Is length of stay in hospital a stable proxy for injury severity?
- Correspondence to Associate Professor Colin Cryer, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand; colin.cryer{at}ipru.otago.ac.nz
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Contributors All authors contributed to the conception of the project and the development of the methods, and contributed to regular project team meetings including providing a scientific steer, and to the decision making on the project. Additionally, CC was the principal investigator on the project. He managed the project which included chairing regular project team meetings, monitoring activity against the timeline, and making day-to-day decisions concerning the conduct of the project. PG carried out the analytical work, at the direction of CC, supervised by GD. GD (biostatistician) supervised the data management and biostatistical/analytical activities relating to this project. All authors contributed to the drafting and the revisions of the paper.
- Accepted 28 December 2009
- Published Online First 29 June 2010
Abstract
Research question Is length of stay (LoS) in hospital a stable proxy for severity of injury when monitoring time trends in serious injury incidence?
Objective To investigate whether LoS metrics (mean, median and proportion exceeding several LoS thresholds) have changed over time for injury diagnoses with known severity.
Design Time series investigation.
Subjects and setting New Zealand population admitted to hospital for injury and discharged during the period 1989 to 1998.
Main outcome measures Interpolated median and geometric mean lengths of stay, as well as the proportion of cases that have an LoS greater than or equal to 3, 4, 7 and 14 days in hospital.
Methods ICD-9-CM diagnoses that are approximately homogeneous in regard to severity of injury (ICD-HS diagnoses) were identified. Trends were investigated in the LoS statistics for: injury and non-injury diagnoses combined; all injury diagnoses; major body sites of injury; severity strata; and ICD-HS diagnoses.
Results Almost without exception, there was a decline in the LoS statistics over time for all diagnoses, all injury diagnoses, each body site of injury investigated, severity strata, and the ICD-HS diagnoses.
Conclusions Reductions in median and geometric mean LoS over time, as well as reductions in the proportion exceeding selected LoS thresholds, were due to factors other than reductions in the incidence of serious injury; for example, changes in service delivery over time. An LoS threshold should not be used as a proxy for severity of injury if the goal is to monitor time trends in injury incidence.
Footnotes
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Funding This research was supported by the Accident Compensation Corporation of New Zealand, Molesworth Street, Wellington, New Zealand. The views expressed in this paper are those of the authors and do not necessarily reflect those of the ACC.
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Competing interests None.
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Ethics approval This study was conducted with the approval of the Multiregion Ethics Committee, New Zealand.
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Provenance and peer review Not commissioned; externally peer reviewed.
