codes. We intentionally used an older version of Stata (currently up to Version 11), so that users with older versions could still have access to the programs. The current version (3.0) requires STATA 8.0 or higher. The intention of ICDPIC described here is to provide inexpensive methods for translating International Classification of Diseases (ICD) diagnosis codes into standard injury categories and/or scores. Initial development of these programs occurred as part of research projects funded by the National Center for Injury Prevention and Control through the Harvard Injury Control Research Center (CDC R49/CCR 115279) and by the Maine Medical Center Research Strategic Plan. The authors are grateful for this support and would also appreciate suggestions or corrections from any user of the software. Publications of studies in which these programs or tables are used should cite the authors. We hope ICDPIC will make ICD-9-CM codes easier to use for injury research, and facilitate comparison of categorization methods. Modification of lookup tables could allow easy conversion to ICD-10-CM, and empirically-derived scores (like ICISS) can be updated using newer reference databases.

A list of programs to which ICDPIC provides access is found below:

trauma provides various classifications and characterizations of trauma based on ICD-9-CM diagnosis codes, specifically codes for Nature of Injury (N-Codes) and External Cause of Injury (E-Codes).

srr calculates the survival risk ratio (SRR) and the independent survival risk ratio (SRRi) for all valid ICD-9-CM injury codes (N-Codes) in a data set and stores them in a file on disk.

iciss calculates ICISS (ICD-9 based Injury Severity Score) using both survival risk ratios (SRR's) and independent survival risk ratios (SRRl's).

aps calculates the anatomic profile score (APS).

rts calculates the revised trauma score (RTS).

triss, A Trauma and Injury Severity Score (TRISS), estimates patient survival probability.

ascot, A Severity Characterization of Trauma (ASCOT), estimates patient survival probability.

icd9tmpm, A Trauma Mortality Prediction Model (ICD-9-CM TMPM), ICD-9-CM version.

ais_tmpm, A Trauma Mortality Prediction Model (AIS TMPM), AIS version for those with AIS codes only.

altcharl determines which Charlson comorbidities are present, the number of Charlson comorbidities present and the Charlson score.

elixhaus determines which Elixhauser comorbidities are present and the number of Elixhauser comorbidities present.

On a general note, observations in the user's data must be in Stata "wide" format, for example:

ident dx1 dx2 dx3

31416 800.1 959.9 E910.9 31417 800.24 410.0

Use the Stata "wide" command (see help for reshape) to obtain this format if the observations are originally recorded in "long" format, for example:

ident diagnosis

31416 800.16 31416 959.9 31416 E910.9 31417 800.24 31417 410.0

For a detailed discussion on each of ICDPIC's programs, their requirements, and options available, the user is directed to each program's individual help file found in the Also see section at the end of this help file. It is strongly suggested that the user read each program's help file before running it.

Information on the lookup tables provided for use with icdpic can be found in the Remarks section below.

Options

See individual help files for each program.

Remarks

BACKGROUND

Administrative databases and registries often describe specific injuries using the International Classification of Diseases (ICD), which has gone from its Eighth Revision through its Tenth Revision over the past few decades.

Sacco and colleagues tabulated the observed hospital mortality for patients with each diagnosis code, and assigned each patient an Anatomic Index (AI) equal to the maximum of the observed mortality probabilities for that patient's injury diagnoses. Levy and colleagues similarly tabulated the observed hospital survival for patients with each diagnosis code, and assigned each patient an Estimated Survival Probability (ESP) equal to the product of the observed survival probabilities for that patient's injury diagnoses. A variation of the latter approach, the ICD-9-based Injury Severity Score (ICISS), was popularized years later by Osler and colleagues.

The Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) had been previously introduced for clinical studies, and have remained the most popular and most familiar way to describe injury severity, although they were not originally defined in terms of ICD diagnoses. Later, Copes and colleagues described an Anatomic Profile, specified in part by ICD codes, and Osler and colleagues described a New Injury Severity Score (NISS), but these generally failed to displace the AIS or ISS in popular use.

More recently, Barell and an international group of colleagues developed a matrix of ICD-9-CM codes to classify injury diagnoses by type and anatomic region; these authors did not relate these categories to severity, although it is possible to do so. Another innovation is the Trauma Mortality Prediction Model, which uses a new approach based on AIS or ICD-9-CM codes as described by Osler et al.

