| Title: |
Validation of an ICD-9-CM-Based Monitoring Tool for Regional Trauma Systems: The PaTraME Study in Pavia Province, Italy |
| Authors: |
Paola Fugazzola; Leandro Gentile; Francesco Chiarolanza; Pietro Perotti; Mario Alessiani; Federico Capra Marzani; Lorenzo Cobianchi; Simone Frassini; Federico Alberto Grassi; Catherine Klersy; Alba Muzzi; Alessandra Palo; Stefano Perlini; Maurizio Raimondi; Luca Ansaloni; on behalf of the PaTraME Study Group on behalf of the PaTraME Study Group |
| Source: |
Medical Sciences ; Volume 14 ; Issue 1 ; Pages: 13 |
| Publisher Information: |
Multidisciplinary Digital Publishing Institute |
| Publication Year: |
2025 |
| Collection: |
MDPI Open Access Publishing |
| Subject Terms: |
trauma system; centralization; administrative data; TMPM-ICD9; XISS; quality monitoring |
| Description: |
Background/Objectives: Continuous trauma-system monitoring is limited by the lack of scalable, low-cost tools. The Pavia Trauma Management Epidemiology (PaTraME) project uses routinely collected ICD-9-CM discharge data (SDO) and the Trauma Mortality Probability Model (TMPM) to derive Injury Severity Score (XISS) and probability of death (TMPM-POD), creating a cost-free surveillance framework for regional trauma networks. Methods: We conducted a retrospective study of all major-trauma admissions (XISS > 15) in Pavia Province from 2014 to 2021. Anonymized SDO records were linked with emergency department flows and mortality registries. XISS and TMPM-POD were computed for each case. Case volumes, severity distributions, hub-centralization, and mortality (in-hospital, 30-day, and 180-day) were analyzed using trend and regression models (p < 0.05). Conclusions: We identified 1959 major-trauma admissions. Volumes increased up to 2019, dropped during the COVID-19 pandemic, and partially recovered in 2021 (p < 0.001). Overall, 61.5% of patients were admitted to hub centers, with an upward trend (p < 0.001). Hubs treated more severe trauma (median XISS 17 vs. 16; TMPM-POD 0.06 vs. 0.05, both p < 0.001). In-hospital mortality remained stable (8.2–11.4%, p = 0.828). TMPM-POD showed strong agreement with observed in-hospital mortality (Lin’s concordance correlation coefficient 0.81), though calibration worsened at higher risk levels. PaTraME confirms TMPM-POD as a valid mortality predictor and demonstrates a reproducible administrative-data framework for trauma surveillance. Rising hub admissions and stable mortality despite increasing complexity suggest improved system performance. Stratification of XISS and TMPM-POD between hub and spoke centers highlights peripheral hospitals managing disproportionately severe cases, informing targeted resource allocation and supporting quality improvement via automated dashboards. |
| Document Type: |
text |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
Critical Care Medicine; https://dx.doi.org/10.3390/medsci14010013 |
| DOI: |
10.3390/medsci14010013 |
| Availability: |
https://doi.org/10.3390/medsci14010013 |
| Rights: |
https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.DC62FFD6 |
| Database: |
BASE |