Journal of Preventive Medicine and Public Health

Brief Report

The Pyramid of Injury: Estimation of the Scale of Adolescent Injuries According to Severity: Hyejin Han, Bomi Park, Bohyun Park, Namsoo Park, Ju Ok Park, Ki Ok Ahn, Yang Ju Tak, Hye Ah Lee, Hyesook Park; J Prev Med Public Health. 2018;51(3):163-168. Published online May 23, 2018; DOI: https://doi.org/10.3961/jpmph.18.027

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Objectives
Due to their developmental characteristics, adolescents have a higher probability than other age groups of experiencing injuries caused by accidents, violence, and intentional self-harm. The severity and characteristics of injuries vary by the intentionality and mechanism of injury; therefore, there is a need for a national-level estimate of the scale and the severity of injuries in adolescents that takes these factors into account.
Methods
By using data from the Emergency Department-based Injury In-depth Surveillance Data, National Emergency Department Information System, the Korean National Hospital Discharge In-depth Injury Survey, and cause of death statistics, we calculated the emergency department (ED) visit rate, hospitalization rate, and death rate of injuries per 100 000 adolescents for each injury mechanism. The calculated rates were used to generate the injury pyramid ratio (ratio of death rate to hospitalization rate to ED visit rate) to visualize the scale and the severity of the injury.
Results
The mortality rate in adolescents due to injury was 10/100 000; the corresponding rates for hospitalization and ED visits were 1623 and 4923, respectively, resulting in an injury pyramid ratio with the general pyramid form, with a 1:162:492 ratio of deaths to hospitalizations to ED visits. The mortality rate due to suicide/intentional self-harm was 5/100 000, while 35 were hospitalized for this reason and 74 made ED visits. The pyramid ratio of 1:7:15 for intentional self-harm/suicide showed a steep pyramidal form, indicating considerable lethality. The mortality rate due to motor vehicle collisions (MVCs) was 3/100 000; 586 were hospitalized for this reason, while 1023 made ED visits. The pyramid ratio of 1:195:341 for MVCs showed a gradual pyramid form, indicating that the lethality was low and the scale of injury was high.
Conclusions
The main categories of injuries in adolescents were visualized in pyramid form, contributing to an understanding of the scale of each injury by mechanism in terms of levels of death, hospitalization, and ED visits. These findings will be helpful for understanding how to prioritize injuries in adolescents.

Summary

Citations

Citations to this article as recorded by

Burden of Childhood Injuries in India and Possible Public Health Interventions: A Systematic Review
Mohan Kumar, Vineet Kumar Pathak, Saparya Tripathi, Anita Upadhyay, Vivek V. Singh, Chandrakant Lahariya
Indian Journal of Community Medicine.2023; 48(5): 648. CrossRef
Joinpoint Regression About Injury Mortality and Hospitalization in Korea
Hyun Jin Park, Ui Jeong Kim, Won kyung Lee, Bohyun Park, Yoonhee Shin, Seonhwa Lee, Eun Jeong Choi, Nam-eun Kim, Ju Ok Park, Hyesook Park
Journal of Korean Medical Science.2022;[Epub] CrossRef
Identifying intentional injuries among children and adolescents based on Machine Learning
Xiling Yin, Dan Ma, Kejing Zhu, Deyun Li, Kyoung-Sae Na
PLOS ONE.2021; 16(1): e0245437. CrossRef
The injury mechanisms and injury pyramids among children and adolescents in Zhuhai City, China
Xiling Yin, Wencan Dai, Yukai Du, Deyun Li
BMC Public Health.2021;[Epub] CrossRef
Comparison of Intentional and Unintentional Injuries Among Chinese Children and Adolescents
Xiling Yin, Deyun Li, Kejing Zhu, Xiaodong Liang, Songxu Peng, Aijun Tan, Yukai Du
Journal of Epidemiology.2020; 30(12): 529. CrossRef
Global Lifetime and 12-Month Prevalence of Suicidal Behavior, Deliberate Self-Harm and Non-Suicidal Self-Injury in Children and Adolescents between 1989 and 2018: A Meta-Analysis
Kim-San Lim, Celine H. Wong, Roger S. McIntyre, Jiayun Wang, Zhisong Zhang, Bach X. Tran, Wanqiu Tan, Cyrus S. Ho, Roger C. Ho
International Journal of Environmental Research and Public Health.2019; 16(22): 4581. CrossRef

English Abstract

The Incidence Rates and Risk Factor of Mild Injury for Two Weeks: Using Korea National Health and Nutrition Examination Survey 2001.: Jesuk Lee, Soonduck Kim, Dongki Lee, Jisung Lee; J Prev Med Public Health. 2008;41(4):279-286.; DOI: https://doi.org/10.3961/jpmph.2008.41.4.279

