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Validity of hospital discharge data regarding intentionality of fatal pediatric injuries
1Division of Epidemiology, School of Public Health, Columbia University, New York, NY 10032, USA.
Insights
Hospital discharge data underreport fatal child injuries, especially for young children and white children. Death certificates are more accurate for identifying intentional injury cases in pediatric populations.
Area of Science:
- Public Health
- Epidemiology
- Pediatric Trauma
Background:
- Accurate classification of injury intention is crucial for public health surveillance.
- Hospital discharge data are widely used but may not fully capture injury circumstances.
- Understanding discrepancies between data sources is vital for effective injury prevention strategies.
Purpose of the Study:
- To compare the accuracy of hospital discharge data with death certificates in classifying the intention of fatal pediatric injuries.
- To assess the sensitivity of hospital data in identifying intentional injuries across different age groups and races.
Main Methods:
- A retrospective study linking hospital discharge records with death certificates for 302 fatal pediatric injury cases in New York City (1991-1992).
- Comparison of injury intention classification between the two data sources, using death certificates as the criterion standard.
- Calculation of sensitivity for identifying intentional injuries based on hospital data, stratified by age and race.
Main Results:
- Hospital discharge data showed lower sensitivity in identifying intentional injuries compared to death certificates.
- Sensitivity varied by age, with lower accuracy for children under 5 years (0.50) compared to adolescents (0.85).
- Sensitivity was also lower for white children (0.75) than for nonwhite children (0.89).
Conclusions:
- Hospital discharge data tend to understate the incidence and proportion of fatal intentional injuries in children.
- This underestimation is particularly pronounced for very young children and white children.
- Findings highlight the need for improved injury reporting in hospital data or complementary data sources for accurate surveillance.
Abstract:
This study of hospitalized fatal injuries to children in New York City (1991-1992) compares the classification of injury intention on hospital discharge data with that on death certificates in 302 injuries for which records could be linked. Using death certificates as the criterion, the sensitivity of hospital data for identifying intentional injuries ranged from 0.50 for children under age 5 years confidence interval (CI) = 0.27-0.73] to 0.85 for adolescents (95% CI = 0.80-0.90), and from 0.75 for white children (95% CI = 0.65-0.83) to 0.89 for nonwhite children (95% CI = 0.82-0.93). Hospital discharge data for this population appear to understate both the incidence and the proportion of fatal injuries due to intentional causes, particularly those occurring to very young children and to white children.