ICE 2004 update:

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ICE 2004 update Multiple Injury Profiles
A summary of what we have done and learnt since
Paris ICE meeting 2003 Limor Aharonson-Daniel
Israel National Center for Trauma and Emergency
Medicine Research, Gertner Institute for
Epidemiology and Health Policy Research, Israel
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2003 agreements
Multiple Injury Profiles are

• a step forward in the application of the Barell
  Matrix
• an injury descriptor, not a severity measure
• A tool for
• presenting and reporting injury statistics
• comparing injury patterns in populations

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2003 agreements
Choice of groups
We always remain loyal to the full matrix (36
rows) as the basic, most descriptive
unit. Further collapsing and grouping can be
tailor-made by researchers based on study needs,
frequency, clinical reasoning etc.
Too much detail obscures presentation Body region
is usually a good indicator See poster file for
excmples of different levels of detail
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2003 agreements
Excluding AIS1 injuries
The number of combinations may be inflated by a
large number of superficial injuries that make no
difference in terms of outcome or significant
care provided. In order to reduce the number of
combinations, exclude AIS1 injuries from profile
and see the effect
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Homework
Excluding AIS1 injuries
Check on Israeli data what effect would
excluding these injuries have on the overall
results.
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2004 Plan A
Excluding AIS1 injuries
In Theory Specific ICD codes corresponding to
AIS1 have to be selected and excluded from
profile. In practice It is not straight forward
to assign specific ICD codes to correspond to
AIS1.
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2004The problem
Excluding AIS1 injuries
Excluding ICD diagnoses with AIS1 was not
possible.
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2004 New Plan
Excluding AIS1 injuries
Build an AIS based matrix. Use for building
multiple injury profiles. AIS1 codes can be
excluded and results compared.
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2004 Current status
Excluding AIS1 injuries
AIS matrix is built but needs validation. We
preferred to use an accepted method. AIS six
body regions were used to build multiple injury
profiles. A comparison of these profiles with
and without AIS1 injuries was done.
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Multiple Injury Profiles using AIS regions
Building a profile using AIS six body
regions Head, Face, Chest, Abdomen, Extremities,
External A patient has an injury to the Head and
Chest His profile would be H _ C _ _ _
The following are results of the analysis of road
traffic casualties from 1998-2002, a total of
23848 patients using AIS body regions
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Distribution of body regions injured
All injuries
All patients 23848,
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Distribution of body regions injured
All injuries (red) and when excluding AIS1
(yellow)
All patients 23848, Excluding AIS1, 19014
patients
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Distribution of MIP for patients with Head
injuries
All injuries (red) and when excluding AIS1
(yellow)
All patients 9226, Excluding AIS1, 8541 patients
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Distribution of critical injuries (ISS 25)
All injuries (red) and when excluding AIS1
(yellow)
All patients 23848, Excluding AIS1, 19014
patients
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Distribution of inpatient mortality rate
All injuries (red) and when excluding AIS1
(yellow)
All patients 23848, Excluding AIS1, 19014
patients
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What do you think? Should we exclude AIS1?
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Proposed directions to proceed to

• Put efforts into associating individual ICD
  diagnoses with AIS severity so that this will be
  checked on the original matrix based MIP.
• AIS matrix needs to be experimented and validated
  on different populations

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Thanks for your attention