Citation

Zhang M, Guo M, Guo X, Gao L, Zhou J, Bai X, Cui S, Pang C, Gao L, Xing B, Wang Y. Injury 2019; 50(3): 663-670.

Affiliation

Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Collaborating Center for the WHO Family of International Classifications, Beijing, China; National Center for Quality Control of Medical Records, Beijing, China. Electronic address: wypumch@163.com.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.injury.2019.01.029

PMID

30709541

Abstract

INTRODUCTION: Unintentional injuries (UIs) impose a significant burden on low- and middle-income countries (LMICs). However, available UI epidemiological data are limited for LMICs, including China. This article aimed to provide an overview of the UI hospitalization profile, identify risk factors for in-hospital mortality and provide diagnosis-specific survival risk ratios (SRRs) for reference by LMICs using hospital discharge abstract data (DAD) from Beijing, China.

PATIENTS AND METHODS: A cross-sectional study was conducted for patients sustaining UIs requiring admission. Information was retrieved from 138 hospitals in Beijing to describe the demographics, injury nature, mechanisms, severity and hospital outcomes. Multivariate logistic regression was performed to identify and evaluate risk factors for in-hospital mortality for UIs.

RESULTS: Falls (57.1%), transport accidents (19.9%) and exposure to inanimate mechanical forces (16.4%) were the leading causes of UI hospitalization. Falls and transport accidents were responsible for 94.2% of the in-hospital deaths caused by UIs. Injury mechanisms differed among sex (χ² = 5322.1, P <  0.001) and age (χ² = 24,143.3, P <  0.001) groups. Male sex (OR: 1.50, 95% confidence interval (CI): 1.23-1.79), age ≥ 85 years (OR: 16.39, 95% CI: 7.46-36.00), Barthel Index at admission ≤ 60 (OR: 25.78, 95% CI: 13.30-49.95), modified Charlson comorbidity index ≥ 6 (OR: 2.60, 95% CI: 1.91-3.55), International Classification of Diseases-based injury severity score (ICISS) < 0.85 (OR: 15.17, 95% CI: 12.57-18.30), sustaining injuries to the head/neck (OR: 23.20, 95% CI: 7.31-73.64), injuries caused by foreign body entering through natural orifice (OR: 34.00, 95%CI: 6.37-181.54) and injuries resulting from transport accidents (OR: 1.71, 95% CI: 1.41-2.07) were important risk factors for in-hospital mortality for UIs.

CONCLUSIONS: Hospital DAD are an objective and cost-effective data source that allows for a hospital-based perspective of UI epidemiology. Sex, age, functional status at admission, comorbidities, injury nature, severity and mechanism are significantly associated with the in-hospital mortality of UIs in China. This study generates a reference dataset of diagnosis-specific SRRs from a large trauma population in China, which may be more applicable in injury severity estimation using ICISS in LMICs.

Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

Language: en

Keywords

Barthel Index; Charlson comorbidity index; Epidemiological study; Hospitalization; In-hospital mortality; Injury mechanisms; International classification of diseases-based injury severity score; Low- and middle-income countries; Risk factors; Unintentional injuries