title: International variation in clinical injury incidence: exploring the performance of indicators based on health care, anatomical and outcome criteria.
abstract: OBJECTIVE
  To analyse international variation in clinical injury incidence, and explore the performance of different injury indicators in cross-country comparisons.
  
  
  METHODS
  Hospital discharge data of seven European countries (Austria, Denmark, Ireland, Netherlands, Norway, England and Wales) were analysed. We tested existing and newly developed indicators based on (a) health care use, (b) anatomical criteria, or (c) expected health outcome: admissions excluding day-cases (a), hospital stay 4+ (a) and 7+ days (a), (serious) long-bone fractures (b), selected radiological verifiable fractures 'SRVFs' (b), and indicators based on international (Global Burden of Disease) and Dutch disability weights). Assessment criteria were reduction in incidence variation and length of stay in hospital, and the association between incidence and mortality rates.
  
  
  RESULTS
  Indicators based on health care use led to increased variation in incidence rates. Long bone fractures and SRVFs, and both indicators based on injuries with moderate to high disability showed similar variation in clinical incidence compared to the crude rates, smaller variation in median length of stay in hospital and a good association with mortality rates.
  
  
  CONCLUSIONS
  No perfect or near perfect indicators of clinical injury incidence exist. For international comparisons, indicators based on disability weights, SRVFs and long bone fractures may be sensible indicators to use, in the absence of a direct measure of anatomical severity.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Centre, Ae-128, P.B. 2040, 3000 CA Rotterdam, The Netherlands. s.polinder@erasmusmc.nl
authors.forename: Suzanne
authors.initials: S
authors.lastname: Polinder
authors.forename: Willem Jan
authors.initials: WJ
authors.lastname: Meerding
authors.forename: Ronan A
authors.initials: RA
authors.lastname: Lyons
authors.forename: Juanita A
authors.initials: JA
authors.lastname: Haagsma
authors.forename: Hidde
authors.initials: H
authors.lastname: Toet
authors.forename: Eleni Th
authors.initials: ET
authors.lastname: Petridou
authors.forename: Saakje
authors.initials: S
authors.lastname: Mulder
authors.forename: Ed F
authors.initials: EF
authors.lastname: van Beeck
mesh_terms: D004185:Disability Evaluation; D005060:Europe / Q000453:epidemiology; D006305:Health Status Indicators; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D015588:Observer Variation; D017063:Outcome Assessment, Health Care; D015203:Reproducibility of Results; D014947:Wounds and Injuries / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology*