European Seminar on Injury Data for Effective and Innovative Safety Promotion

Power Point Presentations and Abstracts

ACV-Austria Center ViennaBruno-Kreisky-Platz 1, Vienna.

Room L4 (Level 1)

Wednesday, 9 November 2016

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TABLE OF CONTENTS

1. Introduction

2. Abstracts of full paper presentations

3. Abstracts of short presentations

4. List of participants

5. About the organisers

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1. Introduction

EuroSafe organised its annual seminar in Vienna, Wednesday 9 November 2016, in collaboration with the European Public Health Association (EUPHA) and its Injury Prevention and Safety Promotion Section. This year, the joint EuroSafe-EUPHA seminar looked into the “Use of injury data for effective and innovative safety promotion” and was supported by the BRIDGE-Health project.

Scope and purpose

Reliable injury data are essential for making informed decisions about accident prevention priorities and in developing effective safety promotion initiatives. They are critical in harnessing political will, public support and the funding needed to undertake actions. Injury data are also required to evaluate the success and the cost-effectiveness of these actions.

Emergency Departments (EDs) of hospitals have proven to be the most valuable source of injury data, beside death certificates. EDs allow for the collection of data in sufficient number and relevant for prevention. Although great progress has been made in the past years regarding data quality, availability and accessibility, many challenges still remain.

EC co-funded projects, such as the Joint Action on Monitoring Injuries in Europe (JAMIE) and now the BRIDGE-Health project, have helped to create the European Injury Data Base (IDB) of national emergency department surveillance systems. The IDB is managed by a very successful cross European network of National Injury Database Administrators (NDAs), with currently 26 countries collecting and sharing harmonised surveillance data to support policy initiatives and actions at European, national and regional level.

The aim of the Seminar was to demonstrate the value of ED-based injury information both for health initiated policies and actions. The seminar showcased local and national level initiatives that are geared by injury data.

Outcome of seminar

The central purpose of an injury surveillance system is to monitor trends of particular types of injuries and to identify risk factors. A great many countries are using such data to target injury control measures to relevant circumstances and populations and to increase effectiveness of resource allocation for injury prevention..

The Seminar presentations clearly demonstrated the wide range of policy areas for which injury data are most relevant - such as consumer safety policies, road traffic safety research and the prevention suicide and self-harm - and for addressing vulnerable groups such as children, adolescents, high risk sports and older people. The presentations highlighted the great value of injury data in a wide variety of safety initiatives, such as establishing paediatric-counselling programmes in local hospitals, introducing safety management schemes in ski-resorts, developing appropriate safety standards for dangerous power-tools and in setting priorities in health and consumer protection policies.

The availability of accurate information on the causes and circumstances of injuries is indispensable for developing such initiatives and programmes. Through a series of projects co-financed by the European Commission (EC), the IDB-partners are working together to enhance the quality of injury data collection and to expand the number of countries across the continent that are actively engaged in IDB and its injury data exchange at the EU-level. The network of IDB-countries reports regularly on the findings from national data that is collated and analysed at EU-level and presented at the Seminar its latest 6th edition of the report ‘Injuries in the European Union’.

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The health sector plays a key role in injury prevention as the health sector’s mandate includes preventing and responding to all major health threats and causes of mortality and morbidity including injury; and a substantial proportion of direct costs to the health sector result from injuries. The health sector is uniquely positioned to collect data, analyse risk factors and to generate multi-sector prevention efforts across the wider range of relevant policy domains.

Multiple factors are associated with the success of injury surveillance in Emergency Departments (EDs). In the future, more ‘intelligent’ injury surveillance systems could even better inform decision makers at national and local levels and guide practitioners in various organisations in preventing injuries. Examples of smart data linkage systems were presented and opportunities of automatic coding though text and voice recognition systems were demonstrated as effective means to reduce the burden of administration for administrative staff and increase the informative value of existing information.

The Seminar participants agreed as to the need to continue to exchange and collaborate on injury surveillance in Europe and to advocate the use of available data for policy purposes. The IDB was seen as a solid system providing core injury indicators for bench marking policies in countries as well more detailed information that helps to steer prevention actions in w wide range of domains.

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2. Abstracts of full paper presentations[with links to PPTs]

- EU Health Information strategy, Philippe Roux, DG Santé, Country Knowledge and Scientific Committees Unit.

- Safety of consumer products and services ,Mike Hayes, ANEC - the European consumer voice in standardisation, Belgium.

- Child safety promotion: g ood practices in German speaking countries , Gabriele Ellsäßer, Brandenburg State Office of Environment, Health and Consumer Protection, Germany.

- Monitoring alcohol-related injuries for prevention ,Birgitte Blatter, Consumer Safety Institute, the Netherlands.

- Measuring serious injuries on European roads ,Robert Bauer, KFV-Kuratorium für Verkehrssicherheit, Austria.

- Opportunities of data linkage Samantha Turner, Farr Institute, Swansea University Medical School, UK.

- Injury indicators: challenges of country-level comparison ,Rupert Kisser, EuroSafe-Injury Surveillance programme, Austria.

- Comprehensive and uniformly coded injury data delivered by care providers ,Anne Lounamaa, National Institute of Health and Welfare, Finland.

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The importance of data in protecting the safety of consumersMichael Hayes and Tania Vandenberghe, ANEC, Brussels

Have you ever thought why your mobile phone works away from home? Or why your bank card can be used anywhere in the world? Or why the dashboard symbols in the German car you have hired in Spain are the same as in your French car at home in Norway? It’s because of European standards.

For consumers, standards are important as, when they are properly developed and applied, they can make our lives easier; the products we buy safer, interoperable and accessible to people of all ages and abilities. They can also improve product performance, raise consumer protection and help reduce the risk of accidents.

