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Chamaiparn Santikarn, MD., MPH.
1Ministry of Public Health, Thailand
From Provincial to National: From Provincial to National:
The Development of The Development of
Thailand Injury SurveillanceThailand Injury Surveillance
Chamaiparn Santikarn, MD., MPH.
Non-communicable Diseases Bureau, Ministry of Public Health
Siriwan Santijiarakul, MSc.Epidemiology Bureau, Ministry of Public Health, Thailand
Chamaiparn Santikarn, MD., MPH.
2Ministry of Public Health, Thailand
IntroductionIntroduction
1995, Thailand Provincial Injury
Surveillance started in 5 large sentinel
hospitals
Population under surveillance - all injury
cases presenting at the emergency
rooms (occurred within 7 days)
Chamaiparn Santikarn, MD., MPH.
3Ministry of Public Health, Thailand
IntroductionIntroduction
System objectives: Establish a database
for assessing acute care and referral
services; and facilitate injury prevention
at provincial and national levels
Data flow and responsible Data flow and responsible unitunit
E.R.Nurse
Medical Record DepartmentMedical Statistics Technicians
Diskette to Epidemiology Division
National action
Report distributed within hospital and province
Local action4-6 mnth. 6 mnth.
Chamaiparn Santikarn, MD., MPH.
5Ministry of Public Health, Thailand
IntroductionIntroduction Emphasized on local utilization for action
than centralizing the data
Local information users - physicians,
nurses and policymakers
PC software specifically developed for
local processing
Chamaiparn Santikarn, MD., MPH.
6Ministry of Public Health, Thailand
IntroductionIntroduction
Menu of 35 ready-made tabulations
TRISS methodology was used to
estimate survival probability
Screening tool to identify trauma cases
with unexpected outcome for trauma audit
Quality of acute care services monitored
Chamaiparn Santikarn, MD., MPH.
7Ministry of Public Health, Thailand
IntroductionIntroduction
System expanded to 22 large hospitals
In 2001, national coordinating unit proposed reduced reporting criteria, included only severe injuries (deaths, observed and /or admitted)
Chamaiparn Santikarn, MD., MPH.
8Ministry of Public Health, Thailand
ObjectivesObjectives
Dr. Chamaiparn Santikarn
Gain better representativeness
of important injury events in
each province
Better data quality
Decrease resource need
เมษายน 18 2566
Chamaiparn Santikarn, MD., MPH.
9Ministry of Public Health, Thailand
MethodsMethods To assure the sentinel hospitals
Epidemiology Division used the
available data Identify workload decrease under
the new criteria Information changes due to the
new criteria
Chamaiparn Santikarn, MD., MPH.
10Ministry of Public Health, Thailand
15 study sites
7 Other sites
A.D. 2001
22 reporting sentinel sites
Chamaiparn Santikarn, MD., MPH.
11Ministry of Public Health, Thailand
MethodsMethods
In December 2000
Workshop for Establishing the
National Injury Surveillance
Analysis results presented
Chamaiparn Santikarn, MD., MPH.
12Ministry of Public Health, Thailand
ResultsResults With the new reporting criteria
The number of records to be reported decreased
from 197,140 to 63,607 68 % decrease Total workload would
be decreased by 58 %
0
20000
40000
60000
80000
100000
120000
All emergency presentations
DBA, Dead ER. & Admittedinclude observed
Max. AIS 32 4 5 61
No. of records
Source : 15 sentinel hospitals, provincial injury surveillance, Thailand.
Fig. 1 Distribution of maximum AIS of trauma cases Fig. 1 Distribution of maximum AIS of trauma cases previous vs.. new criteria, 15 sentinel hospitals, 1998
Chamaiparn Santikarn, MD., MPH.
14Ministry of Public Health, Thailand
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
100,000All emergency presentations
DBA, Dead ER. & Admitted includeobserved
No. of records
Max. AIS 2 54 61 3 Source : sentinel hospitals, provincial injury surveillance, Thailand 1998.
Fig. 2 Distribution of maximum AIS of trauma casesFig. 2 Distribution of maximum AIS of trauma casesprevious vs.. new criteria, 13 non -Bangkok hospitals
Chamaiparn Santikarn, MD., MPH.
15Ministry of Public Health, Thailand
0
4,000
8,000
12,000
16,000
20,000
24,000
28,000All emergency presentations
DBA, Dead ER. & Admitted includeobserved
No. of records
Max. AIS 1 3 54 62
Source : sentinel hospitals in Bangkok , provincial injury surveillance, Thailand .
Fig. 3 Distribution of maximum AIS of trauma casesFig. 3 Distribution of maximum AIS of trauma casesprevious vs.. new criteria, Bangkok,1998
Chamaiparn Santikarn, MD., MPH.
16Ministry of Public Health, Thailand
Results Results
5 leading cause of injuries in each
sentinel site
Minor change 2nd - 3rd rank
Tendency towards external causes
with more severe outcome
Chamaiparn Santikarn, MD., MPH.
17Ministry of Public Health, Thailand
Five leading cause of injuries, previous criteria vs. new criteria
previous criteria new criteria
cases % cases %
Transp. Acc 93,020 47.2 Transp. Acc 36,922 58.0
Acc. Inan. Frce 36,092 18.3 Acc. Falls * 7,987 12.6
Acc. Falls 25,597 13.0 Acc. Inan. Frce* 7,314 11.5
Assaults 16,106 8.2 Assaults 4,727 7.4
Total 197,140 100.0 Total 63,607 100.0
Self-harm 13,520 6.9 Self-harm 2,619 4.1
Others 12,085 6.5 Others 4,038 6.3
Chamaiparn Santikarn, MD., MPH.
