Glance LG, Osler TM, Mukamel DB, et al. Expert consensus vs empirical estimation of injury severity: Effect on quality measurement in trauma
Department of Anesthesiology, University of Rochester School of Medicine, 601 Elmwood Ave, Box 604, Rochester, NY 14642, USA. Archives of surgery (Chicago, Ill.: 1960)
(Impact Factor: 4.93).
05/2009; 144(4):326-32; discussion 332. DOI: 10.1001/archsurg.2009.8
To determine the extent to which the Injury Severity Score (ISS) and Trauma Mortality Probability Model (T-MPM), a new trauma injury score based on empirical injury severity estimates, agree on hospital quality.
Retrospective cohort study based on 66,214 patients in 68 hospitals. Four risk-adjustment models based on either ISS or T-MPM were constructed, with or without physiologic information.
Hospital quality was measured using the ratio of the observed-to-expected mortality rates. Pairwise comparisons of hospital quality based on ISSaugmented vs T-MPMaugmented were performed using the intraclass correlation coefficient and the kappa statistic.
There was almost perfect agreement for the ratios of the observed to expected mortality rates based on the T-MPM vs the ISS when physiologic information was included in the model (intraclass correlation coefficient, 0.93). There was substantial agreement on which hospitals were identified as high-, intermediate-, and low-quality hospitals (kappa = 0.79). Excluding physiologic information decreased the level of agreement between the T-MPM and the ISS (intraclass correlation coefficient, 0.88 and kappa = 0.58).
The choice of expert-based or empirical Abbreviated Injury Score severity scores for individual injuries does not seem to have a significant effect on hospital quality measurement when physiologic information is included in the prediction model. This finding should help to convince all stakeholders that the quality of trauma care can be accurately measured and has face validity.
Available from: Margaret Peden
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ABSTRACT: To determine the frequency and nature of childhood injuries and to explore the risk factors for such injuries in low-income countries by using emergency department (ED) surveillance data.
This pilot study represents the initial phase of a multi-country global childhood unintentional injury surveillance (GCUIS) project and was based on a sequential sample of children < 11 years of age of either gender who presented to selected EDs in Bangladesh, Colombia, Egypt and Pakistan over a 3-4 month period, which varied for each site, in 2007.
Of 1559 injured children across all sites, 1010 (65%) were male; 941 (60%) were aged >or= 5 years, 32 (2%) were < 1 year old. Injuries were especially frequent (34%) during the morning hours. They occurred in and around the home in 56% of the cases, outside while children played in 63% and during trips in 11%. Of all the injuries observed, 913 (56%) involved falls; 350 (22%), road traffic injuries; 210 (13%), burns; 66 (4%), poisoning; and 20 (1%), near drowning or drowning. Falls occurred most often from stairs or ladders; road traffic injuries most often involved pedestrians; the majority of burns were from hot liquids; poisonings typically involved medicines, and most drowning occurred in the home. The mean injury severity score was highest for near drowning or drowning (11), followed closely by road traffic injuries (10). There were 6 deaths, of which 2 resulted from drowning, 2 from falls and 2 from road traffic injuries.
Hospitals in low-income countries bear a substantial burden of childhood injuries, and systematic surveillance is required to identify the epidemiological distribution of such injuries and understand their risk factors. Methodological standardization for surveillance across countries makes it possible to draw international comparisons and identify common issues.
Available from: Jo Barnes
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ABSTRACT: The aim of this study is to investigate the differences in car occupant injury severity recorded in AIS 2005 compared to AIS 1990 and to outline the likely effects on future data analysis findings. Occupant injury data in the UK Cooperative Crash Injury Study Database (CCIS) were coded for the period February 2006 to November 2007 using both AIS 1990 and AIS 2005. Data for 1,994 occupants with over 6000 coded injuries were reviewed at the AIS and MAIS level of severities and body regions to determine changes between the two coding methodologies. Overall there was an apparent general trend for fewer injuries to be coded at the AIS 4+ severity and more injuries to be coded at the AIS 2 severity. When these injury trends were reviewed in more detail it was found that the body regions which contributed the most to these changes in severity were the head, thorax and extremities. This is one of the first studies to examine the implications for large databases when changing to an updated method for coding injuries.
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ABSTRACT: The estimates of the incidence of deaths and non-fatal injuries from road traffic crashes are essential inputs for prioritising national health and transport policies. This article sketches a methodology for assembling such estimates at the country level by piecing together data from a wide array of sources that include death registers, hospital records, funeral records, health surveys and police reports. Using examples of the types of data sources available in four developing countries (Iran, Mexico, Ghana and India), methods are proposed for making these consistent and extrapolating to estimates of injury incidence at the country level. This requires filling information gaps, mapping from varying case definitions, deriving population-based incidence estimates from sources that may not track denominator populations, and appropriately reapportioning cases assigned to poorly specified causes. The principles proposed here will form the methodological basis for a series of country reports to be published in the future.
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