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Towards valid ‘serious non-fatal injury’ indicators for international comparisons based on probability of admission estimates
  1. Colin Cryer1,
  2. Ted R Miller2,3,
  3. Ronan A Lyons4,
  4. Alison K Macpherson5,
  5. Katherine Pérez6,7,
  6. Eleni Th Petridou8,
  7. Nick Dessypris8,
  8. Gabrielle S Davie1,
  9. Pauline J Gulliver9,
  10. Jens Lauritsen10,11,
  11. Soufiane Boufous12,
  12. Bruce Lawrence13,
  13. Brandon de Graaf1,
  14. Claudia A Steiner14
  1. 1Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
  2. 2Pacific Institute for Research and Evaluation, Calverton, Maryland, USA
  3. 3Curtin University Centre for Health Policy Research, Perth, Australia
  4. 4Farr Institute, Swansea University Medical School, Swansea, UK
  5. 5School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
  6. 6Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
  7. 7CIBER Epidemiología y Salud Pública, Institute of Biomedical Research (IIBSP), Barcelona, Spain
  8. 8Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
  9. 9School of Population Health, University of Auckland, Auckland, New Zealand
  10. 10Injury Prevention Group, Odense University Hospital, Odense, Denmark
  11. 11Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
  12. 12Transport and Road Safety Research, University of New South Wales, Sydney, New South Wales, Australia
  13. 13Pacific Institute for Research and Evaluation, Calverton, Maryland, USA
  14. 14Division of Healthcare Delivery Data, Measures and Research, Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ), Rockville, Maryland, USA
  1. Correspondence to Dr Colin Cryer, Department of Preventive and Social Medicine, University of Otago, P.O. Box 913, Dunedin 9054, New Zealand; colin.cryer{at}


Background Governments wish to compare their performance in preventing serious injury. International comparisons based on hospital inpatient records are typically contaminated by variations in health services utilisation. To reduce these effects, a serious injury case definition has been proposed based on diagnoses with a high probability of inpatient admission (PrA). The aim of this paper was to identify diagnoses with estimated high PrA for selected developed countries.

Methods The study population was injured persons of all ages who attended emergency department (ED) for their injury in regions of Canada, Denmark, Greece, Spain and the USA. International Classification of Diseases (ICD)-9 or ICD-10 4-digit/character injury diagnosis-specific ED attendance and inpatient admission counts were provided, based on a common protocol. Diagnosis-specific and region-specific PrAs with 95% CIs were calculated.

Results The results confirmed that femoral fractures have high PrA across all countries studied. Strong evidence for high PrA also exists for fracture of base of skull with cerebral laceration and contusion; intracranial haemorrhage; open fracture of radius, ulna, tibia and fibula; pneumohaemothorax and injury to the liver and spleen. Slightly weaker evidence exists for cerebellar or brain stem laceration; closed fracture of the tibia and fibula; open and closed fracture of the ankle; haemothorax and injury to the heart and lung.

Conclusions Using a large study size, we identified injury diagnoses with high estimated PrAs. These diagnoses can be used as the basis for more valid international comparisons of life-threatening injury, based on hospital discharge data, for countries with well-developed healthcare and data collection systems.

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  • Contributors The New Zealand team contributed to the conception of the project, from which this paper was derived. All authors contributed to the development of the methods, contributed to periodic project team meetings, including providing a scientific steer, and to the decision making on the project. All authors contributed to the drafting and the revisions of the paper, and to the final approval of the paper prior to submission.

  • Funding Accident Compensation Corporation of New Zealand (105155.05.P.NF Cryer).

  • Competing interests None declared.

  • Ethics approval Only aggregate data were used in this study. The aggregates used were presented only if based on at least 100 ED attendances. The source data was administrative data systems.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Significant variations in diagnosis-specific probabilities of admission, by gender, age group, cause and intent can be found at: