1. ICECI application in Injury Surveillance in Cali, Colombia Andrés Fandiño-Losada Edgar Muñoz María Isabel Gutiérrez Martínez

2. Methodology ► Testing of Injury Surveillance Systems in Latin-American. ► WHO/ PAHO & CDC initiative. ► In Cali, 2 Hospitals were selected.  Commitment, level of care, ease in working in emergency departments.  Hospital San Juan de Dios (Level 2).  Hospital Primitivo Iglesias (Level 1).  In Colombia: 3 levels of care. 3d is the most complex.

3. Methodology ► ICECI Pilot data collection form was designed with physicians participation from Emergency Departments. ► Data Collection  March 26 through July 26 2002.  5377 cases collected. ► Quality control during the process:  Constant review of forms during field work.  Correction of mistakes in the forms.  Double-entry process during typing.

4. Methodology ► Seventeen ICECI V.1.0. variables were used in pilot test.  ICECI level 2 codes for designing the General Data Set.  ICECI level 1 codes for designing the Specific Data Set.  Total: 485 ICECI V.1.0. codes in 17 variables.  Avrg: 28.5 codes per variable. ► ICECI Pilot form used 174 codes:  Avrg: 10.2 codes per variable.

5. ICECI Variables collected in Pilot Test 1. Intent 2. Mechanism 3. Object / Substance 4. Place 5. Activity 6. Alcohol use 7. Psychoactive drug use 8. Previous suicide attempt 9. Risk Factor for Suicide 10. Perpetrator / Victim Relationship 11. Sex of perpetrator 12. Context of Assault 13. Type of Legal Intervention 14. Type of Conflict 15. Mode of Transport 16. Role of Injured Person 17. Counterpart

6. PILOT TEST RESULTS ► ANALYSIS OF SURVEILLANCE DATA ► APPLICATION OF VARIABLES AND CODES OF ICECI CLASSIFICATION

7. Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002 Age groups by Sex (%)

8. Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002 Intent by Sex (%)

9. Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002 Activity when injured by Sex (%)

10. Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002 Place of Ocurrence by Sex (%)

11. Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002 Object that caused injury by Sex (%)

12. Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002 Mechanism by Sex (%)

13. Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002 Mode of Transport by Sex (%)

14. Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002 Perpetrator/ Victim Relationship by Sex (%)

15. Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002 Risk Factors for Intentional Self-Harm by Sex (%) Multiple Response Variable

16. Simplifying ICECI Collecting Form 1.Excluding categories (codes) below a cut off point, into each ICECI variable. 2.Establishing correspondences among categories from different variables for exclusion.

17. Excluding ICECI Categories ► Statistical Criteria:  They don’t apply for “Other” and “Unknown” codes.  Cut off point: To Exclude codes with a frequency less than 1%.  Count the number of codes for exclusion. ► Other Criteria:  Conceptual  Practical

18. Frequency of ICECI Codes ► Frequency lists for each ICECI variable used in pilot test. ► For example,  Intent:  2 / 7 (28.6%) codes will be eliminated. INTENT% Unintentional66.2 Intentional self-harm 1.8 Assault31.0 Legal Intervention 0.2 War / Conflict 0.0 Other0.3 Unknown0.5

19. Codes below cut-off for each Variable Variable Codes Below cut-off % Intent7228.6 Mechanism412663.4 Object / Substance 17741.2 Place14535.7 Activity9111.1 Alcohol use 400 Psychoactive drug use 400 Previous suicide attempt 400 Risk Factor for Suicide 12216.7

20. Codes below cut-off for each Variable Variable Codes Below cut-off % Perpetrator / Victim Relationship 10440 Sex of perpetrator 400 Context of Assault 12433.3 Type of Legal Intervention 44100 Type of Conflict 44100 Mode of Transport 11327.3 Role of Injured Person 700 Counterpart1417.1

21. Excluding ICECI Variables ► Injury Surveillance System Instrument ► Context Dimensions used:  Mechanism  Object ► Number of categories in each variable of dimension:  Mechanism: 41 categories.  Object: 17 categories.  Total: 58 categories. ► By logic, mechanism and object dimensions are closely related.

22. Correspondence Analysis ► Statistical Method for reducing the number of categories or dimensions used in a classification system. ► Components of each studied variable are located into a n dimension cloud. ► Image of that cloud is projected in 2 dimension space. ► Correspondences among categories are determined. ► It’s possible to define a new unique dimension from initial ones.

23. Correspondence Analysis Results …

24. Correspondence Analysis 1 Dimension 1 12 11 10 9 8 7 6 5 4 3 2 1 0 -2 -3 -4 -5 -6 -7 -8 Dimension 2 10 0 -10 -20 -30 Object Mechanism Explosive material Struck by explosive blast Fire Burn

25. Correspondence Analysis 2 Dimension 1 43210-2-3-4-5-6 Dimension 2 10 8 6 4 2 0 -2 Object Mechanism Hot Liquid Burn Firearm Shot by firearm

26. Correspondence Analysis 3 Dimension 1 5 4 3 2 1 0 -2 -3 -4 -5 -6 -7 Dimension 2 10 0 -10 -20 Object Mechanism Smoke Inhalation of smoke

27. Vehicle Road traffic injury Animal Stinging-Biting Person Struck-kicked Sexual assault Knife or cutting arms Cutting Tearing Blunt force Correspondence Analysis 4 Object Mechanism

28. Blunt object Blunt force Floor Falls Medicine Pesticide Street drug Poisoning NS Object NS Mechanism Correspondence Analysis 5 Object Mechanism

29. Final Proposal ► New dimension with a mixed variable:  Mechanism / Object ► Number of Categories in the variable of each dimension:  Mechanism: 3 categories are eliminated.  Object: 10 categories are eliminated.  Total: 13 categories eliminated.  Unique Final Variable with 45 categories. ► A SIMPLER INSTRUMENT.

30. Pilot Test Conclusions ► ICECI is a conceptual advance for injury surveillance and injury control. ► There are a lot of items in each dimension of ICECI. ► It’s necessary a balance between needs of data and instrument complexity. ► Countries with less resources need a simpler injury surveillance system.

31. Evaluation of Injury Surveillance Systems (ISS) Cali, Colombia. April – 2005.

32. Injury Surveillance System ► Injury surveillance system continues in … ► City of Cali:  Hospital San Juan de Dios (HSJD) – level 2  Hospital Mario Correa Rengifo (HMCR) – level 2  H. Universitario del Valle (HUV) – level 3  Foundation Valle del Lili Clinic (FCVL) – level 3  Siloe Health Center (CSS) – level 1 ► City of Santander de Quilichao:  H. Francisco de Paula Santander (HFPS) – level 1

33. Characteristics of Hospitals Hospital Patients/ month % Injury HMCR – L2 130520% HSJD – L2 212123.2% HUV – L3 41850% CSS – L1 283814.3% FCVL – L3 210011% HFPS – L2 230221.3%

34. Time from implementation up to date of the ISS Hospital Months Functioning now HMCR – L2 15YES HSJD – L2 14YES HUV – L3 3NO CSS – L1 4NO FCVL – L3 9YES HFPS – L2 10YES

35. Sensitivity and Positive Predictive Value HospitalSample Sensitivity % PVP % HMCR – L2 28392.283.9 HSJD – L2 19968.586.0 HUV – L3 24076.398.9 CSS – L1 27163.690.3 FCVL – L3 23273.283.3 HFPS – L2 27859.795.2

36. CISALVA Institute for Peace Promotion and Injury / Violence Prevention