Issues to consider when estimating injury severity … Session 4 Coding Dr...CRICOS No. 00213J Dr...
Transcript of Issues to consider when estimating injury severity … Session 4 Coding Dr...CRICOS No. 00213J Dr...
CRICOS No. 00213J
Dr Kirsten Vallmuur and Ms Jesani Limbong 11th October 2013
Issues to consider when estimating
injury severity during risk assessment
Focus of presentation
• Core input into risk assessment model is the
injury severity rank and probability of
occurrence
• Injury severity rank = Table of injury types and
body regions grouped into 4 or 6 point scale
• Core questions:
– How valid is the grouping of injuries?
– How consistent are these groupings across different
severity scales?
– How concordant are these groupings with other
indicators of injury severity?
Canada (Health Canada) Injury Definition
Minor Requires first aid treatment; medical attention is not necessary
Moderate Are temporary or remediable; Consequences are not life-threatening and
are reversible in most instances.
Serious Irreversible; cause permanent disability or long-term illness
Death Any injuries resulting in death
Injury Definition
1 Injury or consequence that after basic treatment (first aid, normally not by a doctor) does not
substantially hamper functioning or cause excessive pain; usually the consequences are completely reversible.
2 Injury or consequence for which a visit to A&E may be necessary, but in general, hospitalization is
not required. Functioning may be affected for a limited period, not more than about 6 months, and recovery is more
or less complete
3 Injury or consequence that normally requires hospitalisation and will affect functioning for more than 6
months or lead to a permanent loss of function.
4 Injury or consequence that is or could be fatal, including brain death; consequences that affect
reproduction or offspring; severe loss of limbs and/or function, leading to more than approximately 10 % of disability.
New Zealand
Europe/Australia (RAPEX Guidelines)
Injury severity ranking systems
Injury
Minor
Moderate
Serious
Severe
Critical
Death
Comparison of RAPEX and Canadian
Injury Severity Categorisation Injury type RAPEX Canada
Abrasion/
Bruising
Internal bruising severe Never severe
Burn/Scald Burns to >16% body surface
severe
Burns to >10% body surface
severe
Concussion Prolonged unconsciousness
severe
Prolonged time for symptoms
to resolve severe
Electrical Other serious effects
(burns/cardiac effects etc) of
electrical exposure severe
Only electrocution severe
Fracture Rib/jaw not severe;
Lower leg severe
Rib/jaw severe;
Lower leg not severe
Piercing/
Puncturing
Eye/internal organ/chest wall
severe
Eye/internal organ/chest wall
not severe
Strangulation Never minor/moderate Bruising/swallowing/
hoarseness not severe
Implications of Different Severity
Categorisation
• Injuries falling below the threshold may not be
raised to an investigation level in one jurisdiction
but may be in another -> inconsistent risk
prioritisation
• If injuries where differences exist are very
common, may lead to considerable discrepancy
(i.e. severity of different fractures)
• Explore injury data to get an indication of size of
problem and decide if better uniformity needed
Classifying injury data into
severity categories
• Injury severity ranks are largely based on injury
nature and body region
• Hospitalisation and mortality data have injury
diagnoses coded (codes structured into nature
of injury and body region codes)
• Assigning severity scores to injury data allows
for better illustration of severity by hazard and
product
Burns Severity Rank Comparisons
RANK RAPEX Canada
1 or
Minor
1st degree burns up to 100 %
of body surface
2nd degree < 6 % of body
surface
1st degree burns
2 or
Moderate 2nd degree burns at 6-15 % of
body surface
2nd degree burns up to ≤10% of the body
not including the head
Chemical burns causing reversible damage
3 or
Severe
2nd degree burns at 16-35 % of
body surface
3rd degree burns up to 35 %
Inhalation burn
2nd degree burns up to >10% of the body or
to the head
3rd degree burns
Any burn resulting in permanent
disfigurement or severe scarring
4 or
Death
2nd or 3rd degree > 35 % of
body surface
Inhalation burn requiring
respiratory assistance
Burn/scald resulting in death
Principal
code:
Burn
Thickness
A B C D
Unspecified Erythema Partial Full
T20.0, T21.0,
T22.0, T23.0,
T24.0 T25.0,
T29.0, T30.0
T20.1, T21.1,
T22.1, T23.1,
T24.1 T25.1,
T29.1, T30.1
T20.2, T21.2,
T22.2, T23.2,
T24.2 T25.2,
T29.2, T30.2
T20.3, T21.3,
T22.3, T23.3,
T24.3 T25.3,
T29.3, T30.3
Secondary code: Body
Surface Area
3rd Ch
3rd Ch 0 1 2 3
1 T31.0
BSA Less than 10% or
unspecified
0 Unclassifiable Burn 1 Burn 1
Burn 2 Burn 3
2 T31.1
BSA 10-19% 1 Unclassifiable Burn 1
Burn 2
Burn 3 Burn 3
3 T31.2
BSA 20-19% 2 Unclassifiable Burn 1 Burn 3 Burn 3
4 T31.3
BSA 30-39% 3 Unclassifiable Burn 1
Burn 3
Burn 4
Burn 3
Burn 4
5 T31.4
BSA 40-49% 4 Unclassifiable Burn 1 Burn 4 Burn 4
6 T31.5
BSA 50-59% 5 Unclassifiable Burn 1 Burn 4 Burn 4
7 T31.6
BSA 60-69% 6 Unclassifiable Burn 1 Burn 4 Burn 4
8 T31.7
BSA 70-79% 7 Unclassifiable Burn 1 Burn 4 Burn 4
9 T31.8
BSA 80-89% 8 Unclassifiable Burn 1 Burn 4 Burn 4
10 T31.9
BSA 90% or more 9 Unclassifiable Burn 1 Burn 4 Burn 4
Example categorisation of burns
data in Queensland children
Validating injury severity ranks
• Other health system-based injury severity scales:
– ICD-based Injury Severity Score (ICISS) => survival risk
ratio (SRR)
– Abbreviated injury score (AIS)
• Other indicators of severity:
– Triage urgency
– Emergency department presentation/ hospital
admission/mortality rates
– Length of stay
– Costs of treatment
– Disability outcomes
Next steps
• Compare injury data for the injuries where ranks
differ across injury severity systems
• Evaluate the validity of the ranks by comparison
with other health system-based injury severity
scales and with other severity indicators
• Revise and consolidate different injury severity
scales to establish a single international scale
for categorisation of injury severity
CRICOS No. 00213J
Questions? [email protected]
Reports:
http://eprints.qut.edu.au/46518/
http://eprints.qut.edu.au/58389/