External Causes Of Injury Research Articles

Drowning surveillance: how well do E codes identify submersion fatalities

Objectives—The aim was to determine in New Zealand: (1) to what degree the International Classification of Diseases Supplementary Classification (ICD) external cause (E) codes for drowning identify all deaths involving...

Influence of travel patterns on mortality from injury among teenagers in England and Wales, 1985-95: trend analysis

Injuries are the leading cause of death among teenagers.1 The Health of the Nation strategy aims to reduce mortality from accidents in young people by 25% by 2005.2 We previously...

Occupational Injuries Among Adolescents in Dunedin, New Zealand, 1990–1993

Study objective: In this study we describe occupational injuries among adolescents (ages 15 through 19 years) presenting at a hospital ED in Dunedin, New Zealand, 1990–1993. Methods: We used a new database to identify work-related injuries, as well as type of injury, cause of injury, injury site, occupation, industry, age, and sex. Results: During the 4 years of the study, 1,361 work-related injuries were treated at the ED, for an injury rate of 13.8 per 200,000 hours worked (100 full-time equivalents). Males had a rate of 20.6 injuries, females 5.8 injuries, per 200,000 hours. Compared with injury rates from other studies, rates were lower than, but reasonably comparable to, those rates estimated through more detailed surveys. Main injury sites included upper extremities (mostly hands), head (mostly eyes), and lower extremities. Laceration was the main type of injury, followed by sprain/strain and foreign body. External cause of injury was mainly cutting/piercing objects, followed by foreign body and being struck by or against an object. The rate was highest for the 16- and 17-year-olds and decreased for 18- and 19-year-olds. The rates of injuries in the construction sector were the highest of all occupational groups, at 27 injuries per 200,000 hours, followed by transportation/ communication, manufacturing (including meat and fish processing), and business and repair services. Laborers were the highest occupational risk group, with 36 injuries per 200,000 hours, followed by machine operators, precision production workers, and service workers. Conclusion: These findings may be helpful in focusing prevention efforts in high-incidence areas. This study demonstrates how a well-planned data-collection system can overcome some of the previously described difficulties of getting prevention-oriented information from EDs. [Dufort VM, Kotch JB, Marshall SW, Waller AE, Langley JD: Occupational injuries among adolescents in Dunedin, New Zealand, 1990–1993. Ann Emerg Med September 1997;30:266-273.]

Incidence of Hospitalized Injuries Among Pregnant Women in Maryland, 1979-1990

Injuries are a leading cause of morbidity among pregnant women. We compared injuries among pregnant women and all women of reproductive age in a large defined population. Maryland hospital discharge data files from 1979-1990 were used to identify injuries in pregnant women and in all women 15-44 years of age. Injured pregnant women were defined as those hospitalized with concurrent ICD-9-CM discharge codes for injury and pregnancy. The 80,311 hospitalizations with injury of women 15-44 years old included 2,185 hospitalizations of pregnant women. The incidence of hospitalized injury per 100,000 person-years was 460 for pregnant women and 608 for all women 15-44 years old. Median length of stay and cost per hospitalization were 3.0 days and $1,478 for pregnant women and 4.0 days and $1,666 for all women 15-44 years old. Leading causes of hospitalized injury in pregnant women were poisonings (16.9%), fractures (14.7%), sprains (10.9%), and contusions (8.0%). Compared to all women 15-44 years of age, pregnant women had significantly fewer hospitalizations for dislocations, fractures, poisoning, sprains, and intracranial injuries, and more hospitalizations for contusions and internal injuries. Based on limited information about external causes of injury, pregnant women had significantly fewer hospitalizations for poisoning, drowning/suffocation, and suicide attempts than all women 15-44 years of age. Many hospitalizations of pregnant women are for relatively minor injuries requiring a short duration of stay, possibly to gauge the impact of the injury on the mother and the fetus. Since most pregnant women receive at least some medical care during pregnancy, prenatal visits represent an ideal time to implement strategies to prevent injuries.

