title: Underestimating injury mortality using statewide databases.
abstract: 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.
  
  
  CONCLUSIONS
  Estimates of injury mortality substantially increase when using multiple independent databases.
authors.affiliation: Intermountain Injury Control Research Center, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah 84108, USA. clay.mann@hsc.utah.edu
authors.forename: N Clay
authors.initials: NC
authors.lastname: Mann
authors.forename: Stacey
authors.initials: S
authors.lastname: Knight
authors.forename: Lenora M
authors.initials: LM
authors.lastname: Olson
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Cook
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002423:Cause of Death; D016009:Chi-Square Distribution; D016208:Databases, Factual; D003644:Death Certificates; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D011336:Probability; D014589:Utah / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality*