De betrouwbaarheid van de registratie van polytrauma-patiënten

Evaluation of the reliability of diagnostic codification by the Medical Codification Department (MCD) as a method of national hospital identification of multiple injury patients and description of epidemiology and mortality among the multiple injury group studied.

Design

Prospectiveretrospective and descriptive.

Setting

Free University Hospital, Amsterdam.

Method

The injuries of 207 severely injured patients presented at the Accident and Emergency department during the year 1992, were coded as an Injury Severity Score (ISS). Those having an ISS ≥ 18 were reviewed on cause and outcome of the injury.

The diagnose for codification (International Classification of Diseases-9 Clinical Modification) of the MCD, from which an Abbreviated Injury Score (AIS) and the ISS can be calculated, was evaluated.

Results

24 out of the 207 severely injured patients were transferred to other hospitals after stabilisation because of lack of room. Of the remaining 183 patients 124 had an ISS ≥ 18. 44 (35) patients died during their stay in hospital. 21 (48) of them died within 2 hours. 28 (64) multiple injury patients died during the first 24 hours after admission. Neurological damage was the main cause of death (59), followed by exsanguination (30). A traffic accident was the cause of the injuries in 61 and a fall or jump in 27. The mean ISS of these patients was 29 and the maximum score was 66. Head and neck injuries were present in 80 of the patients.

The codification of brain damage by the MCD resulted in several mistakes. Brain damage in multiple injury cases results in a high AIS. Since the ISS is calculated by multiplification of AIS values, small differences in AIS create considerable variations in ISS.

Conclusion

Multiple injury patients need fast and adequate help because of the high mortality, especially in the first 24 hours. The diagnostic codification of the MCD was found not reliable enough to be used for a hospital identification and registration of multiple injury patients.