Bicycle helmet use patterns among children : G.B. Rodgers, Pediatrics 97(2), 166

Study objective: Injury is a major cause of morbidity and mortality in the United States. Although the National Vital Statistics System provides data on injury-related deaths, a national surveillance system is needed for timely identification of emerging nonfatal injury problems and continuous monitoring of severe nonfatal injuries. This work assesses the feasibility of expanding the National Electronic Injury Surveillance System (NEISS) to monitor all types and causes of nonfatal injuries treated in US hospital emergency departments and reports national estimates generated by a pilot study of this system. Methods: At a stratified sample of US hospital EDs, persons receiving first-time treatment for an injury were monitored from May 1 through July 31, 1997. National estimates of the annual number and rate of ED-treated injuries overall, by patient characteristics, injury diagnosis, and external cause of injury were generated, and the sensitivity of the system for detecting ED-treated injuries was assessed. Results: An estimated 29.1 million injuries were treated in US EDs in 1997 (rate of 108.6/1,000 population). The leading causes of injury were falls, being struck by or striking against an object or person, cutting or piercing, and motor vehicle traffic. Of 593 cases of injury detected by investigators from the Centers for Disease Control and Prevention during visits to 6 of the 21 NEISS hospitals in the study, 490 were also detected by NEISS coders for an overall sensitivity of 82.6%. Conclusion: Expanding the NEISS is a feasible means of timely and continuous monitoring of all types and causes of nonfatal injuries treated in US hospital EDs. [Quinlan KP, Thompson MP, Annest JL, Peddicord J, Ryan G, Kessler EP, McDonald AK: Expanding the National Electronic Injury Surveillance System to monitor all nonfatal injuries treated in US hospital emergency departments. Ann Emerg Med November 1999;34:637-645.]

Population-based study of emergency department admissions and deaths from injuries in Barcelona, Spain: incidence, causes and severity.

The aim of this study was to estimate the incidence of morbidity and mortality due to injuries in the population over the age of 14 years in Barcelona, Spain. Injury distribution according to sex, age, external cause, place of occurrence of the injury and severity was also obtained. A one-year survey was conducted in the emergency departments of the six main hospitals in Barcelona, based on a multistage sampling. Information was collected prospectively in emergency services by specially trained non-staff interviewers. Mortality data were drawn from death certificates. The incidence rate was 74.7 injury cases per 1,000 person-years over 14 years of age, higher in males than in females. Injury rates were highest in the youngest age-group and progressively lower until people over 75 years of age. Main external causes of injury were falls, being struck or caught by objects, and traffic-related injuries. The leading specific causes of injury mortality were traffic injuries, suicides and poisonings. While the overall admission incidence was 3.34 cases per 1,000 inhabitants, the proportion of hospitalized cases was 45.0 per 1,000 injury cases admitted to emergency rooms, higher for females, for traffic injuries and in the elderly population. Ninety-six percent of injury cases had an ISS value of 8 or less, mean ISS being highest for traffic injuries and falls. Injury morbidity and mortality amongst residents of Barcelona follow sex, age and cause of injury patterns which are, overall, comparable to those observed in other industrialized countries, suggesting that similar etiologic factors might be operating in those areas. The results should enable the orientation of injury prevention policies in the urban environment targeted on the young and the elderly population.

Ten years of experiences from a participatory community-based injury prevention program in Motala, Sweden

Exploratory studies in the Scandinavian countries have suggested that the national cost of unintentional injuries is equal to 4% of the Gross National Product (GNP). One way for Swedish society to handle this situation has been through community-based injury prevention programs. This study used action research methods to supplement the understanding of the community development for injury prevention. The aim of this paper is to present the participative model used in one of the first of these programs, the Motala Injury Prevention Program, and lessons learned from the first 10 years of its operation. The program 'succeeded' in 1993, when Motala Municipality formed a regular Safety Board chaired by the Municipal Commissioner. These are five main messages from the initial phases of the program: a community-based injury prevention program has to be regarded as a long-term project; preferably over more than a 10 year period, economic calculations are important in the community analysis phase of the program, inter-linkage between community organizations is essential in the design phase, the hand-over from the initial program developers to practitioners is critical in the implementation phase, it is important to maintain a high-quality data collection routine even after the conclusion of the community analysis phase of the program. These observations have a potential to be valid at least for Northern Europe, which, by comparison with other parts of the world is a relatively homogenous area with regard to external causes of injuries. Regarding other communities, there are known differences in injury rates and community organization.

Improving the E coding of hospitalizations for injury: do hospital records contain adequate documentation?

