Accuracy of injury coding under ICD-10-AM for New Zealand public hospital discharges

OBJECTIVE

To determine the accuracy in coding for principal injury diagnosis (PDx), external cause, place of occurrence, and activity codes under the Australian Modification of the International Classification of Disease, 10th Revision (ICD-10-AM) for public hospital discharges in New Zealand.

METHOD

A simple random sample of 1800 injury discharges was selected from the National Minimum Dataset (NMDS) of hospital discharges from July 2001 to June 2004. Records were obtained and coded by the Senior Advisor in Clinical Coding (SACC) independently of the codes already recorded in the NMDS.

RESULTS

Of injury discharges selected from the NMDS, 2% were not coded with a PDx of injury by the SACC. Fourteen percent of the PDxs and 26% of the external cause codes (E-codes V01-Y89) had inaccuracies in the first, second, or third characters. Variation in the accuracy of the PDxs and E-codes was obvious by diagnostic and E-code groupings; 22% of the place of occurrence codes (Y92) and 29% of the activity codes (Y93) were incorrect. Accuracy of the PDxs and E-codes was related to the clarity of the documentation in the medical records.

CONCLUSIONS

For countries that are considering implementing ICD-10 or one of its variants, these findings provide insight into possible limitations of the classification and offer guidance on where the focus of training should be placed. For countries that have historical data coded according to ICD-10-AM, these results suggest that some specific estimates of injury and external-cause incidence may need to be treated with caution.

The responsiveness and validity of the CAMPHOR Utility Index

The aim of the present study was to validate and determine the minimal important difference (MID) and responsiveness of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) Utility Index, a new tool enabling cost utility analyses. CAMPHOR, 6-min walking test (6MWT) and New York Heart Association (NYHA) data for 869 pulmonary hypertension patients (545 (63%) female; mean+/-SD age 56.6+/-15.4 yrs) from three centres were analysed. Utility was correlated with 6MWT data and calculated by NYHA class to assess validity. Effect sizes were calculated for those with two CAMPHOR assessments. Distribution and anchor-based MIDs were calculated. Analyses were carried out in patients receiving bosentan in order to determine whether or not those remaining in NYHA class III following treatment improved. The Utility Index distinguished between adjacent NYHA classes and correlated with 6MWT results. CAMPHOR subscales and utility were as responsive as the 6MWT (effect sizes ranged 0.31-0.69 for the CAMPHOR and 0.16-0.34 for the 6MWT). The within-group MID for the Utility Index was estimated to be approximately 0.09. Patients remaining in NYHA class III experienced, on average, a significant improvement (CAMPHOR Utility Index and functioning), which exceeded the MID. The CAMPHOR Utility Index is valid and responsive to change. Patients can experience significant and important improvements even if they do not improve on the basis of traditional outcomes, such as NYHA functional class.

Accuracy of injury coding under ICD-9 for New Zealand public hospital discharges

OBJECTIVE

To determine the level of accuracy in coding for injury principal diagnosis and the first external cause code for public hospital discharges in New Zealand and determine how these levels vary by hospital size.

METHOD

A simple random sample of 1800 discharges was selected from the period 1996-98 inclusive. Records were obtained from hospitals and an accredited coder coded the discharge independently of the codes already recorded in the national database.

RESULTS

Five percent of the principal diagnoses, 18% of the first four digits of the E-codes, and 8% of the location codes (5th digit of the E-code), were incorrect. There were no substantive differences in the level of incorrect coding between large and small hospitals.

CONCLUSIONS

Users of New Zealand public hospital discharge data can have a high degree of confidence in the injury diagnoses coded under ICD-9-CM-A. A similar degree of confidence is warranted for E-coding at the group level (for example, fall), but not, in general, at higher levels of specificity (for example, type of fall). For those countries continuing to use ICD-9 the study provides insight into potential problems of coding and thus guidance on where the focus of coder training should be placed. For those countries that have historical data coded according to ICD-9 it suggests that some specific injury and external cause incidence estimates may need to be treated with more caution.

Comparison of fatalities from work related motor vehicle traffic incidents in Australia, New Zealand, and the United States

OBJECTIVE

To compare the extent and characteristics of motor vehicle traffic incidents on public roads resulting in fatal occupational injuries in Australia, New Zealand (NZ), and the United States (US).

DESIGN AND SETTING

Information came from separate data sources in Australia (1989--92), NZ (1985--98), and the US (1989--92).

METHODS

Using data systems based on vital records, distributions and rates of fatal injuries resulting from motor vehicle traffic incidents were compared for the three countries. Common inclusion criteria and occupation and industry classifications were used to maximize comparability.

RESULTS

Motor vehicle traffic incident related deaths accounted for 16% (NZ), 22% (US), and 31% (Australia) of all work related deaths during the years covered by the studies. Australia had a considerably higher crude rate (1.69 deaths/100,000 person years; 95% confidence interval (95% CI) 1.54 to 1.83) compared with both NZ (0.99; 95% CI 0.85 to 1.12) and the US (0.92; 95% CI 0.89 to 0.94). Industry distribution differences accounted for only a small proportion of this variation in rates. Case selection issues may have accounted for some of the remainder, particularly in NZ. In all three countries, male workers, older workers, and truck drivers were at higher risk.

CONCLUSIONS

Motor vehicle traffic incidents are an important cause of work related death of workers in Australia, NZ, and the US. The absolute rates appear to differ between the three countries, but most of the incident characteristics were similar. Lack of detailed data and inconsistencies between the data sets limit the extent to which more in-depth comparisons could be made.

Minimizing bias in a case-control study of farm injury

We report on our strategies to minimize bias in the FIRM study, a prospective case-control study of risk factors for serious farmwork-related injury. The study base is adult males working on farms in the catchment regions of 14 larger regional hospitals in one Australian state. Cases are identified on presentation to the emergency departments, while age-matched controls are recruited via random telephone survey. Eligibility criteria for cases include a maximum abbreviated injury severity score of at least 2, to minimize the potential for selection bias against those with less severe injuries treated outside the hospital system. An audit at one hospital showed that 93% of eligible patients identified in the electronic surveillance system had been approached regarding participation. Results to date show that 38% of those approached decline to have their contact details made available to researchers. Those who decline are asked to complete two key questions to enable comparison with those who participate. Control recruitment relies on telephoning regional households until an individual from the study base, satisfying the matching criteria, is identified. This process minimizes the potential for selecting against farm workers who may live off-farm. Ninety-four percent of age-matched eligible controls have participated to date. We are testing a dynamic pool of individuals identified as study base members but not matched on the first call to determine its effect on the probabilities of selection. Our strategies appear to be minimizing detection, selection, and response bias, thereby enhancing the validity of the study results.

Comparison of injury case fatality rates in the United States and New Zealand

OBJECTIVE

To compare injury case fatality rates in the United States (US) with New Zealand (NZ) to guide future information collection, research, and evaluation.

DESIGN

Using NZ (1992-96) and US (1996-98) mortality censuses, NZ national 1992-96 hospital discharge censuses, and US 1996-98 National Hospital Discharge Survey data, the authors compared case fatality rates by mechanism and intent of injury and age group. The analysis was restricted to severe injuries (AIS> or =3).

SUBJECTS

NZ (1992-96) and US (1996-98) populations.

MAIN OUTCOME MEASURES

Ratio of case fatality rates in NZ versus the US (RCFR(NZ:US)).

RESULTS

Overall, among cases meeting the study criteria, unintentional injuries were 1.57 times more likely fatal in NZ and intentional assault injuries were 1.14 times more likely to be fatal in the US. Firearms were involved in 50% of US assaults versus 8% of NZ assaults. By mechanism, cutting/piercing injuries were 1.86, firearm injuries were 1.41, and motor vehicle injuries were 1.44 times more to be likely fatal in NZ. Natural/environmental injuries (RCFR(NZ:US) = 0.57), unintentional poisonings (RCFR(NZ:US) = 0.26), and unintentional suffocations (RCFR(NZ:US) = 0.67) were significantly more likely to be fatal in the US.

