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|4C Injury-Related Hospitalization
Description | Specific Indicators | Ontario Public Health Standards (OPHS) | Corresponding Health Indicator(s) from Statistics Canada and CIHI | Corresponding Indicators from Other Sources | Data Sources | Alternative Data Sources | Survey Questions | ICD Codes | Analysis Check List | Method of Calculation | Basic Categories | Indicator Comments | Definitions | Cross-References to Other Sections | Cited References | Other References | Changes Made | Acknowledgements
- Crude hospitalization rate for injury - the number of hospitalizations for selected causes of injury relative to the total population during a given year (fiscal or calendar) (usually expressed per 100,000).
- Age-specific hospitalization rates for injury - the number of hospitalizations for selected causes of injury in a given age group per population in that age group during a given year (fiscal or calendar) (usually expressed per 100,000).
- Age-standardized hospitalization rate (SRATE) for injury - the number of hospitalizations for selected causes of injury per 100,000 population that would occur in the population if it had the same age distribution as the 1991 Canadian population.
- Standardized morbidity ratio (SMR) for injury - the ratio of observed hospitalizations for selected causes of injury to the number expected if the population had the same age-specific hospitalization rates as Ontario.
|Specific Indicators |
- Crude Hospitalization Rate
- Age-Specific Hospitalization Rate
- Age-Standardized Hospitalization Rate (SRATE)
- Standardized morbidity ratio (SMR) for specific unintentional injury (e.g., hospitalization for injury due to all causes, burns, falls, poisoning etc.)
- Injury-specific Standardized Morbidity Ratio (SMR) for intentional injury due to:
|Ontario Public Health Standards (OPHS)|
The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.
|Outcomes Related to this Indicator|
- Board of Health Outcome (Prevention of Injury and Substance Misuse): The board of health is aware of and uses epidemiology to influence the development of healthy public policy and its programs and services for the prevention of injury and substance misuse.
- Board of Health Outcome (Foundational Standard): The public, community partners and health care providers are aware of relevant and current population health information.
|Assessment and Surveillance Requirements Related to this Indicator (Prevention of Injury and Substance Misuse)|
- The board of health shall conduct epidemiological analysis of surveillance data in the areas of injury and substance misuse outcomes.
|Corresponding Indicator(s) from Statistics Canada and CIHI|
- Age-Standardized Injury Hospitalization Rate (per 100 000)
|Corresponding Indicator(s) from Other Sources|
|Data Sources (see Resources: Data Sources)|
Numerator: National Ambulatory Care Reporting System
Original source: National Ambulatory Care Reporting System (NACRS), Canadian Institute of Health Information (CIHI)
Distributed by: Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH ONTARIO (IntelliHEALTH)
Suggested citation (see Data Citation Notes): Ambulatory Emergency External Cause [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].
Denominator: Population Estimates
Original source: Statistics Canada
Distributed by: Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH ONTARIO (IntelliHEALTH)
Suggested citation (see Data Citation Notes): Population Estimates [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].
|Alternative Data Sources |
- Ontario Trauma Registry
- Discharge Abstract Database (DAD) (Hospitalization) Note: for those interested in using hospitalization data from DAD, to avoid double counting of those patients that were admitted to one hospital and then transferred to another (e.g. to a regional trauma hospital), please use the ‘Inpatient Discharges All Tables' and add in the following filter when extracting hospital discharge data:
- 'Transfer from Institution Type' not equal to #1 - which is 'acute care facilities'
- Please refer to Indicator Comments for rationale for choice of data source.
Please refer to the Recommended ICD10-CA codes for Injury Core Indicators document and Recommended ICD-10 groupings for injury Core Indicators Stata syntax file.
|Analysis Check List |
- Aggregation (e.g. combining years, age groups, categories) should also be considered when small numbers result in unstable rates.
- IntelliHEALTH Ontario is developing a complete set of pre-defined reports for injury-related Core Indicators, (i.e., templates that permit standardized queries by local public health agencies). Registered IntelliHEALTH users can find a predefined report called 'Hospitalization - Ext Cause of Injury - PHU indicator list' inthe APHEO Public Health Indicators folder in the Standard Reports section.
- An 'Ambulatory Visits User Guide' is available within IntelliHEALTH.
- The Report Inventory and Webinar Materials tab contains information on pre-defined reports and webinar materials, including information on external causes of injury from a webinar on the pre-defined report titled 'Emergency Visits - External Causes of Injury - PHU'. The webinar material provides guidance on how to extract external cause hospitalization and mortality data.
