Residential institutions

Residential institutions have played a prominent role in American and British society for some time. A recent book titled Residential Institutions in Britain, 1725–1970: Inmates and Environments describes the development of “residential institutions” over time. These institutions were established to mold their inhabitants and were organized in line with professional and economic constraints. In order to be successful, these facilities needed to appeal to both the residents and the general public. The book looks at a variety of residential institutions, including those housing and caring for the poor, the mentally ill, and the infirm, as well as displaced young women and convicts.* The Collins Cobuild English Dictionary for Advanced Learners describes a residential institution as one in which people live while they are studying or receiving care at the facility.†

Injuries at residential institutions

Figure 1. Hospital discharge status

Figure 1. Hospital discharge status

The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) has a set of external cause of injury codes that details the types of places where an injury occurs. These codes are routinely collected as part of the dataset of the National Trauma Data Bank® (NTDB®). Places where an injury may occur include home, public building, street/highway, recreational/sporting center, industrial site, farm, mine, or residential institution. Residential institution is further defined to include a children’s home, dormitory, hospital, jail, old people’s home (nursing home), orphanage, prison, or reform school. Notably, residential institutions have the highest case fatality rate—7.43 percent—by location E code in the 2013 report. This case fatality rate is 1.6 times greater than at the next highest location, which is the home.

Figure 2. Case fatality rate by location e-code

Figure 2. Case fatality rate by location e-code

To examine the occurrence of injuries in a residential institution in the NTDB research dataset for 2013, admissions medical records were searched using the ICD-9-CM place of injury codes. Specifically searched were records that contained place of injury code E849.7 (children’s home, dormitory, hospital, jail, old people’s home, orphanage, prison, or reform school). A total of 29,976 records was found; 27,812 records contained a discharge status, including 6,875 patients discharged to home, 3,120 to acute care/rehab, 15,660 sent to skilled nursing facilities, and 814 sent to hospice; 1,343 died. These patients were 60 percent female, an average of 74.1 years old, had an average hospital length of stay of 5.3 days, an intensive care unit length of stay of 3.7 days, an average injury severity score of 9.4, and were on the ventilator for an average of 4.8 days (see Figures 1 and 2).

Room for improvement

It is not uncommon for surgeons and other health care professionals to provide care to the unfortunate victims of injuries that have occurred in these residential institutions. Hospitals have made great strides toward decreasing the number of unassisted falls, especially those that result in significant injury. Nursing homes have a unique set of challenges with their resident population but have implemented several strategies to decrease injuries, as well. From our heritage to the historical reflections as noted in this column, residential institutions were intended to mold and care for their inhabitants, not injure them.

Throughout the year, we will be highlighting these data through brief reports in the Bulletin. The National Trauma Data Bank Annual Report 2013 is available on the ACS website as a PDF file at In addition, information about how to obtain NTDB data for more detailed study is available on the website. To learn more about submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at

Statistical support for this article has been provided by Alice Rollins, NTDB Coordinator.

*Hamlett J, Hoskins L, Preston R (eds). Residential Institutions in Britain, 1725–1970: Inmates and Environments. London: Pickering & Chatto; 2013. Residential. Available at: Accessed February 16, 2014.

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