• Barbara Toson, Lara A Harvey, and Jacqueline C T Close.
• Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Barker Street, Randwick, NSW 2031, Australia. Electronic address: b.toson@neura.edu.au.
• J Clin Epidemiol. 2016 Nov 1; 79: 62-69.

ObjectivesTo translate, validate, and compare performance of an International Classification of Diseases, 10th revision (ICD-10) version of the Multipurpose Australian Comorbidity Scoring System (MACSS) against commonly used comorbidity measures in the prediction of short- and long-term mortality, 28-day all-cause readmission, and length of stay (LOS).Study Design And SettingHospitalization and death data were linked for 25,374 New South Wales residents aged 65 years and older, admitted with a hip fracture between 2008 and 2012. Comorbidities were identified according to the MACSS, Charlson, and Elixhauser definitions using ICD-10 coding algorithms. Regression models were fitted and area under the curve (AUC) and Akaike Information Criterion assessed.ResultsThe ICD-10 MACSS had excellent discriminating ability in predicting inhospital mortality (AUC = 0.81) and 30-day mortality (AUC = 0.80), acceptable prediction of 1-year mortality (AUC = 0.76) but poor discrimination for 28-day readmission and LOS. The MACSS algorithm provided better model fit than either Charlson or Elixhauser algorithm for all outcomes.ConclusionThis work presents a rigorous translation of the ICD-9 MACSS for use with ICD-10 coded data. The updated ICD-10 MACSS outperformed both Charlson and Elixhauser measures in an older population and is recommended for use with large administrative data sets in predicting mortality outcomes.Copyright © 2016 Elsevier Inc. All rights reserved.

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