Non-fatal injury indicators Colin Cryer and Rolf Gedeborg International Collaborative Effort on Injury Statistics, Swansea, Wales, September 2010 What

Non-fatal injury Non-fatal injury indicatorsindicators

Colin Cryer and Rolf GedeborgColin Cryer and Rolf Gedeborg

International Collaborative Effort on Injury International Collaborative Effort on Injury Statistics, Swansea, Wales, September 2010Statistics, Swansea, Wales, September 2010

What are the pros and con’s of different approaches to measuring serious non-fatal injury?

Program

The session now A ‘basket’ of ICD diagnoses ICISS-based definitions

Tomorrow (8:30 – 10:30 am) Non-fatal indicators work

Facilitators Colin Cryer & Rolf Gedeborg

AimAim

To produce a draft specification of a To produce a draft specification of a serious non-fatal injury indicator for serious non-fatal injury indicator for use in international comparisons.use in international comparisons.

Today’s presentations feed into the Today’s presentations feed into the discussion that will occur tomorrow - discussion that will occur tomorrow - where we aim to agree a (partial) draft where we aim to agree a (partial) draft specification.specification.

3Colin Cryer, IPRU, University of Otago

Main IssueMain Issue

Operational definition of Operational definition of seriousserious non- non-fatal injuryfatal injury

Two main themesTwo main themes ““A ‘basket’ of ICD diagnoses” vs “ICISS-A ‘basket’ of ICD diagnoses” vs “ICISS-

based definitions”based definitions” At the heart of the debate.At the heart of the debate.

Talks between now and 10:00 aimed at Talks between now and 10:00 aimed at informing that discussion tomorrow.informing that discussion tomorrow.


We want valid indicatorsindicators that measure

what they intend to measure

Indicators pointGood indicator

Bad indicator


International comparison International comparison of serious non-fatal of serious non-fatal injury.injury.

Colin CryerColin Cryer

Injury Prevention Research UnitInjury Prevention Research Unit

University of Otago, New ZealandUniversity of Otago, New Zealand







Definition of serious non-fatal injury using a ‘basket’ of ICD diagnoses.






Definition of serious non-fatal injury using a ‘basket’ of ICD diagnoses.

Minimising health service effects in international comparisons.

Potential biases in Potential biases in international international

comparisons - 1comparisons - 1 Serious non-fatal injurySerious non-fatal injury Source of data?Source of data?

Hospital Hospital inpatientinpatient / discharge / separations / discharge / separations datadata

Assumption: Assumption: Most ubiquitous source collected by countries?Most ubiquitous source collected by countries? Most accurate source w.r.t. diagnosis of injury and Most accurate source w.r.t. diagnosis of injury and

external cause.external cause.

Major problemMajor problem Variations in place and time in who gets Variations in place and time in who gets

admitted to hospital.admitted to hospital. Eg. health service provision and access.Eg. health service provision and access.



comparisons - 2comparisons - 2 Major problemMajor problem

Variations in place and time in who gets Variations in place and time in who gets admitted to hospital.admitted to hospital. Eg. health service provision, policy and access.Eg. health service provision, policy and access.

Eg. head injury – hospital A has scanning facilities Eg. head injury – hospital A has scanning facilities available in O/P so minor head injury not admitted vs available in O/P so minor head injury not admitted vs hospital B has not so minor head injury routinely admitted hospital B has not so minor head injury routinely admitted for observation.for observation.

Want to remove this health service effectWant to remove this health service effect Option for operational definitionOption for operational definition

Injuries that have a high probability of admission Injuries that have a high probability of admission (PrA)(PrA)

Others?Others?



comparisons - 3comparisons - 3 Direct methodDirect method

Estimate diagnosis-specific probabilities Estimate diagnosis-specific probabilities of admission (Prob of Admission of admission (Prob of Admission project)project)

Select only those (for our operational Select only those (for our operational definition) that have a high probability definition) that have a high probability of admission.of admission.

Alternative: ICISS-based methodAlternative: ICISS-based method


Probability of admission Probability of admission (PrA) Project(PrA) Project

Thanks to collaboratorsThanks to collaborators Soufiane Boufous, Soufiane Boufous, Senior Research Fellow, Injury Division, The George Senior Research Fellow, Injury Division, The George