Incomplete external cause of injury (E) coding limits the usefulness of hospital discharge data sets for injury surveillance and research. Hospital medical records were examined to determine whether they contained adequate cause of injury documentation to allow for more complete E coding of injury discharges. Medical records for a sample of discharges involving a principal diagnosis of injury from the Uniform Hospital Discharge Data Set for Rhode Island were selected. We assigned E codes to these discharges and compared our E codes with those of the discharge data set. Documentation of cause of injury in the medical records was sufficient to allow assignment of a specific E code to 70% of the injuries for which no E codes or vague E codes were submitted on the Uniform Hospital Discharge Data Set. It was estimated that specific cause of injury documentation is available in the medical records of 80% of all injury discharges in Rhode Island; for approximately 90%, an E code describing at least the broad cause of injury could be assigned. Rates of E coding can be substantially increased by making better use of existing documentation in medical records.

Experiences Using New Zealand’s Hospital Based Surveillance System for Injury Prevention Research

The focus of this paper is the Injury Prevention Research Unit's (IPRU's) experience in analysing New Zealand's national impatient public hospital injury data set. The existence of the national inpatient data management system has enabled the IPRU to develop an injury morbidity data set for the period of 1979-1992. The IPRU, thus, has data on ove 250,000 injury events that were serious enough to warrant admission to a hospital. This data set has been used extensively by the IPRU to address a wide range of injury issues from demographic, environment, activity, product, and injury perspectives. Apart from the demographic variables, those variables that have proved most useful in our work have been: length of stay, readmission indicator, a personal identifier code number, WHO International Classification of Disease coding for diagnoses and external cause of injury (E-code), and written descriptions of external cause of injuries and location of injury event. Practical examples of IPRU's use of each of these variables are given. These examples demonstrate how invaluable New Zealand's inpatient injury data set is for documenting resource utilisation, accurately determining the incidence of events, undertaking analytical epidemiological studies including evaluations, and addressing shortcomings in E-codes. A key aspect of the system is the narrative information. Evidence is produced demonstrates that the electronic recording of narratives of the circumstances of injury is an invaluable tool for conducting epidemiological research which has direct implications for injury prevention policy and practice.(ABSTRACT TRUNCATED AT 250 WORDS)

Blunt trauma in children: Causes and outcomes of head versus extracranial injury: I. Lescohier, and C. DiScala. Pediatrics, 91(4), 721–725

A subset of the National Pediatric Trauma Registry was analyzed to describe causes and outcomes of blunt trauma among children younger than age 15 years. This subset, of 8639 children with blunt trauma, was divided into three groups according to the injured body region: a group with extracranial injury only (ECI) accounted for one half of the population, and the remainder were equally distributed between a group with head injury only (HI) and one with both conditions (ECI + HI). The three groups were compared with respect to demographic characteristics, external cause of injury, injury severity, and outcomes. Falls were the leading cause of injury in the HI group, where children were younger, whereas traffic-related injuries predominated in children with ECI or ECI + HI. Pedestrian injuries accounted for a significant share of poor outcomes. The highest proportions of deaths and severe injuries were observed in the mixed group (ECI +HI), and the lowest, in the ECI group. In contrast, functional impairments at discharge were most frequently noted in the ECI group, where 60% of the children were discharged with at least one impairment. While only 6% of children with HI were discharged with impairment, those affected exhibited more deficits in cognition and behavior, which are expected to persist longer than dysfunction in activities of daily living.

Smoking cessation in relation to total mortality rates in women. A prospective cohort study.

To examine the temporal relationship between stopping smoking and total mortality rates among middle-aged women. Prospective cohort study with 12 years of follow-up. Registered nurses residing in the United States. 117,001 female registered nurses, ages 30 to 55 years, who were free of manifest coronary heart disease, stroke, and cancer (except nonmelanoma skin cancer) in 1976. Total mortality, further categorized into deaths from cardiovascular diseases, cancers, and violent deaths. A total of 2847 deaths (933 among "never smokers," 799 among former smokers, and 1115 among current smokers) occurred during 1.37 million person-years of follow-up. The multivariate relative risks for total mortality compared with never smokers were 1.87 (95% CI, 1.65 to 2.13) for current smokers and 1.29 (CI, 1.14 to 1.46) for former smokers. Participants who started smoking before the age of 15 years had the highest risks for total mortality (multivariate relative risk, 3.15; CI, 2.16 to 4.59), cardiovascular disease mortality (relative risk, 9.94; CI, 5.15 to 19.19), and deaths from external causes of injury (relative risk, 5.39; CI, 1.84 to 15.78). Compared with continuing smokers, former smokers had a 24% reduction in risk for cardiovascular disease mortality within 2 years of quitting. The excess risks for total mortality and both cardiovascular disease and total cancer mortality among former smokers approached the level of that for never smokers after 10 to 14 years of abstinence. The health benefits of cessation were clearly present regardless of the age at starting and daily number of cigarettes smoked. The risk of cigarette smoking on total mortality among former smokers decreases nearly to that of never smokers 10 to 14 years after cessation.