- It is important to note that an individual can have more than one external cause diagnosis for each hospitalization. Unlike with other ICD-10 diagnostic codes, no ‘most responsible diagnosis' exists for external cause diagnosis.
- For in-patient hospitalization in IntelliHEALTH: Use Ambulatory Emergency External Cause (Chapter 20) source from the '04 Ambulatory visits' folder. Please note that this source differs from the Ambulatory All Visits Main Table in that it only includes unscheduled ED visits. If using the Ambulatory All Visits Main Table, the filter "AM Case Type = EMG" must be used to extract only unscheduled ED visits and disposition status = 6, 7 or 8.
- Unintentional Injuries:
- For all unintentional injury hospitalizations, filter for ‘ICD10 Block All Dx' and select blocks V01 through X59, and Y85-Y89.
- Add in a filter on ‘ICD10-CA Problem (3 char) All Dx' to filter not equal to for 'Y87', 'Y88' and 'Y89', as these codes are not part of unintentional injuries.
- The ‘ICD10 Block All Dx' and ‘ICD10-CA Problem (3 char) All Dx' MUST be hidden under the Assign Data option, in order to avoid double counting. For example, a person who has both a V03 code and W10, will only be counted once.
- To select clients admitted as inpatients, use the 'Disposition Status' variables = '6' - (i.e.'Client admitted as inpatient to critical care unit/operating room in reporting facility difect from amb care visit functional center') OR = '7' ('Client admitted as inpatient to other units in reporting facility direct from amb. care visit functional') OR = '8' (Transferred to another acute care facility directly from an ambulatory care visit functional centre).
- Select # Visits (D) measure.
- For intentional injuries:
- For all intentional hospitalizations, filter for ‘ICD10 Block All Dx' and select blocks X60-X84 and X85-Y09 (Filter A).
- Add in a filter on ‘ICD10-CA Problem (4 char) All Dx' to filter equal to for 'Y870', and 'Y871' (Filter B). (Please note: decimal points normally found in these ICD10-CA codes (e.g. ‘Y87.1') have been removed as four character ICD10-CA codes must be entered into IntelliHEALTH without decimal points)
- In the ‘Combine filter', cases must consist of Filter A OR Filter B. If using other custom filters (eg. Filter C), brackets must be used around this request. Eg. (Filter A or Filter B) AND Filter C.
- The ‘ICD10 Block All Dx' and ‘ICD10-CA Problem (4 char) All Dx' MUST be hidden under the Assign Data option, in order to avoid double counting.
- To select clients admitted as inpatients, use the 'Disposition Status' variables = '6' - (i.e.'Client admitted as inpatient to critical care unit/operating room in reporting facility direct from amb care visit functional center') OR = '7' ('Client admitted as inpatient to other units in reporting facility direct from amb. care visit functional') OR = '8' (Transferred to another acute care facility directly from an ambulatory care visit functional centre).
- Select # Visits (D) measure.
- For all unintentional injury hospitalizations by ICD10-CA block, include the ‘ICD10 Block All Dx‘ variable (not hidden) in your report. For example, a person who has both a V03 code and W10, will be counted twice, once in the V01-V09 block and once in the W00-W19 block.
- Distinct counts - a patient can have more than one diagnosis code for one visit (eg. cardiovascular disease). In such cases, one code is deemed ‘the most responsible diagnosis code' or main problem Dx (or MRDx is some data sources). Diagnoses that are identified as due to external causes (eg. fractured elbow) also have a companion "external cause" ICD-10-CA code. A person can have more than one external cause diagnosis for one visit. However, unlike the diagnoses codes mentioned above, external cause diagnoses do not have a main problem diagnosis in emergency (or other hospital) data. Thus, the external cause diagnoses are only included in the multi-record per visit data sources such as the Ambulatory Emergency External Cause (Chapter 20) source. Because the source has multiple records per visit, only distinct counts (# Visits (D)) can be used in order tally number of visits. IntelliHEALTH can now create crosstab tables and sum across distinct counts for external causes (Note: because the column total is a distinct count, it may be smaller than the sum of the cells within the column). For more information, please see the Report Inventory and Webinar Materials and Training sections within IntelliHEALTH.
- Use the pre-defined filter to select the appropriate geography (e.g. public health unit, LHIN) before running the report. Hospital information (hospital name, PHU or LHIN) can also be selected in the report.
