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ICE on Injury Statistics Business Meeting, 6 June 2004 – Injury Indicators update

ICE on Injury Statistics Business Meeting, 6 June 2004 – Injury Indicators update. Colin Cryer Senior Research Fellow. Activities since Paris 2003. Email to ADVICE-USERS@LISTSERV.CDC.GOV Lee Annest: 2 indicator reports from CDC (USA) Yvette Holder

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ICE on Injury Statistics Business Meeting, 6 June 2004 – Injury Indicators update

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  1. ICE on Injury Statistics Business Meeting, 6 June 2004 – Injury Indicators update Colin Cryer Senior Research Fellow

  2. Activities since Paris 2003 • Email to ADVICE-USERS@LISTSERV.CDC.GOV • Lee Annest: • 2 indicator reports from CDC (USA) • Yvette Holder • Report: violence indicators (International) • Saakje Mulder • Eurocost (European) • Indicators for priority setting (National) • John Langley • Report and paper: ICISS (Australia & New Zealand) • Paper: Trends in neck of femur fracture (National) • Paper: Trends in injury: service delivery effects versus real effects (National) • New Zealand Injury Prevention Strategy [NZIPS] (National) • Injury Outcome Indicators

  3. New Zealand Injury Prevention Strategy • Injury Outcome Indicators • ‘All injury’ • 6 priority areas • Assault • Workplace injury • Suicide and deliberate self-harm • Falls • Motor vehicle traffic crashes • Drowning and near-drowning • Approach • Identify current national indicators • Identify generic fatal and serious non-fatal indicators • Apply to priority areas • Validate all using our ICEIInG criteria (Washington DC, 2001)

  4. A tool for investigating face validity - Injury ICE, Washington 2001 • Case definition • The indicator should reflect the occurrence of injury satisfying some case definition of anatomical or physiological damage. • Serious injury • The indicator should be based on events that are associated with significantly increased risk of impairment, functional limitation, disability of death, decreased quality of life, or increased cost. • Case ascertainment • The probability of a case being ascertained should be independent of social, economic, and demographic factors, as well as service supply and access factors. • Representativeness • The indicator should be derived from data that are inclusive or representative of the target population that the indicator aims to reflect. • Data availability • It should be possible to use existing data systems, or it should be practical to develop new systems, to provide data for computing the indicator. • Specification • The indicator should be fully specified to allow calculation to be consistent at any place and at any time.

  5. Generic fatal and serious non-fatal indicators • Fatal (Source: National mortality data) • Age-standardised mortality rate per 100,000 person years at risk. • Number of injury deaths • Serious non-fatal (Source: National hospital discharge data) • Age-standardised serious non-fatal injury rate per 100,000 person years at risk. • Number of cases of serious non-fatal injuries

  6. Definition of a serious non-fatal injury • ICISS < 0.941 • Implies: • includes cases with an estimated probability of death of 5.9% or greater • High threshold • Only includes cases of injury that have a very high likelihood of admission to hospital • Examples: • Fracture of the neck of femur • Intracranial injury (excluding concussion only cases) • Injuries of nerves and spinal cord at neck level

  7. What is ICISS? • ICD-based Injury Severity Score • Threat-to-life anatomical severity of injury measure • How are ICISS scores derived?: • Survival probabilities calculated for every ICD-10-AM diagnosis • from large data sets from which survival status is known • Survival probabilities combined where multiple injuries • Gives ICISS score • (1 – ICISS score) = Pr (death) • Note: also calculated for ICD-9-CM-A • Retrospective trends based on both 9th and 10th revisions

  8. Validity of indicators - General findings • Quality of data • Few publications - None recent • Overseas work indicates potential problems • Potential threat to validity for all indicators • National indicators • Fatal injury indicators – Satisfy our validation criteria • Non-fatal indicators - Significant threat to validity • Generic indicators • Satisfy our validation criteria (Fatal & Serious non-fatal)

  9. Trends in generic indicators – ‘all injury’

  10. Discussion • Interesting findings • Expect trends for deaths and injuries of this severity to be similar • Reasons for differences: • Data problems? • Preventive activities selectively preventing deaths but not serious injury • Case fatality rate falling – ie. effect of better treatment (eg Roberts BMJ 1996) • Getting more seriously injured people to hospital before they die • Other? • Argument for combining fatal and serious non-fatal injury to overcome these problems • Net effect: no decrease?

  11. Centre for Health Services Studies www.kent.ac.uk/chss

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