Accuracy of injury coding under ICD-9 for New Zealand public hospital discharges.
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OBJECTIVE: To determine the level of accuracy in coding for injury principal diagnosis and the first external cause code for public hospital discharges in New Zealand and determine how these levels vary by hospital size. METHOD: A simple random sample of 1800 discharges was selected from the period 1996-98 inclusive. Records were obtained from hospitals and an accredited coder coded the discharge independently of the codes already recorded in the national database. RESULTS: Five percent of the principal diagnoses, 18% of the first four digits of the E-codes, and 8% of the location codes (5th digit of the E-code), were incorrect. There were no substantive differences in the level of incorrect coding between large and small hospitals. CONCLUSIONS: Users of New Zealand public hospital discharge data can have a high degree of confidence in the injury diagnoses coded under ICD-9-CM-A. A similar degree of confidence is warranted for E-coding at the group level (for example, fall), but not, in general, at higher levels of specificity (for example, type of fall). For those countries continuing to use ICD-9 the study provides insight into potential problems of coding and thus guidance on where the focus of coder training should be placed. For those countries that have historical data coded according to ICD-9 it suggests that some specific injury and external cause incidence estimates may need to be treated with more caution. (+info)
An approach to the derivation of the cost of UK vehicle crash injuries.
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An approach to costing of road crash injury has been developed using data from a 'Willingness-to-pay' survey mapped to injuries listed in the Abbreviated Injury Scale 1998 Revision. The costs derived have been applied to a database of real-world crash injuries that have been collected as part of the UK Cooperative Crash Injury Study (CCIS). The approach has been developed in order to determine future research priorities in vehicle passive safety. When all injuries in all crash-types are examined, the results highlight the cost of 'Whiplash' in the UK. When more serious injuries are considered, specifically those at AIS 2+, the cost of head injuries becomes evident in both frontal and side impacts. (+info)
Injuries caused by the attenuated energy projectile: the latest less lethal option.
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OBJECTIVES: To review the injuries resulting from the attenuated energy projectile (AEP) in patients who present to emergency departments. METHOD: Review of case notes of patients presenting with injuries caused by the AEP after three episodes of serious civil disturbance in Northern Ireland from July to September 2005. RESULTS: 14 patients with 18 injuries were identified and included in the study. All patients were male, with an average age of 26.3 years. There were six injuries above the level of the clavicle, to the head, face or neck. There were three chest injuries, seven lower limb injuries and two upper limb injuries. There were no abdominal injuries. Seven patients required hospital admission. Five patients required surgical intervention. One patient required protective, elective intubation and one patient required the insertion of a chest drain. DISCUSSION: Although the study numbers were small, 33.33% of injuries were to the head and neck and 16.67% of the injuries were to the chest. The AEP was introduced as a replacement for its predecessor, the L21A1 plastic baton round, because of a theoretical risk of serious or even life threatening head injury from this projectile in certain circumstances. However, in this first survey of its usage, 50% of the injuries presenting to hospital were to the face, neck, head or chest. This injury pattern was more in keeping with older plastic baton rounds than with the L21A1. (+info)
Quality of hospital discharge data for injury prevention.
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OBJECTIVE: To examine the use of unspecified codes for the circumstances of injury for New Zealand public hospital discharges at a district health board (DHB) level. METHODS: Hospital injury discharges for the period 2000-3 were examined. The use of the International Classification of Diseases unspecified categories was examined for mechanism of injury, activity and place of occurrence. RESULTS: For all DHBs, the combined age-adjusted and mechanism-adjusted usage of unspecified mechanism codes was 7% and ranged from 3% to 11%. Most (57%) of these cases were unspecified falls. The comparable usage for activity was 39% and ranged from 17% to 52%, and for place of occurrence the respective figures were 23% and 7-36%. Only 50% of hospital discharges were completely specified in terms of mechanism of injury, activity and place of occurrence; this varied from 36% to 74% between DHBs. For several DHBs a significant degree of inconsistency was found in performance across mechanism, activity and place of occurrence coding. CONCLUSIONS: Those DHBs with a high proportion of cases coded as unspecified would serve the prevention efforts of their communities better by making efforts to determine the cause of this situation and implement measures to reduce the problem. (+info)
Effect of alcohol on Glasgow Coma Scale in head-injured patients.
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OBJECTIVE: Almost 50% of traumatic brain-injured (TBI) patients are alcohol intoxicated. The Glasgow Coma Scale (GCS) is frequently used to direct diagnostic and therapeutic decisions in these patients. It is commonly assumed that alcohol intoxication reduces GCS, thus limiting its utility in intoxicated patients. The purpose of this study was to test the hypothesis that the presence of blood alcohol has a clinically significant impact on GCS in TBI patients. METHODS: The National Trauma Data Bank of the American College of Surgeons was queried (1994-2003). Patients 18 to 45 years of age with blunt injury mechanism, whose GCS in the emergency department, survival status, anatomic severity of TBI (Head Abbreviated Injury Score [AIS]), and blood alcohol testing status were known, were included. GCS of patients who tested positive for alcohol (n = 55,732) was compared with GCS of patients who tested negative (n = 53,197), stratified by head AIS. RESULTS: Groups were similar in age (31 +/- 8 vs. 30 +/- 8 years), Injury Severity Score (ISS; 12 +/- 11 vs. 12 +/- 11), systolic blood pressure in the ED (131 +/- 25 vs. 134 +/- 25 mm Hg), TRISS (Trauma Injury Severity Score; probability of survival (94% +/- 16% vs. 95% +/- 15%), and actual survival (96% vs. 96%). When stratified by anatomic severity of TBI, the presence of alcohol did not lower GCS by more than 1 point in any head AIS group (GCS in alcohol-positive vs. alcohol-negative patients; AIS 1 = 13.9 +/- 2.8 vs. 14.3 +/- 2.3; AIS 2 = 13.4 +/- 3.2 vs. 14.1 +/- 2.4; AIS 3 = 11.1 +/- 4.7 vs. 11.6 +/- 4.6; AIS 4 = 9.8 +/- 4.9 vs. 10.4 +/- 4.9; AIS 5 = 5.5 +/- 3.8 vs. 5.9 +/- 4.1, AIS 6: 3.4 +/- 1.1 vs. 3.8 +/- 2.8). CONCLUSION: Alcohol use does not result in a clinically significant reduction in GCS in trauma patients. Attributing low GCS to alcohol intoxication in TBI patients may delay necessary diagnostic and therapeutic interventions. (+info)
Major trauma and the injury severity score--where should we set the bar?
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Major trauma is commonly defined using an Injury Severity Score (ISS) threshold of 15. Since this threshold was formulated, there have been significant developments in both the Abbreviated Injury Scale underlying the ISS, and trauma management techniques, both in the preventive and acute-care phases of trauma management. This study assesses whether this ISS threshold is appropriate when evaluating both mortality, and hospital-based indicators of morbidity, in a paediatric population using a large hospital trauma registry. Other registries and datasets using ISS >15 as an inclusion criterion may exclude a substantial body of data relating to significantly morbid trauma patients. (+info)
The association between age, injury, and survival to hospital among a cohort of injured motorcyclists.
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Despite the significant increase in mortality among older motorcyclists during the past decade, few studies have addressed specific injuries or mortality rates among all those injured. The purpose of this study is to describe the crash and injury characteristics among a cohort of motorcyclists injured in Maryland, and to determine the influence of age and crash type on mortality, injury patterns, and place of death (scene vs. hospital). Possible biases introduced by studying only those hospitalized are described. Based on the findings, specific injury prevention strategies for older vs. younger riders are proposed. (+info)
A population-based comparison of CIREN and NASS cases using similarity scoring.
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The Crash Injury Research and Engineering Network (CIREN) provides significant details on injuries, and data on patient outcomes that is unavailable in the National Automotive Sampling System (NASS). However, CIREN cases are selected from specific Level I trauma centers with different inclusion criteria than those used for NASS, and the assertion that a given case is similar to the population of NASS cases is often made qualitatively. A robust, quantitative method is needed to compare CIREN to weighted NASS populations. This would greatly improve the usefulness and applicability of research conducted with data from the CIREN database. Our objective is to outline and demonstrate the utility of such a system to compare CIREN and NASS cases. This study applies the Mahalanobis distance metric methodology to determine similarity between CIREN and NASS/CDS cases. The Mahalanobis distance method is a multivariate technique for population comparison. Independent variables considered were total delta V, age, weight, height, maximum AIS, ISS, model year, gender, maximum intrusion, number of lower and upper extremity injuries, and number of head and chest injuries. The technique provides a unit-independent quantitative score which can be used to identify similarity of CIREN and NASS cases. Weighted NASS data and CIREN data were obtained for the years 2001-2005. NASS cases with Maximum AIS 3 resulted in a subset of 1,869 NASS cases, and 2,819 CIREN cases. (+info)