Does an International Version of ICISS Predict Mortality for Patients Admitted With Trauma in Four Public University Hospitals in Urban India?

Introduction

Trauma causes 10% of the world's annual deaths. Trauma-related deaths are most common in low- and middle-income countries, which accounts for over 90% of global trauma mortality. In 2013 over 1.2 million trauma deaths occurred in India alone. Hence, India accounted for 25% of trauma-related deaths worldwide. Experiences from high income countries show that the establishment of trauma registers have been of importance for the improvement of trauma care and research, allowing for comparisons between different hospitals as well as over time.

To be useful such comparisons should be risk-adjusted to account for differences in care and patient case mix. In trauma one of the most important patient case mix characteristics to adjust for is injury severity. Several different injury severity scores exist for this purpose. One of these scores is the International Classification of Disease Injury Severity Score (ICISS). In contrast to other established scores, such as the Injury Severity Score (ISS), ICISS can be calculated based on injuries coded using ICD for administrative purposes, making it cost effective.

The validity of ICISS has primarily been studied in high-income countries ICISS requires an empirically estimated Survival Risk Ratio (SRR) for each ICD code. Some studies from high income countries has shown similar predictive performance of ICISS when using SRRs derived from other high-income countries. However, the generalisability of such SRRs to low- and middle-income countries such as India has not been researched. Therefore, the aim of this study was to validate an international version of ICISS in patients presenting with trauma to four public university hospitals in urban India.

Study design