1. Carme Clavel -Arcas Alberto Concha-Eastman CDC- PAHO ICE Injury Statistics Meeting Cuernavaca, Mexico June 1-2, 2005 Implementing a Hospital- based Injury Surveillance Systems in Nicaragua, El Salvador and Colombia

2. CALI Where we are working

3. Countries Nicaragua ( 2000 ) –2 in the capital –3 departmental El Salvador ( 2001) –2 in the capital –6 departmental Colombia, Cali ( 2001) -5 in Cali -1 Santander de Quilichao

4. Evaluation of Hospital Injury Surveillance Systems in Nicaragua, El Salvador and Colombia International Workshop Cali, Colombia 6- 8, 2005

5. Evaluation Methodology Qualitative component –Hospital description –Timeline –Flowchart –Simplicity, acceptability –Goals, obstacles, needs –Data: dissemination, use, timeliness Quantitative component –Sensitivity –Predictive Value –Completeness –Quality of data entry –Costs Based on a standardized template

6. Patient arrives at ER Hospital description : Injury Surveillance 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

7. Case Definition First visit to the hospital Emergency Department for any type of injury

8. Manual Data Collection Hospital Emergency Department Medical Record (Intake Form)

9. El Salvador format for the Injury Surveillance System in ER

13. Results Nicaragua team Policies working group Group

14. Achievements Injury data collection in ED is possible Health authorities are interested –Extension of injury surveillance –Creation of injury prevention programs –Promote intersectorial injury mortality surveillance Data being used to make decisions

15. Results - Components Qualitative Staff rotation Training diverse Interruptions at the beginning Flowchart was considered simple “ they don’t have enough time “ More action than information Quantitative 10- 35 % of ER visits are injuries 75- 95 % unintentional 23-4 % intentional - violence 2-1 % self inflected 70 % young male Falls main mechanism

16. Injury Pyramid Pediatric Hospital. San Salvador 2004 34 Deaths 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

17. Colombia : Percent of ER visits due to injury, Sensitivity, Predictive Value Positive Hospital % injuries/ ER visits Sensitivity % PVP % HUV – L3 507699 FVL – L3 117383 HFPS – L2 216095 HMCR-L2209284 HSJD- L2 236986 CSS – L1 146490

18. Data quality : Percent of Missing Data in two General Hospitals. 2004 Variable El Salvador N = 4,890 Nicaragua N= 8, 120 Age 10.1 Sex 00 Place injury occurred 298 Day event 2799 Intentionality 00 Activity 00 Mechanism 00 Alcohol Use 2097 Nature of Injury 00 Disposition 90

19. Data quality : Percent of Missing Data in two General Hospitals. 2004 Variables : Specific Modules EL Salvador Cases % Missing data Nicaragua Cases % Missing data Person injured or road user 5744 9780.1 Relationship of perpetrator to victim 36412 7020.1 Precipitating Factors 6138 1410

20. 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

21. Dissemination data Nationally –National Electronic Bulletins ( Nicaragua ) –Hospital Electronic Bulletins ( El Salvador ) Internationally – Last two Injury World Conferences

22. Results- Interventions Campaign against burns by “ pólvora “ Bicyclist Injury Prevention Plan “ Life Campaign” Summer Prevention Plan Improvement of conditions at hospital level Improvement of conditions at hospital level

23. Challenges ~ Recommendations Strengthen quality of data Reduce minimum data set Improve the dissemination of data, especially through articles Increase injury research Identify best practices for injury prevention

24. Next steps Develop a methodological plan for Injury Information System in the Americas ( PAHO ) : Develop a methodological plan for Injury Information System in the Americas ( PAHO ) : –Hospital Based : CAREISS –Mortality data ( Observatorios Municipales ) –Specific topics like Intimate Partner Violence/ Sexual Violence

25. THANKS to the technical teams and the hospital staff in the three countries Carme Clavel-Arcas e-mail: zgn4@cdc.gov zgn4@cdc.gov Alberto Concha- Eastman e-mail : conchaal@paho.org conchaal@paho.org www.cdc.gov/ncipc www.paho.org