ANEC, the European consumer voice in standardisation, is closely involved in the development of standards from the European Commission’s problem definition and decision-making stages to the technical discussions in CEN and CENELEC committees and working groups. ANEC is represented on the Commission’s committee that oversees the General Product Safety Directive, the directive that controls a wide range of consumer products, and its Consumer Safety Network, a consultative experts group chaired by the European Commission and composed of national experts from the administrations of the EU Member States and EFTA members, and other European stakeholder organisations. Under the Standardisation Regulation, ANEC has a right to be consulted and to participate at various stages in the standards development processes.

To ensure that appropriate decisions are taken throughout the process, injury data is a valuable component, although it is not the only parameter used in the decision-making process. It allows confirmation that there is or, equally importantly, is not a problem to be addressed; that the specific injuries that require detailed consideration in standards committees to be defined; and the populations who are most frequently injured to be identified. The data needed therefore moves from broad, epidemiological data to much more detailed information covering the events – the accidents, the people injured and the injuries.

For example, if the need for a new standard for a consumer product had been identified using epidemiological data, the following IDB data for individual accidents covering a significant sample of events would usefully inform the process: age of victim, nature of injury, part of body injured, severity of injury and/or disposal (i.e. ED attendance only, admission to hospital, death), and, most importantly, a description of event. The data would not need to contain any information that would allow the children or the accidents to be identified (e.g. country, date). The data would need to be available to all members of the technical committee drafting the standard on the understanding that, as with all committee papers, it was not for public distribution.

For several years, ANEC has campaigned with others for the provision of a pan-European database as we feel that without easily accessible, representative, up-to-date injury data there is the risk that consumer safety is compromised, through a lack of or inappropriate and/or incomplete standards or other consumer protection mechanisms.

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Child Safety Promotion: Good Practices in German-Speaking CountriesGabriele Ellsäßer, Brandenburg State Office of Environment, Health and Consumer Protection

This presentation will focus on the under 5-year-olds showing that the highest risk of death or requiring hospital treatment is due to domestic accidents among all children under 15 years (Ellsäßer/Federal Statistic Office 2016). Products are involved in around 75 % of all injuries in the under 5-year-olds (IDB Germany). Therefore, young children in particular are in need of the best possible protection.

The meeting of the German-speaking countries (Germany, Austria and Switzerland) in June 2016 focused on this target group and on an exchange of experience regarding the question: Which safety promotion strategies are currently being used in counselling young parents? In this seminar presentation, the main conclusions from this exchange will be summarised. Examples will be given of medical professionals who are working in close contact to young children (paediatricians, midwives, clinicians) and have introduced injury prevention advice in their work. Also new approaches in addressing refugees are offered.

IDB data is the catalyst for targeting injury prevention and providing information on product related risks. The German-speaking programmes comprise the age- and development-specific approach of accident prevention with reference to products as well as early information for young parents. The main goal is to offer support, rather than criticising unexperienced parents.

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Monitoring alcohol-related injuries for preventionBirgitte Blatter, Consumer Safety Institute, Amsterdam.

The topic of ‘alcohol at the Emergency Department (ED)’ is receiving increasing attention in the Netherlands. Since 2003 the number of children between 12 and 18 that have visited the ED due to an alcohol intoxication has increased dramatically. Recently, a call for action was sent out by an ED in Amsterdam that experienced nuisance due to drunken and intoxicated patients. Having ended up at an ED might be a warning and have a secondary preventive effect for future alcohol abuse or primary preventive effect among peers. Finally, since 2014 Dutch municipalities are responsible for the enforcement and evaluation of the ‘Law on alcohol sale’, which states that alcohol cannot be sold to or be in the possession of people under 18. Although the benefits are hardly questioned, monitoring alcohol use at the ED is not established as a standard procedure in the Netherlands.

The Dutch Injury Surveillance System (LIS) exists since 1997 and includes injuries and (alcohol) intoxications from a random sample of (13) EDs in the Netherlands. However, alcohol use prior to injury is only registered if the signs are obvious or if registration is relevant for treatment, leading to a huge underestimation of alcohol-related injuries.

Since 2015, three projects have been started in which we focus on improvement of registration of alcohol-related injuries in LIS:

- The previously initiated Dutch registry of pediatricians on children admitted to hospital due to alcohol abuse will be integrated into LIS. EDs see the importance to register alcohol use, but the administrative burden is high and the general opinion is that data collection should be integrated in the standard hospital information system. After analyzing hospital specific data we noticed that physicians defined intoxications differently and that standard criteria for alcohol intoxication did not exist. Alcohol blood levels are not always measured at an ED. We have proposed that alcohol intoxication is defined as ´visiting the ED because of effects of the alcohol use´; an injury in a patient being drunk is defined as alcohol-related injury (and not an intoxication). In a feasibility and implementation project, EDs within LIS will collect data on the following variables concerning alcohol use: intoxication yes or no, (amount of) alcohol use 6 hours prior to injury, and if younger than 18: place of purchasing consumed alcohol, place and persons alcohol was consumed with.

- In the East of the Netherlands, a collaboration between VeiligheidNL, the local (LIS) hospital and municipalities has been set up to gather information for local policy making. Data are collected as in the first project. We found out that questions on alcohol use should not be asked by administrative personnel, but by nurses or physicians. After one year of data collection 209 alcohol and drug related cases were registered (13/10.000 inhabitants). There were large differences between municipalities. The concerned municipalities were interested in the results but are still struggling with their role as law enforcers when it concerns alcohol sale to youth.

- In three hospitals in the Netherlands a pilot has started on tailor made screening, secondary prevention, and implementation of interventions (in collaboration with Trimbos Institute). In one hospital the pilot has started. The EDs affirm the role they can play in secondary prevention, but they stress that screening and referring to therapy or e-health interventions should be easy and must not hamper emergency treatment.

