# Presentation: 329164

## International Collaborative Effort on Injury

- June 1-3, 2005
- Cuernevaca, Mexico
***Yvette Holder, ***
***Consultant Biostatistician/Epidemiologist***

## An Overview of ICE-related work

- ICECI (Violence Module)
- WHO’s Injury Surveillance Guidelines
- Violence Indicators

## Intent Variable

**Classification scheme**
**1****	****Unintentional**
**	****     *****Includes ****‘accidental’ injuries*
**2****	****Intentional self-harm**
- 	     Any deliberate or intentional injury to self
*	**      ****Includes**** suicides, para-suicides, self-mutilation*
**3****	****Assault**
- 	     ***Includes**** injuries inflicted by other person(s) with intent to injure or kill someone*
*	**    ****Excludes ***
*legal interventions ****(4.1) **** and operations of war *
* **civil conflict ****(4.2)***
**4****	****Other violence**
- 	4.1	Legal intervention
-           ***Includes**** injuries inflicted by law-enforcing agents during legal action or inflicted by state agencies during attempts to enforce the law, execution or injury performed at the behest of judiciary or ruling authority*
- 	4.2 Operations of war and civil conflict
**5****	****Undetermined intent**
**6****	****Adverse effects or complication of medical or surgical care**

## Violence Module - ICECI

## WHO Injury Surveillance Guidelines

## Purpose of Guidelines

- Provide surveillance officers/researchers with the basic tools for collecting information on injury
- Facilitate capture of injury data in a standardised but flexible format
- Hence, contribute to the building of an internationally comparable body of injury data

## Layout of the Guidelines - Introduction

- Injury - definition; types; epidemiology
- Surveillance - definition; purpose
- Need for injury surveillance
- Steps of the surveillance process
- Attributes of a good surveillance system

## Designing an Injury Surveillance System

## International Classification of External Cause of Injury (ICECI

- Intent
- Mechanism
- Object
- Place
- Activity
- Alcohol Use
- Other Psychoactive Drug Use

- Mode of Transport
- Type
- Counterpart
- Perpetrator/Victim Rel.
- Circumstances of Assault
- Proximal Risk Factor

## Injury Surveillance Information System Overview

- Optional Data Set

**MDS**

- Optional Data Set

**CORE**

**Notes:**
The efforts of the work to standardize information on the cause of injury and the work to establish core injury data elements in surveillance systems are inter-related.  In the diagram shown here, the large orange circle represents the global scale of the ICECI project.  The desire is to standardize the information gathered on injuries.  At the core (in the blue circle) lies the data comprising the minimum basic data set for injury monitoring.  These data elements are common to all types of injuries.

In the second tier, data specific to certain injury types or injury mechanisms enters the equation.  The outer (green) circles represent standard data elements that should be gathered for specific injury categories.  This information will be focused upon the specific injury and will not necessarily apply to all injuries.  As an example, consider the proposed violence module to ICECI.  The data elements recommended for collection regarding injuries from violence include; (1) the relationship of victim to perpetrator, (2) context of the assault, (3) precipitating factors for suicide, etc.  This type of information pertains only to violence and not to other categories of injury.

## Core Data Set - for All Injuries

- Age, Sex, Intent, Place
- Activity, Nature of Injury,
- Mechanism/External Cause
- Text Summary

- Optional Data Set

## CORE INJURY SURVEILLANCE INSTRUMENT- MDS

## Expanded Data Set – All Injuries

## Modules for Specific Injury Typese.g. Assaults

**Minimum Data Set**

- Circumstances,
- Perpetrator/Victim Relationship

- Optional Data Set

- Object

## Slide 15

## Slide 16

## Place Of Occurrence (First Two Levels of Detail

**Place Of Occurrence (First Two Levels of Detail**

## Place of Occurrence (Third Level of Detail)

## Building a Data Set

- Core Minimum Data Set with basic categories
- 	 +  modules
- 		+ data elements
- 		        + detailed categories
- 				= ICECI

## Slide 20

## Way Forward

- Application
-  Surveillance Guidelines
- Validation
- Comparison with Injury Matrix (60% of  specifically defined cells)
- excludes non-traffic, machinery, overexertion and natural/environment
- includes sexual assault
- % of unspecified injuries according to the ICECI MDS
- ?Further editing

## Evaluation

- Retrospective review of surveillance system data
- Prospective System Evaluation
- System Environment Evaluation

## Slide 23

## Indicators for Monitoring Violence

- Purpose: To monitor violence in the Americas in a standardised way
- Types:
- Basic: minimal, readily available
- Developmental: desirable but collection would require a system to be put in place
- Research: best collected via surveys
**Note**: All rates are per 100,000 population

## Basic Indicators

- Age-adjusted suicide rate
- Age-adjusted homicide rate in males aged 15-44 yrs
- Age-adjusted homicide rate in females aged 15-44 yrs
- Homicide rate in children aged 0-4 yrs.
- Reports of assault per 1000 pop.
- Reports of robbery per 1000 pop.
- Reports of kidnappings per 100,000 pop.

## Developmental Indicators – I

- Age-adjusted death rate due to intimate partner violence (IPV)
- Death rate due to child abuse
- Death rate due to elder abuse
- Age-adjusted robbery-related homicide rate
- Age-adjusted hospital discharge rate due to suicide attempts
- Age-adjusted hospital discharge rate due to assault in males aged 15-44 yrs

## Developmental Indicators – I ct’d

- Age-adjusted hospital discharge rate due to assault in females aged 15-44 yrs
- Hospital discharge rate due to assault in children aged less than 5 yrs
- Hospital discharge rate for assault in elderly
- Reported civil rights violations per 1,000 pop.
- Reported cases of child maltreatment per 1,000 pop
- Reported cases of school fights per 100,000 pop of school-aged children per yr

## Developmental Indicators – II 

- Age-adjusted hospital discharge rate for assault resulting from IPV
- Hospital discharge rate resulting from child abuse
- Hospital discharge rate for assault due to elder abuse

## Developmental Indicators – III 

- Age-adjusted Emergency Room (ER) visit rate due to suicide attempts
- Age-adjusted ER visit rate in males aged 15-44 yrs. due to assaults
- Age-adjusted ER visit rate due to assaults resulting from IPV
- ER visit rate due to assaults resulting from child abuse
- ER visit rate due to assaults resulting from elder abuse

## Research Indicators

- Rate of suicide ideation
- Rate of suicide attempts in past 12 months
- Self-reported weapon carrying among youth at school, per 100 school children
- Self-reported fighting rate among youth at school per 100 school children
- Self-reported rate of IPV per 1,000 respondents