Appropriate indicators for injury control?

Abstract

Indicators are valuable tools used to measure progress towards a desired health outcome. Increased awareness of the public health burden due to injury has lead to a concomitant interest in monitoring the impact of national initiatives that aim to reduce the size of the burden. Several injury indicators have now been proposed. This study examines the ability of each of the suggested indicators to reflect the nature and extent of the burden of non-fatal injury. A criterion validity, population-based, prospective cohort study was conducted in Brisbane, a sub-tropical Metropolitan City on the eastern seaboard of Australia, over a 12-month period between 1 January and 31 December 1998. Neither the presence of a long bone fracture nor the need for hospitalisation for 4 or more days were sensitive or specific indicators for 'serious' or major injury as defined by the 'Gold Standard' Injury Severity Score (ISS). Subsequent analysis, using other public health outcome measures demonstrated that the major component of the illness burden of injury was in fact due to 'minor' not serious injury. However, the suggested indicators demonstrated low sensitivity and specificity for these outcomes as well. The results of the study support the need to include at least all hospitalisations in any population-based measure of injury and not attempt to simplify the indicator to a more convenient measure aimed at identifying just those cases of 'serious' injury.

Risk factors for injury in a national cohort of 87,134 Thai adults

“…These criteria for injury reporting threshold have been widely accepted 19 . Additional questions provided the locales of injuries coded as home, workplace, sport and transport.…”

Economic burden of injuries in children: Cohort study based on administrative data in a northwestern Italian region

“…2,14 In the present study we found that the major component of the illness burden of injury was due to minor injuries, in line with indications in the literature. 10,19 Indeed, fracture of upper and lower limb and intracranial injury were the most frequent injuries sustained, which are responsible for >50% of the hospital admissions.…”

“…[6][7][8] The identification of valuable strategies in reducing the size of the burden requires a definition of the indicators for measuring progress toward a desired health outcome. 9,10 The choice of an indicator is a sensitive issue. In fact, validity in measurement addresses the degree to which the concept under study is accurately represented by the particular measurement device.…”

“…11 Initially, injury indicators were measured in terms of lives saved. 10 Subsequently, population-level injury indicators were defined on the basis of those injuries posing the greatest threat to the life of the injured individual. 12 Of late, appropriate injury indicators have been defined as those reflecting the incidence of injuries (in terms of physiological damage or threat to life), which are relevant in terms of increased health costs, and which can be derived from routine or easily collected data.…”

Inclusion of ‘minor’ trauma cases provides a better estimate of the total burden of injury: Queensland Trauma Registry provides a unique perspective

“…This may, in turn, lead to suboptimal development and implementation of new trauma management policies and practices. Although the importance of considering 'minor' trauma has already been established [14][15][16][17] , there currently exists a paucity of information regarding the magnitude of the effect that excluding minor trauma has on total burden of injury estimates.…”