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Measuring serious injuries on European roadsRobert Bauer, KFV (Austrian Road Safety Board), Vienna

In January 2013, the definition of serious injuries as “patients with an injury level of MAIS ≥ 3 (Maximum Abbreviated Injury Score of three or more; MAIS3+ for short)” was established by the High Level Group on Road Safety representing all EU Member States. It was recommended that all EU countries provide data for serious injuries according to this definition from 2014 on. Three main ways were identified for the Member States to collect the data: 1) by applying a correction to police data; 2) by using hospital data; and 3) by using linked police and hospital data. As of June 2016, 17 countries had either delivered MAIS3+ estimates to DG-MOVE or had reported that they would do so shortly.

A fundamental criterion for developing serious road traffic injury indicators is the availability of data that is accurate enough to allow the reliable identification of serious road traffic injuries. A coding of injuries offering accurate information for the diagnostic and external cause (mechanism) is required to apply case definitions and conduct appropriate case ascertainment.

Hence, hospital data are essential for determining the number of serious road injuries, defined as MAIS3+ casualties, and actually almost all countries doing so are using ICD-10 coded hospital data for that purpose, namely official hospital discharge data. At the same time, access to hospital data seems to be problematic for at least some countries, due to privacy regulations.

In this presentation the potential of another type of hospital data, the IDB data, for developing serious road traffic injury indicators will be discussed along the basic requirements for a data source to allow AIS assignment:

- it allows for the distinction of road casualties, ideally by mode of transport; - it contains direct AIS scores or sufficiently detailed ICD codes; and- it is a representative sample or provides full coverage of national road casualties.

The discussion will also consider the experience some IDB countries already have “with MAIS3+”, as well as options for proposing IDB as a possible MAIS3+ data source to DGMove (namely the involvement in the Horizon 2020 project SafetyCube which, in one of its tasks, aims to assess and describe the process needed to estimate the number of serious road injuries in Europe).

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Opportunities of Data LinkageSamantha Turner & Ronan Lyons, Farr Institute, Swansea University Medical School.

To ensure effective injury prevention policies and interventions reach those individuals at greatest risk of injury, high quality injury surveillance systems are required to support informed decisions. While single source surveillance systems (e.g. based solely on Emergency Department data) are useful for observing injury rates and patterns, and supporting generalised prevention strategies; no single data source is able to provide a comprehensive picture of injuries across the injury continuum (e.g. from risk factors to outcomes) and injury spectrum (e.g. from minor injuries to death).

The ability to link individual-level data across multiple data sets, provides a rich data environment, to explore the complex interactions between injury risk factors, exposures, interventions and outcomes. Data linkage systems also offer a low-cost solution for the evaluation of simple and complex interventions, and help improve injury data quality.

Several data linkage systems have been developed in recent years with differing levels of success. The following presentation focuses on a world leading data linkage infrastructure, the Secure Anonymised Information Linkage (SAIL) Databank, in the Farr Institute, Wales, United Kingdom. The SAIL system uses unique, non-identifiable fields, to link individual and household level data across multiple health, educational, social and environmental datasets. As such the SAIL infrastructure provides a rich data platform to conduct comprehensive injury epidemiological analysis, and high quality evaluations of preventative interventions.

An overview of the SAIL system will be presented, including information on how the system operates whilst complying to strict data protection legislation and confidentiality guidelines. SAIL datasets available for injury surveillance projects, including an overview of injury projects which have utilised SAIL will be discussed. It is hoped this presentation will demonstrate the value of linked data and support practitioners who are looking to improve data linkage systems in their own countries.

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Injury indicators: challenges of country-level comparisonRupert Kisser, Injury Surveillance programme, EuroSafe.

For guiding EU-level health policies and programmes and for monitoring the effect of actions reliable indicators on the burden of major health threats, including injury, are needed. A series of “European Core Health Indicators” (ECHI) projects has led to recommendations as to which indicators are meaningful and feasible. Beside injury-specific mortality, incidence rates for home and leisure injuries, road traffic and work-place injuries as well as suicide attempts are recommended to be made available for the EU-28 states.

For non-fatal injuries, data collection in emergency departments (EDs) has been proven as valid, reliable and cost-efficient. The methodology of EU injury databank (IDB) system offers a “minimum data set” (IDB-MDS), which allows for establishing the desired ECHI-indicators. The IDB-MDS can be recorded for every ED patient without noteworthy additional burden to ED-staff and patients.

During the years 2012-2014 IDB-MDS data have been recorded in 26 European countries, although at varying level of quality. For 22 of these countries, various incidence rates could be estimated, for the first time. The general injury rate for the EU is estimated at 77.8 per 1000 persons, with a range of 43.2 to 116.8, and the EU rate e.g. for home and leisure injuries (ECHI-indicator 29) is 53.7, with a range of 19.5 to 84.1.

The estimated national injury rates for home and leisure, road, work-place and violence show quite large ranges, which are not only the result of differences of national morbidity, but also of differences of health care systems (e.g. accessibility of EDs), percentage of non-residents, sampling biases and inadequacies of estimation methods.

In conclusion, IDB-MDS deliver valid injury indicators at national and EU-level, despite of national shortcomings in data quality. The analysis of national differences as their causes will lead to the further harmonization of sampling and estimation methods, although the influence of national health care systems can hardly be eliminated. However, more important is the fact that reliable and sustainable injury surveillance systems exist in all European country for gearing national policies and programmes and for monitoring the impact of these programmes in terms of reduction of injury mortality and morbidity.

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Comprehensive and uniformly coded injury data delivered by care providersAnne Lounamaa, National Institute of Health and Welfare, Helsinki.