Translating ICD codes into AIS codes (and from there to ISS or NISS if desired) was considered with the Eighth Revision of ICD, but only became practical with the increased precision of the ICD Ninth Revision Clinical Modification (ICD-9-CM). A program to make this conversion was further developed with federal grant support at the Johns Hopkins School of Hygiene and Public Health, and was subsequently marketed as ICDMAP-90 by the Tri-Analytics Corporation of Bel Air, Maryland. Since 2001, Tri-Analytics is no longer responsible for this software, although it is still available through Johns Hopkins (according to http://www.trianalytics.com/pdfs/dataspeak_v8n2.pdf). ICDMAP-90 deserves credit for providing a standard method of ICD to AIS conversion for the past two decades. However, it uses proprietary algorithms that are not explicitly stated for the user, and some newer ICD-9-CM codes are not recognized by the program.

Anatomic ICD-9-CM diagnosis codes are sometimes called Nature of Injury codes or N-codes. External Cause of Injury codes in ICD-9 (E-codes) refer to the mechanism of injury, such as vehicle crash or gunshot. The CDC has published a suggested categorization of ICD-9 E-codes by mechanism as well as intent.

The Revised Trauma Score (RTS) uses physiologic information (not available from ICD-9-CM codes) to predict survival after injury. The Trauma and Injury Severity Score (TRISS) derives a "Probability of Survival" equation from ISS, RTS, and an age indicator variable (equal to 0 for age <= 54 and 1 otherwise). Separate equations have been used for penetrating or blunt injuries. ASCOT is an alternative scale based on the Anatomic Profile, which has generally not been as popular as TRISS.

ICD-9-CM codes potentially relating to pre-existing medical conditions may be identified according to the inclusion criteria of Charlson et al, with the "Dartmouth/Manitoba" modifications described by Romano et al. The "Charlson Score" adds weights of 6 for the presence of AIDS or metastatic solid tumor, 3 for severe liver disease, 2 for any malignancy, renal failure, or complications of diabetes, and 1 for other conditions. A more detailed method has been developed by Elixhauser et al but has not been widely used in trauma patients.

LOOKUP TABLES

Lookup tables are provided for use with the trauma, icd9tmpm, ais_tmpm, altcharl, elixhaus and srr programs. If the user wishes to modify these tables, or provide their own, they must be sorted on the diagnosis code variable (DRG variable for table drgtab_h.dta; predot variable for table mais_s.dta). All lookup tables are current through September 30, 2008, except for ntab_s1.dta and ntab_s2.dta, which are current through September 30, 2011, barring any late additions and/or corrections. New tables for etab_s1.dta and etab_s2.dta will be provided when a new recommended framework for presenting injury mortality data is issued.

The tables for use with the trauma program are:

ntab_s1.dta (Nature of Injury codes (N-Codes) and their associated data, no decimal point) ntab_s2.dta (Nature of Injury codes (N-Codes) and their associated data, with decimal point) etab_s1.dta (External Cause of Injury codes (E-Codes) and their associated data, no decimal point) etab_s2.dta (External Cause of Injury codes (E-Codes) and their associated data, with decimal point)

The following variables appear in both ntab_s1.dta and ntab_s2.dta:

dx: Nature of Injury code (N-Code) barell: Barell body region by nature of injury diagnosis matrix category severity: AIS severity issbr: ISS body region apc: Anatomic profile component category

Nature of Injury Codes (N-Codes) included in both ntab_s1.dta and ntab_s2.dta:

800 - 904.9 910 - 929.9 940 - 957.9 (Note: burns, 940 - 949.5, are assigned AIS severity code 9 (Unknown)) 959 - 959.9

Codes for Barell body region by nature of injury diagnosis matrix category:

