Establishing injury surveillance in emergency departments in Nepal: protocol for mixed methods prospective study

Abstract

Background: Globally, injuries cause more than 5 million deaths annually, a similar number to those from HIV, Tuberculosis and Malaria combined. In people aged between 5 and 44 years of age trauma is the leading cause of death and disability and the burden is highest in low-and middle-income countries (LMICs). Like other LMICs, injuries represent a significant burden in Nepal and data suggest that the number is increasing with high morbidity and mortality. In the last 20 years there have been significant improvements in injury outcomes in high income countries as a result of organised systems for collecting injury data and using this surveillance to inform developments in policy and practice. Meanwhile, in most LMICs, including Nepal, systems for routinely collecting injury data are limited and the establishment of injury surveillance systems and trauma registries have been proposed as ways to improve data quality and availability. Methods: This study will implement an injury surveillance system for use in emergency departments in Nepal to collect data on patients presenting with injuries. The surveillance system will be introduced in two hospitals and data collection will take place 24 h a day over a 12-month period using trained data collectors. Prospective data collection will enable the description of the epidemiology of hospital injury presentations and associated risk factors. Qualitative interviews with stakeholders will inform understanding of the perceived benefits of the data and the barriers and facilitators to embedding a sustainable hospital-based injury surveillance system into routine practice. Discussion: The effective use of injury surveillance data in Nepal could support the reduction in morbidity and mortality from adult and childhood injury through improved prevention, care and policy development, as well as providing evidence to inform health resource allocation. This study seeks to test a model of injury surveillance based in emergency departments and explore factors that have the potential to influence extension to additional settings.

Completeness of police reporting of traffic crashes in Nepal: Evaluation using a community crash recording system

“…Hospital records are limited in their ability to validate police data as they will only capture injured patients attending healthcare services, and health facilities generally lack injury surveillance systems (Magnus et al. 2020 ).…”

Emergency department-based injury surveillance information system: a conceptual model

“…One of the most important and cost-effective settings for implementing an ISIS is the ED [ 6 ]. Particularly, in most low and middle income countries, emergency care and injury surveillance have been highlighted as areas which need further attentions and it is necessary to address various opportunities and challenges in these areas [ 14 ]. An ED-based ISIS helps to collect data at the very beginning of patient admission and includes all details of discharge status, recommendations for follow-up, referral to other healthcare settings, and rehabilitation centers [ 41 ].…”

Epidemiology of paediatric injuries in Nepal: evidence from emergency department injury surveillance

“…Objectives of this mixed methods study were (i) to design an injury surveillance tool and data collection process; (ii) prospective collection of data on injuries presenting to two hospital emergency departments over 12 months; (iii) process evaluation to explore the barriers and facilitators to sustainability (reported separately). The published study protocol 15 describes data collector recruitment and training, data tool testing and quality assurance. This paper reports injury cases presenting in children under the age of 18 years.…”