Emergency Department Injury Surveillance System Research Articles

66 - Injury disparities by gender and race identified from an emergency department (ED) injury surveillance system

66 - Injury disparities by gender and race identified from an emergency department (ED) injury surveillance system

Epidemiological patterns and preventability of traumatic hand amputations among adults in Greece

IntroductionHand/finger amputations though rare account for significant disability and health-related costs; yet, information on underlying causes, springing mostly from physicians’ reports, is rather anecdotal. We sought to draw attention to the high preventable fraction of hand/finger amputations among adults in Greece. Patients and MethodsData on external cause of injury and short-term outcome, recorded over nine years in the Emergency Department Injury Surveillance System (EDISS) were analysed, whereas sample weights were used for nationwide extrapolations. ResultsHand/finger injuries accounted for 20.4% (N=57,986) among 284,705 injuries recorded in patients >14-year-old (3% annual probability); 728 (1.3%) resulted in amputations; the estimated incidence rate (IR) was 39.3/100,000 person-years, reaching a high 92.6/100,000 among males aged 45–64 years. As expected, the vast majority of victims were males (90%), frequently young immigrants; ∼two-thirds sustained occupational injuries during working hours. Objects most frequently involved included: machinery (57% overall/69% occupational), means of transport (10.4%), materials (9.5%), parts of buildings/furniture (5%). Wood-working was the most common risk factor (20% overall/28% occupational) whereas 6% of victims accepted own inattention. 30% of amputations were hospitalised whereas 10% transferred to specialised units. DiscussionSpecialised registries reveal the magnitude and specific causes of disabling hand injuries and point to tailored national injury prevention programs; specifically in Greece, as they occur in more controlled occupational environments among middle-aged males, woodworkers, and are caused mainly by machinery. ConclusionsIncreased management of safety in the workplace could play a role in reduction in hand amputations.

Traumatic hand amputations among Greek adults: epidemiology and prevention dimensions

BackgroundData regarding the epidemiology of traumatic hand/finger amputations are scarce. Likewise country specific risk factors that would lead to tailored interventions are rarely available, despite the high costs associated with...

Data sharing for prevention: a case study in the development of a comprehensive emergency department injury surveillance system and its use in preventing violence and alcohol-related harms

ObjectiveTo examine emergency department (ED) data sharing via a local injury surveillance system and assess its contribution to the prevention of violence and alcohol-related harms.Methods6-year (2004–2010) exploratory study analysing injury...

Traumatic hand amputations among children in Greece: epidemiology and prevention potential

BackgroundTraumatic hand and finger amputations frequently lead to permanent disability.ObjectiveTo investigate their epidemiological characteristics and estimate the prevention potential among children 0–14 years old, through a cross-sectional survey.MethodsNationwide extrapolations were...

Epidemiology and prevention of hand amputations in Greece: data from the Emergency Department injury surveillance system

Hand amputations constitute a major cause of disability and public health concern with significant socio-economic dimensions.AimTo investigate hand amputation epidemiology, identify risk groups and estimate the potential for prevention.MethodsEDISS in...

Linking Emergency Medical Department and Road Traffic Police Casualty Data: A Tool in Assessing the Burden of Injuries in Less Resourced Countries

Objective: The study aimed to (1) assess the magnitude of road traffic injuries in a country missing a formal linkage system of police with hospital data, (2) quantify the underreporting, and (3) produce a convenient algorithm exploring its constituent components. Methods: Linkage of disaggregate (individual) data collected by the road traffic police (RTP) with those by the Emergency Department Injury Surveillance System (EDISS) on the Greek island of Corfu and coded with different classification systems was carried out. The applied four-step methodology, also comprising the calculation of underreporting coefficients of the variation by basic demographic variables, mode of transport, and injury outcome, led to the identification of the overall underreporting from either registry. Results: RTP data captured 96.6% (coefficient: 1.035), whereas EDISS captured only 54.4% of total fatalities (overall concordance: 51.1%). On the contrary, EDISS captured 94.6% of nonfatal injuries, whereas RTP only captured 16% (coefficient: 6.238), resulting in a low overall concordance (10.6%). Considering severity of injury assessed by EDISS, by using the ISS as the gold standard, RTP data misclassified 20.3% of severe injuries as less severe, and a statistically significant difference in the underreporting by gender was also noted. Conclusion: Relatively simple methodologies can provide essential coefficients to assess the actual numbers, severity, and components of road casualties by complementing routinely collected RTP with sentinel emergency department reporting systems.

