The Association for the Advancement of Automotive Medicine (AAAM) has developed a contemporary map of ICD-9-CM to AIS 2005/2008 and ICD-10-CM to AIS 2005/2008. The mapping project was originally solicited by the Transport and Mobility, Road Safety Unit (TMRSU) of the European Commission (EC) to report serious injuries.
In order for the AIS and ISS to be used in large, population-based epidemiological studies, AAAM developed code translation maps to be used by computerized mapping systems for converting injury related International Classification of Diseases, ninth revision (ICD-9-CM) codes and tenth revision (ICD-10-CM) codes into AIS derived metrics to determine the significance of injury.
A mapping tool that translates ICD-9-CM and ICD-10-CM codes to the AIS standard is critical for clinical and research purposes, including epidemiologic analyses of large administrative injury databases. Previous maps are outdated (using earlier AIS or ICD standards) and incomplete, identifying the need for a contemporary tool which translates ICD-CM codes to the Abbreviated Injury Scale (AIS) standard. Most importantly, the mapping tool was designed by those who are familiar with the nuances of both the ICD and AIS coding systems, and was validated by comparing it to the rules and best practices of conventional coding completed by trained and certified coders (AIS Certification Board – AISC.B).
The ICDMap is appealing for anyone who wants to adopt AIS-based risk adjustment for injury severity because it is inexpensive and allows exploiting the administrative data banks on hospital admissions that in many countries are comprehensive and easy to access.
The ICDmap was developed by an AAAM technical mapping group consisting of experts trained in the WHO ICD Revisions and ICD country modifications, and the application of the AIS including trainers from the International Faculty. Members of the group are qualified in nursing, health information management, biomedicine, classification, data management and clinical research. Several members are active in the development of AIS revision and ICD country-specific modifications, and several had experience in classification mapping projects.
The reason a technical group was chosen by AAAM was to assure that definitions for the work could be developed to provide consistent mapping outcomes and maintain relativity between the two coding systems.
There are two fundamental maps that were generated concurrently to use ICD codes to map to AIS. The first one is the “Serious Injury” or dichotomous map that meets the requirements of the injury health community and others to report on serious injury using AIS severity. This map is available with the purchase of an AIS2008 dictionary at no additional cost. If a user desires to determine whether an injury is AIS 3+ or < AIS 3, this ICD-Serious Injury map is required. This map operates at a level of granularity that agrees very well with the mismatch in resolutions and descriptions between the two dictionaries (ICD and AIS).
A second map was constructed using the same concept equivalency mapping that was done for the dichotomous map, however a more difficult correlation was performed. This map is called a “Primary Injury” map that meets the requirements of researchers and individuals doing more advanced analysis and reporting with ICD codes. This map provides the AIS severity, AIS chapter, and ISS body region for the most appropriate AIS code(s) from a single choice from an equivalency association with ICD. If a user desires to calculate an Injury Severity Scale (ISS), this ICD-ISS map is required.
The mapping tool platform is dependent on you as the end-user. AAAM provides the maps through a set of data tables in order to keep the methodology as generic as possible and be universally adaptable to individuals’ various needs. The current format is in MS Excel which can be changed by the user to comma separated variable (CSV) format to support end-user requirements.
One of the major outcomes of the AAAM project to examine and create maps to ICD was that the expert group of performers identified that the most resolution that can be provided for any ICD-to-AIS map was ICD code to AIS severity, ISS body region and AIS chapter. This outcome resolution is sufficient to calculate the ubiquitous patient score of ISS and provides additional details for researchers who are interested in examining the body region distributions using the AIS classification system. However, it does not result in a complete 7-digit AIS code.
In order to derive this map as well as the dichotomous map that enables users to identify significant injury by using the AIS severity classification system of AIS three or greater, the experts analyzed and examined a multitude of code-to-code correspondence graphs. These constructed graphs resulted in complex networks that illuminated the taxonomy and coding rule incompatibilities between the dictionaries. The level and number of these incompatibilities made a single best code selection algorithm impossible and/or inappropriate for a significant amount of codes.
AAAM is evaluating the need for the development of a short course on the use of the ICDMap – when available, it will be provided on-demand through online training, designed for self-learning and classroom use.
