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Richard Duszak - One of the best experts on this subject based on the ideXlab platform.
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disproportionate use in minor trauma is driving emergency department cervical spine imaging an Injury Severity Score based analysis
Journal of The American College of Radiology, 2021Co-Authors: Akram Khaja, Michal Horný, Patricia Balthazar, Tarek N Hanna, Paul Harkey, Alexander Villalobos, Richard DuszakAbstract:Abstract Purpose Clinical practice guidelines intended to reduce unnecessary cervical spine imaging have yielded mixed results. We aimed to assess evolving emergency department (ED) cervical spine imaging utilization in patients with trauma by Injury Severity. Methods Using 2009 to 2018 IBM MarketScan Commercial Databases, we identified ED trauma encounters, associated cervical spine imaging, and related diagnosis codes. We classified encounters by Injury Severity (minor, intermediate, major) using an International Classification of Disease code-derived Injury Severity Score algorithm and studied evolving imaging utilization using multivariable Poisson regression models. Results Of all 11,346,684 ED visits for trauma, 7,753,914 (68.3%), 3,524,250 (31.1%), and 68,520 (0.6%) involved minor, intermediate, and major injuries, respectively. Overall cervical spine imaging increased 5.7% annually (incidence rate ratio [IRR] 1.057, P Conclusions Recent increases in cervical spine imaging in commercially insured patients with trauma seen in the ED have been largely related to increases in CT for patients with only minor injuries, in whom imaging utilization has been historically low. Further study is necessary to assess appropriateness, implications on costs and population radiation dose, and factors influencing ordering decision making.
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disproportionate use in minor trauma is driving emergency department cervical spine imaging an Injury Severity Score based analysis
Journal of The American College of Radiology, 2021Co-Authors: Akram Khaja, Michal Horný, Patricia Balthazar, Tarek N Hanna, Paul Harkey, Alexander Villalobos, Richard DuszakAbstract:PURPOSE Clinical practice guidelines intended to reduce unnecessary cervical spine imaging have yielded mixed results. We aimed to assess evolving emergency department (ED) cervical spine imaging utilization in patients with trauma by Injury Severity. METHODS Using 2009 to 2018 IBM MarketScan Commercial Databases, we identified ED trauma encounters, associated cervical spine imaging, and related diagnosis codes. We classified encounters by Injury Severity (minor, intermediate, major) using an International Classification of Disease code-derived Injury Severity Score algorithm and studied evolving imaging utilization using multivariable Poisson regression models. RESULTS Of all 11,346,684 ED visits for trauma, 7,753,914 (68.3%), 3,524,250 (31.1%), and 68,520 (0.6%) involved minor, intermediate, and major injuries, respectively. Overall cervical spine imaging increased 5.7% annually (incidence rate ratio [IRR] 1.057, P < .001) with radiography decreasing 2.7% annually (IRR 0.973, P < .001) and CT increasing 10.5% annually (IRR 1.105, P < .001). Radiography utilization remained unchanged for minor injuries (IRR 0.994, P = .14) but decreased for intermediate (IRR 0.928 versus minor, P < .001) and major (IRR 0.931 versus minor, P < .001) injuries. Increases in CT utilization were greatest for minor injuries (IRR 1.109, P < .001) with smaller increases in intermediate (IRR 0.960 versus minor, P < .001) and major (IRR 0.987 versus minor, P = .022) injuries. CONCLUSIONS Recent increases in cervical spine imaging in commercially insured patients with trauma seen in the ED have been largely related to increases in CT for patients with only minor injuries, in whom imaging utilization has been historically low. Further study is necessary to assess appropriateness, implications on costs and population radiation dose, and factors influencing ordering decision making.
Philip J Schluter - One of the best experts on this subject based on the ideXlab platform.