The Stockholm County programmes for accident and alcohol prevention and injury surveillance--initial experiences.

A comprehensive programme for accident prevention and injury surveillance was established in Stockholm County in 1988. Its main objective is to reduce the morbidity and mortality of unintentional injuries by 25% by the year 2000, and by more than 25% in the high-incidence groups. An accident prevention unit has been assigned to task of planning and implementing an accident prevention programme, while a programme for prevention of alcohol-related problems was set up later. An injury epidemiological unit at the Karolinska Hospital is responsible for coordinating injury surveillance, which is an important contribution for monitoring and evaluation of the prevention programmes. On injured patients information about type of injury, extent of injury, place, activity, injury mechanism, external cause of injury, treatment and other items is entered on a special registration form. In (10%) of 11,327 injury events alcohol was considered by the physician to be a main or contributory cause of the injury, with a predominance among males. An act of violence was approximately three times as common among males and five times as common among females with alcohol involvement than among cases without alcohol involvement. The injury surveillance can be an important means for evaluation of programmes for prevention of injuries and alcohol-related events.

Factors that influence costs and length of stay of persons with traumatic brain injury in acute care and inpatient rehabilitation

This study investigated factors that influence the costs (hospital charges) and length of stay (LOS) in acute care and in rehabilitation of 301 persons with traumatic brain injury (TBI). Factors examined included initial severity of brain injury, external cause of injury, blood alcohol level, intracranial operations, and designated payor. As expected, more severely injured persons had longer LOS and higher charges for both acute care and rehabilitation. Overall mean LOS in acute care was 27 days (standard deviation [SD] = 24) and charges (not including physicians' fees) were $66,368. Overall mean LOS in rehabilitation was 48 days (SD = 47) and charges were $51,416. The external causes of injury resulting in the largest average overall charges (acute care and rehabilitation combined) were motorcycle accidents ($165,294 per case) and gunshot wounds to the head ($164,250 per case). Ninety-five percent of persons included in the study were living in private residences just prior to the onset of their injuries, and 81% were discharged from inpatient rehabilitation to a private residence. No trends were evident regarding the LOS and type of designated payor for rehabilitation services. The results support the premise that the TBI model systems are effective in minimizing the average LOS and in achieving functional benefits that reduce the disability of persons with severe TBI.

Surveillance of poisoning and drug overdose through hospital discharge coding, poison control center reporting, and the Drug Abuse Warning Network

There is no gold standard for determining poisoning incidence. We wished to compare four measures of poisoning incidence: International Classification of Diseases 9th Revision (ICD-9) principal (N-code) and supplemental external cause of injury (E-code) designations, poison control center (PCC) reporting, and detection by the Drug Abuse Warning Network (DAWN). We studied a case series at two urban hospitals. We assigned ICD-9 N-code and E-code classifications, determining whether these matched with medical records. We ascertained PCC and DAWN system reporting. A total of 724 subjects met entry criteria; 533 were studied (74%). We matched poisoning N-codes for 278 patients (52%), E-code by cause in 306 patients (57%), and E-code by intent in 171 patients (32%). A total of 383 patients (72%) received any poisoning N-code or any E-code. We found that PCC and DAWN reporting occurred for 123 of all patients (23%) and 399 of 487 eligible patients (82%), respectively. In multiple logistic regression, factors of age, hospital admission, suicidal intent, principal poisoning or overdose type, and mixed drug overdose were statistically significant predictors of case match or report varying by surveillance measure. Our findings indicate that common surveillance measures of poisoning and drug overdose may systematically undercount morbidity.

Emergency Department Record Keeping and the Potential for Injury Surveillance

Successful design of injury prevention measures relies on understanding the occurrence and circumstances of injuries, which, in turn, necessitates that good quality data be collected about injured persons. The emergency department (ED) is an important source of injury information. This paper reports the results of a survey of all 129 hospital emergency departments in North Carolina to examine record-keeping practices and determine what information is collected and stored in the EDs. The findings demonstrate that there is considerable variability in the types of data that would be available to a researcher attempting to use ED records. Of special note is the absence of information about the external cause of injury.

