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Study on various approaches used globally to identify and tabulate injury records in hospital separation data, analyzing differences in outcomes and suggesting recommendations. Information from 11 countries and the EU available for analysis. Examination of ICD versions used and methodologies employed. Notable variation in classification methods for diagnosis and external causes observed. The study concludes that selection approaches significantly impact the quantity and nature of injury records retrieved, with external cause approaches typically yielding more data.
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Hospital Separations Identification of records for use in tabulating of national injury data Susan G. Mackenzie Presented at the ICE meeting in Washington, September 2006
Questions • What approaches to identifying injury hospital separation records for national tabulation are used in different countries? • What are the results of the different approaches? • Should ICE recommend an approach?
Methods – Survey of approaches to record selection • Survey of ICE members • Which version of ICD is used for hospital separation data? • Record identification • By Diagnosis or External cause code? or both? • All or selected? • Tabulation by External cause? • If yes, all or selected? • 15 responses received
Methods – Analysis overview • Identify the different approaches used to select hospital separation records for tabulation • Apply each of the approaches to the same set of hospital separation data • Compare the groups of records retrieved using the different approaches • Total numbers of records • Numbers of particular types of injuries, classified by external cause
Thanks for the information • Australia James Harrison • Canada Susan Mackenzie • Colombia Andrés Fandiño-Losado Victor Hugo Álvarez Castaño • Denmark Birthe Frimodt-Moller, Jens Lauritsen • El Salvador Oscar Salinas, Gerardo De Cosio • Israel Limor Aharonson-Daniel • Jamaica Yvette Holder • The Netherlands Saakje Mulder • New Zealand Colin Cryer, John Langley • Trinidad and Tobago Roanna Morton-Williams Bynoe • United States Lois Fingerhut
More thanks • Africa Olive Kobusingye • South Africa Richard Matzopoulos • Japan Tatsuhiro Yamanaka • European Union Maria Segui-Gomez Information from 11 countries and the EU study available for analysis
ICD version used to classify hospital separations ICD-10 ICD-9 ICD-9-CM ICD-10 modification Netherlands Israel Colombia Australia 1 other EU United States Denmark Canada 5 EU El Salvador New Zealand Jamaica Trinidad and Tobago 16 other EU
Approaches used to identify injury records – Diagnosis • Based on the principal, primary, or first-listed, diagnosis code on the record • Use All records with any diagnosis in the Injury and Poisoning chapter • Use selected records with a diagnosis in the Injury and Poisoning chapter • Community injuries • Trauma
Approaches used to identify injury records –External cause • Based on the first-listed External cause on the record • Use All records with an External cause • Use selected records with an External cause • Exclude adverse effects (AE) • Trauma
ICD codes used to identify records for injury hospitalization tabulation Diagnosis codes External cause codes All Selected All Selected DNK AUS – community NLD CAN – trauma COL ISR – trauma NZL CAN – Exclude AE SLV USA – community JAM EU study
Methods – Dataset • Used Hospital Morbidity Database from the Canadian Institute for Health Information • Initial selection: • All acute care separations from one Canadian province for fiscal year 2000-01. • N=126,217.
Methods – Record selection • From the 126,217 acute care records • Considered the primary diagnosis and the first listed external cause and selected records where: The primary diagnosis was an injury or poisoning (in chapter XVII of ICD-9) or There was an external cause on the record. • 14,772possible injury records were retrieved
Externalcause on record Present Not present A B XVII - Injury & poisoning 10,273 8,254 (56%) 2,019 (14%) ICD-9 Diagnosischapter C C D 4,499 Other 4,499 (30%) 0 14,772 12,753 2,019 14,772
Percentage of records retained where diagnosis is not from the injury chapter 0 0 0
Distribution of non-injury diagnoses when identification is based on external cause, by approach Percentage of non-injury diagnoses ICD- 9 chapter
Numbers of all records and all records with external causes, by approach
Selected external causes:All records, Unintentional injuries, falls
Selected unintentional external causes:Motor vehicle traffic crashes, Other transport, Fire/flames
Selected unintentional external causes: Poisoning, Natural & environmental, (near) Drowning 0
Selected unintentional external causes:Suffocation, Other foreign bodies 0 0
Conclusions • There is variation between and within countries in capacity to classify injury diagnoses and external causes for hospital separation records • Where the information is available, the selection approach used can make an important difference in the number and nature of injury records retrieved • External cause approaches generally yield more records than the injury diagnosis approaches
Questions • Is there a preferred selection approach? • Is there value in using different selection approaches for different purposes • Acute injury occurrence • Total burden of injury • Issues • Diagnosis vs. external cause as primary selection? or possibly a combination of diagnosis and external cause? • If diagnosis: All, Community, Trauma, (Other)? • If external cause: All, All but adverse effects, Trauma, (Other)? • If other: what?
References • Injury Surveillance Workgroup. Consensus recommendations for using hospital discharge data for injury surveillance. Marietta (GA): State and Territorial Injury Prevention Directors Association; 2003. • Centers for Disease Control and Prevention. Recommended framework for presenting injury mortality data . MMWR 1997;46 (No. RR-14) • Hospital separations due to injury and poisoning, Australia 2001-02. Jesia Berry, James E. Harrison, March 2006, Australian Institute of Health and Welfare, Canberra.