# Presentation: 688335

## From Provincial to National: The Development of Thailand Injury Surveillance

*Chamaiparn Santikarn, MD., MPH.*
*Non-communicable Diseases Bureau, Ministry of Public Health*
*Siriwan Santijiarakul, MSc.*
*Epidemiology Bureau, Ministry of Public Health, Thailand*

## 		Introduction

**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) **

## 		Introduction

**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 unit

**  ****E.R.**
**Nurse**

**Medical Record Department**
**Medical Statistics Technicians**

**Diskette to **
**Epidemiology Division**

**National action**

**Report distributed within hospital and province**

**Local action**

**4-6 mnth.**

**6 mnth.**

## 		Introduction

**Emphasized on local utilization for action than centralizing the data**
**Local information users - physicians, nurses and policymakers**
**PC software specifically developed for local processing**

## 		Introduction

**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 **

## 		Introduction

**System expanded to 22 large hospitals **
**In 2001, ****national coordinating unit proposed ****reduced**** ****reporting criteria, included only severe injuries (deaths, observed and /or admitted)                                                                 **

## 			Objectives

- Dr. Chamaiparn Santikarn

**Gain better ****representativeness  of important injury events in  each province**
**Better**** data quality**
**Decrease resource need**

## Methods

**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**

## A.D. 2001 

*** ******15 study sites***

***7 Other sites***

***A.D. 2001 ***
***22 reporting sentinel sites ***

## Methods

**In December 2000 **
**Workshop for Establishing the National Injury Surveillance**
**Analysis results presented**

## Results

**  ****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 %**

## Fig. 1  Distribution of maximum AIS of trauma cases 

**Max. AIS**

**3**

**2**

**4**

**5**

**6**

**1**

**No. of records**

*                         **Source : 15 sentinel hospitals, provincial injury surveillance, Thailand.*

***Fig. 1  Distribution of maximum AIS of trauma cases ***

***previous vs.. new criteria, 15 sentinel hospitals, 1998***

## Fig. 2  Distribution of maximum AIS of trauma cases

**No. of records**

**Max. AIS**

**2**

**5**

**4**

**6**

**1**

**3**

***                   ******Source :  sentinel hospitals, provincial injury surveillance, Thailand 1998.***

***Fig. 2  Distribution of maximum AIS of trauma cases***

***previous  vs..  new criteria, 13 non -Bangkok***** *****hospitals***

## Fig. 3 Distribution of maximum AIS of trauma cases

**No. of records**

**Max. AIS**

**1**

**3**

**5**

**4**

**6**

**2**

*                    **Source : sentinel hospitals in Bangkok , provincial injury surveillance, Thailand .*

***Fig. 3 Distribution of maximum AIS of trauma cases***

***previous vs.. new criteria, Bangkok,1998***

## Results 

**5 leading cause of injuries in each sentinel site **
** ****Minor change 2nd - 3rd rank **
** ****Tendency towards external causes ****	****with more severe outcome**

## Five leading  cause of injuries, previous criteria                                   vs. new criteria          

***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****  **

## Results

**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**

## 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**** **

## Results 

**Simple computer technique                   needed  to manage electronic file                         before sending in the data**** **

## Results (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 )**

**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.***_

## Discussion

##  Discussions

**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**

##  Discussions

**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**

##  Discussions

**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 !?!**

## Lesson learned

** ****More difficult to live with    ****  less data after having it ! **

## Recommendations

**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**

## Conclusion

** ****This reporting criteria of                                          **** Thailand National injury Surveillance  **** s****uitable for developing countries **
**resources are scarce **
**acute care still needs improvement**
**injury prevention just begun**

## Acknowledgment

**International Collaborative Effort on Injury Statistics**
**LA Fingerhut, MA**
**U.S. CDC's NCHS, NIH's                                                                NICHD**
**28 sentinel hospitals**
**Surveillance evaluating **
**   ****team**

## Results 

***Investment for the first year (not including salary)***
** ****3.8 million baht **
** ****approximately 10,000** **US $                                   ****(according to the exchange rate **
**  ****at present )**

## Results 

**Distribution of trauma cases by **
**	****severity **
**maximum AIS scale in each patient **
**161,916 cases - current criteria **
**47,900 cases   - new criteria**

## current  vs.  new criteria,  15 sentinel hospitals, 1998

***current  vs.  new criteria,  15 sentinel hospitals, 1998***

***Fig. 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]**

## Fig. 5  Distribution of age of trauma cases

**Percentage**

**Age [year]**

***Fig. 5  Distribution of age of trauma cases***

***compared between current  v.s.  new criteria,                      ******             15 sentinel hospitals, 1998 ***

**>1**

**5-9**

**15-19**

**25-29**

**35-39**

**45-49**

**55-59**

**% of decreased of new criteria cases **

## ResultsData 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%**