Projects
Injury Surveillance System
Starting from September 2003, an injury surveillance system was piloted at the AED of PMH. A total of 2000 injury cases were captured and analyzed. In 2005, having funding support from the OSH Council, technical assistance from the HK Poly University; a system was designed to capture the core data related to all types of injuries presented at the AED of PMH. It is used to provide directions for injury prevention and as a measurement tool for the effectiveness of these programs.
The surveillance system was developed in 4 phases. In Phase 1, all injured attendances to the AED were assessed by the triage nurses using the injury classification (WHO & CDC, 2001). Based on the data collected in Phase 1, the team had compiled a local injury classification with electronic input in Phase 2. In Phase 3, it involved prototype development, training and reliability check. The system would integrate with the hospital current database. These databases included the International Classification of disease (ICD-9-CM), Abbreviated Injury Scale (AIS) and Injury Severity Scale (ISS). Then, usability test would be performed in phase 4 for system evaluation.
All the injury related AED attendance was recruited in 2006. The data entry points were located in the AED. After triage, the nurse would enter the related information into the computer. The data was then retrieved from a reporting module with different levels of filtering. Standardized reports and scenario based reports were available. An analysis of data from injury surveillance system would provide a picture of the injury burden in the district.
The Injury Data
A total of 18,316 cases were captured from Jan to Dec 2006 (figure 1). Male contributed to the major portion (n=11,193; 61.11%) while female represented 38.89% (n=7,123) of the injury attendance. For those aged above 64, the majority was female (n=1,725, 67%). Most of the cases were between the age of 25 and 44 (n=6,208; 34%).
Most injury events occurred at street (30.87%) and home (20.99%). Workshop (12.04%) and office (5.64%) were also major places of occurrence. Most of the street-related injured victims were between the age of 25 and 44. There were 33.29% of fall, 25.49% of blunt force and 10.89 stab/cut injuries occurred in street. The peak number of the fall incidents occurred on holidays. It might be related to congestion on the road and seasonal changes. Within the street related injured group, 17% of the cases needed hospital admission. Peak admission rate fell between March and April. For home-related injury, children (age; 1-5) and elderly (age >65) are the majority. There were 24.92% of fall, 17.85% of blunt force and 31.31 % of stab/cut injuries at home.
The most common injury related activities were traveling (42.55%) and work (38.63%). Male was also the major portion. There were 52.66% of fall, 32.84% of blunt force and 28.58 % of stab/cut injuries during traveling. On the other hand, there were 24.54% of fall, 47.92% of blunt force and 59.89 % of stab/cut injuries at work.
Incident rates were an indication of how many incidents have occurred, or how severe they were. The total injury incident rate was employed for the calculation. In Kwai Tsing, the injury rate (figure 4) per 1000 people was estimated to be 28 (male: 51; female 32). Male aged between 25-54 years was subject to high risk for injury. For female elderly aged above 65 years, the incident rate was 70 per 1000 people.
Based on preliminary findings and prevalence analysis, risk factors were identified among the place of occurrence, related activities, cause of injury, age groups and body site. The system identified that most of the injury events occurred outdoors. As there were different findings from the previous hospital data, most of the injured events were classified as domestic. With the classification of places of injury event, a clearer identification of places could be made. Corresponding to the more outdoor injury events, traveling took up a major portion as compared to other injury related activities. In addition, female elderly were at higher risk for injury with double incident rate (70/1000 people) as compared to the male elderly and other age groups. For injury site, superficial and head injury were recognized as major types of injury.