International International Collaborative Effort on Collaborative Effort on

InjuryInjury

June 1-3, 2005June 1-3, 2005Cuernevaca, MexicoCuernevaca, Mexico

Yvette Holder, Yvette Holder, Consultant Biostatistician/EpidemiologistConsultant Biostatistician/Epidemiologist

An Overview of ICE-related workAn Overview of ICE-related work

ICECI (Violence Module)ICECI (Violence Module)

WHO’s Injury Surveillance GuidelinesWHO’s Injury Surveillance Guidelines

Violence IndicatorsViolence Indicators

Violence Module - ICECIViolence Module - ICECI

Adverse Effects

Unintentional

INTENT

War/ Civil Conflict

Interpersonal Context of Assault

Perpetrator/Victim Relationship

Interpersonal Violence Sub-module

Type of conflict

No. of previous attempts

Proximal Risk Factors

Intentional Self-harm

Self-directed Violence Sub-module

War/Civil Conflict Sub-Module

INTENTIONAL

WHO Injury Surveillance WHO Injury Surveillance GuidelinesGuidelines

Purpose of GuidelinesPurpose of Guidelines

Provide surveillance Provide surveillance officers/researchers with the basic tools officers/researchers with the basic tools for collecting information on injuryfor collecting information on injury

Facilitate capture of injury data in a Facilitate capture of injury data in a

standardised but flexible formatstandardised but flexible format

Hence, contribute to the building of an Hence, contribute to the building of an

internationally comparable body of internationally comparable body of

injury datainjury data

Layout of the Guidelines - Layout of the Guidelines - IntroductionIntroduction

Injury - definition; types; epidemiologyInjury - definition; types; epidemiology

Surveillance - definition; purposeSurveillance - definition; purpose

Need for injury surveillanceNeed for injury surveillance

Steps of the surveillance processSteps of the surveillance process

Attributes of a good surveillance systemAttributes of a good surveillance system

Designing an Injury Surveillance Designing an Injury Surveillance SystemSystem

Identify Stakeholders

Define/ Redefine Objectives

Identify Data Sources & Systems

Assess available resources

Sensitise/Orient Stakeholders

State Data Needs

Draft Form & Formulate Data Collection System

Process Data

Design Output for Dissemination

Implement & Train

Monitor & Evaluate

Injury Surveillance Information Injury Surveillance Information System OverviewSystem Overview

Occupation

Assaults Transport

SportSuicides

MDS

CORCOREE

Core Data Set - for All InjuriesCore Data Set - for All Injuries

Minimum Data Set (MDS)

Age, Sex, Intent, PlaceActivity, Nature of Injury,

Mechanism/External CauseText Summary

Optional Data Set

Date, Time, Residence,Alcohol Use, Drug Use, Object,

Severity, Disposition

Age: __ __ yrs. Sex: 1. Male 2. Female 9. Unknown Intent: 1. Unintentional 2. Intentional – others

3. Intentional – self 8. Other ......................... 9. Unknown

Place: Where were you when you were injured? 1. Home 2. Street/ Highway 3. School 8. Other ................................................. 9. Unknown Activity: What were you doing when you were injured? 1. Work 2. Travelling 3. Education 4. Sports 8. Other ............................... 9. Unknown Mechanism: How were you hurt? Or how was the injury inflicted? 1. Traffic Injury 2. Sexual Assault 3. Other Blunt Force 4 . Fall 5. Gun Shot 6. Stab/ Cut 7. Choking/ hanging 8. Drowning 9. Poisoning 10. Fire, heat 98. Other ........................ 99. Unknown Nature of Injury: 1. Fracture 2. Sprain/ strain 3. Cut, bite, open wound 4. Bruise 5. Burn 6. Concussion 7. Organ System Injury 8. Other ............................ 9. Unknown Incident Summary:

CORE INJURY SURVEILLANCE INSTRUMENT- MDS

Reg. or ID #: Date: _ _/ _ _/ _ _ _ _ Time:_ _:_ _ am/ pm Age: __ __ yrs. Residence: ……………………………………….. Sex: 1. Male 2. Female 9. Unknown Intent: 1. Unintentional 2. Intentional – others 3. Intentional – self

8. Other ......................... 9. Unknown Object Involved: 1. Club, stick 2. Knife, cutting tool 3. Fire 4. Gun, firearm 8. Other …………………………. 9. Unknown Place: Where were you when you were injured? 1. Home 2. Street/ Highway 3. School 8. Other ................................................. 9. Unknown Activity: What were you doing when you were injured? 1. Work 2. Travelling 3. Education 4. Sports 8. Other ............................... 9. Unknown Mechanism: How were you hurt? Or how was the injury inflicted? 1. Motor Vehicle Injury 2. Sexual Assault 3. Other Blunt Force 4 . Fall/ J ump 5. Gun Shot 6. Stab/ Cut 7. Choking/ hanging 8. Drowning 9. Poisoning 10. Fire, heat 98. Other ........................ 99. Unknown Alcohol Use: Did you use alcohol within 6 hours of the incident? 1. Yes, confirmed 2. Suspected or reported 3. No, confirmed 9. Unknown Substance Use: Did you use a mood-altering substance? 1. Yes, confirmed 2. Suspected or reported 3. No, confirmed 9. Unknown Severity: 1. No injury 2. Minor 3. Moderate 4. Serious Disposition: 1. Treated & discharged 2. Admitted/ Referred to hospital 3. Died 8. Other ……………….. 9. Unknown Nature of Injury: 1. Fracture 2. Sprain/ strain 3. Cut, bite, open wound 4. Bruise 5. Burn 6. Concussion 7. Organ System Injury 8. Other ............................ 9. Unknown Incident Summary

