Validation study of injury surveillance data collected through Queensland hospital emergency departments

Abstract

Objective: The objective of this study was to assess and validate the EDIS (Emergency Department Information System) as a means of acquiring Level 2 injury surveillance data as defined by the National Data Standards for Injury Surveillance in public hospital emergency departments in Queensland. Methods: This validation was based on interviews with patients presenting to selected emergency departments in Queensland for treatment of an injury which was then compared to data obtained from emergency department staff completing the routine medical record for these patients using EDIS. To assess the level of coding variability and set baseline levels of agreement the data were separately coded by three experienced coders and the level of agreement evaluated. At the time of the validation emergency department staff were also asked to complete a questionnaire relating to their attitudes towards EDIS and to injury surveillance. Results: A total of 572 cases of injury were collected during the period of the validation of which 509 (89.0%) corresponded to an injury recorded in EDIS. Demographic details collected in the emergency department data were coded correctly in almost all cases. The exception was Indigenous status where the emergency department systems recorded only 38% of the Indigenous cases correctly. Injury data fields were better than 85% complete for two sites but only 65% complete for the third. Coding agreement between Emergency Department Information System and the validation study for items relating to the injury event varied from 95% for Intent to 50% for Activity when injured. The interrater agreement analysis revealed that the highest agreement between the coders was for intent (94–96%) while the lowest was for main injury factor (63–78%). The results of the emergency department staff satisfaction survey showed a high acceptance of EDIS and injury surveillance in general. Conclusions: This analysis demonstrates that injury surveillance is a viable proposition for most emergency departments using computerized patient management systems designed with injury surveillance in mind. Emergency department-based injury surveillance provides a pro-active mechanism for monitoring injuries in specific areas of known concern, identifies previously unrecognized injury events and risk factors and permits the evaluation of preventive strategies.