01A = Head and Neck, Traumatic Brain Injury, Type 1, Fracture 01D = Head and Neck, Traumatic Brain Injury, Type 1, Internal 01K = Head and Neck, Traumatic Brain Injury, Type 1, Nerves 02A = Head and Neck, Traumatic Brain Injury, Type 2, Fracture 02D = Head and Neck, Traumatic Brain Injury, Type 2, Internal 03A = Head and Neck, Traumatic Brain Injury, Type 3, Fracture 04E = Head and Neck, Other Head, Face and Neck, Other Head Injury, Open Wound 04J = Head and Neck, Other Head, Face and Neck, Other Head Injury, Burns 04K = Head and Neck, Other Head, Face and Neck, Other Head Injury, Nerves 04L = Head and Neck, Other Head, Face and Neck, Other Head Injury, Unspecified 05A = Head and Neck, Other Head, Face and Neck, Face Injury, Fracture 05B = Head and Neck, Other Head, Face and Neck, Face Injury, Dislocation 05C = Head and Neck, Other Head, Face and Neck, Face Injury, Sprains and Strains 05E = Head and Neck, Other Head, Face and Neck, Face Injury, Open Wound 05J = Head and Neck, Other Head, Face and Neck, Face Injury, Burns 06E = Head and Neck, Other Head, Face and Neck, Eye Injury, Open Wound 06H = Head and Neck, Other Head, Face and Neck, Eye Injury, Contusion/Superficial 06J = Head and Neck, Other Head, Face and Neck, Eye Injury, Burns 06K = Head and Neck, Other Head, Face and Neck, Eye Injury, Nerves 07A = Head and Neck, Other Head, Face and Neck, Neck Injury, Fracture 07C = Head and Neck, Other Head, Face and Neck, Neck Injury, Sprains and Strains 07E = Head and Neck, Other Head, Face and Neck, Neck Injury, Open Wound 07I = Head and Neck, Other Head, Face and Neck, Neck Injury, Crush 07J = Head and Neck, Other Head, Face and Neck, Neck Injury, Burns 07K = Head and Neck, Other Head, Face and Neck, Neck Injury, Nerves 08G = Head and Neck, Other Head, Face and Neck, Head, Face and Neck Unspecified, Blood Vessels 08H = Head and Neck, Other Head, Face and Neck, Head, Face and Neck Unspecified, Contusion/Superficial 08I = Head and Neck, Other Head, Face and Neck, Head, Face and Neck Unspecified, Crush 08J = Head and Neck, Other Head, Face and Neck, Head, Face and Neck Unspecified, Burns 08K = Head and Neck, Other Head, Face and Neck, Head, Face and Neck Unspecified, Nerves 08L = Head and Neck, Other Head, Face and Neck, Head, Face and Neck Unspecified, Unspecified 09A = Spine and Back, Spinal Cord Injury, Cervical, Fracture 09D = Spine and Back, Spinal Cord Injury, Cervical, Internal 10A = Spine and Back, Spinal Cord Injury, Thoracic/Dorsal, Fracture 10D = Spine and Back, Spinal Cord Injury, Thoracic/Dorsal, Internal 11A = Spine and Back, Spinal Cord Injury, Lumbar, Fracture 11D = Spine and Back, Spinal Cord Injury, Lumbar, Internal 12A = Spine and Back, Spinal Cord Injury, Sacrum Coccyx, Fracture 12D = Spine and Back, Spinal Cord Injury, Sacrum Coccyx, Internal 13A = Spine and Back, Spinal Cord Injury, Spine + Back Unspecified, Fracture 13D = Spine and Back, Spinal Cord Injury, Spine + Back Unspecified, Internal 14A = Spine and Back, Vertebral Column Injury, Cervical, Fracture 14B = Spine and Back, Vertebral Column Injury, Cervical Dislocation 14C = Spine and Back, Vertebral Column Injury, Cervical, Sprains and Strains 15A = Spine and Back, Vertebral Column Injury, Thoracic/Dorsal, Fracture 15B = Spine and Back, Vertebral Column Injury, Thoracic/Dorsal, Dislocation 15C = Spine and Back, Vertebral Column Injury, Thoracic/Dorsal, Sprains and Strains 16A = Spine and Back, Vertebral Column Injury, Lumbar, Fracture 16B = Spine and Back, Vertebral Column Injury, Lumbar, Dislocation 16C = Spine and Back, Vertebral Column Injury, Lumbar, Sprains and Strains 17A = Spine and Back, Vertebral Column Injury, Sacrum Coccyx, Fracture 17B = Spine and Back, Vertebral Column