Transcript Rebranding Safe Kids Worldwide

CHILDHOOD INJURY PREVENTION CONFERENCE 2013
1
Hospital-Based Injury Surveillance:
Tools, Resources and Concepts
Holly Hedegaard, MD, MSPH
National Center for Health Statistics
Office of Analysis and Epidemiology
Safe Kids Worldwide Childhood Injury Prevention
Conference
June 21, 2013
National Center for Health Statistics
Office of Analysis and Epidemiology
Overview
•
Resources and partners
•
Local data on injury hospitalizations
─ Data from hospital billing departments
─ Trauma registry data
•
National data on injury hospitalizations
─ Web-based Injury and Statistics Query and
Reporting System (WISQARS)
─ Healthcare Cost and Utilization Project (HCUP)
Resources and Partners
•
The Injury Prevention Program at your state or
local public health department
•
Trauma registrars at hospitals
•
Universities or schools of public health; Injury
Control Research Centers
•
National organizations
─ Safe States Alliance
─ CDC, National Center for Injury Prevention and Control
Useful Tools
Consensus Recommendations
for Using Hospital Discharge
Data for Injury Surveillance
www.safestates.org/associations/
5805/files/HospitalDischargeData
.pdf
Local Data on Injury
Hospitalizations
Data from Hospital Billing Departments
•
Based on the 2004 Universal Billing form (UB-04)
•
May be available for both ED visits and hospital
discharges
•
Includes basic information on:
─
─
─
─
─
Patient demographics (e.g., age, sex)
Diagnoses
Cause of injury
Procedures
Hospital charges
Data from
Hospital Billing Departments
•
Diagnoses, causes of injury and procedures are
coded using the ICD-9-CM
─ Change to ICD-10-CM in October 2014
•
Tools for creating standard groups
─ Barell Matrix, for injury diagnoses
injuryprevention.bmj.com/content/8/2/91.full.pdf+html
─ ICD-9-CM External Cause Matrix, for causes of injury
www.cdc.gov/injury/wisqars/ecode_matrix.html
Hospitalizations for Children Ages 4-8 Injured as an
Occupant in a Motor Vehicle Crash, Colorado
Relevant Colorado Child Passenger
Safety Laws for 4-8 Year Olds
A. 1995 Children under age 16 required
to use seatbelts/car seats in front and
back seats, primary enforcement.
Hospitalizations per 100,000 children ages 4-8
30 A
B. 1999 Children must be in a seating
position with a seatbelt/car seat
available.
25
B
20
C. 2003 Children 4- or 5-years-old,
unless > 55 inches tall, must ride in a
booster seat, secondary enforcement.
C
15
D. 2010 Children ages 6-7 must ride in
a booster seat.
10
D
5
0
1996
1998
2000
2002
2004
Year
2006
2008
2010
Trauma Registry Data
•
Collected by trauma nurses and registrars
•
Often based on the National Trauma Data Standards
www.ntdsdictionary.org
•
Additional information collected
─
─
Clinical data
Use of protective devices
Selected Mechanisms of Injury, by Age
Data from the National Trauma Data Bank Pediatric Annual Report 2010
Number of cases
7000
6000
5000
Fall
Other Transport
Firearm
MV Traffic
Struck by/Against
Cut/pierce
4
10
4000
3000
2000
1000
0
<1
2
6
8
Age (years)
12
14
16
18
National Data on Injury
Hospitalizations
Web-based Injury and Statistics Query and
Reporting System (WISQARS)
Centers for Disease Control and Prevention
•
Data are obtained from a sample of hospital
emergency departments and analyzed to provide
national estimates
•
Includes ED visits and hospitalizations that result
from ED visits
•
On-line query system
www.cdc.gov/injury/wisqars/index.html
5 Leading Causes of Non-fatal Injury
for Children Treated and Released from the ED
By Age Group, US, 2011
Rank
<1
1-4
5-9
10-14
15-19
1
Fall
Fall
Fall
Fall
Struck by/
Against*
2
Struck by/
Against*
Struck by/
Against*
Struck by/
Against*
Struck by/
Against*
Fall
3
Other
bite/sting+
Other
bite/sting+
Other
bite/sting+
Overexertion
Overexertion
4
Foreign body
Foreign body
Cut/pierce
Cut/pierce
MV Occupant
5
Fire/burn
Overexertion
Overexertion
Pedal cyclist
Physical
Assault
*Accidentally struck by or struck against a person or object, including in
sports
+Bite or sting, not including dog bites
Healthcare Cost and Utilization Project (HCUP)
Agency for Healthcare Research and Quality
•
Hospital discharge data from 44 states
•
Can provide national estimates on injury
hospitalizations and ED visits
•
Several on-line query systems, one specific to kids
Pediatric age groups are pre-set
─ Need to have an understanding about ICD codes
─ hcupnet.ahrq.gov
─
Percent of Children Ages < 17 with Traumatic Brain
Injury (TBI) admitted to the hospital from the ED
12%
10%
8%
6%
4%
Age < 1
Ages 1-17
2%
0%
2006
2007
2008
2009
ICD-9-CM codes for TBI: 800-804, 850-854, 950.1-950.3, 995.55, 959.01
From the National Emergency Department Sample (NEDS), HCUPnet at http://hcupnet.ahrq.gov/
2010
Suggestions for Getting Started
•
Identify people who can help
•
Learn a little bit about the International
Classification of Diseases (ICD) codes for injury
•
On-line tools for national estimates
Questions?
