Updating Recommendations for Injury Surveillance in State Health Departments

Report from the Injury Surveillance Workgroup

Collaborative Effort of

STIPDACSTENCIPCNCHSSAVIR

Injury Surveillance Workgroup Members

Lee AnnestLois FingerhutHolly Hedegaard Renee JohnsonMark KindeMel KohnSue MalloneeHank Weiss

Consensus Recommendations for Injury Surveillance in State Health

Departments-1st Edition (ISW1)

Table. Core Injuries, Injury Risk Factors, and Data Sets for State Injury Surveillance 

Injury/Injury Risk Factor

VR HDD FARS BRFSS YRBSS

ED ME CDR Other

Motor Vehicle Injuries X X (X)   (X) (X) (X) (EMS)

Alcohol in MV deaths     X     (X)    

Self-reported seat belt/safety seat use

      Both       (OPU)

Homicide X       (X) (X) (X) (UCR)

Suicide X       (X) (X) (X)  

Suicide attempts   X   Both (X)      

Firearm injuries X X     (X) (X) (X) (UCR)

Traumatic brain injuries

X X     (X)   (X)  

Fire and burn injuries X X     (X)   (X)  

Smoke alarm use       BRFSS        

Submersion injuries X X     (X)     (EMS)

Traumatic spinal cord injuries*

(X) (X)     (X)      

Fall injuries* X X     (X)   (X)  

Poisoning* X X     (X)   (X)  

(Indicates supplemental)

Injury Surveillance Workgroup (ISW5)

Challenge

• Update Green Book

• Readership-Novice and Experienced State Injury Personnel

• Move Injury Surveillance Field Forward

• Challenge the Field Toward the Future

Background

• Define uses of surveillance at the state and local level

• Document many efforts at improving state injury surveillance since 1999– CSTE Position Statements– State Injury Indicators– Matrices– STAT Guidelines– Other Consensus Documents

Injury Surveillance Principles

• Classification and Coding of Fatal Injuries– Underlying and Multiple Cause Coding– Matrices– Comparability of Mortality Data: ICD9-ICD10

• Coding of Nonfatal Injury Data – External Cause Coding

• Injury Severity– AIS– ICDMAP– ICISS

Injury Surveillance PrinciplesRecommendations

State injury prevention programs should: • Regularly evaluate the completeness and

specificity of external cause coding in their statewide hospital discharge and emergency department databases.

• Provide information on the uses and adequacy of external cause coding back to those who produce the data as a way to improve data quality.

• Explore the possibility of using statutory tools, rule-making or other policy actions to enhance the completeness and specificity of external cause coding.

Injury Surveillance PrinciplesRecommendations

State injury prevention programs should:

• Support efforts at the national level to improve external cause coding.

• Explore opportunities to provide training for health care providers and hospital coders regarding the importance of injury cause documentation.

State Injury Surveillance Capacity

• Access to Data– Need for Statutes/Regulations– HIPAA– National Sources of Data– Confidentiality – Human Subjects Issues

State Injury Surveillance Capacity

• Core Injuries and Injury Risk Factors for State Injury Surveillance

• Motor Vehicle Injuries • Fire/Burn Injuries• Alcohol in MV Deaths • Smoke Alarm Use• Self-Reported Seat Belt Use • Submersion Injuries• Homicide • Fall Injuries• Suicide/Suicide Attempts • Poisoning• Firearm Injuries • Spinal Cord Injuries• Traumatic Brain Injuries

State Injury Surveillance Capacity

• Data Quality

• Data Linkage

• Dissemination of Data

• Staffing and Training

• Partnerships

Recommendations for State Injury Surveillance Capacity

State injury programs should:• Utilizing the STIPDA STAT guidelines, conduct a

self-review of surveillance capacities.• Have injury morbidity, mortality, and risk behavior

data available via web-based query systems.• Make it a priority to invest in training staff in injury

surveillance and epidemiology.• Work with other organizations and agencies to

implement statewide hospital discharge or emergency department data if no such data systems exists in the state.

New Challenges in Injury Surveillance

• Injury Surveillance in Statewide Emergency Department Datasets

• Disaster Surveillance

Case Definition for Injury Hospitalization in Discharge Data

• Principal reason for admission (I.e., first listed code) is injury using nature of injury codes– 800-994; 995.5– Excludes adverse

effects & complications of care

– External cause codes not included

Injury Surveillance in Statewide Emergency Department (ED) Datasets

• 25 states have access to ED data

• No definition of Injury ED visits to be counted has been recommended

• State-to-state or state-to-national comparisons of ED visits requires standardization of definitions

Trends in Number of Injury Visits to Emergency Departments based on Five Alternative Definitions:

United States, 1995-2004

10,000,000

100,000,000

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f vi

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SOURCES: CDC/NCHS, NHAMCS-ED, 1995-2004 data files and NEISS-AIP data from WISQARS.NOTES: See text for description of each data line. Lines 1-4 are based on data from NHAMCS and Line 5 is from NEISS-AIP.

1. NHAMCS-ED all injury-related visits

2. Modified recommended definition for injury visit

3. Recommended definition for initial visit injury

4. Visits based on 1st listed injury diagnosis

5. NEISS-AIP (5)

NCHS Recommendation for Injury Surveillance in ED Datasets

• First listed injury diagnosis

OR

• Any mention of an external cause of injury code

• Initial visits only

• Excludes adverse effects and complications of care

New Challenges in Injury Surveillance Recommendations

State injury programs should:• Use the expanded injury case definition in

analysis of the state’s Emergency Department data if they have the requisite data elements.

• Each state should establish and maintain expertise in disaster epidemiology and collaborate with the state all-hazards preparedness programs.

• State injury programs should support efforts at the national level to establish standardized reporting methods and data collection instruments for disaster surveillance.

Future Challenges

• Determining Incidence: De-duplicating Injury Morbidity Data

• Capturing Complete Data from Hospitalized Injuries

• Emergency Medical Service (EMS) Data

Future Challenges in Injury Surveillance Recommendations

• States should understand the importance of de-duplication of statewide hospital discharge and emergency department data systems

• States should consider participation in efforts to develop standardized guideline for the de-duplication of statewide injury morbidity data.

• There should be efforts to continue analyses of the effect of expanding the case definition to include external causes.

Report Finalization and Distribution

• Recommendations and report to be finalized by July 31, 2007.

• Printing and distribution to all states, collaborating agencies, and other interested partners by October 2007.