@article{ref1,
title="Missing cases of injury death: use of quantitative methods and case reviews to inform future improvements in case definition",
journal="Injury prevention",
year="2021",
author="Cryer, Colin and Gulliver, Pauline and Davie, Gabrielle and Samaranayaka, Ari and Fowler, Christine",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Knowledge of fatal injuries is required to inform prevention activities. Where hospital patients with an injury principal diagnosis (PDx) died and were certified to a medical underlying cause of death (UCoD), there is the potential to underestimate injury mortality. We sought to characterise injury/non-injury (NI) mismatches between PDx and UCoD by identifying which subgroups had small/large mismatches, and to understand why mismatches had occurred using informative examples. <br><br>METHOD: Hospital records (n=10 234) with a PDx of injury were linked to the mortality collection using a unique personal identifier. Percentages UCoD coded to a NI were tabulated, for three follow-up periods and by selected variables. Additionally, we reviewed a sample of 70 records for which there was a mismatch. <br><br>RESULTS: %NIs were 39%, 66% and 77% for time from injury to death of <1 week, <90 days and <1 year, respectively. Variations in %NI were found for all variables. Illustrative examples of 70 medical UCoD deaths showed that for 12 cases the injury event was unequivocally judged to have resulted in premature death. A further 16 were judged as injury deaths using balance of probability arguments. <br><br>CONCLUSION: There is variation in rates of mismatch between PDx of injury and UCoD of NI. While legitimate reasons exist for mismatches in certain groups, a material number of injury deaths are not captured using UCoD alone; a new operational definition of injury death is needed. Early solutions are proposed. Further work is needed to investigate operational definitions with acceptable false positive and negative detection rates.<p /> <p>Language: en</p>",
language="en",
issn="1353-8047",
doi="10.1136/injuryprev-2021-044371",
url="http://dx.doi.org/10.1136/injuryprev-2021-044371"
}