The central purpose of an injury surveillance system is to monitor trends of particular types of injuries or their risk factors. More detailed data can be used to target injury control measures to relevant circumstances and populations and to increase effectiveness of resource allocation. To be comprehensive, surveillance systems ought to treat all types of injuries equally. Ideally surveillance systems are socially, geographically and thematically inclusive. Socially inclusive data sources should capture data evenly across all socioeconomic and population groups. Geographically inclusive data sources cover different parts of a region and also different living environments. Thematically inclusive data excludes no type of injury.

For decades it has been argued that for comprehensive injury surveillance the data should be collected during the care of the injured person, in Emergency Departments (EDs) and during inpatient care. Complexity of classification systems is commonly a target of criticism. We know that multiple factors are associated with the success of injury surveillance. ED related factors, such as the pace of work, properties of the software used in data entry, communication culture among ED staff and the alignment of injury registration with existing organisational routines are organisational antecedents associated with the success of injury data collection in EDs. Also data dissemination practices and established practices for co-operation with information users are associated with surveillance success.

Presently, two developments affect injury surveillance. The first is related to IT systems development. The second is related to changes in the care systems. Already current and even more so future IT systems are intelligent and will have features that could increase automatic coding from speech or written texts. This will have implications for future coding systems. In the past fewer codes and logical hierarchies of codes were targeted, while in the future detailed and comprehensive codes could work better. Intelligent IT systems could even suggest to us improvements in coding systems. Integrated and client oriented care systems will offer possibilities and even require us to extend data collection points. Outpatient care settings are more and more registering injury data, also including external factors. In addition social welfare service providers will soon share the same information systems and data structures as medical care providers and therefore in the future ought to also be considered as data providers.

Contextual changes in Western societies challenge us, injury surveillance experts. In the future, more comprehensive injury surveillance systems could better inform decision makers at national and local levels and guide practitioners in various organisations in preventing injuries. We need to take into account that both social welfare and health care employees need to share a common understanding of injury surveillance and the logic of coding systems. This is an extension to our target audience. It is also important that we reconsider the ideal of the coding systems as IT systems change. Further, we need to better understand organisational practices when registering injuries, as well as using and disseminating injury information.

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3. Abstracts of short paper presentations[with links to PPTs]

1. Examples of data use from the National Self-Harm Registry Ireland ,Eve Griffin, National Suicide Research Foundation, University College Cork.

2. Use of hospital emergency department data to detect dangerous power tools involved in injuries, Dritan Bejko, Institute of Public Health, Luxembourg.

3. Unintentional injury in England: an analysis of the emergency care dataset pilot in Oxfordshire ,Errol Taylor, Royal Society for the Prevention of Accidents, Birmingham.

4. Seasonality and periodicities of external causes mortality (1980 to 2012): Is there a sex difference?

Emanuel Rodrigues, Ministério da Saude, Instituto Nacional de Saúde, Lisbon.

5. Injury diagnoses is also a tool for monitoring , Johan Lund, University of Oslo.

6. Vision Zero for fatal child injuries in Austria , Monica Steiner, Kuratorium für Verkehrssicherheit-KFV, Vienna.

7. Examples of the use of data in Lithuania, Neringa Madeikytė, Institute of Hygiene, Vilnius.

8. Ski Resorts: Safety Management based on Local and Hospital Data, Peter Spitzer, Research Center for Childhood Accidents at Safe Kids Austria, Graz.

9. Burn epidemiology: feasibility of national data collection for all hospitalised patients , J cJacques Latarjet, Burn Centre at St Joseph & St Luc Hospital, Lyon.

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Examples of data use from the National Self-Harm Registry IrelandGriffin, Eve, National Suicide Research Foundation, University College Cork, Ireland.

The National Self-Harm Registry Ireland is a national surveillance system for the monitoring of hospital-treated intentional self-harm. Since 2006, the Registry has recorded data on presentations to all Irish hospital emergency departments (n=36) following an episode of self-harm (X60-X84). The Registry is funded by the Irish Health Service Executive. The Registry has been used as an example of best practice in the World Health Organisation’s 2014 report – ‘Preventing Suicide: A Global Imperative’.

Data from the Registry has been used to inform national suicide prevention initiatives, service provision, resource deployment and the development of national guidelines for the assessment and management of self-harm in clinical settings. Having access to up-to-date data is important in the evaluation of local and national interventions, and to monitor regional and temporal variations. Data is used by a range of stakeholders including governmental agencies, clinical staff and health care workers, international agencies and researchers. The use of standardised inclusion criteria and operational definitions has also allowed for cross-country comparisons with other sources.

This presentation will provide specific examples of how data from the Registry is used in national activities, and will illustrate how similar approaches could be applied to IDB-data.

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Use of hospital emergency department data to detect dangerous power tools involved in injuries in Luxembourg.Dritan Bejko1,Saverio Stranges1 ,Nathalie de Rekeneire2 ,Sophie Couffignal1 ,Patrick Ficerai3

BackgroundIn recent years, notifications from Consumer Product Safety authorities in Europe and USA brought attention to power tool-related injuries. Detecting dangerous power tools on the marketplace and maintaining a priority-list to be targeted in the future are among objectives of PROSAFE 2014 and 2015. The Luxembourg consumer safety authority is using among available data, the hospital-based national injury surveillance system to respond to those objectives. Injury surveillance in Luxembourg is part of a larger European Injury Database (IDB) that provides valuable information, in particular through its full data set (FDS), on the product involvement. According to the common IDB methodology Luxembourg is collecting FDS level data in one hospital and a relatively limited set of data (Minimum Data Set or MDS) in two other hospitals.

MethodsIn the FDS, all injury cases involving a product from the Powered hand tool/equipment (code 11.02xx) category of the IDB-FDS Data Dictionary IDB were selected. In the MDS, accident narratives were searched for presence of selected keywords commonly used for power tools. A SPSS syntax searching for names of power tools in the text narratives of 36 964 cases was developed. Narratives of all selected cases were reviewed and false positives eliminated.

