1. Multiple Injury Profile Methodology ICE 2004 update: Multiple Injury Profiles Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Israel A summary of what we have done and learnt since Paris ICE meeting 2003 Limor Aharonson-Daniel

2. Multiple Injury Profile Methodology oa step forward in the application of the Barell Matrix oan injury descriptor, not a severity measure oA tool for opresenting and reporting injury statistics ocomparing injury patterns in populations Multiple Injury Profiles are 2003 agreements

3. Multiple Injury Profile Methodology Choice of groups “ We always remain loyal to the full matrix (36 rows) as the basic, most descriptive unit.” Further collapsing and grouping can be tailor- made by researchers based on study needs, frequency, clinical reasoning etc. 2003 agreements Too much detail obscures presentation Body region is usually a good indicator See “poster” file for excmples of different levels of detail

4. Multiple Injury Profile Methodology Excluding AIS=1 injuries The number of combinations may be inflated by a large number of superficial injuries that make no difference in terms of outcome or significant care provided. In order to reduce the number of combinations, exclude AIS=1 injuries from profile and see the effect 2003 agreements

5. Multiple Injury Profile Methodology Check on Israeli data – what effect would excluding these injuries have on the overall results. Homework Excluding AIS=1 injuries

6. Multiple Injury Profile Methodology In Theory: Specific ICD codes corresponding to AIS=1 have to be selected and excluded from profile. In practice: It is not straight forward to assign specific ICD codes to correspond to AIS=1. 2004: Plan A Excluding AIS=1 injuries

7. Multiple Injury Profile Methodology Excluding ICD diagnoses with AIS=1 was not possible. 2004:The problem Excluding AIS=1 injuries

8. Multiple Injury Profile Methodology Build an AIS based matrix. Use for building multiple injury profiles. AIS=1 codes can be excluded and results compared. 2004: New Plan Excluding AIS=1 injuries

9. Multiple Injury Profile Methodology AIS matrix is built but needs validation. We preferred to use an accepted method. AIS six body regions were used to build multiple injury profiles. A comparison of these profiles with and without AIS=1 injuries was done. 2004: Current status Excluding AIS=1 injuries

10. Multiple Injury Profile Methodology Multiple Injury Profiles using AIS regions Building a profile using AIS six body regions: Head, Face, Chest, Abdomen, Extremities, External A patient has an injury to the Head and Chest His profile would be: H _ C _ _ _ The following are results of the analysis of road traffic casualties from 1998-2002, a total of 23848 patients using AIS body regions

11. Multiple Injury Profile Methodology All patients: 23848, Distribution of body regions injured All injuries

12. Multiple Injury Profile Methodology All patients: 23848, Excluding AIS=1, 19014 patients Distribution of body regions injured All injuries (red) and when excluding AIS=1 (yellow)

13. Multiple Injury Profile Methodology All patients: 9226, Excluding AIS=1, 8541 patients Distribution of MIP for patients with Head injuries All injuries (red) and when excluding AIS=1 (yellow)

14. Multiple Injury Profile Methodology All patients: 23848, Excluding AIS=1, 19014 patients Distribution of critical injuries (ISS 25+) All injuries (red) and when excluding AIS=1 (yellow)

15. Multiple Injury Profile Methodology All patients: 23848, Excluding AIS=1, 19014 patients Distribution of inpatient mortality rate All injuries (red) and when excluding AIS=1 (yellow)

16. Multiple Injury Profile Methodology What do you think? Should we exclude AIS=1?

17. Multiple Injury Profile Methodology Proposed directions to proceed to Put efforts into associating individual ICD diagnoses with AIS severity so that this will be checked on the original matrix based MIP. AIS matrix needs to be experimented and validated on different populations

18. Multiple Injury Profile Methodology