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Revision of DRGs regarding Multiple significant trauma (484, 485, 486, 486O and 487) MDC 21 Nils Oddvar Skaga, MD PhD Oslo University Hospital Trauma Registry Oslo University Hospital, Ullevl Oslo - Norway Objectives Oslo University

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Revision of DRGs regarding Multiple significant trauma

(484, 485, 486, 486O and 487) – MDC 21 Nils Oddvar Skaga, MD PhD Oslo University Hospital Trauma Registry Oslo University Hospital, Ullevål Oslo - Norway

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Objectives

Oslo University Hospital (OUH) trauma

service – brief introduction

The trauma registry at OUH (TR-OUH)
Scoring of anatomic injury in trauma
What is the DRG-problem in trauma?
Our suggestions

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OUH Trauma Service

Major trauma centre, Oslo (600,000)
Trauma referral centre, health regions East

and South of Norway (2.7 million)

1,800 trauma admissions each year
Severe injury (ISS >15)

600 patients/yr (40%)

ISS = Injury Severity Score

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Trauma service activity

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200 400 600 800 1000 1200 1400 1600 1800 2000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Trauma team activations 2000 - 2014 OUH-TR, Ullevål

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Oslo University Hospital Trauma Registry

Operative since August 2000
Nearly 17.000 patients included
Document trauma service activity and quality
Research
DRG revision – potential financial gain for the

hospital

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What is the DRG-problem in trauma?

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Formal request MDC21

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Formal request for MDC21

principal diagnosis from the group Fresh trauma
r fresh trauma related diagnosis (principal

diagnosis property 00P21) (1011 diagnoses)

two or more diagnoses indicating significant

trauma in more than one body region (24X10 – 24X81) OR

a diagnosis indicating injuries in multiple areas of

the body (diagnosis property 24X90)

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Present DRG

a good description of the field
necessary to do a revision of the diagnosis

properties – in order to make the system more consistent and more logical

“Significant injury”
“Not significant injury”

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International classification of traumatic injury

1350 codes Severity score 1 to 6:

AIS code 1 Minor
AIS code 2 Moderate
AIS code 3 Serious
AIS code 4 Severe
AIS code 5 Critical
AIS code 6 Maximum

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Suggestion

Focus on 5 categories 1) Columna injuries 2) Large blood vessels 3) Open wounds 4) Nerve damage in arms and legs 5) Other diagnosis

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Suggestions

Marked “IN” – should be reclassified as

significant

Marked “OUT” – should be reclassified as

not significant

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Columna

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Inconsistency?

Diagnosis included (significant) today:
Must be included:

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Injuries on large blood vessels

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Open wounds

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Nerve damage in arms and legs

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Other injuries

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Other injuries, continued

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Severe Injury TR-OUS 2009 – 2013 DRG-groups

Injury Severity Score > 15

476 patients (17,0%)

116 patients (4.1%)

13 patients (0.5%)

454 patients (16.2%)

279 patients (10.0%)

Number of patients with ISS > 15: 2803 Number of patients in actual DRG groups: 1338 (47,7%)

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Severe injury – international convention

Injury Severity Score (ISS) > 15

– Range 1 (small) to 75 (lethal)

ISS = AIS2 + AIS2 + AIS2
ISS = 42 + 32 + 32 = 34

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Conclusion

A trauma rigistry is a unique tool for quality

assurance

The present DRG groups give a good

description of the field

demanding to do a revision of the diagnosis