James Edward Harrison

Lethality of suicide methods

Objectives: To (a) quantify the lethality of suicide methods used in Australia in the period 1 July 1993 to 30 June 2003, (b) examine method-specific case fatality by age and sex, and (c) identify changes in case fatality during the study period. Methods: Two sources of data on episodes of self-harm in Australia were used, mortality and hospital separation data. Double counting of cases recorded in both sources was controlled by omitting fatal hospital cases from estimates of episodes of self-harm. Results: Overall case fatality was 12%. For each suicide method, case fatality was higher in males and older age groups. Firearms were the most lethal suicide means (90%) followed by hanging (83%). Rates of suicide involving firearms declined over time, and those involving hanging rose. Case fatality for firearm cases changed little over time, but declined for self-harm by hanging/suffocation, poisoning, sharp objects, and crashing a motor vehicle. Conclusions: This study (Australia) and two others (USA) show differences in method-specific lethality by gender and age. This study adds the finding of changes in lethality over time. Understanding of suicidality in populations, on which prevention efforts depend, requires explanation of these findings.

Diagnosis based injury severity scaling: investigation of a method using Australian and New Zealand hospitalisations.

Objective: To assess the performance of the International Classification of Diseases (ICD) based injury severity score, ICISS, when applied to two versions of the 10th edition of ICD, ICD-10 and ICD-10-AM. Design: ICISS was assessed on its ability to predict threat to life using logistic regression modelling. Models used ICISS and age as predictors and survival as the outcome. Setting: Australia and New Zealand. Patients or subjects: Hospitalisations with an ICD-10-AM principal diagnosis in the range S00–T89 from 1 July 1999 to 30 June 2001 (Australia) or 1 July 1999 to 31 December 2001 (New Zealand). Interventions: None. Main outcome measures: The models were assessed in terms of their discrimination, measured by the concordance score, and calibration, measured using calibration curves and the Hosmer-Lemeshow statistic. Results: 523 633 Australian and 124 767 New Zealand hospitalisations were selected, including 7230 and 1565 deaths respectively. Discrimination was high in all the fitted models with concordance scores of 0.885 to 0.910. Calibration results were also promising with all calibration curves being close to linear, though ICISS appeared to underestimate mortality somewhat for cases with an ICISS score less than 0.6. Overall ICISS performed better when applied to the Australian than the New Zealand hospitalisations. Australian and New Zealand hospitalisations were very similar. ICISS was also only a little more successful when ICD-10-AM rather than mapped ICD-10 was used. Conclusions: ICISS appears to be a reasonable way to estimate severity for databases using ICD-10 or ICD-10-AM. It is also likely to work well for other clinical variants of ICD-10.

Data Sources for Improving Estimates of the Global Burden of Injuries: Call for Contributors

Kavi Bhalla and colleagues invite individuals and organizations to provide local injury data sources to help inform estimates of the global burden of injuries.

Measuring the population burden of fatal and nonfatal injury.

The value of measuring the population burden of fatal and nonfatal injury is well established. Population health metrics are important for assessing health status and health-related quality of life after injury and for integrating mortality, disability, and quality-of-life consequences. A frequently used population health metric is the disability-adjusted life-year. This metric was launched in 1996 in the original Global Burden of Disease and Injury study and has been widely adopted by countries and health development agencies alike to identify the relative magnitude of different health problems. Apart from its obvious advantages and wide adherence, a number of challenges are encountered when the disability-adjusted life-year is applied to injuries. Validation of disability-adjusted life-year estimates for injury has been largely absent. This paper provides an overview of methods and existing knowledge regarding the population burden of injury measurement. The review of studies that measured burden of injury shows that estimates of the population burden remain uncertain because of a weak epidemiologic foundation; limited information on incidence, outcomes, and duration of disability; and a range of methodological problems, including definition and selection of incident and fatal cases, choices in selection of assessment instruments and timings of use for nonfatal injury outcomes, and the underlying concepts of valuation of disability. Recommendations are given for methodological refinements to improve the validity and comparability of future burden of injury studies.

Accuracy of external cause-of-injury coding in hospital records

Objective: To appraise the published evidence regarding the accuracy of external cause-of-injury codes in hospital records. Design: Systematic review. Data sources: Electronic databases searched included PubMed, PubMed Central, Medline, CINAHL, Academic Search Elite, Proquest Health and Medical Complete, and Google Scholar. Snowballing strategies were used by searching the bibliographies of retrieved references to identify relevant associated articles. Selection criteria: Studies were included in the review if they assessed the accuracy of external cause-of-injury coding in hospital records via a recoding methodology. Methods: The papers identified through the search were independently screened by two authors for inclusion. Because of heterogeneity between studies, meta-analysis was not performed. Results: Very limited research on the accuracy of external cause coding for injury-related hospitalisation using medical record review and recoding methodologies has been conducted, with only five studies matching the selection criteria. The accuracy of external cause coding using ICD-9-CM ranged from ∼ 64% when exact code agreement was examined to ∼85% when agreement for broader groups of codes was examined. Conclusions: Although broad external cause groupings coded in ICD-9-CM can be used with some confidence, researchers should exercise caution for very specific codes until further research is conducted to validate these data. As all previous studies have been conducted using ICD-9-CM, research is needed to quantify the accuracy of coding using ICD-10-AM, and validate the use of these data for injury surveillance purposes.

Cervical spinal cord injury in rugby union and rugby league: are incidence rates declining in NSW?

Objectives: To estimate trends in incidence rates of rugby code‐related severe cervical spinal cord injuries in New South Wales (NSW) from 1986 to 2003. To evaluate the Australian Spinal Cord Injury Register (ASCIR) for injury surveillance by comparison with two published studies.

