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January 21, 2004

Definitions of Medical Injuries

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(3):303. doi:10.1001/jama.291.3.303-e

To the Editor: Drs Zhan and Miller1 used administrative data to identify medical injuries in a national sample of hospital discharge abstracts. The authors concluded that some injuries incurred during hospitalization pose a significant threat to patients and costs to society. Given this study's reliance on patient safety indicators (PSIs) from administrative data, however, it is simply impossible to know whether these events were in fact related to hospital-acquired injuries. The assumption that all adverse events represent injuries is unwarranted. The PSIs, which are so costly in terms of mortality and length of stay, are such a mixed bag of procedural complications, system or individual error, complications of disease states, and host factors that no assessment of error can be made. This limitation is hardly surprising given the study's total reliance on administrative data.

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