European Seminar on Injury Data for Effective and Innovative Safety Promotion
Power Point Presentations and Abstracts
ACV-Austria Center Vienna
Bruno-Kreisky-Platz 1,Vienna.
Room L4 (Level 1)
Wednesday, 9 November 2016
TABLE OF CONTENTS
- Introduction
- Abstracts of full paper presentations
- Abstracts of short presentations
- List of participants
- About the organisers
- Introduction
EuroSafe organised its annual seminar in Vienna, Wednesday 9 November 2016, in collaboration with the European Public Health Association (EUPHA) and its Injury Prevention and Safety Promotion Section. This year, the joint EuroSafe-EUPHA seminar looked into the “Use of injury data for effective and innovative safety promotion” and was supported by the BRIDGE-Health project.
Scope and purpose
Reliable injury data are essential for making informed decisions about accident prevention priorities and in developing effective safety promotion initiatives. They are critical in harnessing political will, public support and the funding needed to undertake actions. Injury data are also required to evaluate the success and the cost-effectiveness of these actions.
Emergency Departments (EDs) of hospitals have proven to be the most valuable source of injury data,beside death certificates. EDs allow for the collection of data in sufficient number and relevant for prevention.Although great progress has been made in the past years regarding data quality, availability and accessibility, many challenges still remain.
EC co-funded projects, such as the Joint Action on Monitoring Injuries in Europe (JAMIE) and now the BRIDGE-Health project, have helped to create the European Injury Data Base (IDB) of national emergency department surveillance systems. The IDB is managed by a very successful cross European network of National Injury Database Administrators (NDAs), with currently 26 countries collecting and sharing harmonised surveillance data to support policy initiatives and actions at European, national and regional level.
The aim of the Seminar was to demonstrate the value of ED-based injury information both for health initiated policies and actions. The seminar showcased local and national level initiatives that are geared by injury data.
Outcome of seminar
The central purpose of an injury surveillance system is to monitor trends of particular types of injuries and to identify risk factors. A great many countries are using such data to target injury control measures to relevant circumstances and populations and to increase effectiveness of resource allocation for injury prevention..
The Seminar presentations clearly demonstrated the wide range of policy areas for which injury data are most relevant -such as consumer safety policies, road traffic safety research and the prevention suicide and self-harm - and for addressing vulnerable groups such as children, adolescents, high risk sports and older people. The presentations highlighted the great value of injury data in a wide variety of safety initiatives, such as establishing paediatric-counselling programmes in local hospitals, introducing safety management schemes in ski-resorts, developing appropriate safety standards for dangerous power-tools and in setting priorities in health and consumer protection policies.
The availability of accurate information on the causes and circumstances of injuries is indispensable for developing such initiatives and programmes. Through a series of projects co-financed by the European Commission (EC), the IDB-partners are working together to enhance the quality of injury data collection and to expand the number of countries across the continent that are actively engaged in IDB and its injury data exchange at the EU-level. The network of IDB-countries reports regularly on the findings from national data that is collated and analysed at EU-leveland presented at the Seminar its latest 6th edition of the report ‘Injuries in the European Union’.
The health sectorplays a key role in injury prevention asthe health sector’s mandate includes preventing and responding to all major health threats and causes of mortality and morbidity including injury; anda substantial proportion of direct costs to the health sector result from injuries. The health sector is uniquely positioned to collect data, analyse risk factors and to generate multi-sector prevention efforts across the wider range of relevant policy domains.
Multiple factors are associated with the success of injury surveillance in Emergency Departments (EDs). In the future, more ‘intelligent’ injury surveillance systems could even better inform decision makers at national and local levels and guide practitioners in various organisations in preventing injuries. Examples of smart data linkage systems were presented and opportunities of automatic coding though text and voice recognition systems were demonstrated as effective means to reduce the burden of administration for administrative staff and increase the informative value of existing information.
The Seminar participants agreed as to the need to continue to exchange and collaborate on injury surveillance in Europe and to advocate the use of available data for policy purposes. The IDB was seen as a solid system providing core injury indicators for bench marking policies in countries as well more detailed information that helps to steer prevention actions in w wide range of domains.
- Abstracts of full paper presentations
[with links to PPTs]
- EU Health Information strategy,
Philippe Roux, DG Santé, Country Knowledge and Scientific Committees Unit.
-Safety of consumer products and services,
Mike Hayes, ANEC- the European consumer voice in standardisation, Belgium.
-Child safety promotion: good practices in German speaking countries,
Gabriele Ellsäßer, Brandenburg State Office of Environment, Health and Consumer Protection, Germany.
-Monitoring alcohol-related injuries for prevention,
BirgitteBlatter, Consumer Safety Institute, the Netherlands.
-Measuring serious injuries on European roads,
Robert Bauer, KFV-Kuratorium für Verkehrssicherheit, Austria.
-Opportunities of data linkage
Samantha Turner, Farr Institute, Swansea University Medical School, UK.
