# Presentation: 265040

## ICECI application in Injury Surveillance in Cali, Colombia

**Andrés Fandiño-Losada**
**Edgar Muñoz **
**María Isabel Gutiérrez Martínez**

## Methodology

- Testing of Injury Surveillance Systems in Latin-American.
- WHO/ PAHO & CDC initiative.
- In Cali, 2 Hospitals were selected.
- Commitment, level of care, ease in working in emergency departments.
- Hospital San Juan de Dios (Level 2).
- Hospital Primitivo Iglesias (Level 1).
- In Colombia: 3 levels of care. 3d is the most complex.

## Methodology

- ICECI Pilot data collection form was designed with physicians participation from Emergency Departments.
- Data Collection
- March 26 through July 26 2002.
- 5377 cases collected.
- Quality control during the process:
- Constant review of forms during field work.
- Correction of mistakes in the forms.
- Double-entry process during typing.

## Methodology

- Seventeen ICECI V.1.0. variables were used in pilot test.
- ICECI level 2 codes for designing the General Data Set.
- ICECI level 1 codes for designing the Specific Data Set.
- Total: 485 ICECI V.1.0. codes in 17 variables.
- Avrg: 28.5 codes per variable.
- ICECI Pilot form used 174 codes:
- Avrg: 10.2 codes per variable.

## ICECI Variables collected in Pilot Test

- Intent
- Mechanism
- Object / Substance
- Place
- Activity
- Alcohol use
- Psychoactive drug use
- Previous suicide attempt
- Risk Factor for Suicide

- Perpetrator / Victim Relationship
- Sex of perpetrator
- Context of Assault
- Type of Legal Intervention
- Type of Conflict
- Mode of Transport
- Role of Injured Person
- Counterpart

## PILOT TEST RESULTS

- ANALYSIS OF SURVEILLANCE DATA
- APPLICATION OF VARIABLES AND CODES OF ICECI CLASSIFICATION

## Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Age groups by Sex (%)

## Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Intent by Sex (%)

## Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Activity when injured by Sex (%)

## Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Place of Ocurrence by Sex (%)

## Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Object that caused injury by Sex (%)

## Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Mechanism by Sex (%)

## Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Mode of Transport by Sex (%)

## Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Perpetrator/ Victim Relationship by Sex (%)

## Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Risk Factors for Intentional Self-Harm by Sex (%)Multiple Response Variable

## Simplifying ICECI Collecting Form

- Excluding categories (codes) below a cut off point, into each ICECI variable.
- Establishing correspondences among categories from different variables for exclusion.

## Excluding ICECI Categories

- Statistical Criteria:
- They don’t apply for “Other” and “Unknown” codes.
- Cut off point: To Exclude codes with a frequency less than 1%.
- Count the number of codes for exclusion.
- Other Criteria:
- Conceptual
- Practical

## Frequency of ICECI Codes

- Frequency lists for each ICECI variable used in pilot test.
- For example,
- Intent:
- 2 / 7 (28.6%) codes will be eliminated.

| INTENT | % |
| --- | --- |
| Unintentional | 66.2 |
| Intentional self-harm | 1.8 |
| Assault | 31.0 |
| Legal Intervention | 0.2 |
| War / Conflict | 0.0 |
| Other | 0.3 |
| Unknown | 0.5 |

## Codes below cut-off for each Variable

| Variable | Codes | Below cut-off | % |
| --- | --- | --- | --- |
| Intent | 7 | 2 | 28.6 |
| Mechanism | 41 | 26 | 63.4 |
| Object / Substance | 17 | 7 | 41.2 |
| Place | 14 | 5 | 35.7 |
| Activity | 9 | 1 | 11.1 |
| Alcohol use | 4 | 0 | 0 |
| Psychoactive drug use | 4 | 0 | 0 |
| Previous suicide attempt | 4 | 0 | 0 |
| Risk Factor for Suicide | 12 | 2 | 16.7 |

