Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago-Dunedin Campus, Dunedin, New Zealand
Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago-Dunedin Campus, Dunedin, New Zealand.
Inj Prev. 2019 Dec;25(6):552-556. doi: 10.1136/injuryprev-2019-043293. Epub 2019 Jul 23.
It has been commonplace internationally, when using hospital data, to use the principal diagnosis to identify injury cases and the first external cause of injury code (E-code) to identify the main cause. Our purpose was to investigate alternative operational definitions of serious non-fatal injury to identify cases of interest for injury surveillance, both overall and for four common causes of injury.
Serious non-fatal injury cases were identified from New Zealand (NZ) hospital discharge data using an alternative definition: that is, case selection using principal and additional diagnoses. Separately, identification of cause used all E-codes on the discharge record. Numbers of cases identified were contrasted with those captured using the usual definition. Views of NZ government stakeholders were sought regarding the acceptability of the additional cases found using these alternative definitions. Views of international experts were also canvassed.
When using all diagnoses there was a 7% increase in 'all injury' cases identified, a 17% increase in self-harm cases and 8% increase in falls cases. Use of all E-codes resulted in a 4% increase in self-harm cases, 2% increase in assault cases and 1% increase in both falls and motor vehicle traffic crash cases.
A case definition based solely on principal diagnosis fails to count a material number of serious non-fatal injury cases that are of interest to the injury prevention community. There is a need, therefore, to use an alternative case definition that includes additional diagnoses. Use of multiple E-codes to classify cause of injury should be considered.
在国际上，使用医院数据时，通常使用主要诊断来识别伤害病例，并使用第一外伤外因代码（E 码）来识别主要外伤原因。我们的目的是研究严重非致命性伤害的替代操作定义，以确定伤害监测感兴趣的病例，包括整体和四种常见伤害原因的病例。
从新西兰（NZ）医院出院数据中使用替代定义识别严重非致命性伤害病例：即使用主要和附加诊断进行病例选择。另外，使用出院记录上的所有 E 码识别病因。对比使用常规定义识别的病例数量。征求新西兰政府利益相关者对使用这些替代定义发现的附加病例的可接受性的意见。还征求了国际专家的意见。
当使用所有诊断时，“所有伤害”病例的识别数量增加了 7%，自残病例增加了 17%，跌倒病例增加了 8%。使用所有 E 码导致自残病例增加了 4%，攻击病例增加了 2%，跌倒和机动车交通碰撞病例各增加了 1%。
仅基于主要诊断的病例定义未能统计出伤害预防界感兴趣的大量严重非致命性伤害病例。因此，需要使用包括附加诊断的替代病例定义。应考虑使用多个 E 码来分类伤害原因。