Magnitude and object-specific hazards of aspiration and ingestion injuries among children in Greece

To assess the public health impact of injuries due to foreign body aspirations and ingestions among children in terms of overall magnitude and estimation of object-specific incidence. Two thousand two hundred and seven injuries due to aspiration and ingestion of foreign bodies were identified among 110 066 records of children (less than 15 years old) collected by the Hellenic Emergency Department Injury Surveillance System (EDISS) during the 5-year study period 1996-2000. Countrywide estimates of overall and object-specific injury incidence rates were computed using appropriate age and place of residence-sampling ratios. Simple cross-tabulations were performed along with a free text description analysis of injury events, whereas a composite score using (1) frequency of injury occurrence, (2) hospitalisation rate and (3) average length of hospitalisation was developed to measure the overall object-specific burden of injuries. Aspirations and ingestions of foreign bodies accounted for 2% of the total burden of accident and emergency department visits, corresponding to an annual incidence of approximately 2.3 accidents per 1000 children. Fish bones and nuts prevailed among the high (44%) proportion of aspirations and ingestions due to edible foreign bodies, while the main inedibles involved were small objects. Toddlers, boys and migrant children were over-represented among children sustaining injuries due to inedibles. As expected, the vast majority of food-related injuries occurred in the kitchen, in most instances under parental supervision. Injuries due to edibles were of minor severity and treatment was provided in the emergency departments, while those due to inedibles were responsible for injuries resulting in higher hospitalisation rates, albeit of relatively short duration. The composite impact score was highest for nuts and other food, nails, pins and sharp instruments. X-rays were performed in nearly all cases; upper gastrointestinal endoscopy was required in about 1 out of 10 instances and laryngoscopy or bronchoscopy in 1 out of 20, whereas the object was spontaneously removed in less than 3% of the cases. Depending on whether caused by edible or inedible objects, injuries due to foreign body aspirations and ingestions showed distinct epidemiological patterns. Composite scores taking into account measures of injury frequency and severity, seemed to reflect a country-specific spectrum of this type of injuries and provided useful information for the design of targeted public health oriented interventions.

Patterns of injuries and motor-vehicle traffic accidents in Athens

The extremely high cost of motor-vehicle accidents in public health leads to the necessity of a better injury data collection in the Accident and Emergency Hospital Departments. The ‘Asclepeion’ of Voula Hospital covers the southeastern suburban areas of the greater Athens area (1 000 000 population). The aim of this study is to present information on the pattern of injuries in Athens, in order to understand the magnitude of the problem and develop rational prevention programmes. Specially trained health visitors of the Emergency Department Injury Surveillance System (EDISS) interviewed in person every injured victim who was brought into the Emergency Service of the ‘Asclepeion’ of Voula Hospital. The study was performed during a 3-year period, from 1996 to 1998; 4564 persons were interviewed. Traffic accidents were more frequent on weekdays with a seasonal peak in July and among young Greeks (aged 25 – 34 years). The usual type of injuries seen in vehicle-accident victims were cerebral contusion and concussion, while in motorcycle-accident victims, head contusion and fractures. The most common reasons for the accident were excessive speed, poor condition of road, inattention, abstraction or drowsiness and drug effects. A total of 29.8% of motorcycle drivers and 5.7% of motorcycle passengers wore a helmet and 26.3% of car drivers and 14.1% of car passengers were using seatbelts. The identification of road traffic injury patterns can contribute to the development of injury prevention measures and guide rational preventive interventions that can reduce the incidence of these injuries. The EDISS system established at ‘Asclepeion’ of Voula Emergency Service can provide useful and accurate information about this serious and multidimensional problem of Greek Public Health.

