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Methodology
Establishing an injury indicator for severe paediatric injury
  1. Ian Pike1,2,
  2. Mina Khalil3,
  3. Natalie L Yanchar4,
  4. Hala Tamim3,
  5. Avery B Nathens5,
  6. Alison K Macpherson3
  1. 1Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, British Columbia, Canada
  3. 3School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
  4. 4Division of Pediatric General Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
  5. 5Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Alison K Macpherson, School of Kinesiology and Health Science, York University, 337 Norman Bethune College, Toronto, Ontario, Canada M3J 1P3; alison3{at}yorku.ca

Abstract

Background Routinely gathered injury data, such as hospitalisations, may be subject to variation from sources other than injury incidence. There is a need for an indicator that defines severe injury, which may be less vulnerable to fluctuations due to changes in care policies. The purpose of this study was to identify International Classification of Diseases-10 codes associated with severe paediatric injuries and to specify and validate a severe paediatric injury indicator.

Methods Two data sets that included the ISS and the survival risk ratio were used to produce a list of diagnoses to define severe paediatric injury. The list was sent to trauma surgeons who classified each code as severe enough or not severe enough to require care in a trauma centre. The indicator was fully specified, then validated by using a different data set to validate the codes in a real-world situation.

Results Sixty diagnoses were identified as representing severe paediatric injury. Following specification, the indicator was applied to an existing comprehensive data set of paediatric injuries. The decline in hospitalisation of paediatric injuries was significantly steeper for severe than non-severe injuries, suggesting that factors related to the decline in this trauma subset are unlikely to be related to changes in access or other components of trauma care delivery.

Conclusions This indicator can be used for the evaluation of trends in severe paediatric trauma and will help identify populations at risk. This research may inform policies and procedures for referrals of severe childhood injury to appropriate levels of care.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/injuryprev-2016-042028

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    Footnotes

    • Contributors IP helped design, analyse and write the final version of the manuscript. MK designed the study, conducted the analysis and wrote a first draft of the manuscript. NLY provided input into study design and critically appraised all versions of the manuscript. HT and ABN helped with study design and critically appraised all versions of the manuscript. AKM supervised and contributed to study design, analysis and writing of the manuscript. As senior author she has agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding This study was funded by the Canadian Institutes of Health Information's Graduate Student Data Access Program and the Canadian Institutes of Health Research Chair in Reproductive and Child Health Services and Policy Research.

    • Competing interests None declared.

    • Ethics approval As this study employed a secondary data analysis of anonymous data, there were no study participants, and York University's Human Participants' Review Committee granted this study an exemption for ethical approval.

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