A needle in a haystack: the use of routinely collected emergency department injury surveillance data to help identify physical child abuse

A retrospective, descriptive analysis of a sample of children under 18 years presenting to a hospital emergency department (ED) for treatment of an injury was conducted. The aim was to explore characteristics and identify differences between children assigned abuse codes and children assigned unintentional injury codes using an injury surveillance database. Only 0.1% of children had been assigned the abuse code and 3.9% a code indicating possible abuse. Children between 2 and 5 years formed the largest proportion of those coded to abuse. Superficial injury and bruising were the most common types of injury seen in children in the abuse group and the possible abuse group (26.9% and 18.8%, respectively), whereas those with unintentional injury were most likely to present with open wounds (18.4%). This study demonstrates that routinely collected injury surveillance data can be a useful source of information for describing injury characteristics in children assigned abuse codes compared to those assigned no abuse codes.

Electronic injury surveillance in Perth emergency departments: Validity of the data

OBJECTIVE

To assess the validity of data collected by a new injury surveillance system in metropolitan public hospital ED in Western Australia.

METHODS

A reference group of four experts used text descriptions recorded in the injury surveillance system to independently assign codes for intent and cause of injury for each case in the sample. These codes were then compared with the intent and cause codes which triage nurses had assigned to these cases. The level of agreement between these codes were assessed by means of descriptive statistics. Systematic coding errors were also identified and analysed.

RESULTS

Of the 419 cases with adequate text descriptions, triage nurses agreed with the reference group of experts in 91.9% (intent) and 79.2% (cause) of cases. Falls accounted for 28.6% (n = 120) of cases and falls code agreement was 86.7%. Self-harm accounted for 5.3% (n = 22) of cases and self-harm code agreement was 77.3%. Systematic errors were detected in the coding of agent of injury, the underlying mechanism of injury and falls involving a mode of transport.

CONCLUSIONS

The new injury surveillance system can be successfully used in ED and provides a valid mechanism for monitoring injuries. Refinements to reduce systematic coding errors might improve the validity and quality of the data. A larger sample is needed to assess the validity of the self-harm code.

Use of emergency departments by Aboriginal and Torres Strait Islander people

OBJECTIVE

To review published Australian literature about ED care of Aboriginal and Torres Strait Islander peoples.

METHOD

Six databases were searched electronically for articles about ED use by Indigenous people in Australia. This strategy was complemented by manual searches of two websites, Emergency Medicine (1994-2004) and three bibliographies.

RESULTS

Aboriginal and Torres Strait Islander peoples attend EDs about twice as often as other Australians. The waiting times of Indigenous patients are similar to, or slightly shorter than, those of non-Indigenous patients. However, more Indigenous than other patients choose to walk out before being seen, indicating possibly greater Indigenous dissatisfaction with ED care.

CONCLUSIONS

Further conclusions of the present literature review were limited by contradictory results in the few studies of reasonable quality and by general concerns about data quality, especially the poor (but slowly improving) identification of Indigenous people in routine ED data sets. Closer collaboration between ED staff and Indigenous hospital liaison staff, combined with regular monitoring of routinely-collected ED data, have the potential to improve Indigenous ED care and so contribute to improvements in Indigenous health.

Victorian Emergency Minimum Dataset: factors that impact upon the data quality

OBJECTIVE

The Victorian Emergency Minimum Dataset (VEMD) records details of approximately 80% of Victoria's ED presentations. Its usefulness for quality assurance and research relies on the data being both complete and accurate. We aimed to determine the factors that impact adversely on the collection of high-quality VEMD data.

METHODS

The study was a voluntary, anonymous, cross-sectional survey of a range of ED staff (medical, nursing, clerical) who collect and enter data into the VEMD. Nine of the 28 hospitals that contribute to the VEMD were surveyed. The questionnaire was purpose-designed and self-administered.

RESULTS

A total of 218 staff participated (response rate 95%). Six different software types were used, with 40% of respondents using the Pickware (MCAT) system. There was no consistency of ED personnel for the completion of specific data fields. One hundred and twenty-six (56%) respondents had heard of the VEMD, 67 (29%) had had its structure and purpose explained and 65 (30%) had been trained to enter data. Ninety-seven (45%) respondents knew what the VEMD data was used for, 38 (17%) knew they could request VEMD data for their own use and 17 (7.8%) had done so. Time constraints, software problems and lack of formal orientation and training in data entry were reported as the most important factors impacting adversely upon quality data entry.

CONCLUSION

Staff knowledge of the VEMD system and its uses are poor. Numerous factors impact on the quality of data entered and interventions aimed at improving staff education, training and feedback and software are indicated.