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Injury Surveillance

Injury Surveillance. Thomas Songer, PhD University of Pittsburgh. Why should we be concerned with monitoring injuries ?. Definitions. Prevention. Reducing the incidence of disease Reducing the prevalence of disease. Control.

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Injury Surveillance

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  1. Injury Surveillance Thomas Songer, PhD University of Pittsburgh

  2. Why should we be concerned with monitoring injuries?

  3. Definitions Prevention • Reducing the incidence of disease • Reducing the prevalence of disease Control • Ongoing programs aimed at reducing the incidence or prevalence of disease Last, Dictionary of Epidemiology

  4. Public 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 Intervention

  5. death rates disability rates hospitalization rates incidence rates prevalence rates Epidemiology is a Science of Rates numerator denominator

  6. Injury Deaths, Australia, 1992 Harrison, 1995

  7. Injury Death Rates, Australia, 1992 Harrison, 1995

  8. How do we identify injuries?

  9. Approaches Towards Monitoring Injury in the Population Death Certificates Population Surveys Surveillance Registries Capture-Recapture

  10. Government Surveys • National Health Interview Survey • National Hospital Ambulatory Care Survey • National Hospital Discharge Survey • Behavioural Risk Factor Survey and Surveillance Provide a better picture of the health status of the population

  11. Surveillance: Systematic, regular ascertainment of incidence using methods distinguished by their practicality, uniformity, and frequently their rapidity, rather than by complete accuracy. Last, 1990

  12. Types of Surveillance • Active • Passive

  13. Active 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 departments

  14. Passive Surveillance • data generated without contact by the agency carrying out the surveillance. Reportable diseases fall under this type of surveillance. spinal cord injuries

  15. Sentinel Events • An event(s) that can be used to assess the stability or change in the health of a population. John Last Dictionary of Epidemiology

  16. Registry: 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 Epidemiology

  17. Where do the data for the numerator and denominator come from in injury surveillance?

  18. EMS Police Self-Treat Emergency Dept. doctor Injury Hospital Morgue Trauma Center Rehab Center Robertson, 1992

  19. 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, 1990

  20. Numerator Issues • Definition • Ascertainment • Severity ?

  21. ICD-9 Codes N Codes - Nature of injury, anatomy E-Codes - External cause of injury

  22. E-codes Are often missing on medical records Some states now require their use in ED and Hospital Admission records Important for identifying cause of injury and designing control programs Help to assign intent

  23. Sources for Monitoring Injuries Woodland Hills School District 4 month 1 month recall student recall medical excuses attendance records

  24. Percent ascertainment for each of the four monitoring sources 90 80 70 60 50 40 30 20 10 0 1 month medical attendance 4 month

  25. Data Sources and Injury Severity No injury Mild Moderate Severe Fatal Survey Doctor visit Hospital adm. Trauma ctr. Death cert. Rogams, 1995

  26. Denominator Issues • Population Base • Which Denominator? ?

  27. What is the crash risk related to older drivers? How important is this risk?

  28. Crash Involvement Rate 200 150 100 per 1000 licensed drivers 50 0 16 20 25 30 35 40 45 50 55 60 65 70 75 80 85+ Age NHTSA, FHWA

  29. Involvement Rate by Mileage 2000 1500 per 100 million miles VMT 1000 500 0 16 20 25 30 35 40 45 50 55 60 65 70 75 80 85+ Age NHTSA, FHWA

  30. Fatality Rate 12 10 8 6 per 100 million miles 4 2 0 16 20 25 30 35 40 45 50 55 60 65 70 75 80 85+ Age NHTSA, FHWA

  31. Limitations in Injury Surveillance • Few standards or guidelines • Lack of population-based data • Inflexibility of data systems • Inability to integrate data systems • Important data elements are not collected

  32. A 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 happened

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