CONCLUSIONS

Possible reasons for the observed results include: differences in geography and proportion of population in rural areas, trauma system differences, road design and vehicle types, seat belt use, larger role of firearms in US assaults, coding practices, policies, and environmental factors. Disparities evoke hypotheses to test in future research that will guide priority setting and intervention.

An Advisory Committee Statement (ACS). National Advisory Committee on Immunization (NACI). Update: statement on influenza vaccination for the 2003-04 season

The National Advisory Committee on Immunization (NACI) provides Health Canada with ongoing and timely medical, scientific, and public health advice relating to immunization. Health Canada acknowledges that the advice and recommendations set out in this statement are based upon the best current available scientific knowledge and is disseminating this document for information purposes. People administering or using the vaccine should also be aware of the contents of the relevant product monograph(s). Recommendations for use and other information set out herein may differ from that set out in the product monograph(s) of the Canadian licensed manufacturer(s) of the vaccine(s). Manufacturer(s) have sought approval of the vaccine(s) and provided evidence as to its safety and efficacy only when it is used in accordance with the product monographs.

Traps for the unwary in estimating person based injury incidence using hospital discharge data

BACKGROUND

Injuries resulting in admission to hospital provide an important basis for determining priorities, emerging issues, and trends in injury. There are, however, a number of important issues to be considered in estimating person based injury incidence using such data. Failure to consider these could result in significant overestimates of incidence and incorrect conclusions about trends.

AIM

To demonstrate the degree to which estimates of the incidence of person based injury requiring hospital inpatient treatment vary depending on how one operationally defines an injury, and whether or not day patients, readmissions, and injury due to medical procedures are included.

METHOD

The source of data for this study was New Zealand's National Minimum Dataset. The primary analyses were of a dataset of all 1989-98 discharges from public hospital who had an external cause of injury and poisoning code assigned to them.

RESULTS

The results show that estimates of the incidence of person based injury vary significantly depending on how one operationally defines an injury, and whether day patients, readmissions, and injury due to medical procedures are included. Moreover the effects vary significantly by pathology and over time.

CONCLUSIONS

(1) Those using New Zealand hospital discharge data for determining the incidence of injury should: (a) select cases which meet the following criteria: principal diagnosis injury only cases, patients with day stay of one day or more, and first admissions only, (b) note in their reporting that the measure is an estimate and could be as high as a 3% overestimate. (2) Other countries with similar data should investigate the merit of adopting a similar approach. (3) That the International Collaborative Effort on Injury Statistics review all diagnoses within International Classification of Diseases 9th and 10th revisions with a view to reaching consensus on an operational definition of an injury.

Impact of graduated driver licensing restrictions on crashes involving young drivers in New Zealand

OBJECTIVE

To determine the impact on young driver crashes of the three main driving restrictions in the New Zealand graduated driver licensing (GDL) system: night-time curfew, no carrying of young passengers, and a blood alcohol limit of 30 mg/100 ml.

METHOD

The database for this study was created by linking police crash reports to hospital inpatient records (1980-95). Multivariate logistic regression was used to compare car crashes involving a young driver licensed before GDL (n=2,252) with those who held a restricted graduated licence (n=980) and with those who held a full graduated licence (n=1,273), for each of the main driving restrictions.

RESULTS

Compared with the pre-GDL group, the restricted licence drivers had fewer crashes at night (p=0.003), fewer involving passengers of all ages (p=0.018), and fewer where alcohol was suspected (p=0.034), but not fewer involving young casualties (p=0.980). Compared with the pre-GDL drivers, those with the full graduated licence had fewer night crashes (p=0.042) but did not differ significantly for any of the other factors examined.