Burn injuries related to motorcycle exhaust pipes: a study in Greece

Purpose: To identify measures that should reduce the incidence of burn injuries resulting from motorcycle exhaust pipes through epidemiological analysis of such injuries. Basic procedures: During a 5-year period, 251 persons who suffered burn injuries related to motorcycle exhaust pipes have contacted four major hospitals belonging to the Emergency Department Injury Surveillance System (EDISS) operating since 1996 in Greece. These burn injuries were studied in relation to person, environment and vehicle characteristics. Main findings: The estimated countrywide incidence of burns from motorcycle exhaust pipes was 17 per 100,000 person-years (208 per 100,000 motorcycle-years). The incidence was two times higher for children than for older persons and among the latter it was 60% higher among females than among males. Most of burn injuries (70.5%) concerned motorcycle passengers, mainly when getting on or off motorcycle, with peak incidence during summer. The most frequent location of burn wounds was below the knee and particularly the right leg. It was estimated that the risk of motorcycle exhaust pipe burns when wearing shorts could be reduced by 46% through wearing long pants. Among the victims 65.3% experienced second degree burns. Principal conclusions: Motorcycle exhaust burns could be substantially reduced by systematically wearing long pants, by incorporating in the design of motorcycles external thermo resistant shields with adequate distance to the exhaust pipe, and by avoiding riding with children on motorcycles.

Home and leisure activities and childhood knee injuries

To assess the relative occurrence of non motor-vehicle knee injuries and identify important clusters that can be targeted for preventive interventions. The study subjects covered 2167 children (0-14 years) who suffered non motor-vehicle knee injuries out of 66870 registered during a three-year period in an established Emergency Department Injury Surveillance System (EDISS). A more serious joint injury was identified in 263 (12%) children, whereas the remaining 1904 children had only soft tissue knee injuries. The incidence of non motor-vehicle knee injuries was estimated at 6.5 per 1000 children-years. Both the incidence of knee injuries and the male-to-female ratio increase with increasing age, reflecting the gender and age pattern of physical activity. Three clusters were identified: The first consisted of more serious knee injuries among older children, frequently resulting after a fall from stairs or a collision in school during winter months; the second cluster consisted of rather minor knee injuries occurring mostly among younger girls at home or in playgrounds, following a fall after stumbling or hit by an object while playing, especially during the summer; the third cluster comprised injuries among older boys, sustained mainly subsequent to overexertion in a sports area. Knee injuries tend to be more common among boys but more serious among girls. More and less serious knee injuries tend to fall into distinct clusters that could facilitate prioritization of preventive measures.

Estimating the Population Burden of Injuries

Injuries represent an important public health problem but their incidence is difficult to estimate. We conducted a population-based household survey in Greece covering 4079 interviewed individuals. The interviewees reported, for themselves and for cohabitating adults (age 15 years and older; n = 7157), injuries that occurred during the preceding year. Major injuries were defined as those requiring contact with a health institution. We compared these survey data with data obtained through a national Emergency Department Injury Surveillance System (EDISS). For the month closest to the survey interview, the incidence reported for the responders was 5.9 per 100 person-year, whereas the incidence for cohabitating adults was 3.7 per 100 person-years. These incidence rates declined for months more remote to the interview. Comparison of survey and EDISS data suggested that survey reporting was less accurate for nontraffic-related injuries. Taking into account possible recall and telescoping biases, the best survey estimate of the national annual number of major injuries is 525,000 (5.9 per 100 person-year), whereas the EDISS data yielded an estimate of 1,150,000 major injuries (12.9 per 100 person-years) Comparison of survey and EDISS data systems provides quantitative assessment of accuracy of the survey data in relation to time of injury before report date, to severity of injury, and to whether the injury is to the interviewee or to a cohabitant. The 2 systems could be used in a complementary way, although EDISS generates information that is medically more accurate and is a more cost-effective data collection system.

