Article

Validation of Length of Hospital Stay as a Surrogate Measure for Injury Severity and Resource Use Among Injury Survivors

Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA.
Academic Emergency Medicine (Impact Factor: 2.2). 02/2010; 17(2):142-50. DOI: 10.1111/j.1553-2712.2009.00647.x
Source: PubMed

ABSTRACT While hospital length of stay (LOS) has been used as a surrogate injury outcome when more detailed outcomes are unavailable, it has not been validated. This project sought to validate LOS as a proxy measure of injury severity and resource use in heterogeneous injury populations.
This observational study used four retrospective cohorts: patients presenting to 339 California emergency departments (EDs) with a primary International Classification of Diseases, Ninth Revision (ICD-9), injury diagnosis (years 2005-2006); California hospital injury admissions (a subset of the ED population); trauma patients presenting to 48 Oregon EDs (years 1998-2003); and injured Medicare patients admitted to 171 Oregon and Washington hospitals (years 2001-2002). In-hospital deaths were excluded, as they represent adverse outcomes regardless of LOS. Duration of hospital stay was defined as the number of days from ED admission to hospital discharge. The primary composite outcome (dichotomous) was serious injury (Injury Severity Score [ISS] >or= 16 or ICD-9 ISS <or= 0.90) or resource use (major surgery, blood transfusion, or prolonged ventilation). The discriminatory accuracy of LOS for identifying the composite outcome was evaluated using receiver operating characteristic (ROC) analysis. Analyses were also stratified by age (0-14, 15-64, and >or=65 years), hospital type, and hospital annual admission volume.
The four cohorts included 3,989,409 California ED injury visits (including admissions), 236,639 California injury admissions, 23,817 Oregon trauma patients, and 30,804 Medicare injury admissions. Composite outcome rates for the four cohorts were 2.1%, 29%, 27%, and 22%, respectively. Areas under the ROC curves for overall LOS were 0.88 (California ED), 0.74 (California admissions), 0.82 (Oregon trauma patients), and 0.68 (Medicare patients). In general, the discriminatory value of LOS was highest among children, tertiary trauma centers, and higher volume hospitals, although this finding differed by the injury population and outcome assessed.
Hospital LOS may be a reasonable proxy for serious injury and resource use among injury survivors when more detailed outcomes are unavailable, although the discriminatory value differs by age and the injury population being studied.

0 Followers
 · 
105 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective The objective of this study is to identify the prevalence of opioid prescription use in an Australian workers' compensation population and assess predictors of long-term use.DesignRetrospective administrative data analysis.SettingWorkSafe Victoria (Australia) workers' compensation.SubjectsWorkers with a workers' compensation claim were included if the injury/illness started in 2008 or 2009 (N = 54,931).Methods Claim payments records dating up to 2 years postinjury were analyzed to determine receipt of prescription opioids. Long-term use was defined as use of any opioid beyond 1 year postinjury.ResultsWithin the follow-up period, 8,933 (16.3%) workers claimed prescription opioids: 10.0% claimed opioids in the first year only, and 6.3% claimed opioids beyond the first year. The most commonly received opioids were codeine (10.4%), oxycodone (7.5%), and tramadol (5.0%). Dextropropoxyphene, which is considered unsafe in many countries because of potentially fatal side effects, was used by 1.9% of injured workers. Progression to long-term use of opioids was common (N = 3,446; 39%): age (35–64 years; the association with age followed an inverse U-shaped curve), women, laborers, lower socioeconomic status, greater work disability, and greater hospital expense were associated with opioid use beyond the first year postinjury.Conclusion Prescription opioid use for workplace injury in Australia is common but not as common as reports from U.S. workers' compensation schemes. The type of opioid and number of repeat prescriptions are factors that should be carefully considered by practitioners prescribing opioids to injured workers: progression to long-term use is common and not fully explained by injury severity.
    Pain Medicine 04/2014; 15(9). DOI:10.1111/pme.12421 · 2.24 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The purpose of this study was to determine the construct validity of the PedsQL¿ health related quality of life (HRQoL) instrument for use among injured children and to examine the impact of using different modes of administration, including paper and pencil, online and telephone.Methods Two hundred thirty-three participants (aged 0 ¿ 16) were recruited from hospital wards and the emergency department of a pediatric hospital in a large urban center in British Columbia, Canada. Data used to evaluate the construct validity of the PedsQL¿ were collected from participants at the time of seeking injury treatment (baseline) to capture a retrospective measure of pre injury health, and one month post injury. Data used to compare different modes of administration (n¿=¿44) were collected at baseline. To assess construct validity repeated measures analysis of variance (rANOVA) was used to determine whether the PedsQL¿ tool was able to discriminate between patients pre and post injury while investigating possible interaction by category of length of stay in hospital. The impact of different modalities of administering the PedsQL¿ on item responses was investigated using Bland-Altman plots.ResultsrANOVA showed significant differences in PedsQL¿ total score between baseline and one month post injury (p¿<¿.001), and differences in mean total score at one month post injury by category of injury severity (p¿<¿.001). There was also significant interaction by category of injury severity for the change in PedsQL¿ total score from baseline to one month (p¿<¿.001). Pearson¿s correlations were highly significant across three modalities of survey administration: paper and pencil, computer and telephone administration (range: .92 to .97, p¿<¿.001). Bland-Altman plots showed strong consistency.Conclusion The PedsQL¿ instrument is able to discriminate between pre and post injury HRQoL, as well as HRQoL post injury for injuries of varying severity. These findings are an indication that this instrument has good construct validity for the purpose of evaluating HRQoL of injured children. Data collected via paper-pencil, online and telephone administration were highly consistent. This is important as depending on the setting, clinical or research, different modalities of completing this instrument may be more appropriate.
    Health and Quality of Life Outcomes 11/2014; 12(1):168. DOI:10.1186/s12955-014-0168-2 · 2.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In civilian trauma care, field triage is the process applied by prehospital care providers to identify patients who are likely to have severe injuries and immediately need the resources of a trauma center. Studies of the efficacy of field triage have used various measures to define trauma center need because no "criterion standard" exists, making cross-study comparisons difficult. This study aimed to develop a consensus-based functional criterion standard definition of trauma center need. Local and national experts were recruited for participation. Blinded key informant interviews were conducted in order of availability until no new themes emerged. Themes identified during the interviews were used to develop a Modified Delphi survey, which was electronically delivered via Survey Monkey. The trauma center need criteria were refined iteratively based on participant responses. Participants completed additional surveys until there was at least 80% agreement for each criterion. Fourteen experts were recruited. Five participated in key informant interviews. A Modified Delphi survey was administered five times (four modifications based on the expert's responses). After the fifth round, there was at least 82% agreement on each criterion. The final definition included 10 time-specific indicators: major surgery, advanced airway, blood products, admission for spinal cord injury, thoracotomy, pericardiocentesis, cesarean delivery, intracranial pressure monitoring, interventional radiology, and in-hospital death. We developed a consensus-based functional criterion standard definition of needing the resources of a trauma center, which may help to standardize field triage research and quality assurance in trauma systems as well as allow for cross study comparisons.
    04/2014; 76(4):1157-63. DOI:10.1097/TA.0000000000000189

Full-text (2 Sources)

Download
14 Downloads
Available from
Sep 4, 2014