CONCLUSION

These results suggest that some of the GDL restrictions, especially the night-time curfew, have contributed to a reduction in serious crashes involving young drivers.

Increasing daily walking lowers blood pressure in postmenopausal women

PURPOSE

The American College of Sports Medicine and the Centers for Disease Control and Prevention (ACSM-CDC) recommend 30 min of daily moderate-intensity physical activity for health; however, the effectiveness of this recommendation in lowering blood pressure (BP) in hypertensives is unclear. The present study tested the hypothesis that walking activity following the ACSM-CDC physical activity recommendation would lower BP in postmenopausal women with high BP.

METHODS

Resting BP was measured in 24 postmenopausal women with borderline to stage 1 hypertension at baseline, 12 wk, and 24 wk. Fifteen women in the exercise (EX) group walked 3 km.d-1 above their daily lifestyle walking, whereas 9 women in the control (CON) group did not change their activity. Walking activity was self-measured with a pedometer in both groups.

RESULTS

Resting systolic BP was reduced in the EX group after 12 wk by 6 mm Hg (P < 0.005) and was further reduced by 5 mm Hg at the end of 24 wk (P < 0.005). There was no change in diastolic BP with walking. The CON group experienced no change in BP at either 12 or 24 wk. Body mass was modestly reduced by 1.3 kg in the EX group after 24 wk (P < 0.05); however, it was not correlated with the change in BP. There were no changes in selected variables known to impact BP including percent body fat, fasting plasma insulin, or dietary intake.

CONCLUSION

In conclusion, a 24-wk walking program meeting the ACSM-CDC physical activity recommendation is effective in lowering systolic BP in postmenopausal women with borderline to stage 1 hypertension.

Maori work-related fatal injury, 1985-1994

AIMS

To document the rate of work-related fatal injury for Maori; to establish whether a difference exists between Maori and non-Maori; and to examine possible explanations in the event that differences did occur.

METHODS

Coronial files collected as part of the examination of work-related fatal injuries occurring between 1985 and 1994, excluding motor vehicle fatalities on public roads, were reviewed. Maori were identified by either the classification recorded upon death certificates or if they were identified as Maori within coroner's files.

RESULTS

89 Maori were identified within the 741 worker fatalities. Agreement between the data sources used to identify ethnic status was approximately 52%. The crude rate for the decade was significantly higher for Maori than non-Maori. A significant linear decline across years was evident for the non-Maori rates but not for Maori rates.

CONCLUSIONS

This study, the first to specifically investigate work-related injury for Maori, confirms that an overall disparity exists between Maori and non-Maori, and that it is probably due to differences in employment patterns.

Under-reporting of motor vehicle traffic crash victims in New Zealand

Our aim was to ascertain the extent of under-reporting of seriously injured motor vehicle traffic crash victims, as recorded by police in New Zealand, and to what extent this coverage was biased by crash, injury, demographic, and geographic factors. Hospital data and police records were linked using probabilistic methods. During 1995, less than two-thirds of all hospitalised vehicle occupant traffic crash victims were recorded by the police. Reporting rates varied significantly by age, injury severity, length of stay in hospital, month of crash, number of vehicles involved, whether or not a collision occurred, and geographic region, but not by gender, ethnicity or day of the week of the crash. Those using these police files for prioritization, resource allocation and evaluation purposes need to be aware of the extent and nature of these biases contained within these databases.

The work-related fatal injury study: numbers, rates and trends of work-related fatal injuries in New Zealand 1985-1994

AIMS

To determine the number and rates of work-related fatal injuries by employment status, occupation, industry, age and gender in New Zealand 1985-1994.

METHODS

Potential cases of work-related injury deaths of persons aged 15-84 years were identified from the national electronic mortality data files. Main exclusions were deaths due to suicide and deaths due to motor vehicle crashes. The circumstances of the deaths of each fatal incident meeting inclusion criteria were then reviewed directly from coronial files to determine work-relatedness.

