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Empirical validation of the New Zealand serious non-fatal injury outcome indicator for ‘all injury’
  1. Colin Cryer1,
  2. Gabrielle S Davie1,
  3. Pauline J Gulliver2,
  4. Eleni Th Petridou3,4,
  5. Nick Dessypris3,
  6. Jens Lauritsen5,6,
  7. Alison K Macpherson7,
  8. Ted R Miller8,9,
  9. Brandon de Graaf1
  1. 1 Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
  2. 2 Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
  3. 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
  4. 4 Unit of Clinical Epidemiology, Medical School, Karolinska Institute, Stockholm, Sweden
  5. 5 Accident Analysis Group, Department of Orthopedics, Odense University Hospital, Odense, Denmark
  6. 6 Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
  7. 7 Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
  8. 8 Calverton Center, Pacific Institute for Research and Evaluation, Calverton, Maryland, USA
  9. 9 Health Science Research and Graduate Studies, Curtin University Centre for Health Policy Research, Perth, Western Australia, Australia
  1. Correspondence to Dr. Colin Cryer, Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand; colincryer{at}


Our purpose was to empirically validate the official New Zealand (NZ) serious non-fatal ’all injury' indicator. To that end, we aimed to investigate the assumption that cases selected by the indicator have a high probability of admission. Using NZ hospital in-patient records, we identified serious injury diagnoses, captured by the indicator, if their diagnosis-specific survival probability was ≤0.941 based on at least 100 admissions. Corresponding diagnosis-specific admission probabilities from regions in Canada, Denmark and Greece were estimated. Aggregate admission probabilities across those injury diagnoses were calculated and inference made to New Zealand. The admission probabilities were 0.82, 0.89 and 0.90 for the regions of Canada, Denmark and Greece, respectively. This work provides evidence that the threshold set for the official New Zealand serious non-fatal injury indicator for ’all injury' captures injuries with high aggregate admission probability. If so, it is valid for monitoring the incidence of serious injuries.

  • indicators
  • surveillance
  • hospital care
  • scale development
  • severity scales

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  • Contributors The New Zealand team managed this project. They contributed to its design, steered its execution including quality assurance, and advised on the analysis and reporting. PJG carried out the analyses with support from the University of Otago Preventive and Social Medicine team responsible for data preparation and statistical analysis. The international collaborators provided aggregates of hospital records for the estimations of probabilities of admission. They provided guidance for the development of the protocol, and provided discussion, identified potential problems and solutions, and gave invaluable feedback. All coauthors contributed to the drafting of the paper, led by CC.

  • Funding The participation of the New Zealand team in this study was funded and supported by the Accident Compensation Corporation (ACC), Wellington, New Zealand. Views and/or conclusions in this report are those of the project team and may not reflect the position of the ACC. The Emergency Department Injury Surveillance System and the Greek participation in this project were supported in part by the National and Kapodistrian University of Athens.

  • Competing interests None declared.

  • Ethics approval We have ethical approval from the Health and Disability Ethics Committee to conduct research using NZ hospital records data for the purpose of monitoring injury at a national level.

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