Injury, Sacrum Coccyx, Dislocation 17C = Spine and Back, Vertebral Column Injury, Sacrum Coccyx, Sprains and Strains 18A = Spine and Back, Vertebral Column Injury, Spine + Back Unspecified, Fracture 18B = Spine and Back, Vertebral Column Injury, Spine + Back Unspecified, Dislocation 19A = Torso, Chest (Thorax), Fracture 19B = Torso, Chest (Thorax), Dislocation 19C = Torso, Chest (Thorax), Sprains and Strains 19D = Torso, Chest (Thorax), Internal 19E = Torso, Chest (Thorax), Open Wound 19G = Torso, Chest (Thorax), Blood Vessels 19H = Torso, Chest (Thorax), Contusion/Superficial 19I = Torso, Chest (Thorax), Crush 19J = Torso, Chest (Thorax), Burns 19K = Torso, Chest (Thorax), Nerves 19L = Torso, Chest (Thorax), Unspecified 20D = Torso, Abdomen, Internal 20E = Torso, Abdomen, Open Wound 20G = Torso, Abdomen, Blood Vessels 20H = Torso, Abdomen, Contusion/Superficial 20J = Torso, Abdomen, Burns 20K = Torso, Abdomen, Nerves 20L = Torso, Abdomen, Unspecified 21A = Torso, Pelvis and Urogenital, Fracture 21B = Torso, Pelvis and Urogenital, Dislocation 21C = Torso, Pelvis and Urogenital, Sprains and Strains 21D = Torso, Pelvis and Urogenital, Internal 21E = Torso, Pelvis and Urogenital, Open Wound 21G = Torso, Pelvis and Urogenital, Blood Vessels 21H = Torso, Pelvis and Urogenital, Contusion/Superficial 21I = Torso, Pelvis and Urogenital, Crush 21J = Torso, Pelvis and Urogenital, Burns 21K = Torso, Pelvis and Urogenital, Nerves 21L = Torso, Pelvis and Urogenital, Unspecified 22A = Torso, Trunk, Fracture 22E = Torso, Trunk, Open Wound 22H = Torso, Trunk, Contusion/Superficial 22I = Torso, Trunk, Crush 22J = Torso, Trunk, Burns 22K = Torso, Trunk, Nerves 22L = Torso, Trunk, Unspecified 23C = Torso, Back and Buttock, Sprains and Strains 23E = Torso, Back and Buttock, Open Wound 23H = Torso, Back and Buttock, Contusion/Superficial 23I = Torso, Back and Buttock, Crush 23J = Torso, Back and Buttock, Burns 24A = Extremities, Upper, Shoulder and Upper Arm, Fracture 24B = Extremities, Upper, Shoulder and Upper Arm, Dislocation 24C = Extremities, Upper, Shoulder and Upper Arm, Sprains and Strains 24E = Extremities, Upper, Shoulder and Upper Arm, Open Wound 24F = Extremities, Upper, Shoulder and Upper Arm, Amputations 24H = Extremities, Upper, Shoulder and Upper Arm, Contusion/Superficial 24I = Extremities, Upper, Shoulder and Upper Arm, Crush 24J = Extremities, Upper, Shoulder and Upper Arm, Burns 24L = Extremities, Upper, Shoulder and Upper Arm, Unspecified 25A = Extremities, Upper, Forearm and Elbow, Fracture 25B = Extremities, Upper, Forearm and Elbow, Dislocation 25C = Extremities, Upper, Forearm and Elbow, Sprains and Strains 25E = Extremities, Upper, Forearm and Elbow, Open Wound 25F = Extremities, Upper, Forearm and Elbow, Amputations 25H = Extremities, Upper, Forearm and Elbow, Contusion/Superficial 25I = Extremities, Upper, Forearm and Elbow, Crush 25J = Extremities, Upper, Forearm and Elbow, Burns 26A = Extremities, Upper, Wrist, Hand and Fingers, Fracture 26B = Extremities, Upper, Wrist, Hand and Fingers, Dislocation 26C = Extremities, Upper, Wrist, Hand and Fingers, Sprains and Strains 26E = Extremities, Upper, Wrist, Hand and Fingers, Open Wound 26F = Extremities, Upper, Wrist, Hand and Fingers, Amputations 26H = Extremities, Upper, Wrist, Hand and Fingers, Contusion/Superficial 26I = Extremities, Upper, Wrist, Hand and Fingers, Crush 26J = Extremities, Upper, Wrist, Hand and Fingers, Burns 26L = Extremities, Upper, Wrist, Hand and Fingers, Unspecified 27A = Extremities, Upper, Other and Unspecified, Fracture 27E = Extremities, Upper, Other and Unspecified, Open Wound 27F = Extremities, Upper, Other and Unspecified, Amputations 27G = Extremities, Upper, Other and