- Note that ambulatory care data (and in-patient data) are reported by fiscal year (April 1 - March 31). Any changes in the source data occur on a fiscal year basis (e.g., ICD10 reporting began on April 1, 2002) and will affect reporting by calendar year.
- 'Place of occurrence' may also be used for codes W00-Y34 to identify place of external cause. Please note that there may be a large number of cases where place of occurrence is missing or not specfied.
- NOTE**Intellihealth has made a change and will now expose both historical data and current fiscal year data in the NACRS maps - folder 04. In practice, you will need to pay close attention to year filtering when creating reports using maps in folder 04 - as the most recent year may not have a complete year of data.
Method of Calculation
|total number of injury-related hospitalizations || x 100,000|
|total population |
|total number of injury-related hospitalizations in a given age group || x 100,000|
|total population in that age group|
SRATE (See Resources: Standardization of Rates)
|sum of (injury-related hospitalizations in a given age group x 1991 Canadian population in that age group)|| x 100,000|
|sum of 1991 Canadian population|
SIR (See Resources: Standardization of Rates)
sum of injury-related hospitalizations in the population
| x 100 |
sum of (Ontario age-specific rate x population in that age group)
|Basic Categories |
- Suggested Age Groups:
- <1-19 yr, 20-44, 45-64, 65-74, 75+. (IntelliHEALTH Chronic Disease age groups -Age Group (CD)) or
- <1, 1-4, then 5 yr groups to 90+. (IntelliHEALTH Infant + 5-yr age groups - (inf,5yr))
*Note: Health units may choose to merge age categories due to small numbers, or change age categories depending on the specific analysis questions. Examples of other potential age categories include:
- '<1, 1-4 could be changed to "0-4"
- ‘Youth' could be analyzed as '15-24', a common category for analyzing self-harm data
- ‘Seniors/Older adults' could be analyzed as ages "65+"
- Sex: male, female and total
- Geographic areas of residence: Ontario, public health unit, municipality, and smaller areas of geography based on aggregated postal code
|Indicator Comments |
Choice of Data Source:
- NACRS, and not DAD, captures admissions to acute care psychiatric beds. For this reason, NACRS is used to derive the Intentional Self-Harm-Related Hospitalization Core Indicator. For consistency, NACRS is also the recommended data source for all other injury-related hospitalization indicators (i.e. Injury-Related Hospitalization, Fall-Related Hospitalization and Neurotrauma-Related Hospitalization).
- More timely information is provided through NACRS as injury data are based on admission to an inpatient bed from the emergency department. Discharge information following injury-related hospitalization obtained from the DAD may not be captured in the same year in which the injury occurred for some patients (especially those hospitalized for a prolonged period of time).
- All non-elective hospital admissions (i.e. including all hospital admissions for injury) must first be admitted to the emergency department and thus, will be captured in NACRS. Sometimes a patient seen in one ED can be transferred to another acute care facility. Ideally, a person that is transferred to another acute care facility will enter through the ED and receive a NACRS record with the new facility, however, this does not always occur. Thus, we recommend the inclusion of disposition status code '8', even though this may result in some over-counting of visits. Over-counting varied between 7% and 10% over the past several years in Ontario.
- Note that injury events found in DAD will not be identical to those found in NACRS:
- DAD also captures injury events that occur in acute care (e.g. a fracture from a fall in hospital will not be captured in NACRS). However, in-care injury events reflect patient safety within hospitals rather community safety, which is of greater public health concern.
- ICD-10-CA codes assigned based on emergency department presentation may differ from those assigned on discharge after hospitalization.
- Hospitalization - in this indicator, a hospitalization occurs when a patient is admitted as an inpatient after being seen in the emergency department for an unscheduled visit.
|Cross-References to Other Sections |
|Cited References |
- Hofman K, Primack A, Deush G, Hrynkow S. Addressing the growing burden of trauma and injury in low- and middle-income countries. Am J Public Health. 95(1); 2005: 13 - 7.
- Canadian Institute for Health Information. National Trauma Registry 2006 injury hospitalizations highlights report. Ottawa: Canadian Institute for Health Information; 2006 [cited 2012 Jul 10]. Available from: https://secure.cihi.ca/free_products/ntr_highlights_2006_en.pdf.
- Canadian Institute for Health Information. Injury hospitalizations and socio-economic status. Ottawa: Canadian Institute for Health Information; 2010 [cited 2012 Jul 10]. Available from: https://secure.cihi.ca/free_products/Injury_aib_vE4CCF_v3_en.pdf.
