Carme Clavel -Arcas Alberto Concha-Eastman CDC- PAHO ICE Injury Statistics Meeting Cuernavaca,...
-
Upload
poppy-hutchinson -
Category
Documents
-
view
212 -
download
0
Transcript of Carme Clavel -Arcas Alberto Concha-Eastman CDC- PAHO ICE Injury Statistics Meeting Cuernavaca,...
Carme Clavel -Arcas Carme Clavel -Arcas Alberto Concha-Eastman Alberto Concha-Eastman
CDC- PAHOCDC- PAHO
IICE Injury Statistics Meeting CE Injury Statistics Meeting
Cuernavaca, Mexico June 1-2, 2005Cuernavaca, Mexico June 1-2, 2005
Implementing a Hospital- based Injury Surveillance Systems in Nicaragua ,
El Salvador and Colombia
CALI
Where we are working
Countries Countries Nicaragua ( 2000 )Nicaragua ( 2000 )
– 2 in the capital 2 in the capital – 3 departmental3 departmental
El SalvadorEl Salvador ( 2001)( 2001)– 2 in the capital 2 in the capital – 6 departmental 6 departmental
ColombiaColombia, , Cali ( 2001)Cali ( 2001) - 5 in Cali 5 in Cali - 1 Santander de Quilichao 1 Santander de Quilichao
Evaluation of Hospital Injury Surveillance Systems in Nicaragua, El Salvador and Colombia
International Workshop Cali, Colombia 6- 8, 2005
Evaluation Methodology Evaluation Methodology
Qualitative componentQualitative component– Hospital descriptionHospital description– Timeline Timeline – FlowchartFlowchart– Simplicity, acceptabilitySimplicity, acceptability– Goals, obstacles, needsGoals, obstacles, needs– Data: dissemination , Data: dissemination ,
use , timelinessuse , timeliness
Quantitative componentQuantitative component– Sensitivity Sensitivity – Predictive Value Predictive Value – CompletenessCompleteness– Quality of data entryQuality of data entry– Costs Costs
Based on a standardized template
Patient arrives at ER
Hospital description : Injury Hospital description : Injury Surveillance SystemSurveillance System
Data analysis
Statistician & Epidemiologist Data entry and quality control
Identification of injured person Fill out Format
Dissemination of the results
Intervention for Injury Prevention
Case DefinitionCase Definition
First visit First visit
to the hospital to the hospital
EmergencyEmergency
Department forDepartment for
any type of injuryany type of injury
Manual Data CollectionManual Data Collection
Hospital Hospital Emergency Emergency Department Department Medical Record Medical Record (Intake Form)(Intake Form)
El Salvador format for the Injury Surveillance System in ER
ResultsResults
Nicaragua team Policies working group
Group
AchievementsAchievements
Injury data collection in ED is possible Injury data collection in ED is possible
Health authorities are interested Health authorities are interested – Extension of injury surveillance Extension of injury surveillance
– Creation of injury prevention programs Creation of injury prevention programs
– Promote intersectorial injury mortality Promote intersectorial injury mortality surveillance surveillance
Data being used to make decisions Data being used to make decisions
Results - ComponentsResults - ComponentsQualitativeQualitative
Staff rotation Staff rotation Training diverse Training diverse Interruptions at the Interruptions at the beginning beginning Flowchart was Flowchart was considered simpleconsidered simple“ “ they don’t have they don’t have enough timeenough time “ “More action than More action than informationinformation
QuantitativeQuantitative
10- 35 % of ER visits 10- 35 % of ER visits are injuries are injuries 75- 95 % 75- 95 % unintentional unintentional 23-4 % intentional -23-4 % intentional -violence violence 2-1 % self inflected 2-1 % self inflected 70 % young male 70 % young male Falls main Falls main mechanismmechanism
Injury Pyramid Pediatric Hospital. Injury Pyramid Pediatric Hospital. San Salvador 2004San Salvador 2004
34Deaths
2486 Hospitalizations
9495 Injury Emergency Visits
Injuries in the community ?