Unspecified, Blood Vessels 27H = Extremities, Upper, Other and Unspecified, Contusion/Superficial 27I = Extremities, Upper, Other and Unspecified, Crush 27J = Extremities, Upper, Other and Unspecified, Burns 27K = Extremities, Upper, Other and Unspecified, Nerves 27L = Extremities, Upper, Other and Unspecified, Unspecified 28A = Extremities, Lower, Hip, Fracture 28B = Extremities, Lower, Hip, Dislocation 28C = Extremities, Lower, Hip, Sprains and Strains 28H = Extremities, Lower, Hip, Contusion/Superficial 28I = Extremities, Lower, Hip, Crush 29A = Extremities, Lower, Upper Leg and Thigh, Fracture 29F = Extremities, Lower, Upper Leg and Thigh, Amputations 29H = Extremities, Lower, Upper Leg and Thigh, Contusion/Superficial 29I = Extremities, Lower, Upper Leg and Thigh, Crush 29J = Extremities, Lower, Upper Leg and Thigh, Burns 30A = Extremities, Lower, Knee, Fracture 30B = Extremities, Lower, Knee, Dislocation 30C = Extremities, Lower, Knee, Sprains and Strains 30H = Extremities, Lower, Knee, Contusion/Superficial 30I = Extremities, Lower, Knee, Crush 30J = Extremities, Lower, Knee, Burns 31A = Extremities, Lower, Lower Leg and Ankle, Fracture 31B = Extremities, Lower, Lower Leg and Ankle, Dislocation 31C = Extremities, Lower, Lower Leg and Ankle, Sprains and Strains 31F = Extremities, Lower, Lower Leg and Ankle, Amputations 31H = Extremities, Lower, Lower Leg and Ankle, Contusion/Superficial 31I = Extremities, Lower, Lower Leg and Ankle, Crush 31J = Extremities, Lower, Lower Leg and Ankle, Burns 32A = Extremities, Lower, Foot and Toes, Fracture 32B = Extremities, Lower, Foot and Toes, Dislocation 32C = Extremities, Lower, Foot and Toes, Sprains and Strains 32E = Extremities, Lower, Foot and Toes, Open Wound 32F = Extremities, Lower, Foot and Toes, Amputations 32H = Extremities, Lower, Foot and Toes, Contusion/Superficial 32I = Extremities, Lower, Foot and Toes, Crush 32J = Extremities, Lower, Foot and Toes, Burns 33A = Extremities, Lower, Other and Unspecified, Fracture 33C = Extremities, Lower, Other and Unspecified, Sprains and Strains 33E = Extremities, Lower, Other and Unspecified, Open Wound 33F = Extremities, Lower, Other and Unspecified, Amputations 33G = Extremities, Lower, Other and Unspecified, Blood Vessels 33H = Extremities, Lower, Other and Unspecified, Contusion/Superficial 33I = Extremities, Lower, Other and Unspecified, Crush 33J = Extremities, Lower, Other and Unspecified, Burns 33L = Extremities, Lower, Other and Unspecified, Unspecified 34A = Unclassifiable by Site, Other and Unspecified, Other/Multiple, Fracture 34G = Unclassifiable by Site, Other and Unspecified, Other/Multiple, Blood Vessels 34J = Unclassifiable by Site, Other and Unspecified, Other/Multiple, Burns 34K = Unclassifiable by Site, Other and Unspecified, Other/Multiple, Nerves 35A = Unclassifiable by Site, Other and Unspecified, Unspecified Site, Fracture 35B = Unclassifiable by Site, Other and Unspecified, Unspecified Site, Dislocation 35C = Unclassifiable by Site, Other and Unspecified, Unspecified Site, Sprains and Strains 35D = Unclassifiable by Site, Other and Unspecified, Unspecified Site, Internal 35E = Unclassifiable by Site, Other and Unspecified, Unspecified Site, Open Wound 35G = Unclassifiable by Site, Other and Unspecified, Unspecified Site, Blood Vessels 35H = Unclassifiable by Site, Other and Unspecified, Unspecified Site, Contusion/Superficial 35I = Unclassifiable by Site, Other and Unspecified, Unspecified Site, Crush 35J = Unclassifiable by Site, Other and Unspecified, Unspecified Site, Burns 35K = Unclassifiable by Site, Other and Unspecified, Unspecified Site, Nerves 35L = Unclassifiable by Site, Other and Unspecified, Unspecified Site, Unspecified

