Gaps in injury statistics: multiple injury profiles reveal them and provide a comprehensive account

Abstract

Objective: To demonstrate the benefit of using multiple injury profiles (MIP) as an alternative to ''primary diagnosis,'' for the presentation and analysis of multiple injuries in populations. Methods: Retrospective analysis of national trauma registry data in Israel between 1 January 1998 and 31 December 2002. Multiple diagnoses per patient were recorded. A primary diagnosis was selected for each patient and data were presented twice: first by selecting a primary diagnosis and then using multiple injury profiles. Results: 23 909 transport casualties were included. Findings show that MIP enable the identification of all patients with a specific injury, even where secondary. The proportion of additional injuries recorded when using MIP ranged from 12% in head injuries to 270% for facial injuries. Based on the primary diagnosis patients with head, chest, and abdominal injuries had a 5-6% inpatient death rate each. Multiple injury profiles of the same population reveal that an isolated head injury has a 3% inpatient death rate, isolated chest and isolated abdomen have a 1% inpatient death rate, while combined head and chest casualties have a 21% inpatient death rate. Conclusions: Multiple injury profiles are a new approach that enables presenting an improved picture of injury in a population.

Revision of the International Classification of Diseases to include standardized descriptions of multiple injuries and injury severity

“…S52.7 indicates "multiple fractures of the forearm"). This arbitrariness, due to a lack of standardization, also applies to the presentation and analysis of morbidity statistics, 1 although not to the way that they are recorded because clinical modifications of the ICD require the coding of each injury, thereby superseding the multiple-injury codes.…”

“…Choosing just one code results in a loss of information on the other, unselected, pathologies, so the resultant statistics underestimate the significance of each injury and inadequately depict the interactions between them. 1 The limited number of multiple-injury codes included in the ICD cannot cover all possible patterns. For example, codes T00-T07 indicate injuries involving multiple body regions while S codes also include multiple injuries in the same body regions, (e.g.…”

“…The multi-dimensional phenomenon of multiple injury is thus usually reduced either to a single code reflecting the primary (most severe) injury or to one of a few multiple-injury codes, based upon an arbitrary decision. 1,4 Selecting the primary injury when filling in death certificates, or the underlying cause from among several injuries reported in death certificates, is also an arbitrary practice that reflects the certifier's or coder's perception of which pathology is the most important. Choosing just one code results in a loss of information on the other, unselected, pathologies, so the resultant statistics underestimate the significance of each injury and inadequately depict the interactions between them.…”

“…1 Each injury falls into one of the cells in the matrix. The multiple injury profile can summarize all of the individual injuries in one patient using cell combinations.…”

“…For example, designating the most severe injuries as the primary injuries or categorizing multiple injuries as such without further details. 1 Second, an increasing need to describe injury severity for case-mix groups has led to the introduction of various additional severity-scoring methods, as the ICD itself, as a diagnosis classification for mortality, does not consider severity. To avoid the costs of additional severity scoring, methods have been developed to convert administrative ICD-based diagnosis codes into severity scores using computer software or to calculate survival probability for each diagnosis code from patient data.…”