Global Burden Of Injury Research Articles

The Role of SIGN in the Development of a Global Orthopaedic Trauma Database

The global burden of injury is receiving recognition as a major public health problem but inadequate information delays many proposed solutions. Many attempts to collect reliable data on orthopaedic trauma have been unsuccessful. The Surgical Implant Generation Network (SIGN) database is one of the largest collections of fracture cases from lower and middle income countries. We describe the information in the SIGN database then address two questions: In the context of the design and implementation of a global trauma database, what lessons does the SIGN database teach? Does the SIGN program have a role in the evolution of a wider global system? The SIGN database is Internet based. After treating a patient with a SIGN nail surgeons enter radiographs and details of the case. Over 26000 cases are in the SIGN database. The database has been used as a source of cases for followup studies. Analysis shows the data are of sufficient quality to allow studies of fracture patterns but not for outcome studies or bone measurement. WHERE DO WE NEED TO GO?: A global database with more comprehensive coverage of injuries, causes, treatment modalities and outcomes is needed. HOW DO WE GET THERE?: The SIGN database itself will not become a global trauma database (GTD) but the personnel of the SIGN program have much to offer in the design and adoption of a GTD. Studies of suitable methods of data collection and the incentive to use them are required.

Availability and quality of cause-of-death data for estimating the global burden of injuries

To assess the availability and quality of global death registration data used for estimating injury mortality. The completeness and coverage of recent national death registration data from the World Health Organization mortality database were assessed. The quality of data on a specific cause of injury death was judged high if fewer than 20% of deaths were attributed to any of several partially specified causes of injury, such as "unspecified unintentional injury". Recent death registration data were available for 83 countries, comprising 28% of the global population. They included most high-income countries, most countries in Latin America and several in central Asia and the Caribbean. Categories commonly used for partially specified external causes of injury resulting in death included "undetermined intent," "unspecified mechanism of unintentional injury," "unspecified road injury" and "unspecified mechanism of homicide". Only 20 countries had high-quality data. Nevertheless, because the partially specified categories do contain some information about injury mechanisms, reliable estimates of deaths due to specific external causes of injury, such as road injury, suicide and homicide, could be derived for many more countries. Only 20 countries had high-quality death registration data that could be used for estimating injury mortality because injury deaths were frequently classified using imprecise partially specified categories. Analytical methods that can derive national estimates of injury mortality from alternative data sources are needed for countries without reliable death registration systems.

Should pediatric neurosurgeons still manage neurotrauma today?

Neurotrauma remains a major global burden of injury, especially for young patients, and will consequently always be a condition that pediatric neurosurgeons are called upon to treat. However, the face of modern neurotrauma management is changing, presenting important challenges to today's pediatric neurosurgeons. This article summarizes some of the issues in neurotrauma facing clinicians whose responsibility it is to treat these children. It is up to the individual neurosurgeon to familiarize him- or herself with the emerging literature on the modern management of pediatric neurotrauma.