Codes for AIS severity:

1 = Minor 2 = Moderate 3 = Serious 4 = Severe 5 = Critical 6 = Unsurvivable 9 = Unknown

Codes for ISS body region:

1 = Head/neck 2 = Face 3 = Chest 4 = Abdomen and pelvic contents 5 = Extremities or pelvic girdle 6 = External 9 = Unknown

ISS body region and AIS severity codes for lookup tables ntab_s1.dta and ntab_s2.dta were created by analysis of the National Trauma Data Bank (NTDB). The NTDB contains more than 2 million patient records compiled by the American College of Surgeons Committee on Trauma from hundreds of contributing hospitals (see http://www.facs.org/trauma/ntdb.html for further information). ICDPIC does not attempt to assign a specific AIS code for each ICD-9-CM diagnosis code, but only to classify injuries (N-Codes) into a general severity and body region in order to allow for approximate severity scoring. For ICDPIC, we associated each N-Code in the NTDB (Version 6.1) with the ISS body region and AIS severity for the same injury most frequently selected by trauma registrars submitting data to the NTDB. For the few N-Codes that never appeared in association with an AIS code, the authors assigned a body region and AIS score by consensus. N-Codes relating to burn injuries were not coded for AIS severity. Instead, an AIS severity value of 9 (Unknown) was assigned.

ISS Body Regions and AIS Severities not assigned by NTDB usage:

N-Code Body Region Severity 803.83 1 3 803.89 1 3 804.49 1 3 804.54 1 3 804.56 1 3 804.59 1 3 804.89 1 3 804.91 1 3 804.92 1 3 804.93 1 3 813.45 5 2 813.46 5 2 813.47 5 2 819.1 5 2 823.40 5 2 823.41 5 2 823.42 5 2 831.13 5 2 832.2 5 1 835.12 5 2 836.63 5 2 839.18 1 2 839.50 5 2 839.51 5 2 840.7 5 2 850.11 1 1 850.12 1 1 851.19 1 3 851.69 1 3 851.72 1 3 851.79 1 3 852.59 1 4 910.3 2 1 910.7 2 1 911.3 6 1 913.3 5 1 914.3 5 1 914.4 5 1 915.4 5 1 927.01 5 2 959.11 3 1 959.12 4 1 959.13 4 1 959.14 4 1 959.19 6 1

Codes for anatomic profile component categories:

A = All severe head, brain and spinal cord injuries (AIS score 3, 4, 5 or 6) B = All severe thorax and neck injuries (AIS score 3, 4, 5 or 6) C = All other severe injuries (AIS score 3, 4, 5 or 6) D = All non-serious injuries (AIS score 1 or 2)

The following variables appear in both etab_s1.dta and etab_s2.dta:

dx: External Cause of Injury code (E-Code) mechmaj: CDC external cause of injury major mechanism category mechmin: CDC external cause of injury minor mechanism category intent: CDC external cause of injury intent category

Codes for CDC external cause of injury major/minor mechanism categories:

0 = Cut/pierce 1 = Drowning/submersion 2 = Fall 3 = Fire/burn Fire/flame = 0 Hot object/substance = 1 4 = Firearm 5 = Machinery 6 = Motor vehicle traffic Occupant = 0 Motorcyclist = 1 Pedal cyclist = 2 Pedestrian = 3 Unspecified = 4 7 = Pedal cyclist, other 8 = Pedestrian, other 9 = Transport, other 10 = Natural/environmental Bites and stings = 0 11 = Overexertion 12 = Poisoning 13 = Struck by, against 14 = Suffocation 15 = Other specified, classifiable 16 = Other specified, not elsewhere classifiable 17 = Unspecified 18 = Adverse effects Medical care = 0 Drugs = 1

Codes for CDC external cause of injury intent category:

