Abstract
Objectives: To examine and discuss the implications on the incidence of hospitalised injuries of selecting cases from principal diagnosis field only compared with considering all diagnosis fields, the inclusion compared with the exclusion of medical injuries, and the impact of identifying multiple admissions.
Methods: Analysis of data from the 1999–2000 New South Wales Inpatient Statistics Collection, Australia, including an internal linkage of the same dataset.
Results: Approximately 27.5% of records with a non-injury primary diagnosis include a nature of injury diagnosis in a subsequent diagnostic field. This figure increased to more than half (53%) of discharges for medical injuries. The internal linkage showed that 6.5% of discharges were repeat admissions for the same International Classification of Diseases, 10th revision (ICD-10) injury code and that 13.8% were repeat admissions for any ICD-10 injury code. The proportions of repeat admissions varied according to the type and the mechanism of injury.
Conclusions: Selecting hospitalised injury cases from the principal diagnosis alone would underestimate medical injury cases as well as other injuries occurring in hospital. Repeat admissions should always be considered particularly in the case of thermal injuries, self harm, and medical injuries. Due to the limitations of data linkage, alternative methods need to be developed to identify repeat admissions. Other areas in which further research would be beneficial to a more uniform reporting of injury hospitalisations include better identification of injuries occurring in hospital, a review of ICD-10 injury codes, and the development an ICD-10 based severity measure which can be readily used with hospital discharge data.
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Selected References
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- Alsop J. C., Langley J. D. Determining first admissions in a hospital discharge file via record linkage. Methods Inf Med. 1998 Jan;37(1):32–37. [PubMed] [Google Scholar]
- Ameratunga S. N., Alexander C. S., Smith G. S., Lennon D. R., Norton R. N. Trauma-related hospitalizations among urban adolescents in New Zealand: priorities for prevention. J Adolesc Health. 1999 Jul;25(1):75–83. doi: 10.1016/s1054-139x(98)00088-3. [DOI] [PubMed] [Google Scholar]
- Cook A., Sheikh A. Trends in serious head injuries among cyclists in England: analysis of routinely collected data. BMJ. 2000 Oct 28;321(7268):1055–1055. doi: 10.1136/bmj.321.7268.1055. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cryer C., Langley J. D., Stephenson S. C. R., Jarvis S. N., Edwards P. Measure for measure: the quest for valid indicators of non-fatal injury incidence. Public Health. 2002 Sep;116(5):257–262. doi: 10.1038/sj.ph.1900878. [DOI] [PubMed] [Google Scholar]
- Cummings P., Koepsell T. D., Mueller B. A. Methodological challenges in injury epidemiology and injury prevention research. Annu Rev Public Health. 1995;16:381–400. doi: 10.1146/annurev.pu.16.050195.002121. [DOI] [PubMed] [Google Scholar]
- Cummings P., Theis M. K., Mueller B. A., Rivara F. P. Infant injury death in Washington State, 1981 through 1990. Arch Pediatr Adolesc Med. 1994 Oct;148(10):1021–1026. doi: 10.1001/archpedi.1994.02170100019005. [DOI] [PubMed] [Google Scholar]
- Durbin D. R., Schwarz D. F., Localio A. R., MacKenzie E. J. Trends in incidence of pediatric injury hospitalizations in Pennsylvania. Am J Public Health. 2000 Nov;90(11):1782–1784. doi: 10.2105/ajph.90.11.1782. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jacobsen S. J., Goldberg J., Miles T. P., Brody J. A., Stiers W., Rimm A. A. Hip fracture incidence among the old and very old: a population-based study of 745,435 cases. Am J Public Health. 1990 Jul;80(7):871–873. doi: 10.2105/ajph.80.7.871. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kypri K., Chalmers D. J., Langley J. D., Wright C. S. Adolescent injury morbidity in New Zealand, 1987-96. Inj Prev. 2002 Mar;8(1):32–37. doi: 10.1136/ip.8.1.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Langley J., Stephenson S., Cryer C., Borman B. Traps for the unwary in estimating person based injury incidence using hospital discharge data. Inj Prev. 2002 Dec;8(4):332–337. doi: 10.1136/ip.8.4.332. [DOI] [PMC free article] [PubMed] [Google Scholar]
- MacCallum H., Morrison A., Stone D. H., Murray K. Non-fatal head injury among Scottish young people: the importance of assault. J Epidemiol Community Health. 2000 Jan;54(1):77–78. doi: 10.1136/jech.54.1.77. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Osler T., Rutledge R., Deis J., Bedrick E. ICISS: an international classification of disease-9 based injury severity score. J Trauma. 1996 Sep;41(3):380–388. doi: 10.1097/00005373-199609000-00002. [DOI] [PubMed] [Google Scholar]
- Phillips David P., Bredder Charlene C. Morbidity and mortality from medical errors: an increasingly serious public health problem. Annu Rev Public Health. 2001 Oct 25;23:135–150. doi: 10.1146/annurev.publhealth.23.100201.133505. [DOI] [PubMed] [Google Scholar]
- Quinlan K. P., Wallace L. J., Furner S. E., Brewer R. D., Bolen J., Schieber R. A. Motor vehicle related injuries among American Indian and Alaskan Native youth, 1981-92: analysis of a national hospital discharge database. Inj Prev. 1998 Dec;4(4):276–279. doi: 10.1136/ip.4.4.276. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Robinson J. C. Decline in hospital utilization and cost inflation under managed care in California. JAMA. 1996 Oct 2;276(13):1060–1064. [PubMed] [Google Scholar]
- Rosman D. L., Knuiman M. W., Ryan G. A. An evaluation of road crash injury severity measures. Accid Anal Prev. 1996 Mar;28(2):163–170. doi: 10.1016/0001-4575(95)00052-6. [DOI] [PubMed] [Google Scholar]
- Smith G. S., Langlois J. A., Buechner J. S. Methodological issues in using hospital discharge data to determine the incidence of hospitalized injuries. Am J Epidemiol. 1991 Nov 15;134(10):1146–1158. doi: 10.1093/oxfordjournals.aje.a116018. [DOI] [PubMed] [Google Scholar]
- Thurman D., Guerrero J. Trends in hospitalization associated with traumatic brain injury. JAMA. 1999 Sep 8;282(10):954–957. doi: 10.1001/jama.282.10.954. [DOI] [PubMed] [Google Scholar]
- Waller A. E., Marshall S. W., Langley J. D. Adult thermal injuries in New Zealand resulting in death and hospitalization. Burns. 1998 May;24(3):245–251. doi: 10.1016/s0305-4179(98)00018-7. [DOI] [PubMed] [Google Scholar]
- Watt G. M., Ozanne-Smith J. Non-fatal injuries to young Victorians, 1986-1991. Med J Aust. 1994 Jun 20;160(12):790–794. doi: 10.5694/j.1326-5377.1994.tb125948.x. [DOI] [PubMed] [Google Scholar]