Emergency Department-based Injury Surveillance Research Articles

Emergency department-based injury surveillance information system: a conceptual model

BackgroundInjury data play a pivotal role in monitoring public health issues and Injury Surveillance Information Systems (ISIS) are useful for continuous data collection and analysis purposes. Since emergency department (ED) is usually the first place of referral for the injured people, the aim of this study was to develop a conceptual model for an ED-based ISIS.MethodsThis study was completed in 2020 and the Delphi technique (three rounds) was used to determine the main components of an ED-based ISIS. The participants were selected using the purposive sampling method. A 5-point Likert scale questionnaire was used for data collection and data were analyzed using descriptive statistics.ResultsIn the first, second, and third rounds of the Delphi study, 60, 44, and 28 experts participated, respectively. In the first and second rounds, most of the items including the personal data, clinical data, data sources, and system functions were found important. In the third round of the Delphi study, 13 items which did not reach a consensus in the previous rounds were questioned again and five items were removed from the final model.ConclusionAccording to the findings, various data elements and functions could be considered for designing an ED-based ISIS and a number of data sources should be taken into count to be integrated with this system. Although the conceptual model presented in the present study can facilitate designing the actual system, the final system needs to be implemented and used in practice to determine how it can meet users’ requirements.

The effect of age on in-hospital mortality among elderly people who sustained fall-related traumatic brain injuries at home: A retrospective study of a multicenter emergency department-based injury surveillance database

BackgroundPeople older than 65 years tend to have traumatic brain injuries (TBIs) more frequently and have a higher mortality rate after TBI than younger individuals. The aim of this study was to determine the effects of age on in-hospital mortality among patients who had fall-related TBIs at home, emphasizing the effect of specific locations in the house on the outcome. MethodsThis cross-sectional study was conducted using the Emergency Department-based Injury In-Depth Surveillance (EDIIS) database in South Korea. Patients aged 65 years or older with a slip or fall injury, accidental injury at home, and no major diagnosis other than TBI were included. The primary outcome was in-hospital mortality. Subgroup analysis was conducted to determine the effect of locations on the relationship between age and in-hospital mortality. ResultsOf the 2,571,442 patients in the EDIIS database, 9,747 were included in this study. The most common injury location was room or bedroom (29.1%), followed by living room or kitchen (23.0%), bathroom (20.2%), stairs (15.8%), and outdoor spaces of the house (11.9%). There was a significant association between increased in-hospital mortality and oldest old age. The stairs or outdoor spaces of the house was significantly associated with in-hospital mortality compared to rooms inside the house. The oldest age group showed a higher association with in-hospital mortality than the young-old group, especially in the bathroom, stairs, and outdoor spaces of the house. ConclusionsElderly individuals over the age of 85 are the most vulnerable to fall-related TBI mortality at home. A fall prevention strategy for the oldest-old is needed, especially for the bathroom, stairs, and the ancillary space outside the house.

Traumatic brain injury in patients aged ≥65 years versus patients aged ≥80 years: a multicenter prospective study of mortality and medical resource utilization.

ObjectiveThis study aimed to determine whether there is a difference in mortality and medical resource utilization between geriatric (aged ≥65 years) and super-geriatric patients (aged ≥80 years) with traumatic brain injury (TBI).MethodsWe obtained comprehensive data (demographics, injury characteristics, injury severities, and outcomes) of geriatric and super-geriatric TBI patients from an emergency department-based injury surveillance system database from 2011 to 2016. Multivariate logistic regression analysis was performed to compare the mortality and nonroutine discharge (NRDC) status between both groups.ResultsAmong 442,533 TBI patients, 48,624 were older than 65 years. A total of 48,446 patients (37,140 geriatric and 11,306 super-geriatric) without exclusion criteria were included in the final analysis. Both overall in-hospital mortality (adjusted odds ratio, 1.88; 95% confidence interval [CI], 1.28 to 2.74; P=0.001) and NRDC (adjusted odds ratio, 1.35; 95% CI, 1.07 to 1.71; P=0.011) were significantly higher in the super-geriatric group. In the stratified analysis, there were no significant differences in NRDC rate for all stratifications of treatment timing (emergency department vs. ward admission), but mortality remained to be significant for all stratifications.ConclusionSuper-geriatric TBI patients showed a significantly higher risk-adjusted overall mortality and more inadequate medical resource utilization than did geriatric TBI patients. However, super-geriatric patients were more likely to undergo NRDC after admission; thus, further research about age-related health inequalities is needed in the treatment of super-geriatric patients.