-Injury indicators: challenges of country-level comparison,
Rupert Kisser, EuroSafe-Injury Surveillance programme, Austria.
-Comprehensive and uniformly coded injury data delivered by care providers,
Anne Lounamaa, National Institute of Health and Welfare, Finland.
The importance of data in protecting the safety of consumers
Michael Hayes and Tania Vandenberghe, ANEC, Brussels
Have you ever thought why your mobile phone works away from home? Or why your bank card can be used anywhere in the world? Or why the dashboard symbols in the German car you have hired in Spain are the same as in your French car at home in Norway? It’s because of European standards.
For consumers, standards are important as, when they are properly developed and applied, they can make our lives easier; the products we buy safer, interoperable and accessible to people of all ages and abilities. They can also improve product performance, raise consumer protection and help reduce the risk of accidents.
ANEC, the European consumer voice in standardisation, is closely involved in the development of standards from the European Commission’s problem definition and decision-making stages to the technical discussions in CEN and CENELEC committees and working groups. ANEC is represented on the Commission’s committee that oversees the General Product Safety Directive, the directive that controls a wide range of consumer products, and its Consumer Safety Network, a consultative experts group chaired by the European Commission and composed of national experts from the administrations of the EU Member States and EFTA members, and other European stakeholder organisations. Under the Standardisation Regulation, ANEC has a right to be consulted and to participate at various stages in the standards development processes.
To ensure that appropriate decisions are taken throughout the process, injury data is a valuable component, although it is not the only parameter used in the decision-making process. It allows confirmation that there is or, equally importantly, is not a problem to be addressed; that the specific injuries that require detailed consideration in standards committees to be defined; and the populations who are most frequently injured to be identified. The data needed therefore moves from broad, epidemiological data to much more detailed information covering the events – the accidents, the people injured and the injuries.
For example, if the need for a new standard for a consumer product had been identified using epidemiological data, the following IDB data for individual accidents covering a significant sample of events would usefully inform the process: age of victim, nature of injury, part of body injured, severity of injury and/or disposal (i.e. ED attendance only, admission to hospital, death), and, most importantly, a description of event. The data would not need to contain any information that would allow the children or the accidents to be identified (e.g. country, date). The data would need to be available to all members of the technical committee drafting the standard on the understanding that, as with all committee papers, it was not for public distribution.
For several years, ANEC has campaigned with others for the provision of a pan-European database as we feel that without easily accessible, representative, up-to-date injury data there is the risk that consumer safety is compromised, through a lack of or inappropriate and/or incomplete standards or other consumer protection mechanisms.
Child Safety Promotion: Good Practices in German-Speaking Countries
Gabriele Ellsäßer,Brandenburg State Office of Environment, Health and Consumer Protection
This presentation will focus on the under 5-year-olds showing that the highest risk of death or requiring hospital treatment is due to domestic accidents among all children under 15 years (Ellsäßer/Federal Statistic Office 2016). Products are involved in around 75 % of all injuries in the under 5-year-olds (IDB Germany). Therefore, young children in particular are in need of the best possible protection.
The meeting of the German-speaking countries (Germany, Austria and Switzerland) in June 2016 focused on this target group and on an exchange of experience regarding the question: Which safety promotion strategies are currently being used in counselling young parents? In this seminar presentation, the main conclusions from this exchange will be summarised. Examples will be given of medical professionals who are working in close contact to young children (paediatricians, midwives, clinicians) and have introduced injury prevention advice in their work. Also new approaches in addressing refugees are offered.
IDB data is the catalyst for targeting injury prevention and providing information on product related risks. The German-speaking programmes comprise the age- and development-specific approach of accident prevention with reference to products as well as early information for young parents. The main goal is to offer support, rather than criticisingunexperienced parents.
Monitoring alcohol-related injuries for prevention
BirgitteBlatter, Consumer Safety Institute, Amsterdam.
The topic of ‘alcohol at the Emergency Department (ED)’ is receiving increasing attention in the Netherlands. Since 2003 the number of children between 12 and 18 that have visited the ED due to an alcohol intoxication has increased dramatically.
Recently, a call for action was sent out by an ED in Amsterdam that experienced nuisance due to drunken and intoxicated patients. Having ended up at an ED might be a warning and have a secondary preventive effect for future alcohol abuse or primary preventive effect among peers.
Finally, since 2014 Dutch municipalities are responsible for the enforcement and evaluation of the ‘Law on alcohol sale’, which states that alcohol cannot be sold to or be in the possession of people under 18.
Although the benefits are hardly questioned, monitoring alcohol use at the ED is not established as a standard procedure in the Netherlands.
The Dutch Injury Surveillance System (LIS) exists since 1997 and includes injuries and (alcohol) intoxications from a random sample of (13) EDs in the Netherlands. However, alcohol use prior to injury is only registered if the signs are obvious or if registration is relevant for treatment, leading to a huge underestimation of alcohol-related injuries.
