Underestimating injury mortality using statewide databases

J Trauma. 2005 Jan;58(1):162-7. doi: 10.1097/01.ta.0000114067.37731.da.


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.

MeSH terms

  • Adult
  • Aged
  • Analysis of Variance
  • Cause of Death
  • Chi-Square Distribution
  • Databases, Factual*
  • Death Certificates
  • Emergency Medical Services / statistics & numerical data*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Humans
  • Injury Severity Score
  • Male
  • Middle Aged
  • Patient Discharge / statistics & numerical data
  • Probability
  • Utah / epidemiology
  • Wounds and Injuries / mortality*