Holly Hedegaard, MD, MSPH
Office of Analysis and Epidemiology
National Center for Health Statistics
3311 Toledo Rd.
Hyattsville, MD 20782
Phone: 301-458-4460
[email protected]
Injury Surveillance In
Connecticut
Data in Connecticut
• What we have
• How we share it
• What we can do
with it
Our set up
• Safe Kids Connecticut is a program
of the Injury Prevention Center
(IPC)
• IPC has 10 hour per week GIS
Research Assistant (RA) to run
geo-spatial analysis (including
making maps) and run data
• Money for RA and to purchase
data comes out of IPC money
Our statewide resources
• Dept of Public Health (DPH)
– No longer has Injury Prevention section
• Lost funding 2011
• Previously had injury data and ran CODES project
• Dept of Transportation (DOT)
– Has some data, but MV only
• Poison Control Center
– Has some data, but Poison only
Statewide Resources (cont’d)
• Office of the Child Advocate
– Runs Connecticut Child Fatality Review Panel
which reviews all unexpected and unexplained
child deaths
– Runs special analysis upon request
– Detailed information on topics like safe sleep
– We do not have access to the data but do to the
detailed analysis
Data we have – Purchased
• Connecticut Hospital Association (CHA)
– Emergency Department visits
– Hospitalizations
– Deaths (that occur in a hospital or are processed
through a hospital)
• DPH - Vital Records
– CT Death Certificate Files
– $10/year
Data we have - Free
• DOT Crash file
– Requires extensive formatting and processing of
the data
• Medical Examiner Data
– Must request yearly
– Specific Causes (Firearm and Drowning)
Data Limitations
• Data Cleaning
– Almost all data we receive (including CHA)
requires extensive data formatting processing
• Time Lag
– We generally have a 2 to 3 year data lag
• Example: Just now requesting 2011 and 2012 data
• Hard to compare long periods of time
– Ex) CT Death cert data 1990-2010, but change in
ICD9 to ICD10 makes long term analysis difficult
Data Limitations
• E-Codes make certain information hard to get
– Motor vehicle crash info? Yes!
– Bike crash info? No… (only if they crashed into MV)
• Based on cause of injury, rather than
consumer product
– Bikes
– Batteries
– Crib bumpers
Sharing data
• Due to our agreements, we share the analysis
of the data, not the raw data
• We share data via:
– ED Injury books for our local Safe Kids
– Reports (Drowning, violent death)
– Requests
ED data books
• Updated when we get new data from CHA
• Data books started 1995 and ends 2010
• We give all unintentional injury data for kids
19 and under by 5 year age groups
• Data broken down by county (8) and then
total for the state
• We collapse and expand categories as needed
• Given to each local Safe Kids organization
Safe Kids in CT are not county based
Example from Data Book
How we use our data
• Media
– Lots of requests for local data
• Especially with national reports
• Stories we pitch to them
– Posts for our Facebook page
– Social media for our lead organization
How we use our data
• Grants
– Statewide data
– Local data for
local foundations
– Mapped data
– Safe Kids Worldwide
Educational material
Questions?
Karen Brock Gallo, MPH
Safe Kids Connecticut
[email protected]
860-837-5308
Using E-Coded Data in the Pediatric
Emergency Department
Rennie Ferguson, MHS, CPH
Safe Kids Worldwide
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
36
Objectives
•
•
•
•
Purpose of E-coding
Why it isn’t used more often
Hospital-based injury surveillance
Components of a successful injury surveillance
system
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
37
Pediatric Emergency Care, July 2013
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
38
Injury surveillance systems
• Provide information on populations susceptible to
injury, types of injuries, and factors that put
people at increased risk
• How well interventions are working
• Successful systems require:
•
•
•
•
•
•
•
Simplicity
Flexibility
Acceptability
Reliability
Utility
Sustainability
Timeliness
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
39
What is E-coding?
• International Classification of Diseases external
causes of injury and poisoning codes
• Provide information about mechanism, location
and intentionality of the injury
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
40
Design of literature review
• 2 sets of search criteria:
• E-coding in the PED
• Injury surveillance by the PED
• PubMed, PubMed Central, Google Scholar
• CINAHL, EMBASE, Academic Search Elite
• Exclusion criteria
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
41
Findings
• 111 sources identified
• E-coding in the PED: 2 reports met criteria
• Non-E-coding PED injury surveillance: 5 reports
met criteria
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
42
E-coding in PED
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
43
Injury surveillance in PED
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
44
Injury surveillance in PED
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
45
Common challenges
• Insufficient chart information (n=4)
• Incompleteness of questionnaires by physicians
(n=2)
• Bias toward more severe cases (n=1)
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
46
Reduce the burden
• Earlier systems: “flagging” injury cases,
questionnaires, assigning clinical staff to enter
data
• Economic and resource burden
• Electronic charting
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
47
Practicality
• Usefulness in tracking health outcome of interest
• Falls (n=2)
• Relevant by tailoring questions
• Ease of use for hospital trauma education
coordinators and others
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
48
Ensuring data quality
• Little published research on quantifying the
accuracy of E-codes
• Outside of PED—ranged from 64-85% (McKenzie 2009)
• Need for more research on feasibility, quality, and
utility of individual hospital PED injury
surveillance systems
• Role of triage nurses, parents in improved Ecoding
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
49
Funding
Preparation of this research was supported by Cooperative
Agreement 5R49CE001507 from the Centers for Disease Control and
Prevention.
The contents of this presentation are solely the responsibility of the
authors and do not represent the official views of the Centers for
Disease Control and Prevention.
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
50
CHILDHOOD INJURY PREVENTION CONFERENCE 2013
51