Zolpidem as a high risk factor for elderly suicide in South Korea

Backgrounds South Korea, a nation with rapidly aging population, has the highest suicide rates in the world, and the elderly have a suicide rate three times higher than the national average. We classified the drugs ingested for suicide attempts by age groups and compare the clinical outcomes between non-elderly and elderly patients who attempted suicide by ingesting drugs. Materials and methods Data were obtained from the nationwide Emergency Department-Based Injury Surveillance of the Korea Centers for Disease Control and Prevention, South Korea between January 2011 and December 2016. Results There were 12,104 patients who attempted suicide by ingesting drugs, of whom the elderly (73.5%) ingested more sedatives and hypnotics than the non-elderly (53.9%); of these drugs, zolpidem ingestion was higher in the elderly than the non-elderly. Conversely, the non-elderly ingested more antipsychotics and antidepressants (15.9%) and analgesics (10.8%) than the elderly (7.4% and 2.8%, respectively). The elderly had longer hospital stay, higher intensive care unit (ICU) admission rate, and higher mortality rate than the non-elderly: more elderly patients (30.2%) were admitted to the ICU than the non-elderly (15.7%); the duration of hospital stays was 6.27 ± 11.35 days in the elderly and 8.94 ± 14.85 days in the non-elderly; and the mortality rate was 0.4% in the non-elderly and 3.0% in the elderly. Conclusion Findings suggest that zolpidem has become the greatest risk factor for the elderly Koreans in suicide attempts. Further prevention efforts are needed to prevent suicide among the elderly.

The Extent of Consumer Product Involvement in Paediatric Injuries.

A challenge in utilising health sector injury data for Product Safety purposes is that clinically coded data have limited ability to inform regulators about product involvement in injury events, given data entry is bound by a predefined set of codes. Text narratives collected in emergency departments can potentially address this limitation by providing relevant product information with additional accompanying context. This study aims to identify and quantify consumer product involvement in paediatric injuries recorded in emergency department-based injury surveillance data. A total of 7743 paediatric injuries were randomly selected from Queensland Injury Surveillance Unit database and associated text narratives were manually reviewed to determine product involvement in the injury event. A Product Involvement Factor classification system was used to categorise these injury cases. Overall, 44% of all reviewed cases were associated with consumer products, with proximity factor (25%) being identified as the most common involvement of a product in an injury event. Only 6% were established as being directly due to the product. The study highlights the importance of utilising injury data to inform product safety initiatives where text narratives can be used to identify the type and involvement of products in injury cases.

Characteristics of Farmers' Injuries in Jeju

Farmers' injuries are more frequent and severe than those in the other job groups. To identify the characteristics of agricultural injuries in Jeju, 119 first aid records and emergency department based injury surveillance system data for four years were analyzed retrospectively. Farmers' injuries in 119 first aid records were 1,947 cases, and mean age of injured patients was 63.9±11.8 years. The proportion of major trauma was 27.4%. The more frequent months of farmers' injuries were from August to October. In comparison between farmers' and non-farmers' injuries, farmers' injuries showed more male proportion (70%), mean age (54.0±17.0 years), and old age proportion (29%) than non-farmers' injuries did, with significance(p<0.001). However, farmers' injuries revealed less usage of 119 rescue transportation (26%) and self-injury proportion (2%) significantly (P<0.001). Further studies including expansion of injury surveillance for agricultural injuries would be needed for in-depth investigation.

Development of an electronic emergency department-based geo-information injury surveillance system in Hong Kong

ObjectivesTo describe the experience in the development of an electronic emergency department (ED)-based injury surveillance (IS) system in Hong Kong using data-mining and geo-spatial information technology (IT) for a Safe Community setup. MethodsThis paper described the phased development of an emergency department-based IS system based on World Health Organization (WHO) injury surveillance Guideline to support safety promotion and injury prevention in a Safe Community in Hong Kong starting 2002. ResultsThe initial ED data-based only collected data on name, sex, age, address, eight general categories of injury types (traffic, domestic, common assault, indecent assault, batter, industrial, self-harm and sports) and disposal from ED. Phase 1 – manual data collection on International Classification of External Causes of Injury pre-event data; Phase 2 – manual form was converted to electronic format using web-based data mining technology with built in data quality monitoring mechanism; Phase 3 – integration of injury surveillance-data with in-patient hospital information; and Phase 4 – geo-spatial information and body mapping were introduced to geo-code exact place of injury in an electronic map and site of injury on body map. ConclusionIt was feasible to develop a geo-spatial IS system at busy ED to collect valuable information for safety promotion and injury prevention at Safe Community setting. The keys for successful development and implementation involves engagement of all stakeholders at design and implementation of the system with injury prevention as ultimate goal, detail workflow planning at front end, support from the management, building on exiting system and appropriate utilisation of modern technology.

