Injury in China: a systematic review of injury surveillance studies conducted in Chinese hospital emergency departments

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

BACKGROUND

Injury data play a pivotal role in monitoring public health issues and Injury Surveillance Information Systems (ISIS) are useful for continuous data collection and analysis purposes. Since emergency department (ED) is usually the first place of referral for the injured people, the aim of this study was to develop a conceptual model for an ED-based ISIS.

METHODS

This study was completed in 2020 and the Delphi technique (three rounds) was used to determine the main components of an ED-based ISIS. The participants were selected using the purposive sampling method. A 5-point Likert scale questionnaire was used for data collection and data were analyzed using descriptive statistics.

RESULTS

In the first, second, and third rounds of the Delphi study, 60, 44, and 28 experts participated, respectively. In the first and second rounds, most of the items including the personal data, clinical data, data sources, and system functions were found important. In the third round of the Delphi study, 13 items which did not reach a consensus in the previous rounds were questioned again and five items were removed from the final model.

CONCLUSION

According to the findings, various data elements and functions could be considered for designing an ED-based ISIS and a number of data sources should be taken into count to be integrated with this system. Although the conceptual model presented in the present study can facilitate designing the actual system, the final system needs to be implemented and used in practice to determine how it can meet users' requirements.

Injury surveillance information system: A review of the system requirements

PURPOSE

An injury surveillance information system (ISIS) collects, analyzes, and distributes data on injuries to promote health care delivery. The present study aimed to review the data elements and functional requirements of this system.

METHOD

This study was conducted in 2019. Studies related to injury surveillance system were searched from January 2000 to September 2019 via the databases of PubMed, Web of Knowledge, ScienceDirect, and Scopus. Articles related to the epidemiology of injury, population survey, and letters to the editor were excluded, while the review and research articles related to ISISs were included in the study. Initially 324 articles were identified, and finally 22 studies were selected for review. Having reviewed the articles, the data needed were extracted and the results were synthesized narratively.

RESULTS

The results showed that most of the systems reviewed in this study used the minimum data set suggested by the World Health Organization injury surveillance guidelines along with supplementary data. The main functions considered for the system were injury track, data analysis, report, data linkage, electronic monitoring and data dissemination.

CONCLUSION

ISISs can help to improve healthcare planning and injury prevention. Since different countries have various technical and organizational infrastructures, it is essential to identify system requirements in different settings.

Comparison of trauma care systems in Asian countries: A systematic literature review

OBJECTIVE

The study aims to compare the trauma care systems in Asian countries.

METHODS

Asian countries were categorised into three groups; 'lower middle-income country', 'upper middle-income country' and 'high-income country'. The Medline/PubMed database was searched for articles published from January 2005 to December 2014 using relevant key words. Articles were excluded if they examined a specific injury mechanism, referred to a specific age group, and/or did not have full text available. We extracted information and variables on pre-hospital and hospital care factors, and regionalised system factors and compared them across countries.

RESULTS

A total of 46 articles were identified from 13 countries, including Pakistan, India, Vietnam and Indonesia from lower middle-income countries; the Islamic Republic of Iran, Thailand, China, Malaysia from upper middle-income countries; and Saudi Arabia, the Republic of Korea, Japan, Hong Kong and Singapore from high-income countries. Trauma patients were transported via various methods. In six of the 13 countries, less than 20% of trauma patients were transported by ambulance. Pre-hospital trauma teams primarily comprised emergency medical technicians and paramedics, except in Thailand and China, where they included mainly physicians. In Iran, Pakistan and Vietnam, the proportion of patients who died before reaching hospital exceeded 50%. In only three of the 13 countries was it reported that trauma surgeons were available. In only five of the 13 countries was there a nationwide trauma registry.

CONCLUSION

Trauma care systems were poorly developed and unorganised in most of the selected 13 Asian countries, with the exception of a few highly developed countries.

An Exploratory Analysis of the Geographical Distribution of Trauma Incidents in Shenzhen, China

BACKGROUND

The city of Shenzhen, China, is planning to establish a trauma system. At present, there are few data on the geographical distribution of incidents, which is key to deciding on the location of trauma centres. The aim of this study was to perform a geographical analysis in order to inform the development of a trauma system in Shenzhen.

METHODS

Retrospective analysis of trauma incidents attended by Shenzhen Emergency Medical Services (EMS) in 2014. Data were obtained from Shenzhen EMS. Incident distribution was explored using dot and kernel density estimate maps. Clustering was determined using the nearest neighbour index. The type of healthcare facilities which patients were taken to was compared against patients' needs, as assessed using the Field Triage Decision Scheme.

