The injury severity classifications generated from the Abbreviated Injury Scale (AIS) provide information that allows for standardized comparisons in the field of trauma injury research. However, the majority of injuries are coded in International Classification of Diseases (ICD) and lack this severity information. A system to predict injury severity classifications from ICD codes would be beneficial as manually coding in AIS can be time-intensive or even impossible for some retrospective cases. It has been previously shown that the encoder-decoder-based neural machine translation (NMT) model is more accurate than a one-to-one mapping of ICD codes to AIS. The objective of this study is to compare the accuracy of two architectures, feedforward neural networks (FFNN) and NMT, in predicting Injury Severity Score (ISS) and ISS ≥16 classification. Both architectures were tested in direct conversion from ICD codes to ISS score and indirect conversion through AIS for a total of four models. Trauma cases from the U.S. National Trauma Data Bank were used to develop and test the four models as the injuries were coded in both ICD and AIS. 2,031,793 trauma cases from 2017-2018 were used to train and validate the models while 1,091,792 cases from 2019 were used to test and compare them. The results showed that indirect conversion through AIS using an NMT was the most accurate in predicting the exact ISS score, followed by direct conversion with FFNN, direct conversion with NMT, and lastly indirect conversion with FFNN, with statistically significant differences in performance on all pairwise comparisons. The rankings were similar when comparing the accuracy of predicting ISS ≥16 classification, however the differences were smaller. The NMT architecture continues to demonstrate notable accuracy in predicting exact ISS scores, but a simpler FFNN approach may be preferred in specific situations, such as if only ISS ≥16 classification is needed or large-scale computational resources are unavailable.

The authors have declared no competing interest.

Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under the award number R03TR004015. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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University of Virginia - Institutional Review Board for Health Sciences Research - HIPAA Privacy Board - The project was exempted/had approval waived.

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