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Where to start? Injury prevention priority scores for traumatic injuries in Canada
Samuel Jessula1, Natalie L Yanchar2, Rodrigo Romao2
1From the Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS (Jessula); the Section of Pediatric Surgery, Department of Surgery, University of Calgary, Calgary, Alta (Yanchar); the Division of Pediatric General and Thoracic Surgery, Department of Surgery, IWK Health Centre, Dalhousie University, Halifax, NS (Romao); Trauma Nova Scotia, Halifax, NS (Green); the Department of Critical Care, Dalhousie University, Halifax, NS (Green); and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Asbridge) samuel.jessula@mail.mcgill.ca.
Background:
Given limited resources for injury prevention, it is essential to determine which mechanisms of injury to target to provide the most benefit to the largest proportion of the population. We developed objective, evidence-based injury prevention priority scores (IPPSs) for the Canadian population across 4 prevention perspectives: mortality, injury severity, resource use and societal cost.
Methods:
We performed a retrospective cohort study of all injuries in Canada from 2009/10 to 2013/14. Hospital admissions were obtained from the Discharge Abstract Database, and deaths from the Statistics Canada Canadian Vital Statistics Death Database. For each mechanism of injury, we calculated an IPPS as a balanced measure of injury frequency and 1) mortality rate, 2) median 1 - ICISS (Injury Severity Score derived from the International Statistical Classification of Diseases and Related Health Problems, 10th revision, enhanced Canadian version), 3) median cost per hospital stay or 4) median potential years of life lost (PYLL), providing a ranking of mechanisms of injury in priority order. The IPPS by definition has a mean of 50 and a standard deviation of 10. The higher the IPPS, the higher the priority for injury prevention.
Results:
A total of 694 535 injuries were identified over the study period. The most frequent mechanism of injury was falls (391 068 [56.3%]). The overall mortality rate was 0.09 deaths/injured person, the median 1 - ICISS was 0.017, the median cost was $5217, and the median PYLL was 0. The mechanisms with the 3 highest IPPSs were falls (75), self-harm (67) and drowning (66) for mortality; falls (77), drowning (70) and suffocation (61) for severity; falls (80), suffocation (63) and fire (60) for resource use; and falls (72), assault (62), and firearms and legal interventions (59 in both cases) for societal cost.
Conclusion:
This study produced IPPSs for traumatic injuries in Canada that provide objective and quantifiable methods for identifying mechanisms of injury to target for specific prevention initiatives. Preventing falls would provide the most benefit to the largest proportion of Canadians and should be prioritized in injury-prevention policy.