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trauma and Injury Severity Score triss is it time for variable re categorisations and re characterisations
Injury-international Journal of The Care of The Injured, 2011Co-Authors: Philip J SchluterAbstract:Background: Despite its limitations, the Trauma and Injury Severity Score (TRISS) continues to be the most commonly used tool for benchmarking trauma outcome. Since its inception, considerable energy has been devoted to improving TRISS. However, there has been no investigation into the classification or characterisation of the TRISS variables. Using a major nationally representative database, this study aims to explore the adequacy of the existing TRISS model by investigating variable re-categorisations and alternative characterisations in a logistic model used to predict survival in adults after traumatic Injury. Materials and methods: Data were obtained from the National Trauma Data Bank National Sample Project (NSP). Each variable in the TRISS model was related to discharge status and various categorisations considered using weighted logistic regression. Categorisations were treated nominally, using a series of indicator variables. For each variable and classification level, the best category combination was ascertained using the Bayesian Information Criterion (BIC). All best 5-category classified TRISS variables were combined, as were all best 10-category classified TRISS variables, and their predictive performance assessed against two conventionally defined TRISS models on the unweighted NSP sample using area under the Receiver Operating Characteristic curve (AUC) and BIC statistics. Results: Overall, the weighted sample included 1,124,001 adults with Injury events and known discharge status, of whom 1,061,709 (94.5%) were alive at discharge. When separately related to discharge status, each re-classified TRISS variable yielded a superior BIC statistic to its original specification. When investigating predictive performance, complete information was available for 167,239 (79.9%) adults with blunt and 20,643 (82.3%) adults with penetrating Injury mechanisms. AUC and BIC estimates for the re-classified TRISS models were superior to the conventionally defined TRISS models. While having better predictive precision, the complexity associated with the best 10-category model resulted in the best 5-category model being preferred for penetrating mechanism injuries and being negligibly inferior for blunt mechanism injuries. Discussion: Substantial improvements in the predictive power of TRISS were demonstrated by re-classifying the component variables and treating the variable categories nominally. However, before a new TRISS model with updated coefficients can be published, variable interactions and the effect of missing data needs thorough statistical evaluation.
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the trauma and Injury Severity Score triss revised
Injury-international Journal of The Care of The Injured, 2011Co-Authors: Philip J SchluterAbstract:Abstract Background The Trauma and Injury Severity Score (TRISS) remains the most commonly used tool for benchmarking trauma fatality outcome. Recently, it was demonstrated that the predictive power of TRISS could be substantially improved by re-classifying the component variables and treating the variable categories nominally. This study aims to develop revised TRISS models using re-classified variables, to assess these models’ predictive performances against existing TRISS models, and to identify and recommend a preferred TRISS model. Materials and methods Revised TRISS models for blunt and penetrating Injury mechanism were developed on an adult (aged ≥15 years) sample from the National Trauma Data Bank National Sample Project (NSP), using 5-category variable classifications and weighted logistic regression. Their predictive performances were then assessed against existing TRISS models on the unweighted NSP, National Trauma Data Bank (NTDB), and New Zealand Database (NZDB) samples using area under the Receiver Operating Characteristic curve (AUC) and Bayesian Information Criterion (BIC) statistics. Results The weighted NSP sample included 1,124,001 adults with blunt or penetrating Injury mechanism events and known discharge status, of whom 1,061,709 (94.5%) survived to discharge. Complete information for all TRISS variables was available for 896,212 (79.7%). Revised TRISS models that included main-effects and two-factor interaction terms had superior AUC and BIC statistics to main-effects models and existing TRISS models for patients with complete data in NSP, NTDB and NZDB samples. Predictive performance decreased as the number of variables with missing values included within revised TRISS models increased, but model performances generally remained superior to existing TRISS models. Discussion Revised TRISS models had importantly improved predictive capacities over existing TRISS models. Additionally, they were easily computed, utilised only those variables already collected for existing TRISS models, and could be applied and produce meaningful survival probabilities when one or more of the predictor variables contained missing values. The preferred revised TRISS model included main-effects and two-factor interaction terms and allowed for missing values in all predictor variables. A strong case exists for replacing existing TRISS models in trauma scoring systems benchmarking software with this preferred revised TRISS model.
