6.1 Injury Burden

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Description of Indicator

Relationship to Quality Medical care should be effective
Type of Indicator Prehospital, Hospital and Posthospital outcome, System level
Proposed Data Source EMS Records, Coroner Data, Trauma Registries, Administrative Data
Definition Number of injury associated ED visits, hospital admissions and deaths per 100,000 population*
Numerator All patients age 18 years and older with a primary injury diagnosis AND associated: ED visit(s), Hospital admission(s), Death
Denominator Population in metropolitan area, health region or State/Province, age 18 years and older
Benchmark Not specified at present
Risk Adjustment Not applicable

* We propose reporting a separate measure for the 3 outcomes of interest: ED visits, hospital admissions and deaths, each with a numerator and denominator.


This indicator is intended to summarize the burden of injury according to geographical area. Panel Review
Panelists agreed that deaths are only a small component of injury burden. They suggested that a more comprehensive, bur practical measurement of injury burden, could include total injury deaths, total number of injury admissions and total number of ED visits that are injury related. They suggested that this indicator could provide an excellent opportunity to facilitate injury prevention through monitoring of injuries and death. It was noted that all injury deaths should be reviewed in some way and suggested that using injury surveillance that captures the location and time of death from injury would be one informative way of doing so. In addition panelists noted that for many trauma systems there is a disconnect between the coroner and trauma center. Establishing a connection between the two would be important in order to ensure successful and effective implementation of this indicator.


Trauma Center Review
The trauma centers noted this indicator to be an important population based measure and useful tool for comparing injury burden across different geographical areas. However, centers noted implementation challenges due to limited access to essential documentation. It was noted that electronic medical records could decrease the resources needed to collect and analyze data for this indicator, but had concerns that a large number of trauma systems are not equipped with these electronic databases.


Review of Literature & Evidence
Face Validity: No studies identified.
Construct Validity: No studies identified.
Reliability: No studies identified.
Risk Adjustment: Not applicable.
Utilization: Measures of injury burden do not appear to be used as a quality indicator by trauma centers.
The risk of injury and injury-related mortality vary amongst developed countries, states/provinces and other geographical areas110. Kortbeek and Buckley described the injury burden on the Canadian health system111.
Some countries with national trauma registries report injury rates and mortality at a population level3.
International comparisons of injury death rates among high income countries have demonstrated clinically important variation between countries110.


Derived from the American College of Surgeons Committee on Trauma audit filter All Trauma Deaths2.


2. American College of Surgeons Committee on Trauma. Resources for Optimal Care of the Injured Patient 2006. Chicago: American College of Surgeons; 2006.
3. Canadian Institute for Health Information. National Trauma Registry 2011 report: hospitalizations for major injury in Canada (includes 2008-2009 data). 2011; https://secure.cihi.ca/estore/productFamily.htm?pf=PFC1600&lang=en&media=0. Accessed September 26, 2011.
110. Fingerhut LA, Cox CS, Warner M. International comparative analysis of injury mortality. Findings from the ICE on injury statistics. International Collaborative Effort on Injury Statistics. Adv Data. 1998;303:1-20.
111. Kortbeek JB, Buckley R. Trauma-care systems in Canada. Injury. 2003;34(9):658-663.