Institute for International Health, Institute for International Health, Australia; Li-Hui Chen, Office of Australia; Li-Hui Chen, Office of Analysis and Epidemiology, National Center for Health Statistics, Analysis and Epidemiology, National Center for Health Statistics, Maryland, USA; Nick Dessypris, Department of Hygiene and Maryland, USA; Nick Dessypris, Department of Hygiene and Epidemiology, Athens University Medical School, Greece; Lois Fingerhut, Epidemiology, Athens University Medical School, Greece; Lois Fingerhut, L A Fingerhut Consulting, Washington, DC, USA; Vicki Kalampoki, L A Fingerhut Consulting, Washington, DC, USA; Vicki Kalampoki, Department of Hygiene and Epidemiology, Athens University Medical Department of Hygiene and Epidemiology, Athens University Medical School, Greece; Jens Lauritsen, Consultant, Orthopedic Dpt., Accident School, Greece; Jens Lauritsen, Consultant, Orthopedic Dpt., Accident Analysis Group, Odense Universitetshospital, Sdr., Denmark ; Bruce Analysis Group, Odense Universitetshospital, Sdr., Denmark ; Bruce Lawrence, Pacific Institute for Research and Evaluation, Calverton, Lawrence, Pacific Institute for Research and Evaluation, Calverton, Maryland, USA; Alison Macpherson, School of Kinesiology and Health Maryland, USA; Alison Macpherson, School of Kinesiology and Health Science, York University, Toronto, Canada; Ted Miller, Pacific Institute Science, York University, Toronto, Canada; Ted Miller, Pacific Institute for Research and Evaluation, Calverton, Maryland, USA; Catherine Perez, for Research and Evaluation, Calverton, Maryland, USA; Catherine Perez, Agència de Salut Pública de Barcelona, Spain; Eleni Petridou, Agència de Salut Pública de Barcelona, Spain; Eleni Petridou, Department of Hygiene and Epidemiology, Athens University Medical Department of Hygiene and Epidemiology, Athens University Medical School, Greece; Margie Warner, Office of Analysis and Epidemiology, School, Greece; Margie Warner, Office of Analysis and Epidemiology, National Center for Health Statistics, Maryland, USANational Center for Health Statistics, Maryland, USA


MethodsMethods

6 countries involved6 countries involvedAgreed protocol data supplyAgreed protocol data supplySubmittedSubmittedChecked and analysed by Checked and analysed by IPRUIPRU


Probability of admission Probability of admission (PrA)(PrA)

Results / Issues / ProblemsResults / Issues / Problems Summary of results on spreadsheetSummary of results on spreadsheet Small number of diagnoses show Small number of diagnoses show

consistently high estimated PrAconsistently high estimated PrA Lower 95% CI for PrA Lower 95% CI for PrA >>0.750.75

Fractured shaft and neck of femurFractured shaft and neck of femur

Wide confidence intervals for many Wide confidence intervals for many diagnosesdiagnoses Diagnoses with potentially consistently high Diagnoses with potentially consistently high

PrA – ie. Upper 95% CI PrA – ie. Upper 95% CI >>0.750.75 see over for listsee over for list


S052 – Ocular laceration and rupture S052 – Ocular laceration and rupture with prolapse and loss of intraocular with prolapse and loss of intraocular tissue.tissue.

S063 – Focal brain injuryS063 – Focal brain injury S272 - Traumatic haemopneumothoraxS272 - Traumatic haemopneumothorax S360 – Injury of spleenS360 – Injury of spleen S361 – Injury of liver and gall bladderS361 – Injury of liver and gall bladder S364 – Injury of small intestineS364 – Injury of small intestine


PrA Project - IssuesPrA Project - Issues ICD-10ICD-10

Used only 4-character -> Lack of specificityUsed only 4-character -> Lack of specificity Can we infer high PrA ICD-10 diagnoses from ICD-9 Can we infer high PrA ICD-10 diagnoses from ICD-9

results - Eg. open long bone fractures; brain results - Eg. open long bone fractures; brain haemorrhage / lacerationhaemorrhage / laceration

Use of only 1st diagnosis listed eg. for head injuryUse of only 1st diagnosis listed eg. for head injury Inconsistent results.Inconsistent results.

Surprising for certain diagnosesSurprising for certain diagnoses Eg. traumatic subdural haemorrhage (v low PrA for Eg. traumatic subdural haemorrhage (v low PrA for

1country). 1country).

Combining ICD-9 and ICD-10 resultsCombining ICD-9 and ICD-10 results Possible for some diags (eg. fractured neck & Possible for some diags (eg. fractured neck &

shaft of femur)shaft of femur) Less obvious for othersLess obvious for others


ConclusionsConclusions In theory, using a ‘basket’ of diagnoses is a solution In theory, using a ‘basket’ of diagnoses is a solution

to reducing health service effects on international to reducing health service effects on international comparisons.comparisons.

Creating an operational definition of high PrA Creating an operational definition of high PrA diagnoses requires some judgement.diagnoses requires some judgement.

My proposed set includesMy proposed set includes Fractured neck and shaft of femurFractured neck and shaft of femur Those with UCLThose with UCL>>0.75 for all available countries0.75 for all available countries Long bone open fracturesLong bone open fractures Brain laceration and haemorrhageBrain laceration and haemorrhage Spinal cord lesionSpinal cord lesion Intra-thoracic and intra-abdominal injury (excl. bladder & Intra-thoracic and intra-abdominal injury (excl. bladder &

urethra)urethra)

This is a starting point for discussionThis is a starting point for discussion17Colin Cryer, IPRU, University of Otago

Documents

Non-fatal injury indicators Colin Cryer and Rolf Gedeborg International Collaborative Effort on Injury Statistics, Swansea, Wales, September 2010 What