Expanded Data Set – All InjuriesExpanded Data Set – All Injuries

Modules for Specific Injury TypesModules for Specific Injury Typese.g. Assaultse.g. Assaults

Minimum Data Set

Circumstances,Perpetrator/Victim Relationship

Optional Data Set

Object

Reg. or ID #: Date: _ _/ _ _/ _ _ _ _ Time:_ _:_ _ am/ pm Age: __ __ yrs. Residence: ……………………………………….. Sex: 1. Male 2. Female 9. Unknown Intent: 1. Unintentional 2. Intentional – others 3. Intentional – self

8. Other ......................... 9. Unknown If Intent = 2, complete the following three questions – Context: 1. Quarrel 2. Drug-related 3. Sexual Assault 4. Other crime 5. Gang activity 8. Other ………………………….. 9. Unknown Victim/ Perpetrator Relationship: 1. Partner, past or present 2. (Step-) parents 3. Other relative 4. Friend, acquaintance 5. Stranger 8. Other ……………….. 9. Unknown Object Used: 1. Club, stick 2. Knife, cutting tool 3. Fire 4. Gun, firearm 8. Other …………………………. 9. Unknown Place: Where were you when you were injured? 1. Home 2. Street/ Highway 3. School 8. Other ................................................. 9. Unknown Activity: What were you doing when you were injured? 1. Work 2. Travelling 3. Education 4. Sports 8. Other ............................... 9. Unknown Mechanism: How were you hurt? Or how was the injury inflicted? 1. Motor Vehicle Injury 2. Sexual Assault 3. Other Blunt Force 4 . Fall 5. Gun Shot 6. Stab/ Cut 7. Choking/ hanging 8. Drowning 9. Poisoning 10. Fire, heat 98. Other ........................ 99. Unknown Alcohol Use: Did you use alcohol within 6 hours of the incident? 1. Yes, confirmed 2. Suspected or reported 3. No, confirmed 9. Unknown Substance Use: Did you use a mood-altering substance? 1. Yes, confirmed 2. Suspected or reported 3. No, confirmed 9. Unknown Severity: 1. No injury 2. Minor 3. Moderate 4. Serious Disposition: 1. Treated & discharged 2. Admitted/ Referred to hospital 3. Died 8. Other ……………….. 9. Unknown Nature of Injury:1. Fracture 2. Sprain/strain 3. Cut, bite, open wound 4. Bruise

Reg. or ID #: Date: _ _/ _ _/ _ _ _ _ Time:_ _:_ _ am/ pm Age: __ __ yrs. Residence: ……………………………………….. Sex: 1. Male 2. Female 9. Unknown Intent: 1. Unintentional 2. Intentional – others 3. Intentional – self

8. Other ......................... 9. Unknown If Intent = 3 complete the following question – Precipitating Factor: 1. Psychological Problem 2. Conflict With Family/ friend 3. Physical Illness 4. Financial Problems 5. Legal System Encounters 6. Sexual/ Physical Abuse 7. Death in Family 98. Other .................................. 99. Unspecified Object Used: 1. Club, stick 2. Knife, cutting tool 3. Fire 4. Gun, firearm 8. Other …………………………. 9. Unknown Place: Where were you when you were injured? 1. Home 2. Street/ Highway 3. School 8. Other ................................................. 9. Unknown Activity: What were you doing when you were injured? 1. Work 2. Travelling 3. Education 4. Sports 8. Other ............................... 9. Unknown Mechanism: How were you hurt? Or how was the injury inflicted? 1. Motor Vehicle Injury 2. Sexual Assault 3. Other Blunt Force 4 . Fall/ J ump 5. Gun Shot 6. Stab/ Cut 7. Choking/ hanging 8. Drowning 9. Poisoning 10. Fire, heat 98. Other ........................ 99. Unknown Alcohol Use: Did you use alcohol within 6 hours of the incident? 1. Yes, confirmed 2. Suspected or reported 3. No, confirmed 9. Unknown Substance Use: Did you use a mood-altering substance? 1. Yes, confirmed 2. Suspected or reported 3. No, confirmed 9. Unknown Severity: 1. No injury 2. Minor 3. Moderate 4. Serious Disposition: 1. Treated & discharged 2. Admitted/ Referred to hospital 3. Died 8. Other ……………….. 9. Unknown Nature of Injury: 1. Fracture 2. Sprain/ strain 3. Cut, bite, open wound 4. Bruise 5. Burn 6. Concussion 7. Organ System Injury 8. Other ............................ 9. Unknown Incident Summary