Trends in paediatric injury rates using emergency department based injury surveillance

The primary aim of this study was to develop a method of calculating paediatric injury rate from Emergency Department injury surveillance data and use this to describe trends in paediatric injury. This study also aimed to establish whether triage category could be used as an indicator of severity. Prospective observational study of paediatric injury in Brisbane, Australia from 1998 to 2005 using Emergency Department injury surveillance data. Injury incidence was calculated using postcode restriction, census data and analysis of injury surveillance data quality and alternative hospital presentations. The incidence of Emergency Department injury presentation increased by 56% between 1998 and 2005. The incidence of injury (adjusted for ascertainment and other hospital presentations) increased from 5,323/100,000/year to 8,316/100,000/year (p<0.01). The overall incidence of admission increased from 1,066/100,000/year to 1,238/100,000/year (p<0.01). The incidence of injury presentations triaged as urgent or above increased by 16% over the study period (2,348/100,000/year to 2,723/100,000/year, p<0.01). Injury incidence can be determined using Emergency Department injury surveillance data and triage category is a useful indicator of injury severity. Paediatric emergency department injury presentations, including serious injury, increased significantly between 1998 and 2005. The methodology used in this study is easily repeatable and could be used to evaluate injury prevention interventions. The prevention and management of injury should be directed by accurate injury incidence data.

Evaluation of an emergency department-based injury surveillance project in China using WHO guidelines

Objectives:To assess an emergency department-based injury surveillance project (S-EDISP) in China using WHO evaluation guidelines. To identify problems and make suggestions for improvement.Methods:According to the methods provided by the WHO...

The Yorkhill CHIRPP story: a qualitative evaluation of 10 years of injury surveillance at a Scottish children’s hospital

Background:The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) is an emergency department-based injury surveillance system that was devised in Canada and has been in operation since 1990. CHIRPP was...

Injuries in Homes with Certain Built Forms

Rates of injuries may occur more frequently in different types of homes. Retrospective population-based cohort study utilizing three linked databases: a population register, an architectural assessment of homes in the area, and an emergency department-based injury surveillance system. Over 58,000 homes were classified into 94 different types according to age, size, and built form. Among the 112,248 inhabitants, there were 18,044 emergency department attendances for treatment of an injury suffered in the home. Adjusted odds ratio of injuries for residents of purpose-built apartments was substantially elevated for all injuries (2.07; 95% confidence interval [CI]=1.87-2.30) and poisoning episodes (5.6; 95% CI=3.8-8.3). Residents of apartment buildings have substantially higher injury rates. Additional research is required to investigate the contribution of environmental hazards and behavioral factors underlying these high rates.

Occupational injuries identified by an emergency department based injury surveillance system in Nicaragua

Objectives: To identify and describe the work related injuries in both the formal and informal work sectors captured in an emergency department based injury surveillance system in Managua, Nicaragua. Setting:...

Comparative evaluation of different modes of a national Accident and Emergency department-based injury surveillance system: Jamaican experience

The objective was to conduct a comparative evaluation of two injury surveillance systems in operation in the Accident and Emergency departments of public hospitals in Jamaica. The evaluation was conducted at 12 hospitals across Jamaica offering varying levels of service delivery. It was designed in three phases: (1) a retrospective review of surveillance system data; (2) prospective process evaluation; (3) system environment evaluation. These data were analysed to determine the sensitivity and specificity of the manual Accident & Emergency Statistical Report (A&ESR) versus the computer-based Patient administration system/Jamaica injury surveillance system (PAS/JISS), and to determine an injury registration rate. Results showed a variation from 8% to 27% in injury registration rates at the hospitals reviewed. The sensitivity of the computer-based PAS ranged from 29.7% to 97.1% while the sensitivity of the manual system ranged from 22.1% to 100%. The computer-based system generally detected a greater percentage of injuries. Problems were identified with missing data fields in the computer-based system, while problems of recording and transcription were identified in the manually-based system. Recommendations were made to improve data quality in both data collection systems. Although shortcomings were identified with the A&ESR, the system is performing the function for which it was designed, that of tracking A&E workload. The PAS/JISS is more user-friendly and a truer reflection of the injury situation.

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

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.

Development of an Emergency Department—Based Injury Surveillance System

Study objective: To describe the development of an emergency department-based injury surveillance system, to describe the problems encountered, and to briefly describe the data output and potential applications. Methods: Within our university-based hospital system and Level I trauma center register, injury data currently exist on all ED patients. Over a 1-year period, these data sets were linked with our ED log using the hospital identification number and date of service as the key merge variables. Elements in our data set included demographic information, ED-related variables, and codes for nature of injury and circumstances of injury. Data files for 1 month were inspected manually to validate the success of the merger. Problems encountered in developing the system were summarized. Results: A manual review of 1 month of data files from our hospital system, trauma register, and ED log revealed that the records of more than 97% (2,802) of 2,878 injury patients seen in our ED had additional data attached after the merger. No errors of commission were found, but errors of omission occurred. The barriers that were encountered during the development of this injury surveillance system are described. Conclusion: Hospital data can be linked to the ED log to create an injury surveillance system that captures valuable information on patients admitted and discharged from the ED. [Williams JM, Furbee PM, Prescott JE: Development of an emergency department-based injury surveillance system. Ann Emerg Med January 1996;27:59-65.]

Development of an emergency department-based injury surveillance system

Development of an emergency department-based injury surveillance system