ResultsIn 2015, out of 50,879 injury cases consulting the emergency services of three hospitals in Luxembourg, only 13,951 (27.4%) were registered in the FDS hospital. In 65 cases a power tool was involved in causing an injury. In the MDS a keyword was found in 212 cases and after revision of narratives, six false positives were excluded. In Luxembourg 271 injuries involving power tools were registered in three hospitals in 2015. 29 (10.7%) patients were hospitalized. More than two thirds of injuries were caused by three categories of power-tools: circular saw, jigsaw with 75 (28%) cases; drilling tools with 65 (24%) cases and grinder, buffer, polisher, sander with 57 (21%) cases.

DiscussionDetailed anonymous information on the 271 injuries involving power tools in Luxembourg in 2015 was sent to the national consumer protection authority. The burden of injuries from power tools might have been underestimated by at least 25% in 2015 due to limitations of data mining methods (non-exhaustive list of keywords or misspellings in the narratives), or non-participation in the surveillance system of one hospital. Death certificate information should also be used to identify fatalities usually not seen in Emergency departments (ED). Deeper investigations from the consumer safety authorities are required to identify specific dangerous products, including brand and producer related information not currently available in hospital files.

ConclusionsThe ED based injury surveillance system is a useful instrument to identify the type of products involved in injuries. The use of data-mining techniques allows to combine information from FDS and MDS level of data collection, is cost/effective and improves exhaustivity.

1 Luxembourg Institute of Health, Luxembourg; 2Ministry of Health, Luxembourg, 3Institut Luxembourgeois de la Normalisation, de l'Accréditation, de la Sécurité et qualité des produits et services(ILNAS), Luxembourg

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Bicycle accidents in The Netherlands: trends and new developments 2008-2016Huib Valkenberg, Karin Klein Wolt, Suzanne Nijman, Erik Sprik & Brigitte Blatter, Consumer Safety Institute (VeiligheidNL), Amsterdam.

IntroductionCyclists are vulnerable road users. In The Netherlands, an all-time high of almost 78.000 cyclists were treated at an Emergency Department of Dutch hospital in 2014. Eighteen percent was admitted to hospital. New developments, like smartphone use or E-bikes, possibly change the injury mechanism of bicycle accidents. Prevention of bicycle accidents requires recent and extensive data on the causes and circumstances of accidents among cyclists.

The Dutch Consumer Safety Institute currently carries out a study on bicycle accidents in the Netherlands, in cooperation with the Dutch Ministry of Infrastructure and Environment.

MethodologyThe Dutch Consumer Safety Institute collects injury data in The Netherlands through the Dutch Injury Surveillance System (DISS). DISS records statistics of people treated at Emergency Departments (EDs) of a selection of currently 13 hospitals in the Netherlands, being injured due to an accident, an act of violence or self-harm. These hospitals form a representative sample of the general and university hospitals in the Netherlands providing a 24 hour accident and emergency service. This enables extrapolation of the recorded injury cases to national estimates, provided the numbers are large enough. Recorded DISS-data contain information on bicycle accidents, including additional person- and injury-variables.

The current follow-up study is an expansion of the registration of injuries in the Dutch Injury Surveillance System. Patients that have visited an ED-department following a bicycle accident, are contacted by the hospitals, and requested to fill out a questionnaire on the bicycle accident. Through this follow-up study, additional information on specific causes of bicycle accidents can be collected, alongside specific information on the exact location of an accident, in order to identify relatively dangerous locations. The questionnaire data will be linked to the injury data already available in the DISS database.

ResultsData-collection is currently in process, and will cover the complete year 2016. Preliminary data analyses will be done half way the data collection. Results of these analyses will be presented during the seminar. Possible trends (comparison with similar surveys in 2008 and 2012) and the influence of various relevant factors in bicycle accidents, like smartphones, headphones, E-bikes, etc. will be reported. Additionally, specific data on the circumstances of the accidents, like infrastructure and cycle maintenance, will be analysed and reported.

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Unintentional injury in England: an analysis of the emergency care dataset pilot in Oxfordshire from 2012 to 2014Graham Kirkwood1, Thomas C Hughes2 and Allyson M Pollock1

BackgroundThe UK is one of the few developed nations in the world without a national injury data collection system or database. In 2008, the Royal Society for the Prevention of Accidents (RoSPA) in collaboration with the electricity safety charity the Electrical Safety Council and the product safety experts Intertek, commissioned a report into the feasibility of establishing a UK wide injury database. In 2012, the Department of Health funded injury data collection exercises in the emergency departments (EDs) of the Oxford University Hospitals NHS Foundation Trust (OUH) and St Mary’s Hospital in London as pilots to inform the development of a new emergency care dataset for the NHS in England. This study uses data from the OUH pilot to examine the effect of area level socioeconomic deprivation on unintentional injury (UI) ED attendance with particular reference to home location; to falls and road traffic collisions as mechanisms; and to leisure and sport as activities. It also tests the completeness and quality of the data collected against routinely collected NHS Hospital Episode Statistic (HES) returns.

MethodsData were collected at the two EDs of OUH, at the John Radcliffe Hospital in Oxford and the Horton General Hospital in Banbury, from 01 January 2012 to 30 March 2014. Data were analysed for Oxford City and Cherwell District Council areas (the two district council areas containing the EDs). Data completeness and quality were checked against HES returns for OUH.

ResultsOf the 63877 injury attendances recorded at the two sites, 26536 were unintentional with a home postcode within Oxford City or Cherwell District council areas. The most frequent location, mechanism, activity and diagnosis were home (39.1% of all UIs), low-level falls (47.1%), leisure (31.1%) and “Injuries to unspecified part of trunk, limb or body region” (20.5%) respectively.