RESULTS

The rate of work-related fatal injury in New Zealand was 5.03/100000 workers per year for the study period. There was a significant decline in crude rate over the study period. However, this was in substantial part accounted for by changes in occupation and industry mix. Older workers, male workers, self-employed workers, and particular occupational groups, all had substantially elevated rates. Agricultural and helicopter pilots, forestry workers and fishery workers had the highest rates. Farmers, forestry workers, and fishery workers also had high numbers of deaths, together accounting for nearly 40% of all deaths.

CONCLUSIONS

This study has demonstrated that work-related fatal injury remains a pressing problem for New Zealand. Several areas in urgent need of prevention efforts were highlighted.

Injury to Maori. II: Serious injury

AIMS

To determine the significance of serious injury in Maori relative to other health problems, to describe the leading causes, and to determine age specific rates for major classes of injury.

METHOD

We used New Zealand Health Information Services' public hospital inpatient data files. The New Zealand Census classification of 'Sole-Maori' was used to determine injury mortality rates.

RESULTS

On average, one in every eight admissions in Maori, was for injury. Injury was the leading reason for admission for those 5-44 years old. Unintentional injury accounted for 85% of injuries, with those ages 1-14 and 15-24 years having the highest numbers and rates. Falls, followed closely by motor vehicle traffic crashes, were the leading causes, accounting for 23% and 20% respectively.

CONCLUSIONS

In order to address the priorities identified here, appropriate partnerships between crown agencies and social agencies, both Iwi and/or community based, must be established.

Injury to Maori. I: Fatalities

AIMS

Our aim was to determine the significance in Maori of injury in relation to other health problems, to describe the leading causes of injury, and to determine age specific rates for major classes of injury.

METHODS

We used New Zealand Health Information Services mortality data files. The New Zealand Census classification of 'Sole-Maori' was used to determine injury mortality rates.

RESULTS

For more than three contiguous decades of life (1-34 yrs) injuries were the leading cause of death. For all age groups combined, unintentional injury accounted for 75% of injury deaths, suicide 17%, and assault 7%. The leading mechanism of death was motor vehicle traffic crashes (49%). Occupants of motor vehicles accounted for the majority of the victims. The occupant fatality rate remained relatively constant for all age groups from 15-24 years. The second most common mechanism of death was suffocation (13%), 76% of which were self-inflicted, all of these being hangings.

CONCLUSIONS

There is a need for government agencies with a mandate for injury prevention to develop specific injury prevention goals for Maori.

Motorcycle engine size and risk of moderate to fatal injury from a motorcycle crash

Current New Zealand law requires that motorcyclists with a learner or restricted licence ride a motorcycle with an engine capacity of 250 cc or less. Previous research has reported inconsistent findings regarding the relationship between cubic-capacity and risk of a crash. We sought to determine: (1) compliance with the law; (2) if the risk of an injury crash is increased for learner/restricted licence holders who do not comply with the cubic capacity regulations; and (3) whether the risk of an injury crash increases with increasing capacity of the motorcycle. A population-based case-control study was conducted in the Auckland region over a 3 year period from February 1993. Among the controls, 66% were riding motorcycles with a capacity greater than 250 cc. The percentages for those with: full, learner and restricted, and no licence were 82, 29 and 60%, respectively. There was no evidence that learner and restricted licence holders who did not comply with the cubic capacity requirement were at increased risk. It should be noted however, that 75% of those who were complying were doing so on motorcycles of 250 cc or less. Relative to motorcycles of less than 250 cc the risk of an injury crash was elevated by at least 50% for all cubic capacity categories, with the exception of the 251-499 group. There was, however, no consistent pattern of increasing risk as cubic capacity increased. The findings of this study coupled with the fact that cubic capacity is a poor measure of power suggest that, if cubic capacity was to remain the sole basis for restricting learner and restricted licence holders, consideration should be given to having a substantially lower cubic capacity than 250 cc. An analysis of risk in terms of power to weight ratio and style of motorcycle may provide a more useful insight into the benefits of motorcycle design restrictions for novice riders.

