# Presentation: 823184

## ICE on Injury Statisticsand its Success in Problem Identification & Description

- 9th  World Conference on Injury Prevention & Safety Promotion
- Merida, 15-18 March, 2008
*Yvette Holder, MPH *
*International Biostatistics & Information Services*

## Public Health Approach & Injury Control (CDC)

## Information Needs & PHA

- Define the problem
- Surveillance data from various sources
- Identification of at-risk populations
- Description of potential risk factors

## Information Needs & PHA ct’d 

- Identify risk/protective factors
- Comparison of data across environments (sites, sub-populations, countries etc.)
- Characterization of injury patterns
- Case-mix comparisons
- In-depth research studies

## Information Needs & PHA ct’d 

- Develop and test intervention strategies
- Evaluation for effectiveness
- Indicators for monitoring

## Information Needs & PHA

- Define the problem
- Surveillance data from various sources
- Identification of at-risk populations
- Description of potential risk factors

## Challenge I

- To establish data collection systems
- Absence of an information culture
- Resistance to data
- Knee-jerk and short-sighted reaction to problems vis-a-vis  designed and evaluated interventions
- Lack of resources
- Human – staff shortages, mobility
- Skills and knowledge re IS implementation
- Materials

## Injury ICE Response

- In collaboration with WHO and CDC, developed a “How To” manual, adaptable to any environment
- Injury Surveillance Guidelines  provide a basis for continuity in a situation of high staff mobility

## Injury Surveillance Guidelines

- Manual
- Identifies potential data sources
- Describes minimum data that should be collected for major types of injuries
- Provides options for increased data collection if resources are available
- Recommends data analyses and outputs

## Injury Surveillance Guidelines ct’d

- Outlines the steps to establishing an ISS
- Identifying and engaging stakeholders
- Seeking resources
- Identifying and overcoming potential obstacles
- Monitoring and evaluating the system and its ouputs

## Further Injury ICE Response

- Encourage the establishment and sustained operation of Injury Surveillance Systems (ISS) worldwide
- Provision of an international forum for sharing of ISS output

## Information Needs & PHA ct’d 

- Identify risk/protective factors
- Comparison of data across environments (sites, sub-populations, countries etc.)
- Characterization of injury patterns
- Case-mix comparisons
- In-depth research studies

## Challenge II

- To operate and maintain injury data collection systems
- What data to collect?
- Quality of data
- Comparability and compatibility of injury data

## Injury ICE Response

- An injury data classification system, the International Classification of External Cause of Injury (ICECI)  that
- standardises injury data and
- facilitates comparability
- Initiative to standardise questions for household surveys (work in progress)

## ICECI

- The ICECI is
- Comprehensive (encompasses all types of injuries), with definitions for all terms
- Multi-axial (covering all factors that describe the circumstances of the event)
- Flexible (modular with optional levels of detail, appropriate to capacity)
- Compatible with the ICD-10

## International Classification of External Cause of Injury (ICECI)

- ALL INJURIES
- Demographics
- Intent
- Mechanism
- Object
- Place
- Activity
- Alcohol Use
- Other Psychoactive Drug Use
- Nature of Injury
- Severity
- Disposition/Outcome

- MOTOR VEHICLE INJURIES
- Mode of Transport
- Type
- Counterpart
- ASSAULTS/HOMICIDES
- Perpetrator/Victim Relationship
- Circumstances of Assault
- SUICIDES
- Proximal Risk Factor
- OTHER e.g. SPORTS, OCCUPATIONAL

## Place Of Occurrence (First Two Levels of Detail

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

## Place of Occurrence (Third Level of Detail)

## Information Needs & PHA ct’d 

- Develop and test intervention strategies
- Evaluation for effectiveness
- Indicators for monitoring

## Challenge III

- To transform data into information such that
- Data are easily understood and interpreted
- Data are comparable across countries, in different environments
- Specifically to group 1200 codes into meaningful but standard groups for reporting.

## Injury ICE Response – Data Reporting Frameworks - I

- External Cause  of Injury Matrix
- Based on the axes of intent and mechanism (from the external cause code)
- 4 x 12 matrix, expandable to 5 x 26
-  < 50 groups, suitable for mortality data
- Updated from ICD-9 to ICD-10
- Provision for a third variable

**Notes:**
Yvette- what does last bullet mean?

## External Cause of Injury Matrix (ICD-9)

| Mechanism | Intent |  |  |  |
| --- | --- | --- | --- | --- |
|  | Unintentional | Suicide | Homicide | Undeter-
mined |
| Drowning |  |  |  |  |
| Poisoning |  |  |  |  |
| Fall |  |  |  |  |
| Fire/burn |  |  |  |  |
| Cut/pierce | E920 | E956 | E966 | E986 |
| Etc. |  |  |  |  |
|  |  |  |  |  |
|  |  |  |  |  |

## Injury Ice Response – Data Reporting Frameworks II

- Barell Matrix
- Framework presenting ICD9-CM codes  (morbidity) using body region and nature of injury
-  Basic 5 x 12 expandable to 10 x 12 and to 36 X 12 cells

## Barell Matrix

## Injury ICE Response – Data Reporting Frameworks – III

- Injury Mortality Diagnosis Matrix:
- 	ICD-10
- Framework that combines the two main axes of injury description, *viz* the body region and the nature of injury
- Reduction from 1169 ICD-10 codes to a minimal 17X16 matrix that captures all of all injury deaths
- Option of a more detailed 43 x 20 matrix
- Potential for use with morbidity data

## Injury Mortality Diagnosis Matrix

**ICD-10 ‘S’ or ‘T’ code**

## Challenge IV

- To monitor changes in injury situations and evaluate interventions
- Valid stable indicators that reflect real changes and not artifacts
- More accurate identification of risk and protective factors

## Injury ICE Response – Indicators  Working Group

- Finalizing a set of valid, robust indicators
- Determining a set of severity scores.

## ICE – A Mechanism for Global Injury Data

- Tools for data collection
- Methodologies for analysis
- Frameworks for information dissemination

## Conclusion

- All ICE efforts serve multiple objectives toward the goal of information for global injury prevention – truly a mechanism of globalization for injury prevention and control