Inj Prev. 2021 Oct 16; doi: 10.1136/injuryprev-2021-044371. Epub 2021 Oct 16.
Missing cases of injury death: use of quantitative methods and case reviews to inform future improvements in case definition.
Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention
Colin Cryer, Pauline Gulliver, Gabrielle Davie, Ari Samaranayaka, Christine Fowler
Affiliations
Affiliations
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand [email protected].
- School of Population Health, University of Auckland, Auckland, New Zealand.
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
- Biostatistics Centre, University of Otago, Dunedin, New Zealand.
- National Collections and Reporting, Ministry of Health, Wellington, New Zealand.
PMID: 34656990
DOI: 10.1136/injuryprev-2021-044371
Abstract
BACKGROUND: Knowledge of fatal injuries is required to inform prevention activities. Where hospital patients with an injury principal diagnosis (PDx) died and were certified to a medical underlying cause of death (UCoD), there is the potential to underestimate injury mortality. We sought to characterise injury/non-injury (NI) mismatches between PDx and UCoD by identifying which subgroups had small/large mismatches, and to understand why mismatches had occurred using informative examples.
METHOD: Hospital records (n=10 234) with a PDx of injury were linked to the mortality collection using a unique personal identifier. Percentages UCoD coded to a NI were tabulated, for three follow-up periods and by selected variables. Additionally, we reviewed a sample of 70 records for which there was a mismatch.
RESULTS: %NIs were 39%, 66% and 77% for time from injury to death of <1 week, <90 days and <1 year, respectively. Variations in %NI were found for all variables. Illustrative examples of 70 medical UCoD deaths showed that for 12 cases the injury event was unequivocally judged to have resulted in premature death. A further 16 were judged as injury deaths using balance of probability arguments.
CONCLUSION: There is variation in rates of mismatch between PDx of injury and UCoD of NI. While legitimate reasons exist for mismatches in certain groups, a material number of injury deaths are not captured using UCoD alone; a new operational definition of injury death is needed. Early solutions are proposed. Further work is needed to investigate operational definitions with acceptable false positive and negative detection rates.
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: epidemiology; indicators; mortality; surveillance
Conflict of interest statement
Competing interests: None declared.
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