RESULTS

There were 49,082 recorded incidents. A total of 3513 were classed as major trauma. Mapping demonstrates that incidents predominantly occurred in the western part of Shenzhen, with identifiable clusters. Nearest neighbour index was 0.048. Of patients deemed to have suffered major trauma, 8.5% were taken to a teaching hospital, 13.6% to a regional hospital, 42.6% to a community hospital, and 35.3% to a private hospital. The proportions of Step 1 or 2 negative patients were almost identical.

CONCLUSION

The majority of trauma patients, including trauma patients who are at greater likelihood of severe injury, are taken to regional and community hospitals. There are areas with identifiable concentrations of volume, which should be considered for the siting of high-level trauma centres, although further modelling is required to make firm recommendations.

A pilot study of a hospital-based injury surveillance system in a secondary level district hospital in India: lessons learnt and way ahead

Background

Reliable epidemiological information on injury burden and pattern is essential to formulate effective injury control and prevention strategies. Injury surveillance systems are globally gaining ground as a tool for collecting such systematic data on injuries, but less so in low and middle income countries. This study describes the experience of setting up a District Level Hospital-Based Injury Surveillance System in India and the pattern of injuries encountered therein.

Methods

A prospective study was conducted during Jan-Dec 2012 at the emergency department of a District Hospital in Fatehgarh Sahib in a North Indian state of Punjab. A comprehensive injury proforma was devised to record information on all injury cases reporting to the hospital. Emergency Medical Officers were trained to record data.

Results

A total of 649 injuries were reported in 2012. The surveilance system used the existing resources at the hospital to collect data without the need for additional manpower, equipments etc. About 78 % of injuries reported were unintentional in nature. More than half (52.9 %) of the patients had injuries due to Road Traffic Crashes. Head (29.7 %) was the most common site of injury. Incised injury (50.2 %) was the most common type of injury and most of the injuries occurred while travelling (61.8 %).

Conclusion

Developing better and sustainable systems of routine injury surveillance or trauma registries is essential to generate reliable information for formulating effective intervention policies.

INternational ORthopaedic MUlticentre Study (INORMUS) in Fracture Care: Protocol for a Large Prospective Observational Study

Despite the fact that orthopaedic trauma injuries represent a serious cause of mortality and morbidity worldwide, there are few data in low-middle income countries quantifying the burden of fractures and describing current treatment practices. To address this critical knowledge gap, a large multinational prospective observational study of 40,000 patients with musculoskeletal trauma in Africa, Asia, and Latin America is proposed. The International Orthopaedic Multicentre Study in Fracture Care (INORMUS) study seeks to determine the incidence of major complications (mortality, reoperation, and infection) within 30 days after a musculoskeletal injury and to determine patient, treatment, and system factors associated with these major complications in low-middle income countries. This study coincides with the World Health Organization's Global Road Traffic Safety Decade (2011-2020) and other international efforts to reduce the burden of injury on developing populations. Insight gained from the INORMUS study will not only inform the global burden of orthopaedic trauma but also drive the development of future randomized trials to evaluate simple solutions and practical interventions to decrease deaths and improve the quality of life for trauma patients worldwide.

The WHO injury surveillance guidelines: a systematic review of the non-fatal guidelines' utilization, efficacy and effectiveness

OBJECTIVES

To systematically assess the utilization, efficacy and effectiveness of the WHO Injury Surveillance Guidelines.

STUDY DESIGN

A systematic review of the literature.

METHODS

A comprehensive systematic search of peer reviewed and grey literature was conducted for relevant studies published between Jan 2002 and May 2013 reporting utilization of the Injury Surveillance Guidelines. Injury experts and government departments from low- and middle-income countries were contacted.

RESULTS

Forty-nine studies met the inclusion criteria. These were conducted in health facilities in five WHO regions, African Region (28%): Eastern Mediterranean and Western Pacific Regions, both 22%. The Guidelines were mostly used selectively: the minimum data set as a survey tool; process and system environment evaluation; categorizing injuries for data analysis; measuring injury severity and for data quality assessment or comparisons. Twenty-six studies used the Guidelines to collect overview injury data prospectively and/or retrospectively, or for Injury Surveillance System (ISS) feasibility studies, with four actually establishing an ISS or informing the establishment process. Few reported effects on injury policies and programs. Most studies used only the minimum dataset, limiting the level of detail for injury prevention. Other ISSs may have been established using the Guidelines, though no English language publications referencing this were found.

CONCLUSIONS

This review provides encouraging results that the Guidelines continue to be used, albeit mainly for short-term studies predominantly in low- and middle-income countries with very limited sustained ISS establishment and local injury prevention capacity building. It highlights the need to improve and expand the minimum dataset to at least include a meaningful narrative text and potentially to expand the mechanism codes to a second level of detail, as well as building local injury prevention capacity.