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Injury Epidemiology Amiss – the systematic underestimation of the burden of injury

Limor Aharonson-Daniel, PhD, Adi Giveon, BA, and Kobi Peleg, PhD MPH. Israel Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Services Research, Sheba Medical Center, Tel Hashomer, 52621, Israel, 972-3-5354252, limorad@gertner.health.gov.il

Background: Injured patients are often described using only primary diagnosis or by ‘multiple injury’, with no further detail, losing information and underestimating the true burden of injury. Multiple injury profiles (MIP) facilitate the identification of all patients with a specific injury and give a more precise description of the injury pattern in the individual. Methods: National trauma-registry data on traffic casualties between 1998-2002 in Israel was used. Up to ten Abbreviated Injury Scale (AIS) diagnoses per patient were extracted. Injury data for the study cohort was presented using the two approaches: (1) selecting a primary diagnosis (2) using a MIP. As no “primary diagnosis” was predefined in the Israeli dataset, a simulation model selected the most severe injury per patient (using AIS severity) and prioritized between injuries of identical severity in one patient. MIP were built by creating vectors that represent all injuries a patient sustained. Results: 23909 patients were included. 46% had diagnoses in multiple body regions. The presentation of MIP added information on these injuries, ranging from 16% previously unreported injuries for head and up to 70% unreported injuries to the face. Inpatient death rate based on the primary diagnosis grouping suggested a 6% death rate each, for patients with head, chest and abdominal injuries. The MIP of the same population revealed that in fact the death rate of patients with an isolated head injury was 3%, isolated chest had a 1% inpatient death rate, yet combined head & chest casualties had a 21% inpatient death rate.

Learning Objectives:

Keywords: Methodology, Injuries

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Measuring Health and Disease in the Population I

The 132nd Annual Meeting (November 6-10, 2004) of APHA