Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), NSW 2006, Australia.
Bull World Health Organ. 2012 Jun 1;90(6):436-443A. doi: 10.2471/BLT.11.092114. Epub 2012 Feb 28.
To identify the hospital admission data set that best captures the incidence of acute poisoning in rural Sri Lanka.
Data were collected on all acute poisoning cases admitted to 34 primary and 1 referral hospital in Anuradhapura district from September 2008 to January 2010. Three admission data sets were compared with the "true" incidence of acute poisoning to determine the systematic bias inherent to each data set. "True" incidence was calculated by adding all direct admissions (not transfers) to primary hospitals and to the referral hospital. The three data sets were: (i) all admissions to primary hospitals only; (ii) all admissions to the referral hospital only (direct and referrals), and (iii) all admissions to both primary hospitals and the referral hospital ("all admissions"). The third is the government's routine statistical method but counts transfers twice, so for the study transferred patients were counted only once through data linkage.
Of 3813 patients admitted for poisoning, 3111 first presented to a primary hospital and 2287 (73.5%) were later transferred to the referral hospital, where most deaths (161/177) occurred. All data sets were representative demographically and in poisoning type, but referral hospital data yielded a more accurate case-fatality rate than primary hospital data or "all admissions" data. Admissions to primary hospitals only or to the referral hospital only underestimated the incidence of acute poisoning by about 20%, and data on "all admissions" overestimated it by 60%.
Admission data from referral hospitals are easily obtainable and accurately reflect the true poisoning incidence.
确定最能捕捉到斯里兰卡农村地区急性中毒发生率的医院入院数据集。
从 2008 年 9 月至 2010 年 1 月，在阿努拉德普勒区的 34 家初级医院和 1 家转诊医院收集所有急性中毒入院病例的数据。将这三个入院数据集与“真实”急性中毒发生率进行比较，以确定每个数据集固有的系统偏差。“真实”发病率是通过将所有直接入院（非转院）到初级医院和转诊医院的病例相加计算得出的。这三个数据集分别是：（i）仅初级医院的所有入院病例；（ii）仅转诊医院的所有直接入院病例和转院病例，以及（iii）初级医院和转诊医院的所有入院病例（“所有入院病例”）。第三种方法是政府的常规统计方法，但会将转院患者重复计算两次，因此，通过数据链接，研究中仅将转院患者计算一次。
在因中毒而入院的 3813 名患者中，有 3111 名患者首先在初级医院就诊，其中 2287 名（73.5%）随后被转至转诊医院，大多数死亡病例（161/177）发生在转诊医院。所有数据集在人口统计学和中毒类型方面都具有代表性，但转诊医院的数据比初级医院的数据或“所有入院病例”数据更能准确反映病死率。仅记录初级医院或转诊医院的入院病例会低估急性中毒的发生率约 20%，而记录“所有入院病例”的数据则会高估该发生率约 60%。
转诊医院的入院数据易于获取，并且能准确反映真实的中毒发生率。