Coding external causes of injury (E-codes) in Maryland hospital discharges 1979-88: a statewide study to explore the uncoded population.

We examined the trends in hospital discharge E-coding in Maryland over a 10-year period. The overall proportion of E-coded discharges has increased from 40 percent in 1979 to 55 percent in 1988. E-coding was lower in the severely injured, the elderly, and patients with long hospital stays. Our findings demonstrate that E-code reporting varies because of the limited number of data fields available for coding of discharge diagnoses. Universal, systematic reporting of E-codes in hospital discharge data is essential if these data are to provide critically needed information about nonfatal injuries. Hospital discharge data formats should contain separate fields for E-codes and the use of these codes, we believe, should be mandated.

Injury Coding and Hospital Discharge Data

Data are currently inadequate to develop, implement, and evaluate injury prevention and control programs in the United States. Information about cause of injury, which is available for fatal injuries, is rarely available for severe nonfatal injuries. Although hospital discharge data systems contain much of the important information needed for injury prevention and control programs, they rarely are coded with information about the external cause of injury (E codes). E-coded hospital discharge data systems are potentially one of the most effective and feasible means available to collect data needed to prevent and control injuries. We recommend that E codes be required elements in hospital discharge data systems, that separate fields for E codes be created, and that E-code definitions and guidelines be developed.

New Mexico safety restraint law: Changing patterns of motor vehicle injury, severity, and cost

The impact of the New Mexico safety belt law on patterns of injury, severity, and cost was evaluated (using an emergency department data base). Data collected from November 1985 through February 1986 compared the 2 months before the January 1986 law with 2 months after. Before the law, 22.2% of the 379 injuries included abrasions, contusions, and lacerations to face, neck, and head. Following the law, this category constituted only 13.8% of 356 injuries, representing a reduction of 38% ( P < .05). Cost and injury severity scores (ISS) for 436 injured patients covered by the law were not significantly different between the pre- and post-seathelt law periods. However, significant cost and severity differences were observed after the law between belted and nonbelted occupants: $2,569 compared with $662; ISS of 3.6 compared with 2.0 ( P < .05). Methodologic problems of an emergency department-based study and the need for E coding (external causes of injury) are discussed.

A microcomputer program for coding external cause of injury.

The publication of Injury in America emphasized a renewed interest in the scientific study of trauma. Collection and analysis of population-based data were viewed as necessary prerequisites for the establishment and evaluation of injury prevention programs. While it was noted that there is an existing broad-based gathering of injury mortality information, it was also made clear that there is a paucity of systematically collected morbidity data. A fundamental step toward correcting this deficiency is to identify and adopt a uniform system for coding causes of injury morbidity that is compatible with the large body of mortality data currently being collected. This paper describes a microcomputer-based program, which is intended to aid in the selection of External Cause of Injury Codes (E-codes). It is designed for coding both fatal and nonfatal injury causes and is appropriate for use in the hospital setting. The system is a modification of the one currently used for coding all injury deaths in the United States.

The incidence of acute brain injury and serious impairment in a defined population.

Studies on the incidence and epidemiologic features of brain injury and the immediate medical outcomes are few, and published results have serious methodological inconsistencies which prohibit comparisons. This study provides incidence rates of brain injury among the residents of San Diego, California. Cases had clinical confirmation and onset of injury occurred during 1981. The 3358 cases identified represent a rate of 180/100,000 with males having a 2.2 times higher rate than females. Rates were highest for males aged 15-24 years and, for both genders, those over age 70. Forty-eight per cent of all cases were from transport-related causes, followed by falls (21%) and assaults (12%). Over 11% were dead-on-arrival, and 16% were classified as having moderate or severe brain damage on admission to a hospital. Age- and sex-specific incidence rates varied according to external cause of injury. For example, for most subcategories of motor vehicle crashes and for assaults, the incidence rate was highest among males aged 15-24, while for brain injuries from falls or firearms, highest incidence rates were observed in older age groups. Almost 7% of all cases discharged alive from an acute care hospital had significant neurologic sequelae. The impact of brain injury is discussed as a major unresolved public health problem.