Smith G S, Langlois J A, Buechner J S
Injury Prevention Center, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205.
Am J Epidemiol. 1991 Nov 15;134(10):1146-58. doi: 10.1093/oxfordjournals.aje.a116018.
Estimates of the incidence of hospitalized injuries based on hospital discharge data are inconsistent because of variations in 1) the definition of injury and 2) the criteria for excluding repeat admissions for the same injury event. Using 1983 data from the Uniform Hospital Discharge Data Set for the state of Rhode Island, the authors demonstrate the effects on injury incidence rates associated with the various definitions and exclusion criteria used in previous studies. The overall injury rate (11.9/1,000 population) was substantially reduced (rate difference, 1.7; 95% confidence interval 1.2-2.1) when adverse effects or complications of medical and surgical care ("medical injuries"), not usually defined as injuries by injury researchers, were excluded. Estimates of the incidence of "true" injury hospitalizations (excluding medical injuries, late effects, and complications of care) ranged from 9.9/1,000, when repeat admissions identified as transfers from another acute facility were excluded, to 7.2/1,000, when repeat admissions identified as elective admissions were excluded. Marked variability in incidence rate estimates by age, sex, nature of injury, and state of residence of victim was also noted. The addition to hospital discharge data sets of a separate variable to identify readmissions for the same problem would result in more valid incidence estimates for injury research and surveillance.
基于医院出院数据对住院伤害发生率的估计并不一致，原因在于：1）伤害的定义；2）排除同一伤害事件再次入院的标准存在差异。作者利用罗德岛州1983年统一医院出院数据集的数据，展示了先前研究中使用的各种定义和排除标准对伤害发生率的影响。当排除医疗和外科护理的不良反应或并发症（“医疗伤害”，伤害研究人员通常不将其定义为伤害）时，总体伤害率（11.9/1000人口）大幅降低（率差为1.7；95%置信区间为1.2 - 2.1）。“真正”伤害住院发生率（不包括医疗伤害、后期效应和护理并发症）的估计范围从9.9/1000（排除被确定为从另一家急性医疗机构转来的再次入院情况）到7.2/1000（排除被确定为择期入院的再次入院情况）。还注意到按年龄、性别、伤害性质和受害者居住州划分的发生率估计存在显著差异。在医院出院数据集中增加一个单独变量以识别同一问题的再次入院情况，将为伤害研究和监测带来更有效的发生率估计。