Injury Deaths of US Citizens Abroad: New Data Source, Old Travel Problem

Global travel continues to increase, including among US citizens. The global burden of injuries and violence, accounting for approximately 5 million deaths worldwide in 2000, is also growing. Travelers often experience heightened risk for this biosocial disease burden. This study seeks to further describe and improve our understanding of the variable risk of travel-related injury and death. Information on US civilian citizen deaths from injury while abroad was obtained from the US Department of State Web site. This information was categorized into regional and causal groupings. The groupings were compared to each other and to injury deaths among citizens in their native countries. From 2004 to 2006, there were 2,361 deaths of US citizens overseas due to injury. Of these US citizen injury deaths, 50.4% occurred in the Americas region. Almost 40% (37.8%) of US citizen injury deaths in the low- to middle-income Americas were due to vehicle crashes compared to about half that (18.9%) (proportional mortality ratio [PMR] = 1.72, 95% confidence interval [CI] 1.59-1.62) for low- to middle-income Americas citizen injury deaths. Similar differences between US citizen injury death abroad and the in-country distributions were also found for vehicle crashes in Europe (35.9% vs 16.5%, PMR = 2.17, 95% CI 1.78-2.64; p < 0.0005), for drowning deaths in the Americas (13.1% vs 4.6%, PMR = 2.67, 95% CI 2.29-3.11) and many island nations (63.5% vs 3.5%, PMR = 11.38, 95% CI 8.17-15.84), and for homicides in the low- to middle-income European countries (16.9% vs 10.5%, PMR = 1.52, 95% CI .90-2.57). US citizens should be aware of regional variation of injury deaths in foreign countries, especially for motor vehicle crashes, drowning, and violence. Improved knowledge of regional variations of injury death and risk for travelers can further inform travelers and the development of evidence-based prevention programs and policies. The State Department Web site is a new data source that furthers our understanding of this challenging travel-related health issue.

Data Sources for Improving Estimates of the Global Burden of Injuries: Call for Contributors

Kavi Bhalla and colleagues invite individuals and organizations to provide local injury data sources to help inform estimates of the global burden of injuries.

Intentional injury reported by young people in the Federated States of Micronesia, Kingdom of Tonga and Vanuatu

BackgroundIntentional injury presents a threat to the physical and psychological well being of young people, especially in developing countries, which carry the greatest part of the global injury burden. While the importance of this problem is recognized, there are limited population data in low and middle income countries that can guide public health action. The present study investigates the prevalence and distribution of intentional injury among young people in three Pacific Island societies, and examines behavioural and psychosocial factors related to risk of intentional injury.MethodsPopulation surveys were conducted with students aged 11–17 years in Pohnpei State in the Federated States of Micronesia (n = 1495), the Kingdom of Tonga (n = 2808) and Vanuatu (n = 4474). Surveys measured self-reported injury and intentional injury, sources of intentional injury, and the range of behavioural, psychological, educational and social variables that may be related to injury risk.ResultsAmong boys and girls aged 14–17 years the respective period prevalence of intentional injury was 62% and 56% in Pohnpei, 58% and 41% in Tonga, and 33% and 24% in Vanuatu. The prevalence of intentional injury declined with age in Tonga and Vanuatu, but there was little evidence of an age-trend in Pohnpei. Across the three societies, the major sources of intentional injury among boys were 'other persons' followed by boyfriends/girlfriends and fathers. Mothers, boyfriends/girlfriends and other persons were primary sources of injury among girls. An intentional injury was reported more often by those who had been bullied (OR 1.40–1.66, P < 0.05), by regular smokers in Tonga and Vanuatu (OR 1.52–2.21, P < 0.05), and illicit drug users in Pohnpei and Vanuatu (OR 1.87–1.92, P < 0.05).ConclusionIntentional injury was reported extensively in these three populations. Interventions directed towards the school environment and which take into account the role of bullying and drug use need to be considered.

The Burden of Musculoskeletal Injury in Low and Middle-Income Countries: Challenges and Opportunities

The global burden of injury is substantial, and injuries are predicted to be a leading cause of death and disability over the next few decades1-6. The majority of this burden will be borne by low and middle-income countries, where preventive strategies are often nonexistent and barriers to the timely and appropriate care of the injured include absent or inefficient systems for the delivery of trauma care, inadequacies in the number and the distribution of health-care facilities and workers, a lack of infrastructure and/or physical resources, and a lack of education and training. Addressing the burden of injury in low and middle-income countries has become a public health priority. So-called essential services, which are low-cost, high-yield, and target major health problems, should be made available to every person in the world7-10. While surgery has been traditionally viewed as a high-cost treatment lying outside the realm of the traditional public health model, evidence is emerging that the burden of surgical diseases such as trauma is substantial, and that essential surgery may be a cost-effective addition to the health system in low and middle-income countries11,12. The goals for this review were (1) to provide a public health perspective on the burden of injury in low and middle-income countries, (2) to discuss the delivery of musculoskeletal trauma care in resource-challenged environments, (3) to highlight deficiencies in physical resources and human resources for health care, (4) to outline approaches to teaching and training, and (5) to describe the information flow between economically developed and underdeveloped regions. ### Background The World Bank classifies countries in July of each year on the basis of per capita gross national income. As of 2005, countries have been classified (in U.S. dollars) as low income (<$875 per year), lower-middle income …

