Slide 1
ICE on Injury Statistics and its Success in Problem Identification & Description
9th World Conference on Injury Prevention & Safety Promotion
Merida, 15-18 March, 2008
Yvette Holder, MPH
International Biostatistics & Information Services
Slide 2
Public Health Approach & Injury Control (CDC)
This figure shows the steps of the public health approach to injury control starting with defining the problem, followed by identifying risk and protective factors, followed by developing and testing prevention strategies, and finally, assuming widespread adoption of effective strategies.
Slide 3
Information Needs & PHA
Define the problem
Surveillance data from various sources
Identification of at-risk populations
Description of potential risk factors
Slide 4
Information Needs & PHA ct'd
Identify risk/protective factors
Comparison of data across environments (sites, sub-populations, countries etc.)
Characterization of injury patterns
Case-mix comparisons
In-depth research studies
Slide 5
Information Needs & PHA ct'd
Develop and test intervention strategies
Evaluation for effectiveness
Indicators for monitoring
Slide 6
Information Needs & PHA
Define the problem
Surveillance data from various sources
Identification of at-risk populations
Description of potential risk factors
Slide 7
Challenge I
To establish data collection systems
Absence of an information culture
Resistance to data
Knee-jerk and short-sighted reaction to problems vis-a-vis designed and evaluated interventions
Lack of resources
Human - staff shortages, mobility
Skills and knowledge re IS implementation
Materials
Slide 8
Injury ICE Response
In collaboration with WHO and CDC, developed a "How To" manual, adaptable to any environment
Injury Surveillance Guidelines provide a basis for continuity in a situation of high staff mobility
Slide 9
Injury Surveillance Guidelines
Manual
Identifies potential data sources
Describes minimum data that should be collected for major types of injuries
Provides options for increased data collection if resources are available
Recommends data analyses and outputs
Slide 10
Injury Surveillance Guidelines ct'd
Outlines the steps to establishing an ISS
Identifying and engaging stakeholders
Seeking resources
Identifying and overcoming potential obstacles
Monitoring and evaluating the system and its ouputs
Slide 11
Further Injury ICE Response
Encourage the establishment and sustained operation of Injury Surveillance Systems (ISS) worldwide
Provision of an international forum for sharing of ISS output
Slide 12
Information Needs & PHA ct'd
Identify risk/protective factors
Comparison of data across environments (sites, sub-populations, countries etc.)
Characterization of injury patterns
Case-mix comparisons
In-depth research studies
Slide 13
Challenge II
To operate and maintain injury data collection systems
What data to collect?
Quality of data
Comparability and compatibility of injury data
Slide 14
Injury ICE Response
An injury data classification system, the International Classification of External Cause of Injury (ICECI) that
standardises injury data and
facilitates comparability
Initiative to standardise questions for household surveys (work in progress)
Slide 15
ICECI
The ICECI is
Comprehensive (encompasses all types of injuries), with definitions for all terms
Multi-axial (covering all factors that describe the circumstances of the event)
Flexible (modular with optional levels of detail, appropriate to capacity)
Compatible with the ICD-10
Slide 16
International Classification of External Cause of Injury (ICECI)
ALL INJURIES
Demographics
Intent
Mechanism
Object
Place
Activity
Alcohol Use
Other Psychoactive Drug Use
Nature of Injury
Severity
Disposition/Outcome
MOTOR VEHICLE INJURIES
Mode of Transport
Type
Counterpart
ASSAULTS/HOMICIDES
Perpetrator/Victim Relationship
Circumstances of Assault
SUICIDES
Proximal Risk Factor
OTHER e.g. SPORTS, OCCUPATIONAL
Slide 17
Place Of Occurrence (First Two Levels of Detail
Place of Occurrence - Category of place where the injury event occurred
Codes
1 Home, includes garden, garage and other building attachments
2 Street/highway
3 School, includes playground; excludes sports field
8(98) Other This may be further separated into
4 Institution , includes prison, shelters, old people's home
5 Sports and athletics area
6 Other Transport area
7 Industrial/construction
8 Commercial
9 Farm, excludes farmhouse
10 Countryside, water, sea
9(9) Unknown
Slide 18
Place of Occurrence (Third Level of Detail)
5 Sports and athletics area
51 Sportsground (outside)
52 Sportshall (inside)
53 Public swimming centre
54 Racetrack, racecourse
55 Riding school
56 Skating rink, ice palace
57 Ski area
58 Other specified sports and athletics area
59 Unspecified sports and athletics area
Slide 19
Information Needs & PHA ct'd
Develop and test intervention strategies
Evaluation for effectiveness
Indicators for monitoring
Slide 20
Challenge III
To transform data into information such that
Data are easily understood and interpreted
Data are comparable across countries, in different environments
Specifically to group 1200 codes into meaningful but standard groups for reporting.
Slide 21
Injury ICE Response -
Data Reporting Frameworks - I
External Cause of Injury Matrix
Based on the axes of intent and mechanism (from the external cause code)
4 x 12 matrix, expandable to 5 x 26
< 50 groups, suitable for mortality data
Updated from ICD-9 to ICD-10
Provision for a third variable
Slide 22
External Cause of Injury Matrix
(ICD-9)
This figure shows the outline of the external cause of injury matrix with rows being the mechanisms of injury (examples include drowning, poisoning, fall, fire or burn, cut or pierce) and the columns the intent (unintentional, suicide, homicide and undetermined). The cells of the matrix contain the ICD-9 codes (in this case) that identify the mechanism and intent. The example given is for cut or pierce, coded as E920 for unintentional, E956 for suicide, E966 for homicide and E986 for undetermined.
Slide 23
Injury Ice Response -
Data Reporting Frameworks II
Barell Matrix
Framework presenting ICD9-CM codes (morbidity) using body region and nature of injury
Basic 5 x 12 expandable to 10 x 12 and to 36 X 12 cells
Slide 24
Barell Matrix
This figure shows the outline of the Barell matrix that was described in Slide 23. The rows of the matrix are body regions of injury and the columns are for the nature of the injury. Cells are filled with ICD-9-CM injury codes.
Slide 25
Injury ICE Response -
Data Reporting Frameworks - III
Injury Mortality Diagnosis Matrix: ICD-10
Framework that combines the two main axes of injury description, viz the body region and the nature of injury
Reduction from 1169 ICD-10 codes to a minimal 17X16 matrix that captures all of all injury deaths
Option of a more detailed 43 x 20 matrix
Potential for use with morbidity data
Slide 26
Injury Mortality Diagnosis Matrix
This figure shows the outline of the Injury Mortality Diagnosis Matrix that was described in slide 25. The rows of the matrix are body regions of injury and the columns are for the nature of the injury. Cells are filled with ICD-10 S or T injury diagnosis codes.
Slide 27
Challenge IV
To monitor changes in injury situations and evaluate interventions
Valid stable indicators that reflect real changes and not artifacts
More accurate identification of risk and protective factors
Slide 28
Injury ICE Response -
Indicators Working Group
Finalizing a set of valid, robust indicators
Determining a set of severity scores.
Slide 29
ICE - A Mechanism for Global Injury Data
Tools for data collection
Methodologies for analysis
Frameworks for information dissemination
Slide 30
Conclusion
All ICE efforts serve multiple objectives toward the goal of information for global injury prevention - truly a mechanism of globalization for injury prevention and control