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. 2019 Oct 30;19(1):61.
doi: 10.1186/s12873-019-0276-8.

Injury coding in a national trauma registry: a one-year validation audit in a level 1 trauma centre

Anna Bågenholm  1   2 , Ina Lundberg  3 , Bjørn Straume  4   5 , Rune Sundset  6   7 , Kristian Bartnes  6   3 , Tor Ingebrigtsen  6   8 , Trond Dehli  6   9
Affiliations

Injury coding in a national trauma registry: a one-year validation audit in a level 1 trauma centre

Anna Bågenholm et al. BMC Emerg Med. .

Abstract

Background: Hospitals must improve patient safety and quality continuously. Clinical quality registries can drive such improvement. Trauma registries code injuries according to the Abbreviated Injury Scale (AIS) and benchmark outcomes based on the Injury Severity Score (ISS) and New ISS (NISS). The primary aim of this study was to validate the injury codes and severities registered in a national trauma registry. Secondarily, we aimed to examine causes for missing and discordant codes, to guide improvement of registry data quality.

Methods: We conducted an audit and established an expert coder group injury reference standard for patients met with trauma team activation in 2015 in a Level 1 trauma centre. Injuries were coded according to the AIS. The audit included review of all data in the electronic health records (EHR), and new interpretation of all images in the picture archiving system. Validated injury codes were compared with the codes registered in the registry. The expert coder group's interpretations of reasons for discrepancies were categorised and registered. Inter-rater agreement between registry data and the reference standard was tested with Bland-Altman analysis.

Results: We validated injury data from 144 patients (male sex 79.2%) with median age 31 (inter quartile range 19-49) years. The total number of registered AIS codes was 582 in the registry and 766 in the reference standard. All injuries were concordantly coded in 62 (43.1%) patients. Most non-registered codes (n = 166 in 71 (49.3%) patients) were AIS 1, and information in the EHR overlooked by registrars was the dominating cause. Discordant coding of head injuries and extremity fractures were the most common causes for 157 discordant AIS codes in 74 (51.4%) patients. Median ISS (9) and NISS (12) for the total population did not differ between the registry and the reference standard.

Conclusions: Concordance between the codes registered in the trauma registry and the reference standard was moderate, influencing individual patients' injury codes validity and ISS/NISS reliability. Nevertheless, aggregated median group ISS/NISS reliability was acceptable.

Keywords: Abbreviated injury scale; Audit; Injury scoring; Patient record; Trauma registry; Validation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Bland–Altman plot for ISS and NISS in NTR versus the reference standard. Bland–Altman ISS and NISS plot for 144 patients quantify agreement in the national trauma registry (NTR) compared to the expert group consensus coding (EGCC). The X -axis presents the mean between the paired measured (a) ISS and (b) NISS in the EGCC and the NTR. Y-axis presents the difference between the paired a) ISS b) NISS in the EGCC versus the NTR. Mean difference ISS 0.194, 95% CI (± 2SD of the mean difference) upper limit + 13.8 and lower limit − 13.4. Mean difference NISS 0.924, 95% CI (± 2SD of the mean difference) upper limit + 16.2, and lower limit–14.4
See this image and copyright information in PMC

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