Injury prevention and control: reflections on the state and the direction of the field

To provide an assessment of the contours of the injury field today and to raise questions about our future direction. We classified the self-reported activities of injury centers, assessed trends in injury-related publications in peer review journals, and compared data on current funding levels. The 47 identified centers are more likely to focus on unintentional injuries and on prevention than on intentional injuries, biomechanics, acute care or rehabilitation. Injury-related publications have doubled over the past decade, yet remained dwarfed by those on other diseases. Funding for injury prevention remains incommensurate with the burden of injury. Within the injury field itself, publications and funding are not commensurate with the burden imposed by particular injuries. Our responsibilities as injury prevention professionals will increase not only because of the projected increase in the global burden of injury but also because of our expanded conceptualization of what the scope of injury prevention should be. The lack of clarity we project about the substantive areas of our expertise and the incommensurate funding for our efforts relative to their toll on global health represent challenges to our field's coherence and ultimate effectiveness.

The UK Burden of Injury Study – a protocol. [National Research Register number: M0044160889

BackgroundGlobally and nationally large numbers of people are injured each year, yet there is little information on the impact of these injuries on people's lives, on society and on health and social care services. Measurement of the burden of injuries is needed at a global, national and regional level to be able to inform injured people of the likely duration of impairment; to guide policy makers in investing in preventative measures; to facilitate the evaluation and cost effectiveness of interventions and to contribute to international efforts to more accurately assess the global burden of injuries.Methods/DesignA prospective, longitudinal multi-centre study of 1333 injured individuals, atttending Emergency Departments or admitted to hospital in four UK areas: Swansea, Surrey, Bristol and Nottingham. Specified quotas of patients with defined injuries covering the whole spectrum will be recruited. Participants (or a proxy) will complete a baseline questionnaire regarding their injury and pre-injury quality of life. Follow up occurs at 1, 4, and 12 months post injury or until return to normal function within 12 months, with measures of health service utilisation, impairment, disability, and health related quality of life. National estimates of the burden of injuries will be calculated by extrapolation from the sample population to national and regional computerised hospital in-patient, emergency department and mortality data.DiscussionThis study will provide more detailed data on the national burden of injuries than has previously been available in any country and will contribute to international collaborative efforts to more accurately assess the global burden of injuries. The results will be used to advise policy makers on prioritisation of preventive measures, support the evaluation of interventions, and provide guidance on the likely impact and degree of impairment and disability following specific injuries.

Strengthening the Care of the Injured Globally: The Role of Emergency Nursing

Injuries have become a major cause of death and disability globally. This is true in developed countries as well as low- and middle-income countries (LMICs, or developing countries). In most developed countries, rates of death from injuries have been declining in recent years, whereas they are continuing to rise in most LMICs, due primarily to increasing rates of road traffic crashes. 1. Krug EG Sharma GK Lozano R The global burden of injuries. Am J Pub Health. 2000; 90: 523-526 Crossref PubMed Scopus (816) Google Scholar Charles Mock is Professor of Surgery, University of Washington, Seattle, Wash. Lydia Owusu-Sekyere, is Nurse-in-Charge, Polyclinic Theatre, Komfo Anokye Teaching Hospital, Kumasi, Ghana.