6 % of all deaths
33 % of all emergency
visits
17 % of all hospitalizations
1
73
279
Ratio
Colombia : Percent of ER visits due to Colombia : Percent of ER visits due to injury, Sensitivity, Predictive Value Positiveinjury, Sensitivity, Predictive Value Positive
HospitalHospital % injuries/% injuries/
ER visits ER visits
Sensitivity Sensitivity %%
PVP %PVP %
HUV – L3HUV – L3 5050 7676 9999
FVL – L3FVL – L3 1111 7373 8383
HFPS – L2HFPS – L2 2121 6060 9595
HMCR-L2HMCR-L2 2020 9292 8484
HSJD- L2HSJD- L2 2323 6969 8686
CSS – L1CSS – L1 1414 6464 9090
Data quality : Percent of Missing Data in two General Hospitals . 2004
VariableEl Salvador N = 4,890
Nicaragua N= 8, 120
Age 1 0.1
Sex 0 0
Place injury occurred 2 98
Day event 27 99
Intentionality 0 0
Activity 0 0
Mechanism 0 0
Alcohol Use 20 97
Nature of Injury 0 0
Disposition 9 0
Data quality : Percent of Missing Data in two General Hospitals . 2004
Variables : Specific Modules
EL Salvador Cases
% Missing data
NicaraguaCases
% Missing data
Person injured or road user
574 4 978 0.1
Relationship of perpetrator to
victim
364 12 702 0.1
Precipitating Factors
61 38 141 0
Variable %Age 100%
Sex 100%
Address of event 94%
Day of event 100%
Intentionality 100%
Activity 100%
Mechanism 100%
Alcohol Use 94%
Nature of Injury 100%
Disposition 88%
SPECIFIC MODULES :
Person injured or road user 100%
Relationship of perpetrator to the victim 80%
Precipitating Factors 100%
Data Entry Quality : Pediatric Hospital El Salvador, 2004
Dissemination dataDissemination dataNationally Nationally
– National Electronic Bulletins ( Nicaragua ) National Electronic Bulletins ( Nicaragua ) – Hospital Electronic Bulletins ( El Salvador )Hospital Electronic Bulletins ( El Salvador )
Internationally Internationally – Last two Injury World ConferencesLast two Injury World Conferences
Results- InterventionsResults- Interventions
Campaign against burns by “ pólvora “Bicyclist Injury Prevention Plan“ Life Campaign” Summer Prevention Plan Improvement of conditions at hospitalImprovement of conditions at hospital level level
ChallengesChallenges ~ Recommendations ~ Recommendations
Strengthen quality of data Strengthen quality of data
Reduce minimum data set Reduce minimum data set
Improve the dissemination of data, Improve the dissemination of data, especially through articles especially through articles
Increase injury research Increase injury research
Identify best practices for injury prevention Identify best practices for injury prevention
Next steps Next steps Develop a methodological plan for Injury Develop a methodological plan for Injury
Information System in the Americas ( PAHO )Information System in the Americas ( PAHO ) : :
– Hospital Based : CAREISS Hospital Based : CAREISS
– Mortality data ( Observatorios Municipales ) Mortality data ( Observatorios Municipales )
– Specific topics like Intimate Partner Violence/ Specific topics like Intimate Partner Violence/ Sexual ViolenceSexual Violence
THANKS THANKS to the technical teams and the to the technical teams and the
hospital staff in the three hospital staff in the three countriescountries
Carme Clavel-ArcasCarme Clavel-Arcas e-mail: e-mail: [email protected]@cdc.gov
Alberto Concha- EastmanAlberto Concha- Eastman e-mail : e-mail : [email protected]@paho.org
www.cdc.gov/ncipcwww.cdc.gov/ncipcwww.paho.orgwww.paho.org