## Codes below cut-off for each Variable

| Variable | Codes | Below cut-off | % |
| --- | --- | --- | --- |
| Perpetrator / Victim Relationship | 10 | 4 | 40 |
| Sex of perpetrator | 4 | 0 | 0 |
| Context of Assault | 12 | 4 | 33.3 |
| Type of Legal Intervention | 4 | 4 | 100 |
| Type of Conflict | 4 | 4 | 100 |
| Mode of Transport | 11 | 3 | 27.3 |
| Role of Injured Person | 7 | 0 | 0 |
| Counterpart | 14 | 1 | 7.1 |

## Excluding ICECI Variables

- Injury Surveillance System Instrument
- Context Dimensions used:
- Mechanism
- Object
- Number of categories in each variable of dimension:
- Mechanism: 41 categories.
- Object: 17 categories.
- Total: 58 categories.
- By logic, mechanism and object dimensions are closely related.

## Correspondence Analysis

- Statistical Method for reducing the number of categories or dimensions used in a classification system.
- Components of each studied variable are located into a n dimension cloud.
- Image of that cloud is projected in 2 dimension space.
- Correspondences among categories are determined.
- It’s possible to define a new unique dimension from initial ones.

## Correspondence Analysis Results ...

## Slide 24

## Slide 25

## Slide 26

## Correspondence Analysis 4

- Vehicle
- Road traffic injury

- Animal
- Stinging-Biting

- Person
- Struck-kicked
- Sexual assault

- Knife or cutting arms
- Cutting
- Tearing
- Blunt force

- Object

- Mechanism

## Slide 28

## Final Proposal

- New dimension with a mixed variable:
- Mechanism / Object
- Number of Categories in the variable of each dimension:
- Mechanism: 3 categories are eliminated.
- Object: 10 categories are eliminated.
- Total: 13 categories eliminated.
- Unique Final Variable with 45 categories.
- A SIMPLER INSTRUMENT.

## Pilot Test Conclusions

- ICECI is a conceptual advance for injury surveillance and injury control.
- There are a lot of items in each dimension of ICECI.
- It’s necessary a balance between needs of data and instrument complexity.
- Countries with less resources need a simpler injury surveillance system.

## Evaluation ofInjury Surveillance Systems(ISS)

- Cali, Colombia.
- April – 2005.

## Injury Surveillance System

- Injury surveillance system continues in ...
- City of Cali:
- Hospital San Juan de Dios (HSJD) – level 2
- Hospital Mario Correa Rengifo (HMCR) – level 2
- H. Universitario del Valle (HUV) – level 3
- Foundation Valle del Lili Clinic (FCVL) – level 3
- Siloe Health Center (CSS) – level 1
- City of Santander de Quilichao:
- H. Francisco de Paula Santander (HFPS) – level 1

## Characteristics of Hospitals

| Hospital | Patients/ month | % Injury |
| --- | --- | --- |
| HMCR – L2 | 1305 | 20% |
| HSJD – L2 | 2121 | 23.2% |
| HUV – L3 | 418 | 50% |
| CSS – L1 | 2838 | 14.3% |
| FCVL – L3 | 2100 | 11% |
| HFPS – L2 | 2302 | 21.3% |

## Time from implementation up to date of the  ISS

| Hospital | Months | Functioning now |
| --- | --- | --- |
| HMCR – L2 | 15 | YES |
| HSJD – L2 | 14 | YES |
| HUV – L3 | 3 | NO |
| CSS – L1 | 4 | NO |
| FCVL – L3 | 9 | YES |
| HFPS – L2 | 10 | YES |

## Sensitivity and Positive Predictive Value

| Hospital | Sample | Sensitivity % | PVP % |
| --- | --- | --- | --- |
| HMCR – L2 | 283 | 92.2 | 83.9 |
| HSJD – L2 | 199 | 68.5 | 86.0 |
| HUV – L3 | 240 | 76.3 | 98.9 |
| CSS – L1 | 271 | 63.6 | 90.3 |
| FCVL – L3 | 232 | 73.2 | 83.3 |
| HFPS – L2 | 278 | 59.7 | 95.2 |

## CISALVAInstitute for Peace Promotion and Injury /  Violence Prevention 

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