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Abstract PDF

OBJECTIVES
This study was performed to provide the basic data for establishing countermeasures for preventing injury by analyzing the incidence rates, the risk factors, the characteristics of the injury and the utilization of medical care for mild injury that lasted for two weeks. METHODS: We examined the injury survey data among the National Health and Nutrition Survey data. The definition of mild injury that lasted for two weeks was that the injury that caused pain at least once a day for two weeks or the injury for which the usual daily activity of the injured person was severely affected. We used statistical analysis methods such as chi-square test and multiple logistic regression analysis. RESULTS: The incidence rate of injury that lasted for two weeks was 4.7 per 1,000 persons. On the multiple logistic regression, the children and adolescents (OR=3.80, 95%CI=1.63-8.84) had higher rates of injuries than the adults, and the middle and high school (OR=0.51, 95%CI=0.31-0.85) and college(OR=0.34, 95%CI=0.17-0.68) students had lower rates of injuries than the elementary school students. The unemployed (OR=0.39, 95%CI=0.20-0.73) and others (OR=0.38, 95%CI=0.21-0.70) had lower rates of injuries than the blue collar workers. The major causes of injuries were found to be falling and slipping, and the most prevalent place of occurrence was near or at home. CONCLUSIONS: A prevention program needs to be developed and continuous education must be offered to the children, adolescents and blue collar workers.

Summary

Citations

Citations to this article as recorded by

The Relationship between Injury and Socioeconomic Status in Reference to the Fourth Korean National Health and Nutrition Examination Survey
Sung-Kyung Kim, Hyocher Kim, Kyungsuk Lee, Hee-Tae Kang, Sung-Soo Oh, Sang Baek Ko
Annals of Occupational and Environmental Medicine.2014;[Epub] CrossRef
Patterns of Unintentional Domestic Injuries in Korea
Eun-Jung Lee, Jin-Seok Lee, Yoon Kim, Kunhee Park, Sang Jun Eun, Soo Kyung Suh, Yong-Ik Kim
Journal of Preventive Medicine and Public Health.2010; 43(1): 84. CrossRef

Original Articles

Severity Measurement Methods and Comparing Hospital Death Rates for Coronary Artery Bypass Graft Surgery.: Youngdae Kwon, Hyungsik Ahn, Youngsoo Shin; Korean J Prev Med. 2001;34(3):244-252.

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Abstract PDF: OBJECTIVE
Health insurers and policy makers are increasingly examining the hospital mortality rate as an indicator of hospital quality and performance. To be meaningful, a risk-adjustment of the death rates must be implemented. This study reviewed 5 severity measurement methods and applied them to the same data set to determine whether judgments regarding the severity-adjusted hospital mortality rates were sensitive to the specific severity measure. METHODS: The medical records of 584 patients who underwent coronary artery bypass graft surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups, Disease Staging, Computerized Severity Index, APACHElll and KDRG were used to quantify severity of the patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex to evaluate the hospitals' performance, the ratio of the observed number of deaths to the expected number for each hospital was calculated. RESULTS: The overall in-hospital mortality rate was 7.0%, ranging from 2.7% to 15.7% depending on the particular hospital. After the severity adjustment, the mortality rates for each hospital showed little difference according to the severity measure. The 5 severity measurement methods varied in their statistical performance. All had a higher c statistic and R2 than the model containing only age and sex. There was a little difference in the relative hospital performance evaluation by the severity measure. CONCLUSION: These results suggest that judgments regarding a hospital's performance based on severity adjusted mortality can be sensitive to the severity measurement method. Although the 5 severity measures regarding hospital performance concurred, more often than would be expected by chance, the assessment of an individual hospital mortality rates varied by the different severity measurement method used.; Summary

Validation of the International Classification of Diseases 10th Edition Based Injury Severity Score(ICISS).: Yoon Kim, Ku Young Jung, Chang Yup Kim, Yong Ik Kim, Youngsoo Shin; Korean J Prev Med. 1999;32(4):538-545.

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Abstract PDF: OBJECTIVE
To compare the predictive power of International Classification of Diseases 10th Edition(ICD-10) based International Classification of Diseases based Injury Severity Score(ICISS) with Trauma and Injury Severity Score(TRISS) and International Classification of Diseases 9th Edition Clinical Modification(ICD-9CM) based ICISS in the injury severity measure. METHODS: ICD-10 version of Survival Risk Ratios(SRRs) was derived from 47,750 trauma patients from 35 Emergency Centers for 1 year. The predictive power of TRISS, the ICD-9CM based ICISS and ICD-10 based ICISS were compared in a group of 367 severely injured patients admitted to two university hospitals. The predictive power was compared by using the measures of discrimination(disparity, sensitivity, specificity, misclassification rates, and ROC curve analysis) and calibration(Hosmer-Lemeshow goodness-of-fit statistics), all calculated by logistic regression procedure. RESULTS: ICD-10 based ICISS showed a lower performance than TRISS and ICD-9CM based ICISS. When age and Revised Trauma Score(RTS) were incorporated into the survival probability model, however, ICD-10 based ICISS full model showed a similar predictive power compared with TRISS and ICD-9CM based ICISS full model. ICD-10 based ICISS had some disadvantages in predicting outcomes among patients with intracranial injuries. However, such weakness was largely compensated by incorporating age and RTS in the model. CONCLUSIONS: The ICISS methodology can be extended to ICD-10 horizon as a standard injury severity measure in the place of TRISS, especially when age and RTS were incorporated in the model. In patients with intracranial injuries, the predictive power of ICD-10 based ICISS was relatively low because of differences in the classifying system between ICD-10 and ICD-9CM.; Summary

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