Carme Clavel -Arcas Carme Clavel -Arcas Alberto Concha-Eastman Alberto Concha-Eastman

CDC- PAHOCDC- PAHO

IICE Injury Statistics Meeting CE Injury Statistics Meeting

Cuernavaca, Mexico June 1-2, 2005Cuernavaca, Mexico June 1-2, 2005

Implementing a Hospital- based Injury Surveillance Systems in Nicaragua ,

El Salvador and Colombia

CALI

Where we are working

Countries Countries Nicaragua ( 2000 )Nicaragua ( 2000 )

– 2 in the capital 2 in the capital – 3 departmental3 departmental

El SalvadorEl Salvador ( 2001)( 2001)– 2 in the capital 2 in the capital – 6 departmental 6 departmental

ColombiaColombia, , Cali ( 2001)Cali ( 2001) - 5 in Cali 5 in Cali - 1 Santander de Quilichao 1 Santander de Quilichao

Evaluation of Hospital Injury Surveillance Systems in Nicaragua, El Salvador and Colombia

International Workshop Cali, Colombia 6- 8, 2005

Evaluation Methodology Evaluation Methodology

Qualitative componentQualitative component– Hospital descriptionHospital description– Timeline Timeline – FlowchartFlowchart– Simplicity, acceptabilitySimplicity, acceptability– Goals, obstacles, needsGoals, obstacles, needs– Data: dissemination , Data: dissemination ,

use , timelinessuse , timeliness

Quantitative componentQuantitative component– Sensitivity Sensitivity – Predictive Value Predictive Value – CompletenessCompleteness– Quality of data entryQuality of data entry– Costs Costs

Based on a standardized template

Patient arrives at ER

Hospital description : Injury Hospital description : Injury Surveillance SystemSurveillance System

Data analysis

Statistician & Epidemiologist Data entry and quality control

Identification of injured person Fill out Format

Dissemination of the results

Intervention for Injury Prevention

Case DefinitionCase Definition

First visit First visit

to the hospital to the hospital

EmergencyEmergency

Department forDepartment for

any type of injuryany type of injury

Manual Data CollectionManual Data Collection

Hospital Hospital Emergency Emergency Department Department Medical Record Medical Record (Intake Form)(Intake Form)

El Salvador format for the Injury Surveillance System in ER

ResultsResults

Nicaragua team Policies working group

Group

AchievementsAchievements

Injury data collection in ED is possible Injury data collection in ED is possible

Health authorities are interested Health authorities are interested – Extension of injury surveillance Extension of injury surveillance

– Creation of injury prevention programs Creation of injury prevention programs

– Promote intersectorial injury mortality Promote intersectorial injury mortality surveillance surveillance

Data being used to make decisions Data being used to make decisions

Results - ComponentsResults - ComponentsQualitativeQualitative

Staff rotation Staff rotation Training diverse Training diverse Interruptions at the Interruptions at the beginning beginning Flowchart was Flowchart was considered simpleconsidered simple“ “ they don’t have they don’t have enough timeenough time “ “More action than More action than informationinformation

QuantitativeQuantitative

10- 35 % of ER visits 10- 35 % of ER visits are injuries are injuries 75- 95 % 75- 95 % unintentional unintentional 23-4 % intentional -23-4 % intentional -violence violence 2-1 % self inflected 2-1 % self inflected 70 % young male 70 % young male Falls main Falls main mechanismmechanism

Injury Pyramid Pediatric Hospital. Injury Pyramid Pediatric Hospital. San Salvador 2004San Salvador 2004

34Deaths

2486 Hospitalizations

9495 Injury Emergency Visits

Injuries in the community ?

6 % of all deaths

33 % of all emergency

visits

17 % of all hospitalizations

1

73

279

Ratio

Colombia : Percent of ER visits due to Colombia : Percent of ER visits due to injury, Sensitivity, Predictive Value Positiveinjury, Sensitivity, Predictive Value Positive

HospitalHospital % injuries/% injuries/

ER visits ER visits

Sensitivity Sensitivity %%

PVP %PVP %

HUV – L3HUV – L3 5050 7676 9999

FVL – L3FVL – L3 1111 7373 8383

HFPS – L2HFPS – L2 2121 6060 9595

HMCR-L2HMCR-L2 2020 9292 8484

HSJD- L2HSJD- L2 2323 6969 8686

CSS – L1CSS – L1 1414 6464 9090

Data quality : Percent of Missing Data in two General Hospitals . 2004

VariableEl Salvador N = 4,890

Nicaragua N= 8, 120

Age 1 0.1

Sex 0 0

Place injury occurred 2 98

Day event 27 99

Intentionality 0 0

Activity 0 0

Mechanism 0 0

Alcohol Use 20 97

Nature of Injury 0 0

Disposition 9 0

Data quality : Percent of Missing Data in two General Hospitals . 2004

Variables : Specific Modules

EL Salvador Cases

% Missing data

NicaraguaCases

% Missing data

Person injured or road user

574 4 978 0.1

Relationship of perpetrator to

victim

364 12 702 0.1

Precipitating Factors

61 38 141 0

Variable %Age 100%

Sex 100%

Address of event 94%

Day of event 100%

Intentionality 100%

Activity 100%

Mechanism 100%

Alcohol Use 94%

Nature of Injury 100%

Disposition 88%

SPECIFIC MODULES :

Person injured or road user 100%

Relationship of perpetrator to the victim 80%

Precipitating Factors 100%

Data Entry Quality : Pediatric Hospital El Salvador, 2004

Dissemination dataDissemination dataNationally Nationally

– National Electronic Bulletins ( Nicaragua ) National Electronic Bulletins ( Nicaragua ) – Hospital Electronic Bulletins ( El Salvador )Hospital Electronic Bulletins ( El Salvador )

Internationally Internationally – Last two Injury World ConferencesLast two Injury World Conferences

Results- InterventionsResults- Interventions

Campaign against burns by “ pólvora “Bicyclist Injury Prevention Plan“ Life Campaign” Summer Prevention Plan Improvement of conditions at hospitalImprovement of conditions at hospital level level

ChallengesChallenges ~ Recommendations ~ Recommendations

Strengthen quality of data Strengthen quality of data

Reduce minimum data set Reduce minimum data set

Improve the dissemination of data, Improve the dissemination of data, especially through articles especially through articles

Increase injury research Increase injury research

Identify best practices for injury prevention Identify best practices for injury prevention

Next steps Next steps Develop a methodological plan for Injury Develop a methodological plan for Injury

Information System in the Americas ( PAHO )Information System in the Americas ( PAHO ) : :

– Hospital Based : CAREISS Hospital Based : CAREISS

– Mortality data ( Observatorios Municipales ) Mortality data ( Observatorios Municipales )

– Specific topics like Intimate Partner Violence/ Specific topics like Intimate Partner Violence/ Sexual ViolenceSexual Violence

THANKS THANKS to the technical teams and the to the technical teams and the

hospital staff in the three hospital staff in the three countriescountries

Carme Clavel-ArcasCarme Clavel-Arcas e-mail: e-mail: zgn4@cdc.govzgn4@cdc.gov

Alberto Concha- EastmanAlberto Concha- Eastman e-mail : e-mail : conchaal@paho.orgconchaal@paho.org

www.cdc.gov/ncipcwww.cdc.gov/ncipcwww.paho.orgwww.paho.org