Changes in methods of male youth suicide: 1980-95

AIMS

To determine if there have been changes in the methods used, particularly hangings, for male youth suicides; whether any changes were similar to those for other age groups; and to what degree any changes identified may have impacted on overall suicide rates.

METHOD

All males aged fifteen to 24 years of age who died between 1980 and 1995 inclusive, and whose death was assigned one of the WHO external cause codes for "suicide and self-inflicted injury" (E950-E959), were selected from the New Zealand Health Information Services national mortality database.

RESULTS

The rate for suicide by hanging was relatively low and stable in the early 1980's. By 1985 it had started to increase dramatically up until 1989, at which point it become stable again. The substantive increase in hangings was largely confined to males aged 24 years and younger. The increase in suicide by hanging cannot be attributed to substitution in methods as the rates for all other methods have also increased, albeit less dramatically.

CONCLUSIONS

Much of the increase in suicide among male youths is due to an increase in hanging. The reasons for the choice of this method are unknown, and warrant study.

Domestic fire injuries treated in New Zealand hospitals 1988-1995

AIM

To describe demographic features of people discharged from New Zealand hospitals following injury caused by fire and flame in domestic locations.

METHOD

Review of hospital discharge data for the years 1988-1995.

RESULTS

From 1988-1995 there were 1493 discharges from New Zealand hospitals with injury as the result of fire and flame in domestic locations. Age-standardised hospitalisation rates for fire related injury over the period have been stable, with an overall discharge rate of 5.45 hospitalisations per 100000 person years. Male discharges exceeded female in all years (RR 1.97, 95% CI 1.73-2.14). Stratification by age indicated that discharge rates were highest among New Zealanders aged over 75 years and under fifteen years. Maori discharge rates exceeded non-Maori over all age groups (RR 3.3, 95% CI 2.82-3.58).

CONCLUSION

Maori discharge rates for fire related injury in the home are substantially higher than non-Maori in all age groups, and highlight the importance of developing culturally appropriate injury prevention strategies. Social and material determinants of injury need to be addressed through public policy, provision of quality housing and community development initiatives.

Increasing age and experience: are both protective against motorcycle injury? A case-control study

OBJECTIVES

To assess the associations between age, experience, and motorcycle injury.

SETTING

Motorcycle riding on non-residential roads between 6 am and midnight over a three year period from February 1993 in Auckland, New Zealand.

METHODS

A population based case-control study was conducted. Cases were 490 motorcycle drivers involved in a crash and controls were 1518 drivers identified at random roadside surveys. Crash involvement was defined in terms of a motorcycle crash resulting in either a driver or pillion passenger being killed, hospitalised, or presenting to a public hospital emergency department with an injury severity score > OR =5.

RESULTS

There was a strong and consistent relationship between increasing driver age and decreasing risk of moderate to fatal injury. In multivariate analyses, drivers older than 25 years had more than 50% lower risk than those aged from 15-19 years (odds ratio (OR) 0.46; 95% confidence interval (CI) 0.26 to 0.81). In univariate analyses, a protective effect from riding more than five years compared with less than two years was observed. However, this protection was not sustained when driver age and other potential confounding variables were included in the analyses. Familiarity with the specific motorcycle was the only experience measure associated with a strong protective effect (OR (> OR =10,000 km experience) 0.52; 95% Ci 0.35 to 0.79) in multivariate analyses.

CONCLUSIONS

Current licensing regulations should continue to emphasise the importance of increased age and might consider restrictions that favour experience with a specific motorcycle.

A direct method for the formation of peptide and carbohydrate dendrimers

Two new methods for the modification of PAMAM dendrimers have been developed which allow the covergent synthesis of either peptide or carbohydrate-bearing dendrimer molecules. Both methods involve condensation between hydroxylamino nucleophiles and appropriate carbonyl-bearing reaction partners.

