Where to Start? Developing Injury Prevention Priority Scores for Traumatic Injury Resulting in Hospitalization or Death Among Canadians

Abstract

Background: Given limited resources, it is essential to determine which mechanisms of injury (MOI) should be prioritized for injury prevention. We developed objective, Injury Prevention Priority Scores (IPPS) for the Canadian population across four priority metrics: mortality, severity, resource utilization, and societal cost.

Methods: A retrospective cohort study was performed examining Canadians with traumatic injuries from 2009-2014 resulting in hospitalization or death, from the Canadian Institute of Health Information’s Discharge Abstract Database and Statistics Canada Vital Statistics database. For each MOI, an IPPS was calculated by balancing both the standardized relative frequency of the injury and a secondary metric: mortality rate; severity [ICD10-derived Injury Severity Score (ICISS)]; resource utilization (hospitalization costs); and societal burden [Years of Potential Life Lost; (YPLL)]. The ICISS represents the probability of death from the specific injury. Separate IPPS were computed across each domain at the provincial level and in three separate age groups: young (0-19 years old), middle-aged (20-59 years old) and elderly (over 60 years old). IPPS across each priority metric were also compared in provinces with inclusive trauma systems and provinces without.

Results: 694,535 injuries were identified: 629,490 non-fatal hospitalizations and 65,045 deaths. The top three most frequent MOI included falls (56.3%), motor vehicle collisions (10.5%) and other (9.2%). The overall mortality rate was 0.09 and was highest in intentional-self harm (0.72), drowning (0.66) and suffocation (0.32). The overall median ICISS was 0.019 and was highest in drowning (0.148), suffocation (0.101) and pedestrian incidents (0.037). The overall median hospitalization cost was $6099 per injury and was highest in fires ($9500), suffocation ($9100) and falls ($7800). The overall median potential years of life lost was 0 and was highest in legal interventions (38 years), assault (38 years) and firearm incidents (38 years).

The top three MOI for mortality were falls (IPPS 75), self-harm (IPPS 67) and drowning (IPPS 66). The top three MOI for injury severity were falls (IPPS 77), drowning (IPPS 70) and suffocation (IPPS 61). The top three MOI for resource utilization were falls (IPPS 81), fires (IPPS 61) and suffocation (IPPS 60). The top three MOI for PYLL were falls (IPPS 72), assault (IPPS 62) and firearms (IPPS 59).

The top three MOIs are consistent across provinces in all priority metrics examined, except Prince Edward Island and the Yukon/Territories. There are marked differences in IPPS rankings in different age groups. The presence or absence of an inclusive trauma system did not change the IPPS rankings across each domain.

Conclusion: IPPS provides a useful tool to evaluate the relative burden of mechanisms of injury. Falls consistently demonstrate a high IPPS across all domains of injury prevention, and if prevented, would provide the most benefit to the largest population in Canada.