1. National Center for Health Statistics Injury Severity… additional thoughts… Lois A Fingerhut, NCHS Ellen MacKenzie, Johns Hopkins University

2. Challenges in Measuring Injury Severity from ICD codes Currently most “popular”: ICD-9 CM to AIS via ICDMAP ICD-9 CM based AIS and ICDMAP are proprietary Need AIS for Functional Capacity Index

3. Challenges in Measuring Injury Severity from ICD codes Emerging interest in: ICISS ICD-based injury severity scale Not yet widely tested Useful for large administrative data bases

4. ICISS Essentially involves calculations of Survival Risk Ratios for each injury ICISS score is product of SRR’s for each injury Results are encouraging

5. Goal: make injury severity scoring easily accessible to all potential users ICISS offers an alternative to AIS/ICDMAP that needs further validation at the international level Australia and New Zealand have already done this Some US trauma based data bases have used ICISS

6. National level issues Population vs trauma system based data Level of specificity of diagnoses varies with system Mortality codes- less detail (may not work with AIS) Morbidity Hospital, ED, household-based Varying levels of detail and severity Need for a measure that discriminates at lower levels of severity

7. Next steps ICE project? Should international scores be pooled for comparability? US may convene a small consensus meeting among current users Australia, New Zealand US Trauma-based physicians