Bicycling-Related Injuries among Children in Greece

To evaluate the burden and patterns of nonmotorized bicycle-related injuries in Greece. Emergency departments of four hospitals across the country, forming an Emergency Department Injury Surveillance System (EDISS), provided injury occurrence data. Exposure data, such as person time spent cycling as well as patterns of bicycle use, were derived from a school survey undertaken by the Center for Research and Prevention of Injuries. Population data were obtained from the National Statistical Service of Greece. Nationwide incidence rates of bicycle-related injuries were estimated. In order to assess patterns of injuries, a Barell diagnostic matrix was constructed, in which bicycle injuries that occurred on roads were compared to off-road ones in order to identify correlates of the generally more serious onroad injuries. 2,711 children with bicycle-related injuries (4.8%) were found among the 56,132 injured children 0–14 years recorded in EDISS during a 3-year period. The incidence of bicycle-related injuries was estimated at about 7.9 per 1,000 children-years or about 20 per 1,000 bicycle-using children per year. Almost half of the children sustained head injuries. No child was wearing a helmet either among those injured or among the school survey participants. 12% of bicycle injuries required hospitalization. Injuries are common among bicycle-using children in Greece, they frequently affect the head and are generally serious. In spite of this unenviable situation, dedicated bicycle lanes are almost nonexistent and bicycle helmet promotion campaigns have not yet been conducted.

The mosaic of equestrian-related injuries in Greece.

This study aims to estimate the burden and describe the profile of equestrian injuries in Greece, where horses, donkeys, and mules are still used in agriculture and where horse riding is a popular leisure activity. Prospectively collected information on 140,823 injuries reported in the national Emergency Department Injury Surveillance System was examined and 244 equestrian-related injuries that occurred during farming, equestrian sports, or horse racing were analyzed. The estimated countrywide injury incidence for farming and equestrian sports combined was 21 per 100,000 person-years, but it was 160 times higher for horse-racing personnel. Men had higher rates of racing injuries and women had higher rates of equestrian sport injuries. Fractures accounted for 39.0% of injuries in horse racing and 30.5% in farming; head injuries accounted for approximately 50% of injuries among farmers. Farming injuries were more serious, with 25% requiring hospitalization. Analysis through the Barell matrix pointed to the role of spurs in the causation of ankle fractures and dislocations and the likely contribution of helmets in preventing traumatic brain injuries. Equestrian-related injuries are a serious but underappreciated health problem and merit targeted prevention efforts for each category affected.

Firework-related childhood injuries in Greece: a national problem

During a 5-year period, out of 110 066 children with injuries recorded in the Greek Emergency Department Injury Surveillance System (EDISS), 91 had firework-related injuries. Descriptive analyses and the Barrell matrix were used to determine risk factors and extrapolated national firework childhood injury figures were calculated. The estimated annual incidence of childhood firework injuries treated in the emergency departments of hospitals countrywide, was 7 per 100 000 children years. Seventy percent of injuries concerned older children (10–14 years), mostly boys with self-inflicted injuries, whereas girls suffered injuries as bystanders. A sharp peak in spring was noted, when the Greek Orthodox Easter is celebrated. Illicitly sold fireworks caused most injuries, but in eight instances homemade firecrackers were responsible.

Injuries among disabled children: a study from Greece

Objective: To compare the differential implications of sociodemographic and situational factors on the risk of injury among disabled and non-disabled children. Design: Data from the Emergency Department Injury Surveillance System...

A cluster analysis of road traffic-related childhood knee injuries.