The most deprived quintile of the population (Index of Multiple Deprivation IMD 1) had the highest European Age Standardised Rate for all UIs while IMD 5 had the lowest, 54.4 (52.3 to 56.5) compared with 32.2 (31.4 to 33.0) per 1000 person-years respectively. There was a significant association (p<0.05) between increasing levels of deprivation and an increasing Incidence Rate Ratio (IRR) for all UIs, for those in the home, for low-level fall UIs and for non-sport leisure UIs with a particularly sharp increase in the IRR for IMD 1 compared to IMD 5. Sport related injuries showed no gradient apart from football. There were 82209 UIs reported to HES from 01 Jan 2012 to 30 Mar 2014 compared to 49731 (60.5% of HES total) in the OUH dataset. For RTCs and sport injuries, 77.0% and 216% respectively of the HES total were recorded.

Conclusion This pilot has demonstrated both the feasibility and importance of prioritising the collection of a national injury dataset.

1 - Queen Mary University of London/ 2 - Oxford University Hospitals NHS Foundation Trust

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Seasonality and periodicities of external causes mortality (1980 to 2012): Is there a sex difference? Rodrigues E.; Neto M.; Mexia R.; Dias C., Ministério da Saude, Instituto Nacional de Saúde

IntroductionSeveral studies of demography researchers show that mortality measures the ecological and social conditions of the environment, and that man and women have different susceptibility to environmental risk. This presentation will present the results obtained using spectral decomposition methods in daily mortality by External causes (ICD-9: Chapter XX) by sex, in three time frames: 1980 -2012, 1980-1996 and 1997-2012. It is the aim of this study to assess seasonal differences in mortality between men and women during the three time frames defined. We used quantitative methods and statistical analysis of time series (spectral decomposition by Fourier series). Graphical representations have been constructed for the different time periods so it could be easier to see and comprehend the periodicities and seasonality fluctuations.

ResultsThe mortality by external causes in men and women and in all periods showed a negative trend. The number of deaths was higher in males in all time periods. In all time periods men showed annual, biannual and weekly periodicities, on other hand female mortality only showed evidence of biannual periodicity.

For biannual periodicity, in both sexes, there was a positive contribution during the winter and summer and negative contribution during spring and autumn. The monthly variation, it was not similar in both sexes, it could be find some differences in March, June, September and December.

The seasonal contribution for the annual fluctuation in male mortality had a positive contribution by spring and summer and negative by winter and autumn. For the monthly fluctuation, there is a positive contributions between May and September, and negative contributions from January to April and by November and December. The weekly periodicity it was revealed only between 1980 and 1996 and revealed positive contributions by Sunday, Monday, and Saturday and negative in the remaining days of the week.

ConclusionThe results show a biannual female mortality seasonal pattern with peaks in winter and summer and a male pattern that showed annual periodicities with a peak in the summer and nadir in the winter. It was disclosed a weekly male mortality periodicity with peak on Sunday and nadir on Wednesday. This periodicity was evident in the past (1980 to 1996) but not revealed in the most recent years (1997 to 2012).

What it means for prevention and care?In Portugal there are seasonal alerts for the population for different causes of morbidity and mortality that should take into account variations by sex. This type of information can also contribute to a better performance of the health facilities in response to the seasonal variation. Seasonal information is useful to EVITA system because the notification quality depend from the reception in hospital, so if it is possible to anticipate the increase or decrease of the number of accidents it could be done a better management of information collection. This study should be in the future complemented with an analysis of mortality from external causes by 3 digits and hospital discharge.

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Injury diagnoses is also a tool for monitoringJohan Lund, University of Oslo

Background For many years, injured patients in Norwegian hospitals (both as in- and out-patients) are being registered by their diagnosis according to Chapter 19 in the International Classification of Diseases (ICD), 10th version, and assembled in the Norwegian Patient Register (NPR). As diagnosis setting is one of the main tasks of the physicians, the completeness and quality of this registration are assessed to be relatively good. Injuries treated in the primary health system are classified according to ICPC – International Classification of Primary Health, and recorded in another register - KUHR. While Chapter 19 of ICD-10 contains about 1.000 more or less detailed diagnoses, there are only about 50 injury related diagnosis in ICPC.In 2009, the Ministry of Health instructed all 50 hospitals in Norway to register a Minimum Data Set (MDS) for injury-patients treated as in- and out-patients, without extra registration resources. NPR has since 2010 published annual reports from these data.

Current statusBy using the unique personal number and injury diagnosis, injured patients registered in KUHR and NPR for the years 2009-11 have been analysed more in depth. When visits for same injury were deleted, it was found that an average of 539.000 persons were annually treated by a physician for an injury in both the primary and the secondary system (10-11 % of the population). 47 % were treated only in the primary system, 34 % treated first in the primary system but had to be transferred to the secondary system, and 19 % went directly to the secondary system. Hence, 53 % of the injured persons were registered in NPR (hospitals in-and out-patients).

ChallengesThe progress of the completeness of the compulsory MDS-registration is rather slow. In order to increase the motivation in the hospitals, it is necessary to show that injury data are important for the local authorities. While waiting for the MDS-data to be of sufficiently high quality, we are utilizing injury diagnosis (ch. 19). In Vestfold, a county close to Oslo, there is high interest in injury prevention. Of the 14 municipalities, 9 of them are working according to the Safe Community requirements, supported by the county health authorities. To give them a monitoring tool, data based on ch. 19 from NPR for the years 2010-2014 were analysed. Diagnoses were collected in 37 groups according to a European project on disability weights (Haagsma et al 2012). Rates (average of 2010-14) and trends (2010/11 – 2013/14) are calculated for all injuries (S00 – T78), and for concussion, other skull-brain injury, fractures of wrist, hip, knee/lower leg, and poisoning, and for the sum of these six diagnosis groups, which are considered solely treated in the hospitals as in/out-patients.

