International Collaborative Effort (ICE) on Injury Statistics and its Success in Problem Identification & Description

How has the ICE on Injury Statistics been successful for problem identification and description?

PowerPoint Presentation

Slide 1
ICE on Injury Statistics and its Success in Problem Identification & Description

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

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

Slide 17
Place Of Occurrence (First Two Levels of Detail

Slide 18
Place of Occurrence (Third Level of Detail)

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