Knee injuries represent an important category of road traffic injuries among children, and they are heterogeneous in their aetiology. The aims of this study were to estimate the incidence of road traffic childhood knee injuries in Greece by age and gender, point out their time, place and person co-ordinates and identify clusters with distinct characteristics with a view to potential preventive interventions. During a 3-year period, 305 children with knee injuries resulting from a road traffic accident were identified among the 66,870 children with injuries recorded in the Emergency Department Injury Surveillance System (EDISS) of Greece. Using previously derived sampling ratios and national data on childhood population, incidence data by age and gender were estimated. Hierarchical analysis was undertaken for cluster identification. The incidence of road traffic knee injuries was 97.5 per 100,000 children-years. The incidence increased with age and was higher among boys than among girls. Most childhood knee injuries (50.2%) occur among pedestrians, and the majority (90.9%) of the children or their guardians admitted responsibility in crossing the road. Of the 31 children injured as car passengers, the vast majority (87.1%) were unrestrained, and a large fraction (38.7%) were front seat passengers. Two clusters were identified: the first consisted of younger children who resided mostly in the Athens area and suffered less serious knee injuries as pedestrians or car passengers during the colder months; the second consisted of older children, frequently tourists, who suffered more serious injuries as cyclists while vacationing. Many of the children who suffered road traffic knee injuries as pedestrians admitted responsibility in road crossing, whereas a large proportion of children who were injured as car passengers were injured while improperly seated in the front and without seatbelt protection. Older children, frequently tourists, were at high risk of knee injuries while using motorcycles and bicycles.

Trauma to adult bicyclists: a growing problem in the urban environment

The proportion of adults involved in serious bicycle accidents has increased in the last two decades. The majority of the bicycle injury prevention efforts, however, are directed toward child riders. The authors performed a retrospective review of injury statistics from the Massachusetts Hospital Discharge Data Set, 1994–1999, the Massachusetts Emergency Department Injury Surveillance System, 1999, and the trauma registry of an Urban Level I Trauma Centre, 1993–2000. Massachusetts’s state-wide injury data reveals a 30% increase in hospital charges between 1994 and 1999 for adults following bicycle falls and collisions with concomitant stability in the charges for children. In the years 1993–2000, 60% of patients requiring inpatient care at the Study Centre for Bicycle Related Injuries were over 16 years of age. Fifty-one percent of patients were without a helmet. Positive blood alcohol tests were present in 35 (16%) of the 222 patients. Forty-six (75%) of patients suffering closed head injury were not helmeted. Adult bicycle trauma is a significant health and financial problem in the urban state of Massachusetts. Bicycle education and legislation emphasising safe bicycling practice, the protective effects of helmets, and the danger of cycling under the influence of alcohol may help alleviate this problem.

Characteristics of farm injuries in Greece.

To assess the characteristics of occupational and leisure farm injuries in Greece. During a five-year period (1996-2000), 4,326 unintentional farm injuries have been recorded by the Emergency Department Injury Surveillance System in Greece. Data concerning demographic variables, accident conditions, and injury characteristics were collected by in person interviews. The data were analyzed by simple cross-tabulation and hierarchical cluster analysis. Injuries from falls on the same level are mainly lower-limb fractures and occur during the winter among older women. Falls from higher level concern migrant workers, who also tend to suffer severe multiple injuries, including concussions, particularly during autumn. Injuries resulting from cutting and piercing instruments, as well as from machinery, are generally open wounds in the upper-limbs, suffered by young migrant workers. Head injuries resulting from striking against an object are more generally spread across socio-demographic variables. Overexertion is the dominant mechanism for dislocations and sprains in the lower limbs. Snake and insect bites are common among younger migrant workers during summer, and they affect the upper limbs during manual work close to the ground. Non-traffic injuries from vehicles are frequently severe, involving head concussion of generally young individuals. In Greece, farm injuries are frequently serious and require hospitalization. These injuries show distinct patterns among older women (lower-limb fractures), young individuals (non-traffic vehicle-related injuries) and migrant workers (injuries from cutting and piercing instruments, falls from high level, and bites). Prevention strategies should give priority to these population groups. These prevention strategies should include guidance for poorly educated workers, including migrants, enforcement of safety regulations concerning farming machinery, and discouragement of risky farming activities among elderly individuals, particularly women.

What distinguishes unintentional injuries from injuries due to intimate partner violence: a study in Greek ambulatory care settings

Objectives: Intimate partner violence (IPV) is an important sociocultural and public health problem. This study aims to assess sociodemographic and injury characteristics of IPV victims among adults in a traditional...