Purpose: Although medical record abstraction is generally considered to be the “gold standard” method of ascertaining information about the nature and severity of injuries, it can be time-consuming and costly. Our objective was to evaluate a survey tool designed to enable parents to identify and characterize the body region and severity of childhood injuries through multiple administration modes. Specifically, we assessed the ability of parents to identify (1) moderate and greater severity injuries (in general, an Abbreviated Injury Scale score (AIS) ≥2 injury) and (2) serious injuries (in general, an AIS≥3 injury), overall and by body region, by comparing survey responses to injury data contained in hospital medical records.
Methods: Children aged ≤17 years treated for injuries at three participating urban emergency departments (EDs) between 08/10-07/11, as well as their parent/legal guardian, were eligible. Parents were randomized to either a telephone interview or self-administered hardcopy survey at two weeks post-ED visit and asked to report child injuries to seven body regions: head, face, neck/spine/back, thorax, abdomen, upper extremities and lower extremities. Injury data were abstracted from electronic medical records using a standardized protocol. The AIS Score was used to assign each subject a body-region injury severity level of minor, moderate, or serious, generally corresponding to AIS scores of 1, 2 and ≥3.
Results: Of the 798 eligible parents (n=859 children) enrolled in the study, 494 completed the survey for an overall response rate of 61.9%. Response rates were similar for subjects initially allocated to the telephone mode (63.4%) and hardcopy mode (60.5%, p=0.41). The overall sensitivity, reflecting the ability of parents to identify a documented moderate or serious injury, was 0.94 (95% CI: 0.93, 0.97). Sensitivities were >0.90 for the face, upper extremity, and lower extremity regions, 0.80-0.90 for head, abdomen, neck/back/spine regions, and <0.60 for the thorax region. Specificities for all body regions were 0.95 or higher. The overall sensitivity for identification of a serious injury (AIS ≥3) was 0.71 (0.60, 0.80).
Conclusion: Overall, this instrument enabled parents to identify the body region of moderate or greater severity injuries experienced by their child with a high degree of sensitivity and specificity. However, the ability of parents to report injuries was more limited in some body regions, in particular the thorax and neck/back/spine regions, as well as for severe injuries. Our detailed investigation of discordant cases helped us identify several modifications that may improve the sensitivity for harder-to-capture injuries. This survey may be particularly valuable to ascertain the burden of injuries among both hospitalized and non-hospitalized populations, as a useful outcome measure in community-based trials of injury prevention strategies, or as a screening tool in population-based surveillance systems to identify cases of interest for more detailed data collection.