Health &amp; Safety Rights and Transnational Liability for Harm

Safety and health is a basic human need and when not met, exacts costs that prevent societies from realizing development goals. Injury is increasing as a leading cause of death and disability. As the result of advances in public health knowledge and safety engineering technology, accidents and other injury events are often preventable. Injuries result from identifiable determinants and conditions that create exposure to identifiable hazards. By controlling hazards, the toll of injury can be reduced. International trade and investment can create conditions that increase or diminish the global injury burden. International institutions and national governments face the question of how to protect safety and health rights and reduce the injury burden in a world of increasingly global business activity. International institutions do not yet provide comprehensive regulation for exported harms. In common law nations, liability through formal law plays an important role in regulating conditions that can lead to injury. In such nations, private law can play an important role in filling segments of the regulatory gap relating to exported harms.

Review of estimates of the global burden of injury and illness due to occupational exposures

Over the last decade, there have been several attempts to estimate the global burden of ill health due to work activity. The most recent of these is the Comparative Risk Assessment (CRA) project of the World Health Organization. Published estimates of global burden of injury and disease due to occupational factors were summarized, compared, and contrasted with the aim of putting the CRA estimates into context, identifying the most reliable and appropriate estimate for total burden due to occupational risks, and making recommendations regarding future work. The best estimate of global work-related deaths of workers is approximately two million per year, with disease responsible for the vast majority of these, but even this is likely to be a considerable underestimate of the true number of deaths because of shortcomings in the available data. The CRA estimates of burden due to individual risk factors appear appropriate for the limited number of exposures and conditions included, but are a major underestimate of the overall number of work-related deaths at a global level due to exclusion of risk factors because of data limitations. Improvements in global estimates are likely to come from the use of different methodologies and improvements in the availability and use of local data.

The burden of orthopaedic disease in developing countries.

The global burden of musculoskeletal disease in low and middle-income countries is large, growing, and neglected. While there is considerable funding for the control of communicable disease, there has been little attention paid to either the prevention or the treatment of orthopaedic problems in developing countries. "Safe Roads" was the theme for World Health Day 2004, and this paper examines the magnitude of injury in low and middle-income countries, as well as the motors powering its growth, and addresses the balance between the prevention and the treatment of injuries. Finally, it calls upon orthopaedic surgeons in developed countries to build partnerships with their colleagues in less developed countries to improve clinical care, teaching, and research aimed at reducing the global burden of injury.

Trauma care systems in Thailand

Trauma has become a leading cause of death and disability in many less developed countries. Road traffic injuries alone are the second leading cause of death among older children and younger adults throughout most such countries [ [2] Krug E.G Sharma G.K Lozano R The global burden of injuries. Am. J. Public Health. 2000; 90: 523-526 Crossref PubMed Scopus (792) Google Scholar ]. Moreover, whereas rates of injury-related death are falling in most developed countries, they are on the rise in most less developed countries; [ 3 Mock C.N Tiska M Adu-ampofo M Boakye G Improvement in prehospital trauma care in an African country with no formal emergency services. J. Trauma. 2002; 53: 90-97 Crossref PubMed Scopus (143) Google Scholar , 4 Murray CJ, Lopez A. A comprehensive assessment of mortality and disability from disease, injuries and risk factors in 1990 and projected to 2020. In: The global burden of disease, vol. 1. Cambridge, MA: Harvard University Press; 1996. Google Scholar , 5 Smith G.S Barss P Unintentional injuries in developing countries: the epidemiology of a neglected problem. Epidemiol. Rev. 1991; 13: 228-266 PubMed Google Scholar , 7 Zwi A The public health burden of injury in developing countries. Trop. Dis. Bull. 1993; 90: R5-R45 Google Scholar ] this is also happening in most of the ASEAN countries, including Thailand [ [6] Supunchaimart V, Chatibanchachai V, Kulliub S, Srivivat S. System for emergency medical service in Thailand: October 1997. Khon Kaen: Local publisher; 1997. Google Scholar ].