0 = Unintentional 1 = Self-inflicted 2 = Assault 3 = Undetermined 4 = Other

The tables for use with the icd9tmpm program are:

micd9_s1.dta (Nature of Injury codes (N-Codes) and their associated MARC values and ISS body regions, no decimal point) micd9_s2.dta (Nature of Injury codes (N-Codes) and their associated MARC values and ISS body regions, with decimal point)

The following variables appear in both micd9_s1.dta and micd9_s2.dta:

dx: Nature of Injury code (N-Code) marc: MARC value for each Nature of Injury code (N-Code) issbr: ISS body region for each Nature of Injury code (N-Code)

The table for use with the ais_tmpm program is:

mais_s.dta (predot AIS codes and their associated MARC values)

The following variables appear in mais_s.dta:

predot: Predot AIS code marc: MARC value for each predot AIS code

The tables for use with the altcharl program are:

cdtab_s1.dta (appropriate diagnosis codes and Charlson categories, no decimal point) cdtab_s2.dta (appropriate diagnosis codes and Charlson categories, with decimal point) cptab_s1.dta (appropriate procedure codes and Charlson categories, no decimal point) cptab_s2.dta (appropriate procedure codes and Charlson categories, with decimal point)

The following variables appear in both cdtab_s1.dta and cdtab_s2.dta:

dx: ICD-9-CM diagnosis code charlson: Charlson comorbidity category code

The following variables appear in both cptab_s1.dta and cptab_s2.dta:

px: ICD-9-CM procedure code charlson: Charlson comorbidity category code

Codes for Charlson comorbidities are:

1 = Myocardial infarction 2 = Peripheral vascular disease 3 = Dementia 4 = Chronic obstructive pulmonary disease 5 = Rheumotologic disease 6 = Mild liver disease 7 = Moderate to severe liver disease 8 = Moderate diabetes mellitus 9 = Chronic complications of diabetes mellitus 10 = Renal disease 11 = Any malignancy 12 = Metastatic solid tumor 13 = AIDS

The tables for use with the elixhaus program are:

drgtab_h.dta (Diagnosis Related Group (DRG) and DRG screen coded value xtab_s1h.dta (appropriate diagnosis codes and Elixhauser categories, no decimal point) xtab_s2h.dta (appropriate diagnosis codes and Elixhauser categories, with decimal point)

The following variables appear in drgtab_h.dta:

drgroup: DRG (diagnosis related group) code, prior to Version 25 drg_cat: DRG screen codes

DRG screen codes are:

A = Cardiac B = Chronic obstructive pulmonary disorder (COPD) C = Peripheral vascular D = Hypertension DF = Hypertension and nervous system E = Cerebrovascular EF = Cerebrovascular and nervous system F = Nervous system FQ = Nervous system and cancer G = Asthma H = Diabetes (uncomplicated or complicated) I = Thyroid J = Endocrine K = Kidney transplant KZ = Kidney transplant and renal L = Renal failure/dialysis LZ = Renal failure/dialysis and renal M = Liver MQ = Liver and cancer N = GI hemorrhage or ulcer O = HIV P = Leukemia/lymphoma PQ = Leukemia/lymphoma and cancer Q = Cancer R = Connective tissue S = Coagulation T = Obesity procedure U = Nutrition/metabolic V = Anemia W = Alcohol or drug X = Psychoses Y = Depression Z = Renal

The following variables appear in both xtab_s1h.dta and xtab_s2h.dta:

dx: ICD-9-CM diagnosis code elix: Elixhauser comorbidity category code

Codes for Elixhauser comorbidities are:

1 = Congestive heart failure 2 = Not used 3 = Vavular disease 4 = Pulmonary circulation disorders 5 = Peripheral vascular disorders 6 = Hypertension combined 6A = Hypertension, uncomplicated 6B = Hypertension, complicated 6B0 = Pre-existing hypertension complicating pregnancy 6B1 = Hypertensive heart disease without heart failure 6B2 = Hypertensive heart disease with heart failure 6B3 = Hypertensive renal disease without renal failure 6B4 = Hypertensive renal disease with renal failure 6B5 = Hypertensive heart and renal disease without heart or renal failure 6B6 = Hypertensive heart and renal disease with heart failure 6B7 = Hypertensive heart and renal disease with renal failure 6B8 = Hypertensive heart and renal disease with heart and renal failure 6B9 = Other hypertension in pregnancy 7 = Paralysis 8 = Other neurological disorders 9 = Chronic pulmonary disease 10 = Diabetes, uncomplicated 11 = Diabetes, complicated 12 = Hypothyroidism 13 = Renal failure 14 = Liver disease 15 = Peptic ulcer disease, excluding bleeding 16 = AIDS 17 = Lymphoma 18 = Metastatic cancer 19 = Solid tumor 20 = Rheumatoid arthritis/collagen vascular disease 21 = Coagulopathy 22 = Obesity 23 = Weight loss 24 = Fluid and electrolyte disorders 25 = Blood loss anemia 26 = Deficiency anemias 27 = Alcohol abuse 28 = Drug abuse 29 = Psychoses 30 = Depression

