ICD-10 based machine learning models outperform the Trauma and Injury Severity Score (TRISS) in survival prediction

BACKGROUND: Precise models are necessary to estimate mortality risk following traumatic injury to inform clinical decision making or quantify hospital performance. The Trauma and Injury Severity Score (TRISS) has been the historical gold standard in survival prediction but its limitations are well-characterized. The present study used International Classification of Diseases 10(th) Revision (ICD-10) injury codes with machine learning approaches to develop models whose performance was compared to that of TRISS. METHODS: The 2015–2017 National Trauma Data Bank was used to identify patients following trauma-related admission. Injury codes from ICD-10 were grouped by clinical relevance into 1,495 variables. The TRISS score, which comprises the Injury Severity Score, age, mechanism (blunt vs penetrating) as well as highest 24-hour values for systolic blood pressure (SBP), respiratory rate (RR) and Glasgow Coma Scale (GCS) was calculated for each patient. A base eXtreme gradient boosting model (XGBoost), a machine learning technique, was developed using injury variables as well as age, SBP, RR, mechanism and GCS. Prediction of in-hospital survival and other in-hospital complications were compared between both models using receiver operating characteristic (ROC) and reliability plots. A complete XGBoost model, containing injury variables, vitals, demographic information and comorbidities, was additionally developed. RESULTS: Of 1,380,740 patients, 1,338,417 (96.9%) survived to discharge. Compared to survivors, those who died were older and had a greater prevalence of penetrating injuries (18.0% vs 9.44%). The base XGBoost model demonstrated a greater receiver-operating characteristic (ROC) than TRISS (0.950 vs 0.907) which persisted across sub-populations and secondary endpoints. Furthermore, it exhibited high calibration across all risk levels (R(2) = 0.998 vs 0.816). The complete XGBoost model had an exceptional ROC of 0.960. CONCLUSIONS: We report improved performance of machine learning models over TRISS. Our model may improve stratification of injury severity in clinical and quality improvement settings.