Since 2015, three projects have been started in which we focus on improvement of registration of alcohol-related injuries in LIS:
-The previously initiated Dutch registry of pediatricians on children admitted to hospital due to alcohol abuse will be integrated into LIS.
EDs see the importance to register alcohol use, but the administrative burden is high and the general opinion is that data collection should be integrated in the standard hospital information system. After analyzing hospital specific data we noticed that physicians defined intoxications differently and that standard criteria for alcohol intoxication did not exist. Alcohol blood levels are not always measured at an ED. We have proposed that alcohol intoxication is defined as ´visiting the ED because of effects of the alcohol use´; an injury in a patient being drunk is defined as alcohol-related injury (and not an intoxication).In a feasibility and implementation project, EDs within LIS will collect data on the following variables concerning alcohol use: intoxication yes or no, (amount of) alcohol use 6 hours prior to injury, and if younger than 18: place of purchasing consumed alcohol, place and persons alcohol was consumed with.
-In the East of the Netherlands, a collaboration between VeiligheidNL, the local (LIS) hospital and municipalities has been set up to gather information for local policy making. Data are collected as in the first project. We found out that questions on alcohol use should not be asked by administrative personnel, but by nurses or physicians. After one year of data collection 209 alcohol and drug related cases were registered (13/10.000 inhabitants). There were large differences between municipalities. The concerned municipalities were interested in the results but are still struggling with their role as law enforcers when it concerns alcohol sale to youth.
-In three hospitals in the Netherlands a pilot has started on tailor made screening, secondary prevention, and implementation of interventions (in collaboration with Trimbos Institute). In one hospital the pilot has started. The EDs affirm the role they can play in secondary prevention, but they stress that screening and referring to therapy or e-health interventions should be easy and must not hamper emergency treatment.
Measuring serious injuries on European roads
Robert Bauer, KFV (Austrian Road Safety Board), Vienna
In January 2013, the definition of serious injuries as “patients with an injury level of MAIS ≥ 3 (Maximum Abbreviated Injury Score of three or more; MAIS3+ for short)” was established by the High Level Group on Road Safety representing all EU Member States. It was recommended that all EU countries provide data for serious injuries according to this definition from 2014 on. Three main ways were identified for the Member States to collect the data: 1) by applying a correction to police data; 2) by using hospital data; and 3) by using linked police and hospital data. As of June 2016, 17 countries had either delivered MAIS3+ estimates to DG-MOVE or had reported that they would do so shortly.
A fundamental criterion for developing serious road traffic injury indicators is the availability of data that is accurate enough to allow the reliable identification of serious road traffic injuries. A coding of injuries offering accurate information for the diagnostic and external cause (mechanism) is required to apply case definitions and conduct appropriate case ascertainment.
Hence, hospital data are essential for determining the number of serious road injuries, defined as MAIS3+ casualties, and actually almost all countries doing so are using ICD-10 coded hospital data for that purpose, namely official hospital discharge data. At the same time, access to hospital data seems to be problematic for at least some countries, due to privacy regulations.
In this presentation the potential of another type of hospital data, the IDB data, for developing serious road traffic injury indicators will be discussed along the basic requirements for a data source to allow AIS assignment:
-it allows for the distinction of road casualties, ideally by mode of transport;
-it contains direct AIS scores or sufficiently detailed ICD codes; and
-it is a representative sample or provides full coverage of national road casualties.
The discussion will also consider the experience some IDB countries already have “with MAIS3+”, as well as options for proposing IDB as a possible MAIS3+ data source to DGMove (namely the involvement in the Horizon 2020 project SafetyCube which, in one of its tasks, aims to assess and describe the process needed to estimate the number of serious road injuries in Europe).
Opportunities of Data Linkage
Samantha Turner & Ronan Lyons,Farr Institute, Swansea University Medical School.
To ensure effective injury prevention policies and interventions reach those individuals at greatest risk of injury, high quality injury surveillance systems are required to support informed decisions. While single source surveillance systems (e.g. based solely on Emergency Department data) are useful for observing injury rates and patterns, and supporting generalised prevention strategies; no single data source is able to provide a comprehensive picture of injuries across the injury continuum (e.g. from risk factors to outcomes) and injury spectrum (e.g. from minor injuries to death).
The ability to link individual-level data across multiple data sets, provides a rich data environment, to explore the complex interactions between injury risk factors, exposures, interventions and outcomes. Data linkage systems also offer a low-cost solution for the evaluation of simple and complex interventions, and help improve injury data quality.
Several data linkage systems have been developed in recent years with differing levels of success. The following presentation focuses on a world leading data linkage infrastructure, the Secure Anonymised Information Linkage (SAIL) Databank, in the Farr Institute, Wales, United Kingdom. The SAIL system uses unique, non-identifiable fields, to link individual and household level data across multiple health, educational, social and environmental datasets. As such the SAIL infrastructure provides a rich data platform to conduct comprehensive injury epidemiological analysis, and high quality evaluations of preventative interventions.