Internationally comparable diagnosis-specific survival probabilities for calculation of the ICD-10-based Injury Severity Score

J Trauma Acute Care Surg. 2014 Feb;76(2):358-65. doi: 10.1097/TA.0b013e3182a9cd31.


Background: The International Statistical Classification of Diseases, 10th Revision (ICD-10)-based Injury Severity Score (ICISS) performs well but requires diagnosis-specific survival probabilities (DSPs), which are empirically derived, for its calculation. The objective was to examine if DSPs based on data pooled from several countries could increase accuracy, precision, utility, and international comparability of DSPs and ICISS.

Methods: Australia, Argentina, Austria, Canada, Denmark, New Zealand, and Sweden provided ICD-10-coded injury hospital discharge data, including in-hospital mortality status. Data from the seven countries were pooled using four different methods to create an international collaborative effort ICISS (ICE-ICISS). The ability of the ICISS to predict mortality using the country-specific DSPs and the pooled DSPs was estimated and compared.

Results: The pooled DSPs were based on a total of 3,966,550 observations of injury diagnoses from the seven countries. The proportion of injury diagnoses having at least 100 discharges to calculate the DSP varied from 12% to 48% in the country-specific data set and was 66% in the pooled data set. When compared with using a country's own DSPs for ICISS calculation, the pooled DSPs resulted in somewhat reduced discrimination in predicting mortality (difference in c statistic varied from 0.006 to 0.04). Calibration was generally good when the predicted mortality risk was less than 20%. When Danish and Swedish data were used, ICISS was combined with age and sex in a logistic regression model to predict in-hospital mortality. Including age and sex improved both discrimination and calibration substantially, and the differences from using country-specific or pooled DSPs were minor.

Conclusion: Pooling data from seven countries generated empirically derived DSPs. These pooled DSPs facilitate international comparisons and enables the use of ICISS in all settings where ICD-10 hospital discharge diagnoses are available. The modest reduction in performance of the ICE-ICISS compared with the country-specific scores is unlikely to outweigh the benefit of internationally comparable Injury Severity Scores possible with pooled data.

Level of evidence: Prognostic and epidemiological study, level III.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Argentina
  • Australia
  • Austria
  • Canada
  • Cause of Death
  • Denmark
  • Female
  • Hospital Mortality*
  • Humans
  • International Classification of Diseases / classification*
  • Logistic Models
  • Male
  • Middle Aged
  • New Zealand
  • Patient Discharge / statistics & numerical data
  • Predictive Value of Tests
  • Probability
  • Survival Analysis
  • Sweden
  • Trauma Severity Indices
  • Wounds and Injuries / classification
  • Wounds and Injuries / diagnosis*
  • Wounds and Injuries / mortality*
  • Wounds and Injuries / therapy