Consult the following references for additional details:
(1) Zonfrillo MR, Weaver AA, Gillich PJ, Price JP, Stitzel JD. New methodology for an expert-designed map from International Classification of Diseases (ICD) to Abbreviated Injury Scale (AIS) 3+ severity injury. Traffic Inj Prev 2015 Oct 8;16 Suppl 2:S197-200. https://www.ncbi.nlm.nih.gov/pubmed/26436232
(2) Loftis KL, Price JP, Gillich PJ, et al. Development of an expert based ICD-9-CM and ICD-10-CM map to AIS 2005 update 2008. Traffic Inj Prev. 2016 Sep;17 Suppl 1:1-5. https://www.ncbi.nlm.nih.gov/pubmed/27586094
To a large extent, the ICD to AIS mapping is validated by design, since it was constructed using expert coders and faculty members of AIS as well as members that have extensive ICD experience. During development, it was thoroughly analyzed and tested by the technical mapping group. From this perspective, the AAAM developed map is very unique as opposed to maps that have been constructed using data repositories and statistical inference to determine mapping relationships. The AAAM ICDMap was developed to consistently follow the AIS coding rules. As part of final review, the maps went through an extensive examination by utilizing a large external group (n=95) of medical coding professionals through the use of a survey tool.
The ICDMaps can be purchased at AAAM online store. Coming Soon.
AIS derived scores are generated through automated translation of the ICD diagnoses using a computer software package that links to the ICDMap tables. Though an ICDMAP conversion program is not a perfect tool for providing precise information on injury severity, it allows scoring of injury when the number of cases makes it impractical to code medical records.
Data from trauma registries that provide ISS are only reliable if trained abstractors who accurately capture all patient injuries assign AIS scores and ISS. Similarly, the accuracy of ISS derived from a mapping algorithm will be dependent on the quality of ICD coding data available in the database to which it is being applied. Researchers should recognize that in many systems ICD coding is done for billing or for other non-trauma specific purposes, and therefore may not be as comprehensive as data from trauma registries. Researchers using the ICDMap algorithm must ensure that ICD diagnoses are reliably coded in the database that will be used; the algorithm cannot accurately assign ISS if the ICD codes are not assigned accurately.
Maintenance of the ICDMap will be performed annually to support the community at large and respond to changes in the ICD. Contact firstname.lastname@example.org for any questions.
The mapping data tables cannot be non-proprietary because the AIS content is protected by copyright and is available only through licensing from the AAAM. Since the maintenance and updating of the AIS is accomplished through the AAAM, which is a non-profit 501(c)(3) organization, the map is available for a nominal fee. Additionally, any organization that creates such a map for commercial or research needs to complete a licensing agreement with AAAM as all users of AIS 2005/2008 are compelled to be licensed according to the intellectual property rights surrounding use of the coding system.
AAAM is able to issue commercial licenses to companies wishing to incorporate and distribute the ICDMap in their software products for sale to customers in certain countries.
- The license is non-exclusive, non-transferable and time limited.
- The license authorizes the use of the ICDMap in a product that will be distributed to customers in specific countries.
- Licensees are not permitted to modify or amend the map in any way.
- There should be no suggestion of endorsement of the product or the company by AAAM.
Companies wishing to obtain a commercial license are asked to complete the following license application <pdf> so that the proposed use of the ICDMap and the type of product are evaluated.
AAAM is able to issue internal licenses to organizations wishing to incorporate ICDMap into their internal information systems for use by employees for use for administrative purposes e.g. health records management.
Companies wishing to obtain an internal license are asked to provide the following information and send this to email@example.com
- Name and address of organization.
- Name and job title of person signing the license.
- Email and telephone number of primary contact.
- Name of the organization’s information system in which AIS will be incorporated
- A short summary of the intended use of ICDMap your organization’s information systems. Please include a selection of screen shots from the product that illustrate how AIS classifications are used in the product. This information will not be used by AAAM for any purpose other than compiling data on the use of AIS classifications and shall not be transmitted outside of AAAM.
- Number of concurrent users accessing AIS classifications within the organization.
If your organization is planning to use ICDMap for non-commercial or research purposes, then you may qualify for a license for non-commercial research use.
No organization or agency outside of AAAM can issue ICDMap licenses to suppliers to the public or non-public sector. If you intend to sell your product that contains AIS copyrighted material, then you will require a license from AAAM.