Physical assault in New Zealand: the experience of 21 year old men and women in a community sample

AIM

To obtain epidemiological information on physical assault in a high risk group of New Zealanders.

METHOD

Rates of physical assault in the preceding twelve months were ascertained by interview in a cohort of 21 year old, Dunedin-born men (n = 482) and women (n = 462).

RESULTS

Forty-five percent of the men and one quarter of the women reported at least one physical assault, either completed, attempted or threatened. A small proportion of these received medical treatment. Most serious assaults were by a perpetrator who was thought to have been drinking alcohol. Most assaults on men were by strangers but partners carried out more assaults against women, especially those receiving medical treatment. One quarter of all assaults on women were by other women, compared to 15% of the assaults on men. Differences between patterns of assaults on women and on men are discussed.

CONCLUSION

It is important for doctors to be aware of the widespread occurrence of interpersonal violence in New Zealand and its underreporting.

Personality differences predict health-risk behaviors in young adulthood: evidence from a longitudinal study

In a longitudinal study of a birth cohort, the authors identified youth involved in each of 4 different health-risk behaviors at age 21: alcohol dependence, violent crime, unsafe sex, and dangerous driving habits. At age 18, the Multidimensional Personality Questionnaire (MPQ) was used to assess 10 distinct personality traits. At age 3, observational measures were used to classify children into distinct temperament groups. Results showed that a similar constellation of adolescent personality traits, with developmental origins in childhood, is linked to different health-risk behaviors at 21. Associations between the same personality traits and different health-risk behaviors were not an artifact of the same people engaging in different health-risk behaviors; rather, these associations implicated the same personality type in different but related behaviors. In planning campaigns, health professionals may need to design programs that appeal to the unique psychological makeup of persons most at risk for health-risk behaviors.

Personality differences predict health-risk behaviors in young adulthood: evidence from a longitudinal study

In a longitudinal study of a birth cohort, the authors identified youth involved in each of 4 different health-risk behaviors at age 21: alcohol dependence, violent crime, unsafe sex, and dangerous driving habits. At age 18, the Multidimensional Personality Questionnaire (MPQ) was used to assess 10 distinct personality traits. At age 3, observational measures were used to classify children into distinct temperament groups. Results showed that a similar constellation of adolescent personality traits, with developmental origins in childhood, is linked to different health-risk behaviors at 21. Associations between the same personality traits and different health-risk behaviors were not an artifact of the same people engaging in different health-risk behaviors; rather, these associations implicated the same personality type in different but related behaviors. In planning campaigns, health professionals may need to design programs that appeal to the unique psychological makeup of persons most at risk for health-risk behaviors.

Does ribavirin impact on the hospital course of children with respiratory syncytial virus (RSV) infection? An analysis using the pediatric investigators collaborative network on infections in Canada (PICNIC) RSV database

OBJECTIVES

To determine the relationship between receipt of aerosolized ribavirin and the hospital course of high-risk infants and children with respiratory syncytial virus (RSV) lower respiratory infection (LRI).

METHODS

The 1993-1994 Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) RSV database consists of prospectively enrolled children with acute RSV LRI, admitted to nine Canadian pediatric tertiary care centers. After excluding cases with compromised immunity and/or nosocomial infection, subsets with any congenital heart disease (CHD), chronic lung disease (CLD), age </=6 weeks (INFANT), gestation </=36 weeks (PREM), or severe disease within 48 hours of admission as shown by an oxygen saturation </=90% or an FiO2 requirement of >.35 (EARLY HYPOXIA) were studied in two ways. First, each risk group subset was analyzed separately to assess the association between ribavirin receipt and measures of disease severity including duration of intensive care, mechanical ventilation, hypoxia and RSV-attributable hospital stay. Secondly, ribavirin was added as an independent variable to a previously described multiple regression model for RSV-attributable length of hospital stay and two mutually exclusive subsets were analyzed: 1) previously healthy patients with >/=1 of: INFANT, PREM, or EARLY HYPOXIA; 2) patients with CHD and/or CLD.

