Chapter 5.

Using data to identify and select an injury problem (continued)

By Sue Mallonee, MPH, RN


 

Considering the significance of injury problems

So, in general, what are some of the most significant injury problems in terms of personal, economic and social consequences? What injuries cause permanent disability? What are the costs associated with treatment of these injuries? How many of these costs were absorbed by the government? These are all important questions. And they lead to even more questions. Next, you might want to ask if your local injury rates are higher or lower than the state or national rates. Where does one go to find this information?

The National Center for Injury Prevention and Control provides a nice document to assist people in accessing some of this information. It is called the
Injury Atlas, and its cover is pictured here. Below is an example of some of the state-level information you can find in the atlas:

This example contains information on
deaths from fires and burns in Mississippi from 1986-1994. By looking at the map, you can see how the Mississippi death rate compares to the overall United States death rate, and how many excess deaths there are per year in Mississippi from fire and burns. By using maps like these, you can compare the rates in your area for different types of injuries to the national rates and you can look at the counties in your state and see how many have very high rates as compared to the national rate.

You can also use published data sources to better understand how injury problems compare to other health problems in our communities.
This chart compares the number of new cases of traumatic brain injury to the number of new cases of lung cancer, breast cancer and AIDS/HIV: What you can see is that there are many more traumatic brain injuries than there are cases of tuberculosis and HIV/AIDS. You can also see that the number of new cases of traumatic brain injury are much higher than the numbers of new cases of lung cancer or breast cancer. Of course, each of these are very important health concerns, but these kinds of data can be helpful in establishing relationships and setting intervention priorities within an agency, a community, or a state.

Looking at all of the data

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Now that we have spent some time discussing the uses of data, it is important to step back and reflect on the importance of getting complete data. Let's consider once again the injury pyramid: To fully understand the nature of an injury problem, we must look not only at injuries that result in death, but also at nonfatal injuries. The data for these two different categories of injury can look very different. As we've discussed in earlier chapters, deaths are more or less the tip of the iceberg. The farther you go down the pyramid, the more the number of cases grows. There are more people who suffer injuries resulting in hospitalization than who die from them, and many more who either are treated in the emergency department and released or who self-treat at home.

The
International Classification of Disease system is the principal system for coding injuries. There are N codes that refer to the nature of the injury and the part of the body affected . Some examples of N codes are concussion, fractured hip or burns.

Let's take
burns as an example. In the current ICD system, burns are coded using the ICD codes 940-949, and if you look in the ICD book you can see that the code 940 refers specifically to burns confined to the eye. The code 943 refers to burns of upper limbs, and code 946 refers to burns of multiple sites. Looking in the book, you can even find codes that may indicate the percent of the body surface burned. In short, these codes are a very valuable and rich source of data.

Unfortunately, N codes do not provide us with any information about how an injury occurred and what may have caused it. So for this information, we have another set of codes in the ICD system, called
E codes. These codes specify the external cause of an injury. Some examples of these external causes are motor vehicle crashes, falls, poisonings and house fires. These E codes can also provide some information on the intentionality associated with the injury -- whether it was self-inflicted or unintentional -- and on the location of the injury -- whether it occurred at home, at work, or at school.

Let's look at some specific examples of E codes. The following set of codes is for
suicide and self inflicted injury. Unlike N codes, E codes are preceded by the letter "E." So, suicide through poisoning by a solid or liquid is coded E950. Suicide by hanging, strangling or suffocation is coded E953. Connecting the nature of the injury -- the N code -- to the external cause of the injury -- the E code -- can be very important to the design of prevention strategies.

Sources of existing data

Now let's consider in more detail where we might find some of the data about deaths and nonfatal injuries that we need for education and for developing interventions. We'll start by looking at data on deaths.
Death data is maintained in every state and territory in the United States, and is fairly easy to obtain. It is also consistently coded as to the external cause of the fatal injury. The primary sources of death data are vital statistics and medical examiner or coroner data. Additional sources may include child death review teams and law enforcement records. But remember, deaths rates aren't by themselves representative of the overall injury problem.

To get the complete picture, we also need to acquire data on nonfatal injuries. This data, called
morbidity data, includes injuries resulting in severe personal, economic and social consequences. Because of its complex nature, this data can be much more difficult to obtain, and its coding and completeness can vary widely. But with some determination, it can usually be accessed at some level.

There are a number of
possible sources of morbidity data. For example, your community may have trauma registries, hospital emergency department records, and hospital discharge records. You may have data on emergency medical service or ambulance service utilization. You may have an injury surveillance system that is operating at the state level, and you may have poison control centers that can provide you with data at the local level.

Information on behaviors that place people at risk for different types of injuries can also be extremely useful during the planning and development of an intervention. Fortunately, most states have a
behavioral risk factor surveillance system which contains information about the knowledge, attitudes, and behaviors that may place people at risk for injuries. For example, seat belt use, smoke detector use, helmet use, drinking and driving, and gun storage are all behaviors that might have an influence on one's risk of experiencing certain types of injuries.

There are many
other potential sources for injury-related data. Many states also have a companion youth behavioral surveillance system that includes data on the prevalence of risk factors such as drinking and driving, seat belt use and drug use among young people: drinking and driving, seat belt use, drug use. You can also conduct your own surveys and observations to learn more about the injury problems in your community, and can seek out additional information from law enforcement agencies, traffic safety records, fire departments, schools, labor departments, and the media.

Assistance in accessing and analyzing data

Thinking about all of the data collection and analysis that needs to take place to develop successful interventions can be overwhelming. However, it is important to remember that
help is available. Both your state and local health departments should be able to direct you to sources of useful information, and you may also have local universities, trauma centers, and other local or state agencies that either have available data, or can point you in the right direction. Finally, there are a number of good Internet-based data sources located on the links page of this course. Data really is the foundation of any good community control program, but avoid getting overwhelmed and frustrated. Start small and then expand your efforts.

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Next: Chapter 6. Identifying and Choosing Prevention Strategies

 


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