Risk adjustment for injured patients using administrative data

J Trauma. 2004 Jul;57(1):130-40; discussion 140. doi: 10.1097/01.ta.0000114240.58834.84.


Background: Risk adjustment methods are needed for population-based studies of injured patients.

Methods: Data were obtained from National Hospital Discharge Surveys, 1996 to 2000. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses were used to categorize Abbreviated Injury Scale score, Injury Severity Score, ICD-9-CM Injury Severity Score, injury mechanisms, and comorbidities. Regression models for weighted survey data were constructed from combinations of these classifications, plus age and sex, to predict mortality, length of stay (LOS), or discharge to long-term care (LTC).

Results: Increased Abbreviated Injury Scale score, increased Injury Severity Score, or decreased ICD-9-CM Injury Severity Score were similarly associated with mortality, prolonged LOS, or more frequent LTC, as was increased age. Penetrating or burn mechanisms were associated with mortality and longer LOS; penetrating or vehicle mechanisms were associated with less frequent LTC. Different comorbidities affected LOS and LTC. Men had shorter LOS and less frequent LTC than women.

Conclusion: Hospital outcomes after injury are predictable from age, sex, and standard diagnosis groupings. Anatomic scales gave similar results when adjusted for other factors.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Diagnosis-Related Groups / statistics & numerical data*
  • Female
  • Humans
  • Injury Severity Score*
  • Male
  • Middle Aged
  • Models, Theoretical
  • Patient Discharge / statistics & numerical data
  • Probability*
  • Risk Factors
  • United States / epidemiology
  • Wounds and Injuries / mortality*