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Low-value injury admissions in an integrated Canadian trauma system: a multicenter cohort study
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  • Marc-Aurèle Gagnon,
  • Mélanie Bérubé,
  • Éric Mercier,
  • Natalie Yanchar,
  • Peter Cameron,
  • Henry T. Stelfox,
  • Belinda Gabbe,
  • Gilles Bourgeois,
  • François Lauzier,
  • Alexis Turgeon,
  • Amina Belcaid,
  • Lynne Moore
Marc-Aurèle Gagnon
Centre de recherche du CHU de Quebec-Universite Laval
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Mélanie Bérubé
Centre de recherche du CHU de Quebec-Universite Laval
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Éric Mercier
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Natalie Yanchar
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Peter Cameron
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Henry T. Stelfox
Univ Calgary
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Belinda Gabbe
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Gilles Bourgeois
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François Lauzier
CHU de Quebec-Universite Laval
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Alexis Turgeon
CHU de Quebec-Universite Laval
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Amina Belcaid
CHU de Quebec-Universite Laval
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Lynne Moore
CHU de Québec-Université Laval
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Abstract

Background: Injury represents 260,000 hospitalisations and $27 billion in healthcare costs each year in Canada. Evidence suggests that there is significant variation in the prevalence of hospital admissions among ED presentations between countries and providers but we lack data specific to injury admissions. We aimed to estimate the prevalence of potentially low-value injury admissions following injury in a Canadian provincial trauma system, identify diagnostic groups contributing most to low-value admissions and assess inter-hospital variation. Methods: We conducted a retrospective multicenter cohort study based on all injury admissions in the Québec trauma system (2013-2018). Using literature and expert consultation, we developed criteria to identify potentially low-value injury admissions. We used a multilevel logistic regression model to evaluate inter-hospital variation in the prevalence of low-value injury admissions with intraclass correlation coefficients (ICC). We stratified our analyses by age (1-15; 16-64; 65-74; 75+ years). Results: The prevalence of low-value injury admissions was 16% (n=19,163) among all patients, 26% (2136) in children, 11% (4695) in young adults and 19% (12,345) in older adults. Diagnostic groups contributing most to low-value admissions were mild traumatic brain injury in children (48% of low-value pediatric injury admissions; n=922), superficial injuries (14%, n=660) or minor spinal injuries (14%, n=634) in adults aged 16-64, and superficial injuries in adults aged 65+ (22%, n=2771). We observed strong inter-hospital variation in the prevalence of low-value injury admissions (ICC=37%). Conclusion: One out of six hospital admissions following injury may be of low-value. Children with mild traumatic brain injury and adults with superficial injuries could be good targets for future research efforts seeking to reduce health care services overuse. Inter-hospital variation indicates there may be an opportunity to reduce low-value injury admissions with appropriate interventions targeting modifications in care processes.

Peer review status:ACCEPTED

22 Apr 2021Submitted to International Journal of Clinical Practice
23 Apr 2021Submission Checks Completed
23 Apr 2021Assigned to Editor
01 May 2021Reviewer(s) Assigned
05 May 2021Review(s) Completed, Editorial Evaluation Pending
12 May 20211st Revision Received
14 May 2021Submission Checks Completed
14 May 2021Assigned to Editor
14 May 2021Review(s) Completed, Editorial Evaluation Pending
16 May 2021Reviewer(s) Assigned
29 May 2021Editorial Decision: Accept