Examples

None

Authors

David E. Clark, M.D.

Maine Medical Center, Portland, Maine, USA University of Vermont College of Medicine, Burlington, Vermont, USA Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts, USA

Correspondence to Dr. Clark, 887 Congress Street, Portland ME 04102 Email: clarkd@mmc.org

Turner M. Osler, M.D.

University of Vermont College of Medicine, Burlington, Vermont, USA

David R. Hahn

Maine Medical Center, Portland, Maine, USA

References

Baker SP, O'Neill B, Haddon WJ, Long WB. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187-196.

Barell V, Aharonson-Daniel L, Fingerhut LA, et al. An introduction to the Barell body region by nature of injury diagnosis matrix. Inj Prev 2002;8:91-96.

Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: The TRISS method. Trauma Score and the Injury Severity Score. J Trauma 1987;27:370-378.

Champion HR, Sacco WJ, Lepper RL, Atzinger EM, Copes WS, Prall RH. An anatomic index of injury severity. J Trauma 1980;20:197-202.

Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma 1989;29:623-629.

Champion HR, Sacco WJ. Trauma risk assessment: Review of severity scales. Emergency Medicine Annual 1983;2:43-71.

Champion HR, Copes WS, Sacco WJ, et al. A new characterization of injury severity. J Trauma 1990;30:539-545.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40:373-383.

Clark DE, Ahmad S. Estimating injury severity using the Barell matrix. Inj Prev 2006;12:111-116.

Copes WS, Champion HR, Sacco WJ, et al. Progress in characterizing anatomic injury. J Trauma 1990;30:1200-1207.

Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998;36:8-27.

Garthe EA. Compatibility of the ICD-9CM with AIS-80. Am Assoc Auto Med QJ 1982;2:42-46.

Glance L, Osler T, Mukamel D, Meredith W, Wagner J, Dick A. TMPM-ICD9: A Trauma Mortality Prediction Model Based on ICD-9-CM Codes. Ann Surg In Press.

Levy PS, Mullner R, Goldberg J, Gelfand H. The estimated survival probability index of trauma severity. Health Serv Res 1978;13:28-35.

MacKenzie EJ, Steinwachs DM, Shankar BS, Turney SZ. An ICD-9CM to AIS conversion table: Development and application. Proc AAAM 1986;30:135-151.

MacKenzie EJ, Steinwachs DM, Shankar B. Classifying trauma severity based on hospital discharge diagnoses. Validation of an ICD-9CM to AIS-85 conversion table. Med Care 1989;27:412-422.

Meredith JW, Evans G, Kilgo PD, et al. A comparison of the abilities of nine scoring algorithms in predicting mortality. J Trauma 2002;53:621-629.

Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma 1997;43:922-925.

Osler T, Rutledge R, Deis J, Bedrick E. ICISS: An International Classification of Disease-9 based injury severity score. J Trauma 1996;41:380-386.

Osler T, Glance L, Buzas JS, Mukamel D, Wagner J, Dick A. A Trauma Mortality Prediction Model Based on the Anatomic Injury Scale. Ann Surg 2008;247:1041-1048.

Rating the severity of tissue damage. I. The abbreviated scale. JAMA 1971;215:277-280.

Recommended framework for presenting injury mortality data. MMWR Morb Mortal Wkly Rep 1997;46:1-30.

Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: Differing perspectives. J Clin Epidemiol 1993;46:1075-1079.

Also see

help for trauma

help for srr

help for iciss

help for aps

help for rts

help for triss

help for ascot

help for icd9tmpm

help for ais_tmpm

help for altcharl

help for elixhaus

help for icdpic