Participants: Adolescents (defined herein as individuals aged 10-19 years) undergoing inpatient bariatric procedures.

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Objectives: To determine the completeness of external cause of injury coding (E-coding) within healthcare administrative databases in the United States and to identify factors that contribute to variations in E-code reporting across states. Design: Cross sectional analysis of the 2001 Healthcare Cost and Utilization Project (HCUP), including 33 State Inpatient Databases (SID), a Nationwide Inpatient Sample (NIS), and nine State Emergency Department Databases (SEDD). To assess state reporting practices, structured telephone interviews were conducted with the data organizations that participate in HCUP. Results: The percent of injury records with an injury E-code was 86% in HCUP's nationally representative database, the NIS. For the 33 states represented in the SID, completeness averaged 87%, with more than half of the states reporting E-codes on at least 90% of injuries. In the nine states also represented in the SEDD, completeness averaged 93%. Twenty two states had mandates for E-code reporting, but only eight had provisions for enforcing the mandates. These eight states had the highest rates of E-code completeness.Conclusions: E-code reporting in administrative databases is relatively complete, but there is significant variation in completeness across the states. States with mandates for the collection of E-codes and with a mechanism to enforce those mandates had the highest rates of E-code reporting. Nine statewide ED data systems demonstrate consistently high E-coding completeness.

Blood transfusion during hospitalization (Tx-hospitalization) in the U.S. is very common in medical practice. In-hospital blood transfusions are indicated for multiple medical, surgical and hemorrhagic conditions. However, descriptions of the patient populations receiving transfusions in U.S. hospitals are vague. The purpose of this study is to use nationally representative hospital discharge data to provide information regarding the patient populations and associated diagnoses that have caused the demand for blood transfusions in U.S. hospitals. Data were obtained through cross-sectional analysis of the 1997 through 2006 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). The NIS is the largest, multi-year, all-payer inpatient care database that is publicly available in the U.S. The NIS contains data from 5 to 8 million unweighted hospital stays from about 1,000 hospitals sampled to approximate a 20-percent stratified sample of U.S. community hospitals. The NIS is drawn from the States participating in HCUP, which represent 90% of all hospital discharges in 2006. The NIS includes weights that allow calculation of reliable, representative national estimates of care in U.S hospitals. Blood transfusion was identified using the Clinical Classifications Software (CCS) procedure grouping 222. In 2006, 2.4 hospital hospitalizations included at least one blood product transfusion compared with 1.1 million in 1997. This 117% increase in Tx-hospitalizations was steady, with an average of 140,000 additional Tx-hospitalizations during each year. During that same period, the total number of U.S. hospitalizations increased 14%. Blood transfusions were among the top 10 procedures performed in all age groups. The elderly (>65+ years of age) accounted for the greatest number of hospitalizations with a transfusion with 1.4 million in 2006 compared to 622,000 in 1997. The most common type of transfusion was packed red cells, which accounted for about 90 percent of all types of transfusions (2.1 million of the 2.4 million transfusions in 2006). Coding of diagnosis at discharge was utilized to determine the conditions contributing to the increased utilization of transfusions. Transfusion was coded as a primary procedure during hospitalizations in which more invasive procedures were not performed. From 1997 to 2006, the fraction of hospitalizations with transfusion listed as the principle procedure was stable, and represented one-fourth of all Tx-hospitalizations. Within that group, the most common principle diagnoses were coded as anemia (15.8%), gastrointestinal hemorrhage (7.3%), CHF (5.5%), pneumonia (5.2%), and septicemia (5.0%). Cancers accounted for <1%. Transfusions were coded as a secondary procedure another invasive procedure occurred during the same hospitalization and represented the remaining three-fourths of cases. In that group, the most common principle diagnoses were osteoarthritis (8.3%), GI hemorrhage (6.5%), fracture of hip (5.1%), septicemia (4.3%), and complication of a device, implant or graft (4.2%). The most common principle procedures were UGI endoscopy (9.1%), hip replacement (6.0%), knee arthroscopy (6.0%) hip fracture repair (4.4%) and CABG (3.7%). In separate analyses, it was demonstrated that 20 percent of all hospitalizations for knee arthoplasty and 30 percent for hip replacement included a transfusion in 2006. In summary, hospital discharge data from the NIS provides critical and detailed clinical information on uses and trends of blood transfusions in U.S. hospitals. There has been a steady and significant increase in Tx-hospitalizations during the last decade that far exceeds the overall increase in hospitalizations (117% vs. 14%). A relatively small group of diagnoses including gastrointestinal bleeding and lower extremity arthroplasty represent one-third of the Tx-hospitalizations. Understanding the clinical demand for blood components in U.S. hospitals should facilitate optimal management of these limited and life-saving resources.