# Presentation: 294952

## Trends in hospitalization for injuries in the United States from 1979 to 2001

**Melissa A. Heinen, MPH**
**Marni J. Hall, PhD**
**Lois A. Fingerhut, MA **

## Injuries serious enough to result in hospitalization are particularly costly in terms of human suffering, health care resource consumption, and time lost from work.  

## Methods

- National Hospital Discharge Survey (NHDS)
- 1979-2001
- State and Territorial Injury Prevention Directors Association (STIPDA) recommended case definition for injury
- Includes ICD-9-CM codes: 800-909.2, 909.4, 909.9, 910-994.9, 995.5-995.59, 995.80-995.85
- Excludes ICD-9-CM codes: <800, 909.3, 909.5. 995.0-995.4, 995.6-995.7, 995.86, 995.89, 996-999
- Categorized using
-  Barell Injury Diagnosis Matrix (ICD-9-CM)
-  ICD-9 External Cause Matrix (for morbidity)
- Test of trends and average percent change

## Barell Matrix

- Two dimensional array of ICD-9-CM injury codes grouped by the body region of the injury and the nature of the injury.

## Barell Matrix rows

**The rows of the matrix are based on principle body regions:**
- Head & neck (including brain, skull, face, and front of neck)
- Spine and back (spinal cord and vertebral column)
- Torso (including abdomen, thorax, pelvic region, trunk, back and buttock)
- Extremities (upper and lower)
- Other and unspecified (including injuries such as foreign bodies, early complications, poisoning and toxic effects, and other and unspecified effects of external causes that cannot be classified into any specific body region)

## Barell Matrix columns

**The columns of the matrix are the 12 nature-of-injury categories:**
- Fracture
- Dislocations
- Sprains and strains
- Internal injuries
- Open wounds
- Amputations
- Injuries to blood vessels
- Injuries to nerves
- Contusion, abrasion, and other superficial injuries excluding minor lacerations
- Crushing injuries
- Burns
- Injuries of other and unspecified nature

## Recommended external cause matrix

- Mechanism  (e.g., fall, motor vehicle traffic related, etc. ) by manner (e.g., self inflicted, unintentional, etc.)
- Exclusion criteria
**place of occurrence**
**second-hand tobacco smoke**
**misadventures to patients during surgical and medical care**
**drugs, medicinal, and biological substances causing adverse effects in therapeutic use**

## RESULTS

- Injury discharge rates by:
- Age and sex
- Injury diagnosis
- Body region
- Hip fractures
- Length of stay
- External cause of injury coding

## Injury discharges

- Source: National Hospital Discharge Survey.  Age-adjusted rates are plotted on a log scale.

**Complications of care and adverse effects discharges**

**Injury discharges**

## Source: National Hospital Discharge Survey.  Age-adjusted rates are plotted on a log scale.

## Source: National Hospital Discharge Survey.  

- Source: National Hospital Discharge Survey.

## System wide injuries

**System wide injuries**

**Internal organ injuries**

**Open wounds**

- Source: National Hospital Discharge Survey.      Age-adjusted rates are plotted on a log scale.

## Source: National Hospital Discharge Survey.      Age-adjusted rates are plotted on a log scale.

## Hip fractures discharge rates among females 65 years and over for 1981, 1991, 2001

- Source: National Hospital Discharge Survey.

## Average length of stay (in days) among injury discharges for those under and over 65 years of age, 1979-2001

- Source: National Hospital Discharge Survey.

## Percent of injury hospitalizations with at least one valid external cause of injury code, 1979-2001

- Source: National Hospital Discharge Survey.

## Percent distribution of injury discharges by external cause of injury codes, 2001

- Source: National Hospital Discharge Survey

## SUMMARY

- Injury discharge rates decreased 62 percent from 1979-2001.
- From the early 1980’s to 2001, females 65 years and over had the highest rate of injury discharges which decreased on average 13 percent.
- Rates highest for fractures and extremity injuries.
- Hip fractures were more common among females 65 years and over. Hip fracture discharge rates for females 85 years and older were 10 times the rates for females 65-74 years of age.
- The hip fracture discharge rate increased on average 16 percent among females 85 years and over.

## SUMMARY, CONT.

- From 1979 to 2001 those 65 years and over hospitalized for injury had a longer average length of stay compared to those under 65 years of age hospitalized for injury.
- In 2001, 68 percent of injury discharges had a valid external cause code.  The majority of injury discharges were unintentional.  The leading mechanisms coded were falls and motor vehicle traffic.

## CONCLUSION

- Applying these recommendations to the analysis of data from the National Hospital Discharge Survey (NHDS) provides national level injury surveillance of injuries requiring hospitalization as a model for states to use when comparing their data to other state level data (including local area data) as well as to national data.