18Ministry of Public Health, Thailand
ResultsResults The experts and authorities supported
the new criteria
Local concerns/worries
Data for administration within the
hospital Epidemics detection of some minor
injuries but potential health service burden in the provincial level
Chamaiparn Santikarn, MD., MPH.
19Ministry of Public Health, Thailand
Results Results
The new criteria became
minimum data collection standard for national injury surveillance
Hospitals could still use previous
criteria to meet with internal need
and provincial utilization
Chamaiparn Santikarn, MD., MPH.
20Ministry of Public Health, Thailand
Results Results
Simple computer technique
needed to manage electronic file
before sending in the data
Chamaiparn Santikarn, MD., MPH.
21Ministry of Public Health, Thailand
Results Results (under new criteria)(under new criteria)
The system could continue in spite of
severe manpower crisis in central
coordinating unit (2002-2003)
Could report RTI victims risk behaviors
monthly the Deputy Prime Minister to
monitor the fight against RTI ( 2004 )
Chamaiparn Santikarn, MD., MPH.
22Ministry of Public Health, Thailand
28 sentinel hospitals in network
Other 12 provincial hospitals operate this
surveillance model for local use
National project to promote child MC helmet - a
response to surveillance report
14 sentinel hospitals broaden roles to health
promoting hospital for road safety
2005 A.D.2005 A.D.
Chamaiparn Santikarn, MD., MPH.
23Ministry of Public Health, Thailand
DiscussionDiscussion
Chamaiparn Santikarn, MD., MPH.
24Ministry of Public Health, Thailand
DiscussionsDiscussions
To much workload is common for agency
collecting or managing surveillance data Negative impact on data quality and
timeliness Capacity of computer hardware usually
wasted in developing countries
Chamaiparn Santikarn, MD., MPH.
25Ministry of Public Health, Thailand
DiscussionsDiscussions
Report of Surveillance Evaluation in Sentinel provinces (2001) Administration within the hospital
use only total number of the ER cases
Epidemics detection of minor injury
not done, nor investigated
Chamaiparn Santikarn, MD., MPH.
26Ministry of Public Health, Thailand
DiscussionsDiscussions
Report of Surveillance Evaluation in Sentinel provinces (2001)
Severe injury data – used for monitoring
referral and intra-hospital trauma care
All hospitals evaluated – still used the
previous criteria !?!
Chamaiparn Santikarn, MD., MPH.
27Ministry of Public Health, Thailand
Lesson learnedLesson learned
More difficult to live with less data after having it !
Chamaiparn Santikarn, MD., MPH.
28Ministry of Public Health, Thailand
RecommendationsRecommendations Future establishment of national injury
surveillance system in developing countries Focus on severe injuries only Aims for quality of acute care as well as
prevention Sentinel surveillance work ! Sentinel hospitals are great partnership
Chamaiparn Santikarn, MD., MPH.
29Ministry of Public Health, Thailand
ConclusionConclusion
This reporting criteria of Thailand National injury Surveillance suitable for developing countries
resources are scarce acute care still needs improvement injury prevention just begun
Chamaiparn Santikarn, MD., MPH.
30Ministry of Public Health, Thailand
AcknowledgmentAcknowledgment International Collaborative Effort on Injury Statistics LA Fingerhut, MA U.S. CDC's NCHS, NIH's
NICHD 28 sentinel hospitals Surveillance evaluating
team
Chamaiparn Santikarn, MD., MPH.
31Ministry of Public Health, Thailand
Results Results
Investment for the first year (not
including salary) 3.8 million baht approximately 10,000 US $ (according to the
exchange rate at present )
Chamaiparn Santikarn, MD., MPH.
32Ministry of Public Health, Thailand
Results Results
Distribution of trauma cases by
severity maximum AIS scale in each patient 161,916 cases - current criteria 47,900 cases - new criteria
Chamaiparn Santikarn, MD., MPH.
33Ministry of Public Health, Thailand
0
5000
10000
15000
20000
25000
30000
35000All emergency presentations
DBA,Daed ER. & Admittedinclude observed
current vs. new criteria, 15 sentinel hospitals, 1998Fig. 4 Distribution of age of trauma casesFig. 4 Distribution of age of trauma cases
<1 5-9 15-19 25-29 35-39 45-49 55-59
No. of records
Age [year]
Chamaiparn Santikarn, MD., MPH.
34Ministry of Public Health, Thailand
0
10
20
30
40
50
60
70
80
90Percentage
Age [year]
Fig. 5 Distribution of age of trauma casesFig. 5 Distribution of age of trauma casescompared between current v.s. new criteria, compared between current v.s. new criteria, 15 sentinel hospitals, 1998 15 sentinel hospitals, 1998
>1
5-9
15-19
25-29
35-39
45-49
55-59
% of decreased of new criteria cases
Chamaiparn Santikarn, MD., MPH.
35Ministry of Public Health, Thailand
ResultsResultsData quality A.D. 2001Data quality A.D. 2001
New national report criteria Report coverage
Observed & admitted 86% Dead cases 77%
Completeness and reliability 89% Timeliness in data entering
within 30 days 46%
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