Underestimating Injury Mortality Using Statewide Databases

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Abstract

Background:

This study examines the potential for misclassifying injury-related deaths reported in Vital Statistics and assesses the rate of postdischarge death among injured patients released from hospital, emergency department (ED), and emergency medical services (EMS) care.

Methods:

Statewide death certificate, inpatient, ED, and EMS databases for 1996 through 1997 were probabilistically linked and information in each database compared.

Results:

One thousand two hundred ninety-four injured inpatients or ED patients were matched with a death certificate record that listed an injury (56.3%) or illness (43.7%) as the primary cause of death. Injured decedents with an illness-coded cause of death were older (p < 0.001), with causes of death indicative of chronic medical conditions. Few deaths occurred within 30 days of inpatient discharge (6%); however, 38% and 9% of deaths in ED and EMS databases occurred after discharge from health care, respectively. Many deaths among EMS and ED patients occur in subsequent phases of care.

Conclusion:

Estimates of injury mortality substantially increase when using multiple independent databases.

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