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trauma and Injury Severity Score triss coefficients 2009 revision
Journal of Trauma-injury Infection and Critical Care, 2010Co-Authors: Philip J Schluter, Avery Nathens, Melanie Neal, Sandra Goble, Cate M Cameron, Tamzyn M Davey, Roderick John McclureAbstract:Background: Currently used Trauma and Injury Severity Score (TRISS) coefficients, which measure probability of survival (PS), were derived from the Major Trauma Outcome Study (MTOS) in 1995 and are now unlikely to be optimal. This study aims to estimate new TRISS coefficients using a contemporary database of injured patients presenting to emergency departments in the United States; and to compare these against the MTOS coefficients. Methods: Data were obtained from the National Trauma Data Bank (NTDB) and the NTDB National Sample Project (NSP). TRISS coefficients were estimated using logistic regression. Separate coefficients were derived from complete case and multistage multiple imputation analyses for each NTDB and NSP dataset. Associated PS over Injury Severity Score values were graphed and compared by age (adult 15 years; pediatric 15 years) and Injury mechanism (blunt; penetrating) groups. Area under the Receiver Operating Characteristic curves was used to assess coefficients' predictive performance. Results: Overall 1,072,033 NTDB and 1,278,563 weighted NSP Injury events were included, compared with 23,177 used in the original MTOS analyses. Large differences were seen between results from complete case and imputed analyses. For blunt mechanism and adult penetrating mechanism injuries, there were similarities between coefficients estimated on imputed samples, and marked divergences between associated PS estimates and those from the MTOS. However, negligible differences existed between area under the receiver operating characteristic curves estimates because the overwhelming majority of patients had minor trauma and survived. For pediatric penetrating mechanism injuries, variability in coefficients was large and PS estimates unreliable. Conclusions: Imputed NTDB coefficients are recommended as the TRISS coefficients 2009 revision for blunt mechanism and adult penetrating mechanism injuries. Coefficients for pediatric penetrating mechanism injuries could not be reliably estimated.
Akram Khaja - One of the best experts on this subject based on the ideXlab platform.
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disproportionate use in minor trauma is driving emergency department cervical spine imaging an Injury Severity Score based analysis
Journal of The American College of Radiology, 2021Co-Authors: Akram Khaja, Michal Horný, Patricia Balthazar, Tarek N Hanna, Paul Harkey, Alexander Villalobos, Richard DuszakAbstract:Abstract Purpose Clinical practice guidelines intended to reduce unnecessary cervical spine imaging have yielded mixed results. We aimed to assess evolving emergency department (ED) cervical spine imaging utilization in patients with trauma by Injury Severity. Methods Using 2009 to 2018 IBM MarketScan Commercial Databases, we identified ED trauma encounters, associated cervical spine imaging, and related diagnosis codes. We classified encounters by Injury Severity (minor, intermediate, major) using an International Classification of Disease code-derived Injury Severity Score algorithm and studied evolving imaging utilization using multivariable Poisson regression models. Results Of all 11,346,684 ED visits for trauma, 7,753,914 (68.3%), 3,524,250 (31.1%), and 68,520 (0.6%) involved minor, intermediate, and major injuries, respectively. Overall cervical spine imaging increased 5.7% annually (incidence rate ratio [IRR] 1.057, P Conclusions Recent increases in cervical spine imaging in commercially insured patients with trauma seen in the ED have been largely related to increases in CT for patients with only minor injuries, in whom imaging utilization has been historically low. Further study is necessary to assess appropriateness, implications on costs and population radiation dose, and factors influencing ordering decision making.