Tables and coloured charts with rates and trends were shown to these municipalities. They have now for the first time some data for setting priorities and assessing the impact of their prevention work. We intend to make similar overviews for all counties and all Safe Communities (N=25) in Norway. In that way we can use injury diagnosis data (ch. 19) for monitoring, and also for showing the hospitals that we utilize injury data, in order for them to improve their registration of the MDS, which we badly need in addition to the diagnoses.

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Vision Zero for fatal child injuries in AustriaMonica Steiner, Robert Bauer, Kuratorium für Verkehrssicherheit-KFV, Vienna

Fortunately, in most EU countries, fatal child injuries have been decreasing continuously over the last two decades. The reasons are manifold, but overall a substantial contribution of various national child safety initiatives, often triggered by respective EU programs, can be credited.

Current statusIn Austria in 2014, 20 children died from unintentional injuries, compared to 49 only ten years ago, and 112 in 1995. Main causes of deaths are transport accidents, drowning, falls from heights and suffocation. In order to effectively fight these remaining risk, KFV has launched a media campaign that is inspired by “Vision Zero” strategy for road safety as advocated by traffic safety experts across Europe, now focusing on children and including road safety as well as home and leisure safety.

Vision ZeroThe Vision of Zero for fatal child injuries in Austria in 2020 wants to unite the many relevant stakeholders under one strategic objective (Vision Zero) and a common focus on a few but clearly defined goals.

Based on mortality data and additional IDB data analyses, the following measures have been identified as being successful and in need for a significant wider implementation across Austria:

- window locks against falls from heights;- swim courses and safety devices for pools against drowning; and - child restraint systems in cars against passenger fatalities

Facts driven action initiativesThe Vision Zero campaign aims to raise awareness of these risks among all relevant target groups, provide easy access to the respective safety equipment and encourage its use. To account for the growing number of immigrant children in Austria, these measures will be adapted also to the special needs of these children and their parents.

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Examples of the use of data in Lithuania,Neringa Madeikytė, Institute of Hygiene, Vilnius

Background and methodExternal causes of death rank third in mortality statistics in Lithuania after circulatory system diseases and malignant neoplasms. Injuries are important as they have huge impact on health of the person and financial burden to health and social sector due to long treatment and disability.

Analysis of injuries is important for developing of prevention programmes, setting up the priorities and evaluation of implementation of programmes and actions. Over the past years injury registration was significantly improved in Lithuania and for the past four years we have fully coded external cause with clinical code, mechanism, location and activity. In Lithuania the leading causes of injuries are falls, exposure to inanimate mechanical forces, intentional self-harm and transport accidents.

This presentation will provide an overview of Lithuania’s legal acts related to injury prevention and use of injury statistics in these acts.

ResultsIn Lithuania there are few main legal acts related with injury prevention such as National development program, National public health care development program, Lithuanian health program and Lithuanian health strategy. The documents are mainly focused in road safety, suicides and falls prevention. In all legal acts basically mortality data is used for background information and for evaluation criteria. This is caused by very high mortality rates from external causes in Lithuania.

Many programmes are very declarative, sometimes without necessary financing, without clear targets, often there is no evaluation of activities. Very often EU funded programmes are used just for buying new equipment for health care institutions and renovating of health care facilities, not investing in changing of people's behaviour.

Morbidity statistics is almost not used. In methodological documents and analysis (not legal acts) hospital injury statistics are more widely used. Injury and accident information system was established in 2015 only. A lot of detailed statistical information about injuries (mortality, morbidity, disability and temporary disability) is available in Health statistics portal. But user probably still not aware about new possibilities.

ConclusionDetailed injury statistics are available only for the last few years and are therefore still unknown to users and not sufficiently used in legal documents on injuries prevention. There is lack of evaluation studies into the effectiveness of prevention programmes. Detailed injury statistics should be used more widely for developing of prevention programmes, setting up the priorities and targets, and in evaluating the implementation of programmes and actions.

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Ski Resorts: Safety Management based on Local and Hospital DataPeter Spitzer, Research Center for Childhood Accidents at Safe Kids Austria, Graz

BackgroundAustria is a well-known winter sport country and many sportsmen from all over the world spend their winter holidays in ski resorts. Their ski and snowboard skills differ widely and therefore any safety management structure on slopes has to meet a high safety standard. The objective of our Safety Management program is to create a safe environment for skiers on Styrian skiing slopes and reduce the number of winter sport accidents.

Method Each winter season a group of experts visits the skiing areas and completes a safety audit of the whole environment. During the season unannounced visits take place to control the whole area and to analyze current accidents. At the end of the winter season standardized documents for recording each accident are analyzed and discussed by the safety managers of all participating areas.

The “Styrian certificate for skiing slopes” includes four components:

information for guests - weather and snow condition, FIS regulations, operating times; orientation on the slopes - marking system, indication of level of difficulty, panorama board; safety audit; and documentation of accidents.

If one components is not fulfilled in accordance with the standards, a warning is issued indicating, if changes are not made, the certificate will be withdrawn.

Results With the winter season 2015/2016 eighteen ski areas were certified by the local government. This means that almost 90% of all Styrian skiing facilities are covered with this safety instrument. Around 2,000 accidents are analyzed each year. The actual injury rate per 1,000 skier days is 1.16/1000 lower than the Austrian wide and international benchmarks. The evaluation of a ten year period in four skiing areas shows a reduction rate varying from 3 up to 40 percent.

ConclusionThe safety audit is an important instrument to analyze the slopes at the beginning of and during each season. A standard procedure in collecting data of each person, who has been rescued from the slope, is necessary to identify risky areas and accident hot spots in a ski resort.

Based on these results risky places and sites can be made safer before an accident happens, and patterns of accidents can be improved. Resort managers realize that a safety culture for skiing areas is a key factor in the reduction of accidents and marketing managers see more and more that safety is an important positive sales/marketing tool.