- Public Health Agency of Canada [homepage on the Internet]. Ottawa: Public Health Agency of Canada; 2010 Feb 1 [cited 2012 Jul 10]. Injury Surveillance On-line. Available from: http://dsol-smed.phac-aspc.gc.ca/dsol-smed/is-sb/index-eng.php.
- Centers for Disease Control and Prevention [homepage on the Internet]. Atlanta: Centers for Disease Control and Prevention; 2009 Nov 25 [cited 2012 Jul 10]. ICD 10 Injury Matrices. Available from: http://www.cdc.gov/nchs/injury/injury_matrices.htm Matrix File: http://www.cdc.gov/nchs/data/ice/icd10_transcode.pdf User friendly Matrix file: http://www4.state.nj.us/dhss-shad/query/InjuryMatrix.html.
- Holder Y, Peden M, Krug E, Lund J, Gururaj G, Kobusingye O, editors. Injury Surveillance Guidelines. Geneva: World Health Organization; 2001[cited 2012 Jul 10]. Available from: http://whqlibdoc.who.int/publications/2001/9241591331.pdf.
- Canadian Institute for Health Information. National Trauma Registry Report: injury hospitalization, 2004 report. Ottawa: Canadian Institute for Health Information; 2004 [cited 2012 Jul 10]. Available from: https://secure.cihi.ca/free_products/NTRInjuryHosp2004.pdf.
- Canadian Institute for Health Information [homepage on the Internet]. Ottawa: Canadian Institute for Health Information; 1996-2012 [cited 2012 Jul 9]. Trauma and injuries. Available from: http://www.cihi.ca/CIHI-ext-portal/internet/EN/TabbedContent/types+of+care/specialized+services/trauma+and+injuries/cihi010639.
- Canadian Institute for Health Information. Ontario Trauma Registry 2011 Report: Major injury in Ontario, 2009 - 2010 data. Ottawa: Canadian Institute for Health Information; 2011 [cited 2012 Jul 9]. Available from: https://secure.cihi.ca/free_products/OTR_CDS_2009_2010_Annual_Report.pdf.
- Macpherson AK, Schull MJ, Manuel D, Cernat C, Redelmeier DA, Laupacis A. Injuries in Ontario: ICES Atlas. Toronto, ON: Institute for Clinical Evaluative Sciences; 2005 [cited 2012 Jul 9]. Chapter 1, General Description of Injuries in Ontario. 2002-2003; p. 1-22. Available from: http://www.ices.on.ca/file/injuries_chp1_final.pdf.
- SMARTRISK. The economic burden of injury in Canada. Toronto: SMARTRISK; 2009 [cited 2012 Jul 9]. Available from: http://www.smartrisk.ca/downloads/burden/Canada2009/EBI-Eng-Final.pdf.
- Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, Fazlur Rahman AKM, et al, editors. World report on child injury and prevention. Geneva: World Health Organization, 2008 [cited 2012 Jul 9]. Available from: http://whqlibdoc.who.int/publications/2008/9789241563574_eng.pdf.
|Changes Made |
Type of Review (Formal Review or Ad Hoc?)
Changes made by
August 3, 2012
Injury and substance misuse prevention sub-group
- Modified indicator name.
- Added new section on OPHS.
- Updated data source information to reflect use of IntelliHEALTH Ontario.
- Updated ICD-10-CA codes based on CDC external cause of injury matrix (5) and SMARTRISK recommendations.
- Revised "Basic Categories" to reflect categories available through IntelliHEALTH Ontario.
- Updated indicator comments and definitions.
- Updated cited references and other references.
- Updated ICD-10-CA codes for Motor Vehicle Traffic Crashes based on the matrix that the International Collaborative Effort on Injury Statistics has put together and posted on the US National Center for Health Statistics website. Changed title back from Motor Vehicle Crashes (title was changed in 2008).
- Suzanne Fegan, KFL&A Public Health (Subgroup Lead)
- Michelle Policarpio, Public Health Ontario
- Injury and Substance Misuse Prevention Subgroup
- Christina Bradley, Niagara Region Public Health
- Badal Dhar, Public Health Ontario
- Jeremy Herring, Public Health Ontario
- Natalie Greenidge, Public Health Ontario
- Sean Marshall, Public Health Ontario
- Jayne Morrish, Parachute
- Lee-Ann Nalezyty, Northwestern Health Unit
- Narhari Timilshina, Toronto General Hospital
- Katherine Russell, Ottawa Public Health (Core Indicators Work Group member)