An integrated surveillance system of road traffic injuries in the Lazio region of Italy: results of a 5-year study (2001-2005)

A systematic review on integration mechanisms in human and animal health surveillance systems with a view to addressing global health security threats

BACKGROUND

Health surveillance is an important element of disease prevention, control, and management. During the past two decades, there have been several initiatives to integrate health surveillance systems using various mechanisms ranging from the integration of data sources to changing organizational structures and responses. The need for integration is caused by an increasing demand for joint data collection, use and preparedness for emerging infectious diseases.

OBJECTIVE

To review the integration mechanisms in human and animal health surveillance systems and identify their contributions in strengthening surveillance systems attributes.

METHOD

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 checklist. Peer-reviewed articles were searched from PubMed, HINARI, Web of Science, Science Direct and advanced Google search engines. The review included articles published in English from 1900 to 2018. The study selection considered all articles that used quantitative, qualitative or mixed research methods. Eligible articles were assessed independently for quality by two authors using the QualSyst Tool and relevant information including year of publication, field, continent, addressed attributes and integration mechanism were extracted.

RESULTS

A total of 102 publications were identified and categorized into four pre-set integration mechanisms: interoperability (35), convergent integration (27), semantic consistency (21) and interconnectivity (19). Most integration mechanisms focused on sensitivity (44.1%), timeliness (41.2%), data quality (23.5%) and acceptability (17.6%) of the surveillance systems. Generally, the majority of the surveillance system integrations were centered on addressing infectious diseases and all hazards. The sensitivity of the integrated systems reported in these studies ranged from 63.9 to 100% (median = 79.6%, n = 16) and the rate of data quality improvement ranged from 73 to 95.4% (median = 87%, n = 4). The integrated systems were also shown improve timeliness where the recorded changes were reported to be ranging from 10 to 91% (median = 67.3%, n = 8).

CONCLUSION

Interoperability and semantic consistency are the common integration mechanisms in human and animal health surveillance systems. Surveillance system integration is a relatively new concept but has already been shown to enhance surveillance performance. More studies are needed to gain information on further surveillance attributes.

Health care costs and functional outcomes of road traffic injuries in the Lazio region of Italy

The economic consequences of road traffic injuries (RTIs) are very important in terms of health care costs. The aim of this study is to provide estimates of health care costs of non-fatal RTIs and to estimate functional outcomes using in-hospital rehabilitation data. We identified all emergency department (ED) visits related to RTI during 2008 and then linked them with hospital discharges and rehabilitation admissions, health care costs following RTI were estimated from the integrated database. We performed an epidemiological evaluation of RTI with a comprehensive description of functional outcomes at 6 months. Health care costs have been estimated at about €80 million with a per person cost of €522. About 18% of the total cost was due to rehabilitation treatments. In multivariate analysis the variables that correlated better with higher total health care costs were: older age, injury severity, presence of spinal lesion. Patients requiring rehabilitation were: the elderly, patients suffering from a spinal cord injury and leg injuries. This study provides consistent health care cost estimates of RTI using administrative databases and it shows a picture of functional outcomes after RTI. Further research is needed for the estimation of other components of the total cost of RTI.

Health burden of road traffic accidents, an analysis of clinical data on disability and mortality exposure rates in Flanders and Brussels

Statistics on road traffic accidents (RTAs) mainly come from police records. The police reported RTA statistics however are known to have a large degree of under-registration, underestimating the true risk of being injured in traffic accidents. The use of medical based datasets can provide a more accurate estimate of the actual traffic accident health risk. Exposure-based rates of the actual burden from Flanders and Brussels were calculated, comparing differences between road user, age, gender and type of injury sustained. Minimal Clinical Data (MCD) was selected for the years 2003-2007, as well as data from the mortality statistics. Disability Adjusted Life Years (DALY) were calculated and put into perspective with the passenger kilometres travelled. Motorcyclists followed by bicyclists and pedestrians showed a higher DALY per travelled kilometre (6365, 1724 and 1359 DALY per billion kilometres respectively), compared to 113 DALY per billion kilometres for motor vehicles. In bicyclists and to lesser extent in motorcyclists, the majority of the health burden was attributed to disability following injuries and not fatalities. Also in the other road user categories disability added substantially to the total health loss. The use of medical data and more particular the MCD may be a valuable addition of those RTAs that are missed by the police scope. Although the results are still conservative estimations, an injury-based approach can help to better understand the health problem that road traffic accidents cause.