title: Establishing an injury indicator for severe paediatric injury.
abstract: Routinely gathered injury data, such as hospitalisations, may be subject to variation from sources other than injury incidence. There is a need for an indicator that defines severe injury, which may be less vulnerable to fluctuations due to changes in care policies. The purpose of this study was to identify International Classification of Diseases-10 codes associated with severe paediatric injuries and to specify and validate a severe paediatric injury indicator.
  
  
  
  Two data sets that included the ISS and the survival risk ratio were used to produce a list of diagnoses to define severe paediatric injury. The list was sent to trauma surgeons who classified each code as severe enough or not severe enough to require care in a trauma centre. The indicator was fully specified, then validated by using a different data set to validate the codes in a real-world situation.
  
  
  
  Sixty diagnoses were identified as representing severe paediatric injury. Following specification, the indicator was applied to an existing comprehensive data set of paediatric injuries. The decline in hospitalisation of paediatric injuries was significantly steeper for severe than non-severe injuries, suggesting that factors related to the decline in this trauma subset are unlikely to be related to changes in access or other components of trauma care delivery.
  
  
  
  This indicator can be used for the evaluation of trends in severe paediatric trauma and will help identify populations at risk. This research may inform policies and procedures for referrals of severe childhood injury to appropriate levels of care.
authors: Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.|BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, British Columbia, Canada.
authors: Ian
authors: I
authors: Pike
authors: School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
authors: Mina
authors: M
authors: Khalil
authors: Division of Pediatric General Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada.
authors: Natalie L
authors: NL
authors: Yanchar
authors: School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
authors: Hala
authors: H
authors: Tamim
authors: Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors: Avery B
authors: AB
authors: Nathens
authors: School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
authors: Alison K
authors: AK
authors: Macpherson
mesh_terms: D000293:Adolescent; D002170:Canada; D002648:Child; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D038801:International Classification of Diseases / Q000639:trends; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012042:Registries; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000145:classification*