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ICECI application in Injury Surveillance in Cali, Colombia

ICECI application in Injury Surveillance in Cali, Colombia. Andrés Fandiño-Losada Edgar Muñoz María Isabel Gutiérrez Martínez. Methodology. Testing of Injury Surveillance Systems in Latin-American. WHO/ PAHO & CDC initiative. In Cali, 2 Hospitals were selected.

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ICECI application in Injury Surveillance in Cali, Colombia

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  1. ICECI application in Injury Surveillance in Cali, Colombia Andrés Fandiño-Losada Edgar Muñoz María Isabel Gutiérrez Martínez

  2. Methodology • Testing of Injury Surveillance Systems in Latin-American. • WHO/ PAHO & CDC initiative. • In Cali, 2 Hospitals were selected. • Commitment, level of care, ease in working in emergency departments. • Hospital San Juan de Dios (Level 2). • Hospital Primitivo Iglesias (Level 1). • In Colombia: 3 levels of care. 3d is the most complex.

  3. Methodology • ICECI Pilot data collection form was designed with physicians participation from Emergency Departments. • Data Collection • March 26 through July 26 2002. • 5377 cases collected. • Quality control during the process: • Constant review of forms during field work. • Correction of mistakes in the forms. • Double-entry process during typing.

  4. Methodology • Seventeen ICECI V.1.0. variables were used in pilot test. • ICECI level 2 codes for designing the General Data Set. • ICECI level 1 codes for designing the Specific Data Set. • Total: 485 ICECI V.1.0. codes in 17 variables. • Avrg: 28.5 codes per variable. • ICECI Pilot form used 174 codes: • Avrg: 10.2 codes per variable.

  5. Intent Mechanism Object / Substance Place Activity Alcohol use Psychoactive drug use Previous suicide attempt Risk Factor for Suicide Perpetrator / Victim Relationship Sex of perpetrator Context of Assault Type of Legal Intervention Type of Conflict Mode of Transport Role of Injured Person Counterpart ICECI Variables collected in Pilot Test

  6. PILOT TEST RESULTS • ANALYSIS OF SURVEILLANCE DATA • APPLICATION OF VARIABLES AND CODES OF ICECI CLASSIFICATION

  7. Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Age groups by Sex (%)

  8. Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Intent by Sex (%)

  9. Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Object that caused injury by Sex (%)

  10. Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Mechanism by Sex (%)

  11. Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Perpetrator/ Victim Relationship by Sex (%)

  12. Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Risk Factors for Intentional Self-Harm by Sex (%)Multiple Response Variable

  13. Simplifying ICECI Collecting Form • Excluding categories (codes) below a cut off point, into each ICECI variable. • Establishing correspondences among categories from different variables for exclusion.

  14. Excluding ICECI Categories • Statistical Criteria: • They don’t apply for “Other” and “Unknown” codes. • Cut off point: To Exclude codes with a frequency less than 1%. • Count the number of codes for exclusion. • Other Criteria: • Conceptual • Practical

  15. Frequency of ICECI Codes • Frequency lists for each ICECI variable used in pilot test. • For example, • Intent: • 2 / 7 (28.6%) codes will be eliminated.

  16. Codes below cut-off for each Variable

  17. Codes below cut-off for each Variable

  18. Excluding ICECI Variables • Injury Surveillance System Instrument • Context Dimensions used: • Mechanism • Object • Number of categories in each variable of dimension: • Mechanism: 41 categories. • Object: 17 categories. • Total: 58 categories. • By logic, mechanism and object dimensions are closely related.

  19. Correspondence Analysis • Statistical Method for reducing the number of categories or dimensions used in a classification system. • Components of each studied variable are located into a n dimension cloud. • Image of that cloud is projected in 2 dimension space. • Correspondences among categories are determined. • It’s possible to define a new unique dimension from initial ones.

  20. Correspondence Analysis Results …

  21. Correspondence Analysis 1 10 0 Explosive material Struck by explosive blast -10 Fire Burn -20 Object Dimension 2 -30 Mechanism -8 -6 -4 -2 0 2 4 6 8 10 12 -7 -5 -3 -1 1 3 5 7 9 11 Dimension 1

  22. Correspondence Analysis 2 10 8 Hot Liquid Burn 6 4 2 Firearm Shot by firearm 0 Object Dimension 2 -2 Mechanism -6 -5 -4 -3 -2 -1 0 1 2 3 4 Dimension 1

  23. Correspondence Analysis 3 10 0 -10 Smoke Inhalation of smoke Object Dimension 2 -20 Mechanism -7 -5 -3 -1 1 3 5 -6 -4 -2 0 2 4 Dimension 1

  24. Correspondence Analysis 4 Knife or cutting arms Cutting Tearing Blunt force Vehicle Road traffic injury Person Struck-kicked Sexual assault Animal Stinging-Biting Object Mechanism

  25. Correspondence Analysis 5 Blunt object Blunt force Floor Falls NS Object NS Mechanism Object Mechanism Medicine Pesticide Street drug Poisoning

  26. Final Proposal • New dimension with a mixed variable: • Mechanism / Object • Number of Categories in the variable of each dimension: • Mechanism: 3 categories are eliminated. • Object: 10 categories are eliminated. • Total: 13 categories eliminated. • Unique Final Variable with 45 categories. • A SIMPLER INSTRUMENT.

  27. Pilot Test Conclusions • ICECI is a conceptual advance for injury surveillance and injury control. • There are a lot of items in each dimension of ICECI. • It’s necessary a balance between needs of data and instrument complexity. • Countries with less resources need a simpler injury surveillance system.

  28. Injury Surveillance System • Injury surveillance system continues in … • City of Cali: • Hospital San Juan de Dios (HSJD) – level 2 • Hospital Mario Correa Rengifo (HMCR) – level 2 • H. Universitario del Valle (HUV) – level 3 • Foundation Valle del Lili Clinic (FCVL) – level 3 • Siloe Health Center (CSS) – level 1 • City of Santander de Quilichao: • H. Francisco de Paula Santander (HFPS) – level 1

  29. CISALVAInstitute for Peace Promotion and Injury / Violence Prevention Thanks

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