RESULTS

Between January 1993 and June 1994, 1425 community-acquired hospitalized cases of RSV LRI were entered into the RSV database. Among these 750 (52.6%) fit into one or more of the defined subsets including 97 CHD, 134 CLD, 213 INFANT, 211 PREM, and 463 EARLY HYPOXIA. The proportion ventilated in each group was 20.6%, 20.9%, 15.5%, 15.2%, and 13.3%, respectively. Across the subsets ribavirin use ranged from 36% to 57% of ventilated patients and 6% to 39% of nonventilated patients. For nonventilated patients in each subset the median RSV-attributable hospital length of stay (RSV-LOS) was 2 to 3 days longer for ribavirin recipients and the duration of hypoxia was significantly increased. Duration of intensive care unit (ICU) stay was also increased for all ribavirin-treated subgroups except those with CHD. In contrast, for ventilated patients, ribavirin therapy was not significantly associated with any of the outcome measures regardless of risk group. In the multiple regression model, ribavirin was significantly associated with a prolonged RSV-LOS both for children with CHD and/or CLD as well as for those whose only risk factors included INFANT, PREM, and/or EARLY HYPOXIA.

CONCLUSIONS

These data raise further doubts about the clinical effectiveness of ribavirin in infants and children with risk factors for severe disease. Selection bias, with ribavirin used for sicker children, may have influenced outcome. Nevertheless the long durations of hospitalization, ICU, ventilation, and oxygen supplementation in nonventilated ribavirin recipients stress the need for further randomized trials to assess its efficacy.

Hospitalizations for injury in New Zealand: prior injury as a risk factor for assaultive injury

OBJECTIVES

This study sought to determine the degree to which injury hospitalization, especially for assaultive injury, is a risk for subsequent hospitalization due to assault.

METHODS

A New Zealand hospitalization database was used to perform a retrospective cohort study. Exposure was defined as an injury hospitalization, stratified into assaultive and nonassaultive mechanisms. Hospitalizations for an assault during a 12-month follow-up period were measured.

RESULTS

Individuals with a prior nonassaultive injury were 3.2 times more likely to be admitted for an assault than those with no injury admission (95% confidence interval [CI] = 2.7, 3.9). The relative risk associated with a prior assault was 39.5 (95% CI = 35.8, 43.5), and the subsequent admission rate did not vary significantly by sex, race, or marital or employment status. Among those readmitted for an assault, 70% were readmitted within 30 days of the initial hospitalization.

CONCLUSIONS

Prior injury is a risk for serious assault, and the risk is even greater if the injury is due to assault. Risk of readmission for assault is largely independent of demographic factors and greatest within 30 days of the initial assault.

Incidence of death and hospitalization from assault occurring in and around licensed premises: a comparative analysis

The aim of the research was to: determine the incidence of serious assault in and around licensed premises in New Zealand, and to compare the circumstances of assault with those that occurred in other locations. For the period 1978-87, inclusive, 49 assault fatalities occurred in or around licensed premises representing 9.4% of all homicides and 12.9% where a place was specified. The comparable figures for assaults resulting in hospitalization in 1988 were: 251, 10.2% and 18.4%, respectively. Further analyses suggests that our estimate of the incidence rate is likely to be an underestimate due to changes over time in the large number of assault cases which have no specific place of occurrence identified. In comparison with homes homicides in licensed premises were more likely to involve: males; Maori, unarmed fights and brawls; unknown assailants; alcohol; occur during the evening and toward the end of the week; and result in head injury. For non-fatal events similar differences were found. In comparison with homes non-fatal assaults were more likely to involve: males; young adults, Maori, the unemployed, unarmed fights and brawls, and head injury. There have been a number of significant policy changes in New Zealand since 1988 which may have resulted in a change to the situation reported here.