Building a Data SetBuilding a Data Set

Core Minimum Data Set with basic Core Minimum Data Set with basic categoriescategories

+ modules+ modules

+ data elements+ data elements

+ detailed categories+ detailed categories

= ICECI= ICECI

Way ForwardWay Forward

ApplicationApplication Surveillance GuidelinesSurveillance Guidelines

ValidationValidation Comparison with Injury Matrix (60% of specifically Comparison with Injury Matrix (60% of specifically

defined cells)defined cells)• excludes non-traffic, machinery, overexertion and excludes non-traffic, machinery, overexertion and

natural/environmentnatural/environment• includes sexual assaultincludes sexual assault

% of unspecified injuries according to the ICECI % of unspecified injuries according to the ICECI MDSMDS

?Further editing?Further editing

EvaluationEvaluation

Retrospective review of surveillance Retrospective review of surveillance system datasystem data

Prospective System EvaluationProspective System Evaluation

System Environment EvaluationSystem Environment Evaluation

Indicators for Monitoring ViolenceIndicators for Monitoring Violence

Purpose: To monitor violence in the Purpose: To monitor violence in the Americas in a standardised wayAmericas in a standardised way

Types:Types: Basic: minimal, readily availableBasic: minimal, readily available Developmental: desirable but collection would Developmental: desirable but collection would

require a system to be put in placerequire a system to be put in place Research: best collected via surveysResearch: best collected via surveys

NoteNote: All rates are per 100,000 population: All rates are per 100,000 population

Basic IndicatorsBasic Indicators

Age-adjusted suicide rate Age-adjusted suicide rate Age-adjusted homicide rate in males aged 15-44 yrsAge-adjusted homicide rate in males aged 15-44 yrs Age-adjusted homicide rate in females aged 15-44 Age-adjusted homicide rate in females aged 15-44

yrsyrs Homicide rate in children aged 0-4 yrs.Homicide rate in children aged 0-4 yrs. Reports of assault per 1000 pop.Reports of assault per 1000 pop. Reports of robbery per 1000 pop.Reports of robbery per 1000 pop. Reports of kidnappings per 100,000 pop.Reports of kidnappings per 100,000 pop.

Developmental Indicators – IDevelopmental Indicators – I

Age-adjusted death rate due to intimate partner Age-adjusted death rate due to intimate partner violence (IPV)violence (IPV)

Death rate due to child abuseDeath rate due to child abuse Death rate due to elder abuseDeath rate due to elder abuse Age-adjusted robbery-related homicide rateAge-adjusted robbery-related homicide rate Age-adjusted hospital discharge rate due to Age-adjusted hospital discharge rate due to

suicide attemptssuicide attempts Age-adjusted hospital discharge rate due to Age-adjusted hospital discharge rate due to

assault in males aged 15-44 yrsassault in males aged 15-44 yrs

Developmental Indicators – I ct’dDevelopmental Indicators – I ct’d

Age-adjusted hospital discharge rate due to Age-adjusted hospital discharge rate due to assault in females aged 15-44 yrsassault in females aged 15-44 yrs

Hospital discharge rate due to assault in Hospital discharge rate due to assault in children aged less than 5 yrschildren aged less than 5 yrs

Hospital discharge rate for assault in elderlyHospital discharge rate for assault in elderly Reported civil rights violations per 1,000 pop.Reported civil rights violations per 1,000 pop. Reported cases of child maltreatment per 1,000 Reported cases of child maltreatment per 1,000

poppop Reported cases of school fights per 100,000 Reported cases of school fights per 100,000

pop of school-aged children per yrpop of school-aged children per yr

Developmental Indicators – II Developmental Indicators – II Age-adjusted hospital discharge rate for assault Age-adjusted hospital discharge rate for assault

resulting from IPVresulting from IPV Hospital discharge rate resulting from child Hospital discharge rate resulting from child

abuseabuse Hospital discharge rate for assault due to elder Hospital discharge rate for assault due to elder

abuseabuse

Developmental Indicators – III Developmental Indicators – III Age-adjusted Emergency Room (ER) visit rate Age-adjusted Emergency Room (ER) visit rate

due to suicide attemptsdue to suicide attempts Age-adjusted ER visit rate in males aged 15-44 Age-adjusted ER visit rate in males aged 15-44

yrs. due to assaultsyrs. due to assaults Age-adjusted ER visit rate due to assaults Age-adjusted ER visit rate due to assaults

resulting from IPVresulting from IPV ER visit rate due to assaults resulting from child ER visit rate due to assaults resulting from child

abuseabuse ER visit rate due to assaults resulting from ER visit rate due to assaults resulting from

elder abuseelder abuse

Research IndicatorsResearch Indicators

Rate of suicide ideationRate of suicide ideation Rate of suicide attempts in past 12 monthsRate of suicide attempts in past 12 months Self-reported weapon carrying among youth at Self-reported weapon carrying among youth at

school, per 100 school childrenschool, per 100 school children Self-reported fighting rate among youth at Self-reported fighting rate among youth at

school per 100 school childrenschool per 100 school children Self-reported rate of IPV per 1,000 respondentsSelf-reported rate of IPV per 1,000 respondents