Return to work and functional outcomes after major trauma: Who recovers, when, and how well?

Objective:To describe the long-term outcomes of major trauma patients and factors associated with the rate of recovery. Background:As injury-related mortality decreases, there is increased focus on improving the quality of survival and reducing nonfatal injury burden. Methods:Adult major trauma survivors to discharge, injured between July 2007 and June 2012 in Victoria, Australia, were followed up at 6, 12, and 24 months after injury to measure function (Glasgow Outcome Scale—Extended) and return to work/study. Random-effects regression models were fitted to identify predictors of outcome and differences in the rate of change in each outcome between patient subgroups. Results:Among the 8844 survivors, 8128 (92%) were followed up. Also, 23% had achieved a good functional recovery, and 70% had returned to work/study at 24 months. The adjusted odds of reporting better function at 12 months was 27% (adjusted odds ratio 1.27, 95% confidence interval [CI] 1.19–1.36) higher compared with 6 months, and 9% (adjusted odds ratio 1.09, 95% CI, 1.02–1.17) higher at 24 months compared with 12 months. The adjusted relative risk (RR) of returning to work was 14% higher at 12 months compared with 6 months (adjusted RR 1.14, 95% CI, 1.12–1.16) and 8% (adjusted RR 1.08, 95% CI, 1.06–1.10) higher at 24 months compared with 12 months. Conclusions:Improvement in outcomes over the study period was observed, although ongoing disability was common at 24 months. Recovery trajectories differed by patient characteristics, providing valuable information for informing prognostication and service planning, and improving our understanding of the burden of nonfatal injury.

Suicide decline in Australia: where did the cases go?

Objectives : To describe the causes of death codes assigned in Australian Bureau of Statistics (ABS) mortality data to deaths in Australia from 2000 to 2005 that were coded as intentional self‐harm (suicide) in the National Coroners Information System (NCIS).

Comparison of measures of comorbidity for predicting disability 12-months post-injury

BackgroundUnderstanding the factors that impact on disability is necessary to inform trauma care and enable adequate risk adjustment for benchmarking and monitoring. A key consideration is how to adjust for pre-existing conditions when assessing injury outcomes, and whether the inclusion of comorbidity is needed in addition to adjustment for age. This study compared different approaches to modelling the impact of comorbidity, collected as part of the routine hospital episode data, on disability outcomes following orthopaedic injury.Methods12-month Glasgow Outcome Scale – Extended (GOS-E) outcomes for 13,519 survivors to discharge were drawn from the Victorian Orthopaedic Trauma Outcomes Registry, a prospective cohort study of admitted orthopaedic injury patients. ICD-10-AM comorbidity codes were mapped to four comorbidity indices. Cases with a GOS-E score of 7–8 were considered “recovered”. A split dataset approach was used with cases randomly assigned to development or test datasets. Logistic regression models were fitted with “recovery” as the outcome and the performance of the models based on each comorbidity index (adjusted for injury and age) measured using calibration (Hosmer-Lemshow (H-L) statistics and calibration curves) and discrimination (Area under the Receiver Operating Characteristic (AUC)) statistics.ResultsAll comorbidity indices improved model fit over models with age and injuries sustained alone. None of the models demonstrated acceptable model calibration (H-L statistic p < 0.05 for all models). There was little difference between the discrimination of the indices for predicting recovery: Charlson Comorbidity Index (AUC 0.70, 95% CI: 0.68, 0.71); number of ICD-10 chapters represented (AUC 0.70, 95% CI: 0.69, 0.72); number of six frequent chronic conditions represented (AUC 0.70, 95% CI: 0.69, 0.71); and the Functional Comorbidity Index (AUC 0.69, 95% CI: 0.68, 0.71).ConclusionsThe presence of ICD-10 recorded comorbid conditions is an important predictor of long term functional outcome following orthopaedic injury and adjustment for comorbidity is indicated when assessing risk-adjusted functional outcomes over time or across jurisdictions.

Alcohol and drowning in Australia

Objectives. To examine the contribution of alcohol to drowning deaths in Australia. Methods. Drowning deaths that occurred in Australia (excluding Queensland) from 1 July 2000 to 30 June 2001 were identified using the National Coroners Information System (NCIS). The current analysis was based on those deaths for which the Coronial process was completed by March 2003 (‘Closed’ cases). Comparison was made with the Australian Bureau of Statistics (ABS) national deaths data and with currently used values of attributable fractions for alcohol and drowning in Australia (these values are based on USA data on drownings from 1980 to 1984). Results. 289 drowning deaths were identified, 5% less than comparable ABS data. Of these deaths, 240 were ‘Closed’ cases, and valid blood alcohol measurements were available for 137 (58%) of these. Alcohol appeared to contribute to approximately 19% of these fatal drowning incidents (25% for recreational aquatic activity; 16% for incidental falls into water; 12% for drowning due to suicide). Using ≥0.10 g/100 ml as the cut-off, the estimated all-ages proportions of unintentional drowning attributed to alcohol was 17% in the current study, compared to the 34% currently used for Australia based on data from North America. Conclusions and implications. A high level of alcohol appears to be present less frequently among recent drowning deaths in Australia than has been assumed to be the case to date. Nevertheless, many drowning victims have high levels of blood alcohol, and public health efforts to minimize the use of alcohol in association with activity on or near water should be continued. Despite some deficiencies, the NCIS appears to be a very useful source of information on public health issues, and to provide a better basis for assessing and monitoring alcohol-related drowning deaths in Australia than the published attributable fractions used to date.