Slide 1Why should we be concerned with monitoring injuries?DefinitionsPublic Health Approach to Injury Control and PreventionEpidemiology is a Science of RatesInjury Deaths, Australia, 1992Injury Death Rates, Australia, 1992How do we identify injuries?Approaches Towards Monitoring Injury in the PopulationGovernment SurveysSurveillance:Types of SurveillanceActive SurveillancePassive SurveillanceSentinel EventsRegistry:Where do the data for the numerator and denominator come from in injury surveillance?Slide 18Slide 19Numerator IssuesICD-9 CodesE-codesSlide 23Percent ascertainment for each of the four monitoring sourcesData Sources and Injury SeverityDenominator IssuesSlide 27Slide 28Slide 29Slide 30Slide 31A Minimum Basic Dataset for Unintentional InjuriesInjury SurveillanceThomas Songer, PhDUniversity of PittsburghWhy should we be concerned with monitoring injuries?Why should we be concerned with monitoring injuries?DefinitionsDefinitions•Reducing the incidence of disease•Reducing the prevalence of disease•Ongoing programs aimed at reducing the incidence or prevalence of diseasePreventionPreventionControlControlLast, Dictionary of EpidemiologyPublic Health Approach to Injury Control and PreventionPublic Health Approach to Injury Control and Prevention•Define the Magnitude of the Problem•Identify associated causes and risk factors•Design and Implement the Intervention•Evaluate the InterventionEpidemiology is a Science of Rates•death rates•disability rates•hospitalization rates•incidence rates•prevalence ratesnumeratordenominatorInjury Deaths, Australia, 1992010020030040050060070010-14 yrs 30-34 50-54 70-74number of deathsMale FemaleAge GroupHarrison, 1995Injury Death Rates, Australia, 199205010015020010-14 yrs 30-34 50-54 70-74deaths per 100,000 pop.Male FemaleAge GroupHarrison, 1995How do we identify injuries?Approaches Towards Monitoring Injury in the PopulationDeath CertificatesPopulation SurveysSurveillanceRegistriesCapture-RecaptureGovernment Surveys•National Health Interview Survey•National Hospital Ambulatory Care Survey•National Hospital Discharge Survey•Behavioural Risk Factor Survey and SurveillanceProvide a better picture of the health status of the populationSurveillance: Systematic, regular ascertainment of incidence using methods distinguished by their practicality, uniformity, and frequently their rapidity, rather than by complete accuracy.Last, 1990Types of Surveillance•Active•PassiveActive Surveillance•the collection of data on a disease by regular outreach. Designated medical personnel are called at regular intervals to collect information on the new cases of disease.monitoring domestic violence in emergency departmentsPassive Surveillance•data generated without contact by the agency carrying out the surveillance. Reportable diseases fall under this type of surveillance. spinal cord injuriesSentinel Events•An event(s) that can be used to assess the stability or change in the health of a population.John LastDictionary of EpidemiologyRegistry:A file of data concerning all cases of a particular disease or other health-relevant condition in a defined population such that the cases can be related to a population base.Last, Dictionary of EpidemiologyWhere do the data for the numerator and denominator come from in injury surveillance?InjuryPoliceHospitalSelf-TreatRobertson, 1992doctorEMSRehab CenterTrauma CenterMorgueEmergency Dept.The monitoring of incidence unfortunately is more complicated than the monitoring of mortality, because incidence data are hard to come by, registration of cases is even now seldom complete, and increases in the recorded rates may be due to an increase in the efficiency of registration.Sir Richard Doll, 1990Numerator Issues•Definition•Ascertainment•Severity?ICD-9 CodesN Codes - Nature of injury, anatomyE-Codes - External cause of injuryE-codesAre often missing on medical recordsSome states now require their use in ED and Hospital Admission recordsImportant for identifying cause of injury and designing control programsHelp to assign intentSources for Monitoring Injuriesmedicalexcuses1 monthstudent recall4 monthrecallrecordsattendanceWoodland Hills School DistrictPercent ascertainment for each of the four monitoring sources01020304050607080901 month medical attendance 4 monthData Sources and Injury SeveritySurveyDoctor visitHospital adm.Trauma ctr.Death cert.No injury Mild Moderate Severe FatalRogams, 1995Denominator Issues•Population Base•Which Denominator??What is the crash risk relatedto older drivers? Howimportant is this risk?Crash Involvement RateAgeper 1000 licensed drivers16 20 25 30 35 40 45 50 55 60 65 70 75 80 85+050100150200NHTSA, FHWAInvolvement Rate by MileageAgeper 100 million miles VMT16 20 25 30 35 40 45 50 55 60 65 70 75 80 85+0500100015002000NHTSA, FHWAFatality RateAgeper 100 million miles16 20 25 30 35 40 45 50 55 60 65 70 75 80 85+024681012NHTSA, FHWA•Few standards or guidelines•Lack of population-based data•Inflexibility of data systems•Inability to integrate data systems•Important data elements are not collected•Few standards or guidelines•Lack of population-based data•Inflexibility of data systems•Inability to integrate data systems•Important data elements are not collectedLimitations in Injury SurveillanceLimitations in Injury SurveillanceA Minimum Basic Dataset for Unintentional Injuries•Age, Gender, Ethnic Group•Place of occurrence•Date of Injury•Outcome of Injury•Location of Injury•Activity when accident