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Burn epidemiology: feasibility of national data collection for all hospitalised patients in France J. Latarjet1, F. Ravat, A. Scherer, O. Guye, P. Vercherin, A.Rigou, A. Pasquereau, B. Thelot.

Limitations of Hospital discharge statisticsThe French P.M.S.I (Programme de Médicalisation des Systèmes d’Information) allows an exhaustive collection of data for 100% of the patients hospitalized for burns (public, private, specialized or non-specialized facilities) taken from Hospital Discharge Registries (HDR). However it did not provide information about the causes and circumstances of injury.

Thus over the year 2011, we know that among 8670 cases, 27% were children aged 0 -4. And that the raw incidence rate of hospitalisation for this age group is 61/100 000 (vs. 10 to 14/100 000 for the rest of the population). But we learned nothing about how these injuries happened.

Mandatory collection of the causes of burn injuriesIn 2007, a decree made the description of the causes of burns mandatory for burn centres. The French Burn Society (S.F.E.T.B.), the Agence Technique de l’Information sur l’Hospitalisation (A.T.I.H.) and the Institut de Veille Sanitaire (InVS) designed a minimum data set based on the codes V01 to Y98 of the chapter XX of the ICD-10 (International Classification of Disease).These codes have been made available up to the 5th character to describe the mechanisms, the place, the activity, and the intentionality.

The data set was defined in a very pragmatic manner in order to make the work of data collectors as easy as possible, while covering the most relevant parameters for describing injury causation.

Preliminary resultsIn 2013, 45,2% of the HDR in all the facilities which admitted burned patients (including non-specialized units) were documented showing important differences between age groups. And currently we are working towards a full coverage of all hospitalised burn patients.

Fatal burn injuries as well as those needing hospitalisation must be a priority target for safety promotion. The continuous surveillance of their causes and circumstances will be an essential tool for their prevention.

4. List of participants1 Centre Hospitalière St Joseph et St Luc, Lyon

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Robert Bauer KFV (Austrian Road Safety Board) AustriaDritan Bejko Luxembourg Institute of Health LuxembourgBirgitte Blatter Consumer Safety Institute NetherlandsIvana Brkic Bilos National Institute of Health CroatiaPhil Buckle The Electrical Safety Council United KingdomAnna Chioti Luxembourg Institute of Health LuxembourgSabine Distl Safe Kids Austria AustriaRobert Ekman Chalmers University of Technology SwedenGabriele Ellsaesser Brandenburg Landesamt für Gesundheit GermanyPernilla Fagerström The National Board of Health and Welfare SwedenEve Griffin National Suicide Research Foundation IrelandMike Hayes ANEC BelgiumEva Jakobsen Norwegian Safety Forum NorwayRupert Kisser EuroSafe AustriaJacques Latarjet CH St Joseph et St Luc FranceBjarne Laursen National Institute of Public Health DenmarkArmando Lenz Swiss Council for Accident Prevention SwitzerlandAnne Lounamaa THL-Institute Public Health FinlandJohan Lund University of Oslo NorwayRonan Lyons Farr Institute, Swansea University Medical School United KingdomNeringa Madeikytė Institute of Hygiene LithuaniaCliona Mcgarvey Temple Street Children's University Hospital IrelandDisa Medwed Minstry of Labour, Social Affairs and Consumer AustriaRicardo Mexia National Health Institute Doutor Ricardo Jorge PortugalSvetlana Miltenovic Institute of Public Health of Belgrade SerbiaDetlev Mohr International Life Saving Federation of Europe GermanyLiisi Panov National Institute for Health Development EstoniaHelmuth Perz Ministry of Labour, Social Affairs and Consumer AustriaVittorio Reina EU Commission - DG JRC ItalyEmanuel Rodrigues National Health Institute Doutor Ricardo Jorge PortugalWim Rogmans EuroSafe NetherlandsPhilippe Roux European Commission, DG Sanco BelgiumPeter Spitzer Research Center for Childhood Accidents AustriaMonica Steiner KFV-Kuratorium für Verkehrssicherheit AustriaErrol Taylor RoSPA United KingdomSamantha Turner Swansea University United KingdomHuib Valkenberg Consumer Safety Institute Netherlands

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5. About the organisers

The European Public Health Association (EUPHA) aims to contribute to the improvement of public health in Europe. The 8th European Public Health Conference offers a unique opportunity for exchanging information and for debate among researchers, policy makers, and practitioners in the field of public health.

The EUPHA Injury Section aims to: a) increase awareness of injury and violence prevention and safety promotion in the broader public health community, b) increase the visibility of issues related to injury and violence prevention beyond the community of injury researchers, c) strengthen the links between researchers, policy makers and practitioners; and d) support the dissemination of research results and their implementation into practice.

The European Association for Injury Prevention and Safety Promotion (EuroSafe) is a non-governmental organisation, representing organisations and individuals working in fields of injury prevention and safety promotion.

EuroSafe is the lead organisation for the exchange good practices in injury research and prevention in Europe through its networking programmes, publications and the series of annual European Injury Seminars. It is in official relationship with the World Health Organization's programme for violence and injury prevention and disability.

BRIDGE-HEALTH, BRidging Information and Data Generation for Evidence-based Health Policy and Research, has been launched in May this year. The objective of BRIDGE-Health is to support European Health Information (EU-HI) and data generation networks covering major EU health policy areas; to facilitate the coordination and convergence of existing key projects in health information; and to promote evidence-based health policy and research for the EU (see also our E-update April 2015).

BRIDGE-HEALTH includes an “Injury Surveillance Platform”-Work package. The network of national Injury Data Base (IDB) centres serves as Platform and fulfils a core role in implementing continuous improvement in injury data gathering within European countries.

Seminar co-ordinator:Wim Rogmans, EuroSafe w.rogmans@eurosafe.eu.com

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