Serious Injury Reporting An Irish Perspective Maggie Martin
Background Investigate the feasibility of adopting the Maximum Abbreviated Injury Scale (MAIS) in Ireland assessed at level 3 or more. Having an internationally agreed definition of serious injuries will help the safety research community to better understand the consequences of road crashes and to monitor progress. The finding of this study will be used to inform the on-going review of public policy in relation to road safety in Ireland.
Serious Injury Definition Hospitalisation or Length of Stay (LOS). Specific type of injury. The inability to work. The length of recovery. Long term disability. There are no commonly agreed definitions on injury severity and these vary from country to country.
Serious Injury in Ireland The definition of serious injury is an injury for which the person is detained in hospital as an in-patient or Any of the following injuries whether or not detained in hospital: fractures, concussion, internal injuries, crushings, severe cuts and lacerations, severe general shock requiring medical treatment.
Serious Injury in Ireland Reported on annually in the Road Safety Authority's Road Collision Factbook. Based on All reported road collisions (means all collisions investigated by or brought to the notice of An Garda Síochána where the exact location of the collision can be determined). Based on the assessment of An Garda at the scene of the collision.
Towards a Medical Definition No agency in Ireland currently uses severity coding such as AIS, MAIS or ISS. Most common medical classification across agencies is the International Classification of Diseases (ICD-9 or 10). Severity scores can be derived from the ICD-10 codes by the application of mapping software or algorithms such as - ICDmap90 ( John Hopkins) - European Centre for Injury Prevention (University of Navarra, Spain)
Potential Databases Health Data - Hospital Inpatient Enquiry Scheme (HIPE) - Proposed Major Trauma Audit (National Office for Clinical Audit) Transport Data Injury Data - Health and Safety Authority (HSA) - Injuries Board
Health Data Hospital In-Patient Enquiry Scheme (HIPE) HIPE is a computer-based system designed to collect demographic, clinical and administrative data on discharges and deaths from acute hospitals nationally. All acute public hospitals participate in HIPE reporting on over 1.4 million records annually. ICD-10-AM classification, 6th Edition (in use since January 2009. HIPE data are used extensively in research and planning.
Health Data (HIPE) Dates of Admission and Discharge Admission Type: booked or emergency Discharge Destination: home, transfer, self-discharge or death Date of Birth Sex Marital / Civil Status Area of Residence by county General Medical services status (i.e. Medical Card) Diagnoses: Principal and up to 29 additional secondary diagnoses Procedures: Principal and up to 19 additional secondary procedures
Health Data (HIPE) Lack of unique identifiers. Some repeat admissions may be included if a patient was admitted to a different hospital and therefore given a different medical record number. A patient may have been coded as an emergency admission when transferred from another hospital, when they should have been coded as a transfer.
Health Data (Major Trauma Audit) National Office for Clinical Audit (NOCA) is working with the Emergency Medicine Programme to establish a national trauma / emergency medicine audit. Based on the TARN UK Methodology (AIS coding). Will collate data from all Emergency Departments. Potential source of serious injury data from RTCs. RSA have established links with the Academic Committee of the Irish Association for Emergency Medicine with regard to Trauma data.
Transport Data Health and Safety Authority (HSA) Road traffic/vehicle accidents involving employees and selfemployed where the person was injured while driving or riding in the vehicle in the course of work. Road traffic/vehicle accidents involving members of the public - only notifiable if they relate to vehicle loads or to the construction or maintenance of roads or structures adjacent to roads. Reported to EUROSTAT.
Transport Data (HSA) Date/Time Gender Nationality Age Days lost Vehicle Type Location Injury and location of injury
Transport Data (HSA) Under-reporting Difficult to segregate out RTC data Fatal, Non Fatal, Dangerous Occurrence
Injury Data Injuries Board All personal injury compensation claims arising from road traffic collisions must be made through the Injuries Board. Data held on average of 15,000 17,000 cases per annum over 100,000 cases in total more detailed information held on approximately 40,000 awards. Cases can be categorised into serious/moderate/minor as correlation between injury severity and monetary compensation awards.
Injury Data (Injuries Board) Gender, age, location, nature and extent of injuries sustained etc. Information based on injured parties medical practitioner, and commissioned medical practitioners reports. Injury data includes full nature and extent of injuries sustained, treatment received and final prognosis. Not ICD 10 coded Source data available no requirement to capture additional information but scope to do so if required in the future.
Under-Reporting Serious Injury Injuries resulting from RTCs are underestimated in many countries. The RSA acknowledges that this is also true for Ireland, despite increased efforts by An Garda Síochána to report on these injuries. The Road Safety Strategy for 2007-2012 stated that it was not possible to set a benchmark for a reduction in serious injuries as there were doubts about the reliability of the reported figures.
Under-Reporting Serious Injury HSE Department of Public Health published: Admission To Acute Hospitals For Injuries As A Result Of Road Traffic Collisions In Ireland, 2005-2009. Bedford, D.(2011) One of the aims: Compare acute inpatient care in acute hospitals in Ireland for road traffic injuries over the five years of 2005-2009 data with the data published by the RSA for the same time period.
Under- Reporting Serious Injury Reported figures were 3.5 times greater than the number of serious injuries reported by the RSA using An Garda Síochána data. In particular, the number of cyclists injured was underestimated in the RSA figures; HIPE data reported (7.1%) hospital discharges compared to (2.6%) seriously injured pedal cyclists as reported by the RSA. Following Table extracted from the report by Bedford, D.(2011)
Under-Reporting Serious Injury YEAR RSA DATA HIPE DATA RATIO HIPE:RSA 2005 1021 3080 3.0 2006 907 3118 3.4 2007 860 2964 3.4 2008 835 2862 3.4 2009 640 2837 4.4 Total 4263 14861 3.5 Sources: RSA & HIPE, 2005-2009
Linking Data Under-reporting and limitations of individual databases have led to the linking of multiple databases. The most common of which are police and hospital. However, other sources of data such as insurance and emergency data are also used. Linking of An Garda Síochána data with health and Injury Board data may be feasible in Ireland as both are national databases. Lack of unique identifier would mean the use of the probabilistic method. The most likely variables to be common to all datasets would be date of the collision (or admittance), gender and location.
Linking Data Successful linkage is dependent on data quality. It is time consuming (data preparation such as standardising formats, missing values, duplicate records etc.) Preliminary investigations are underway in Ireland with regard to data linkage. Health Intelligence Unit have a model which may be modified. Data Protection Commissioner has indicated it is possible to link databases but must adhere to certain conditions.
Conclusion Availability of good quality National Databases place Ireland in a good position. Current investigation into transforming current ICD-10-AM inpatient data underway with the use of the European Centre for Injury Prevention algorithms. Serious injury classification (MAIS 3+) on inpatient data looks feasible in Ireland in the near future. Exploration of trial data linkage exercise with Garda and health and Injury Board databases is in progress.