ICE Injury Statistics International meeting

Washington DC, September 7-8, 2006

Pan American Health Organization Injury Statistics Activities

PAHO’s Current ProjectsPAHO’s Current ProjectsMorbidity data Morbidity data – Hospital injury surveillance Hospital injury surveillance

Mortality data Mortality data – Observatorios Violencia Observatorios Violencia

Interpersonal violenceInterpersonal violence – Intimate partner violence, sexual violence, Intimate partner violence, sexual violence,

child maltreatment, youth violence, suicides, child maltreatment, youth violence, suicides, etc etc

Morbidity data Morbidity data PAHO-CDC-MOH-CISALVA “Injury Surveillance PAHO-CDC-MOH-CISALVA “Injury Surveillance Systems in emergency rooms in Nicaragua, El Systems in emergency rooms in Nicaragua, El Salvador and Colombia ”Salvador and Colombia ”Technical assistance in different LAC countriesTechnical assistance in different LAC countriesExisting ISS as found in Jamaica, Peru, Brasil, Existing ISS as found in Jamaica, Peru, Brasil, Honduras, Bolivia, Chile, Argentina, Paraguay, etcHonduras, Bolivia, Chile, Argentina, Paraguay, etcMOH in Central America : “Family violence and MOH in Central America : “Family violence and sexual violence surveillance” sexual violence surveillance”

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 Form

Dissemination of the results

Intervention for Injury Prevention

Cali, Colombia: a case study in Cali, Colombia: a case study in data cleaning and coding data cleaning and coding

Challenges:Challenges:–Incomplete codebook

–Format–Miscodes

before after

–Missing data

–Excess of variables

Cali, Colombia: a case study in Cali, Colombia: a case study in data cleaning and codingdata cleaning and coding

Injury Intentionality: Post Cleaning

unintentional

self-inf licted

intentional

other

missing

Missing Data Missing Data 1.1. Asses amount of missing dataAsses amount of missing data2.2. Review and Reconstruct Review and Reconstruct Injury Intention: Pre Cleaning

unintentional

self-inf licted

intentional

other

missing

Cali, Colombia: a case study in Cali, Colombia: a case study in data cleaning and codingdata cleaning and coding

Predictors of missing dataPredictors of missing data– HospitalHospital– DoctorDoctor– Presence of alcoholPresence of alcohol– Hour of admissionHour of admission– Pre hospital carePre hospital care

The future…..?The future…..?

AchievementsAchievements

Injury data collection in ED is possible Injury data collection in ED is possible Health authorities are interested in:Health authorities are interested in:– Extension of injury surveillance Extension of injury surveillance – Creation of injury prevention programs Creation of injury prevention programs – Promotion of intersectorial injury mortality surveillancePromotion of intersectorial injury mortality surveillance

Data is being used to make decisions Data is being used to make decisions

Challenges Challenges ““Parallel” systems in the MOH persistParallel” systems in the MOH persistIncomplete data in : Incomplete data in : – alcohol abuse and other drugs, relationship alcohol abuse and other drugs, relationship

between perpetrators and victims, between perpetrators and victims, precipitating factors in self-inflicted, etc precipitating factors in self-inflicted, etc

Lack of consensus in measures of severity Lack of consensus in measures of severity Insufficient dissemination of data to the Insufficient dissemination of data to the authorities authorities

Challenges- Opportunities Challenges- Opportunities Consolidating existing health information systems, and Consolidating existing health information systems, and promoting the integration of ISS in these systems : promoting the integration of ISS in these systems : – Ex SILEX- SIMMOW ( El Salvador ) Ex SILEX- SIMMOW ( El Salvador )

Expert collaborations ( ICE, IACPV, etc ) Expert collaborations ( ICE, IACPV, etc ) – strengthening quality of data, minimum data set, strengthening quality of data, minimum data set,

measures of severity, classification, etc measures of severity, classification, etc New Training Injury ToolsNew Training Injury Tools

Teach- VIP ( WHO ) ; Injury Surveillance Training Teach- VIP ( WHO ) ; Injury Surveillance Training Manual ( CDC) ; etcManual ( CDC) ; etc

Recommendations Recommendations Regulate injury surveillance in the MOH Regulate injury surveillance in the MOH Increase injury research and training (mentoring) in Increase injury research and training (mentoring) in association with national & international universitiesassociation with national & international universitiesDisseminate opportunely data to the authoritiesDisseminate opportunely data to the authoritiesStrengthen coordination at the national and local Strengthen coordination at the national and local level to achieve best practices for injury preventionlevel to achieve best practices for injury preventionDiversify funds to continue technical assistanceDiversify funds to continue technical assistance

Mortality data Mortality data

““Observatorios Municipales del Delito“ Observatorios Municipales del Delito“ CISALVA, ColombiaCISALVA, Colombia– Colombia began in 1992 Colombia began in 1992

PAHO – IACPV : “ Pilot the Observatorios PAHO – IACPV : “ Pilot the Observatorios in Central America in some municipalities : in Central America in some municipalities : data to action data to action

Linking data from mortality- morbidity ( where the Linking data from mortality- morbidity ( where the hospital systems exist ) – family violence data hospital systems exist ) – family violence data ( Pasto, Colombia ) ( Pasto, Colombia )

Contacts in the countries Contacts in the countries Colombia CISALVA Colombia CISALVA – Maria Isabel Gutierrez : mgutierr@univalle.edu.co; Maria Isabel Gutierrez : mgutierr@univalle.edu.co;

cisalva@univalle.edu.cocisalva@univalle.edu.co– Andrés Fandiño : fandino.andres@gmail.comAndrés Fandiño : fandino.andres@gmail.com– www.cisalva.univalle.edu.cowww.cisalva.univalle.edu.co

El SalvadorEl Salvador – Silvia Moran de Garcia : Silvia Moran de Garcia : smoran@mspas.gob.svsmoran@mspas.gob.sv– Janette Ortiz de Montoya : Janette Ortiz de Montoya : janetteom@gmail.comjanetteom@gmail.com– Rafael Chacon : epidemiologia@hospitalbloom.gob.svRafael Chacon : epidemiologia@hospitalbloom.gob.sv– www.mspas.gob.svwww.mspas.gob.sv

Nicaragua Nicaragua – Maribel Rivas : Maribel Rivas : viglesiones@minsa.gob.nicviglesiones@minsa.gob.nic– Julio Rocha : injury12003@yahoo.comJulio Rocha : injury12003@yahoo.com– Francisco Tercero cidsft@yahoo.esFrancisco Tercero cidsft@yahoo.es– www.minsa.gob.niwww.minsa.gob.ni

THANKS THANKS Alberto Concha- EastmanAlberto Concha- Eastman

e-mail : e-mail : conchaal@paho.orgconchaal@paho.org www.paho.orgwww.paho.org

Roberto BeckerRoberto Becker e-mail : e-mail : beckerro@paho.orgbeckerro@paho.org

Carme Clavel-ArcasCarme Clavel-Arcas e-mail: e-mail: zgn4@cdc.govzgn4@cdc.gov

www.cdc.gov/ncipcwww.cdc.gov/ncipcLaura Fraade- BlanarLaura Fraade- Blanar

e-mail : e-mail : lfraade@jhsph.edulfraade@jhsph.eduEugenia M. RodriguesEugenia M. Rodrigues

e-mail eugenia@bra.ops-oms.org e-mail eugenia@bra.ops-oms.org