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disproportionate use in minor trauma is driving emergency department cervical spine imaging an Injury Severity Score based analysis
Journal of The American College of Radiology, 2021Co-Authors: Akram Khaja, Michal Horný, Patricia Balthazar, Tarek N Hanna, Paul Harkey, Alexander Villalobos, Richard DuszakAbstract:PURPOSE Clinical practice guidelines intended to reduce unnecessary cervical spine imaging have yielded mixed results. We aimed to assess evolving emergency department (ED) cervical spine imaging utilization in patients with trauma by Injury Severity. METHODS Using 2009 to 2018 IBM MarketScan Commercial Databases, we identified ED trauma encounters, associated cervical spine imaging, and related diagnosis codes. We classified encounters by Injury Severity (minor, intermediate, major) using an International Classification of Disease code-derived Injury Severity Score algorithm and studied evolving imaging utilization using multivariable Poisson regression models. RESULTS Of all 11,346,684 ED visits for trauma, 7,753,914 (68.3%), 3,524,250 (31.1%), and 68,520 (0.6%) involved minor, intermediate, and major injuries, respectively. Overall cervical spine imaging increased 5.7% annually (incidence rate ratio [IRR] 1.057, P < .001) with radiography decreasing 2.7% annually (IRR 0.973, P < .001) and CT increasing 10.5% annually (IRR 1.105, P < .001). Radiography utilization remained unchanged for minor injuries (IRR 0.994, P = .14) but decreased for intermediate (IRR 0.928 versus minor, P < .001) and major (IRR 0.931 versus minor, P < .001) injuries. Increases in CT utilization were greatest for minor injuries (IRR 1.109, P < .001) with smaller increases in intermediate (IRR 0.960 versus minor, P < .001) and major (IRR 0.987 versus minor, P = .022) injuries. CONCLUSIONS Recent increases in cervical spine imaging in commercially insured patients with trauma seen in the ED have been largely related to increases in CT for patients with only minor injuries, in whom imaging utilization has been historically low. Further study is necessary to assess appropriateness, implications on costs and population radiation dose, and factors influencing ordering decision making.
Michal Horný - One of the best experts on this subject based on the ideXlab platform.
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disproportionate use in minor trauma is driving emergency department cervical spine imaging an Injury Severity Score based analysis
Journal of The American College of Radiology, 2021Co-Authors: Akram Khaja, Michal Horný, Patricia Balthazar, Tarek N Hanna, Paul Harkey, Alexander Villalobos, Richard DuszakAbstract:Abstract Purpose Clinical practice guidelines intended to reduce unnecessary cervical spine imaging have yielded mixed results. We aimed to assess evolving emergency department (ED) cervical spine imaging utilization in patients with trauma by Injury Severity. Methods Using 2009 to 2018 IBM MarketScan Commercial Databases, we identified ED trauma encounters, associated cervical spine imaging, and related diagnosis codes. We classified encounters by Injury Severity (minor, intermediate, major) using an International Classification of Disease code-derived Injury Severity Score algorithm and studied evolving imaging utilization using multivariable Poisson regression models. Results Of all 11,346,684 ED visits for trauma, 7,753,914 (68.3%), 3,524,250 (31.1%), and 68,520 (0.6%) involved minor, intermediate, and major injuries, respectively. Overall cervical spine imaging increased 5.7% annually (incidence rate ratio [IRR] 1.057, P Conclusions Recent increases in cervical spine imaging in commercially insured patients with trauma seen in the ED have been largely related to increases in CT for patients with only minor injuries, in whom imaging utilization has been historically low. Further study is necessary to assess appropriateness, implications on costs and population radiation dose, and factors influencing ordering decision making.
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disproportionate use in minor trauma is driving emergency department cervical spine imaging an Injury Severity Score based analysis
Journal of The American College of Radiology, 2021Co-Authors: Akram Khaja, Michal Horný, Patricia Balthazar, Tarek N Hanna, Paul Harkey, Alexander Villalobos, Richard DuszakAbstract:PURPOSE Clinical practice guidelines intended to reduce unnecessary cervical spine imaging have yielded mixed results. We aimed to assess evolving emergency department (ED) cervical spine imaging utilization in patients with trauma by Injury Severity. METHODS Using 2009 to 2018 IBM MarketScan Commercial Databases, we identified ED trauma encounters, associated cervical spine imaging, and related diagnosis codes. We classified encounters by Injury Severity (minor, intermediate, major) using an International Classification of Disease code-derived Injury Severity Score algorithm and studied evolving imaging utilization using multivariable Poisson regression models. RESULTS Of all 11,346,684 ED visits for trauma, 7,753,914 (68.3%), 3,524,250 (31.1%), and 68,520 (0.6%) involved minor, intermediate, and major injuries, respectively. Overall cervical spine imaging increased 5.7% annually (incidence rate ratio [IRR] 1.057, P < .001) with radiography decreasing 2.7% annually (IRR 0.973, P < .001) and CT increasing 10.5% annually (IRR 1.105, P < .001). Radiography utilization remained unchanged for minor injuries (IRR 0.994, P = .14) but decreased for intermediate (IRR 0.928 versus minor, P < .001) and major (IRR 0.931 versus minor, P < .001) injuries. Increases in CT utilization were greatest for minor injuries (IRR 1.109, P < .001) with smaller increases in intermediate (IRR 0.960 versus minor, P < .001) and major (IRR 0.987 versus minor, P = .022) injuries. CONCLUSIONS Recent increases in cervical spine imaging in commercially insured patients with trauma seen in the ED have been largely related to increases in CT for patients with only minor injuries, in whom imaging utilization has been historically low. Further study is necessary to assess appropriateness, implications on costs and population radiation dose, and factors influencing ordering decision making.
Patricia Balthazar - One of the best experts on this subject based on the ideXlab platform.
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disproportionate use in minor trauma is driving emergency department cervical spine imaging an Injury Severity Score based analysis
Journal of The American College of Radiology, 2021Co-Authors: Akram Khaja, Michal Horný, Patricia Balthazar, Tarek N Hanna, Paul Harkey, Alexander Villalobos, Richard DuszakAbstract:Abstract Purpose Clinical practice guidelines intended to reduce unnecessary cervical spine imaging have yielded mixed results. We aimed to assess evolving emergency department (ED) cervical spine imaging utilization in patients with trauma by Injury Severity. Methods Using 2009 to 2018 IBM MarketScan Commercial Databases, we identified ED trauma encounters, associated cervical spine imaging, and related diagnosis codes. We classified encounters by Injury Severity (minor, intermediate, major) using an International Classification of Disease code-derived Injury Severity Score algorithm and studied evolving imaging utilization using multivariable Poisson regression models. Results Of all 11,346,684 ED visits for trauma, 7,753,914 (68.3%), 3,524,250 (31.1%), and 68,520 (0.6%) involved minor, intermediate, and major injuries, respectively. Overall cervical spine imaging increased 5.7% annually (incidence rate ratio [IRR] 1.057, P Conclusions Recent increases in cervical spine imaging in commercially insured patients with trauma seen in the ED have been largely related to increases in CT for patients with only minor injuries, in whom imaging utilization has been historically low. Further study is necessary to assess appropriateness, implications on costs and population radiation dose, and factors influencing ordering decision making.
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disproportionate use in minor trauma is driving emergency department cervical spine imaging an Injury Severity Score based analysis
Journal of The American College of Radiology, 2021Co-Authors: Akram Khaja, Michal Horný, Patricia Balthazar, Tarek N Hanna, Paul Harkey, Alexander Villalobos, Richard DuszakAbstract:PURPOSE Clinical practice guidelines intended to reduce unnecessary cervical spine imaging have yielded mixed results. We aimed to assess evolving emergency department (ED) cervical spine imaging utilization in patients with trauma by Injury Severity. METHODS Using 2009 to 2018 IBM MarketScan Commercial Databases, we identified ED trauma encounters, associated cervical spine imaging, and related diagnosis codes. We classified encounters by Injury Severity (minor, intermediate, major) using an International Classification of Disease code-derived Injury Severity Score algorithm and studied evolving imaging utilization using multivariable Poisson regression models. RESULTS Of all 11,346,684 ED visits for trauma, 7,753,914 (68.3%), 3,524,250 (31.1%), and 68,520 (0.6%) involved minor, intermediate, and major injuries, respectively. Overall cervical spine imaging increased 5.7% annually (incidence rate ratio [IRR] 1.057, P < .001) with radiography decreasing 2.7% annually (IRR 0.973, P < .001) and CT increasing 10.5% annually (IRR 1.105, P < .001). Radiography utilization remained unchanged for minor injuries (IRR 0.994, P = .14) but decreased for intermediate (IRR 0.928 versus minor, P < .001) and major (IRR 0.931 versus minor, P < .001) injuries. Increases in CT utilization were greatest for minor injuries (IRR 1.109, P < .001) with smaller increases in intermediate (IRR 0.960 versus minor, P < .001) and major (IRR 0.987 versus minor, P = .022) injuries. CONCLUSIONS Recent increases in cervical spine imaging in commercially insured patients with trauma seen in the ED have been largely related to increases in CT for patients with only minor injuries, in whom imaging utilization has been historically low. Further study is necessary to assess appropriateness, implications on costs and population radiation dose, and factors influencing ordering decision making.