Lecture 12: Introduction to Injury

Question 1

How is injury classified systematically?

Answer 1

Using the International Statistical Classification of Diseases and Related Health Problems (ICD)

• which is a legally mandated health data standard

Question 2

Summarise the ICD definition of injury

Answer 2

• injury means physical or physiological bodily harm resulting from interaction with energy that exceeds physical or physiological tolerance.
• injury can also result from lack of vital elements or poisoning by and toxic effects of substances
• injury usually has rapid onset in response to a well-defined event (external causes of injury)
• injury can be cause by the injured person (self harm)
• injury includes manifestations that are evident immediately after onset, which may persist or not, and manifestations that first become evident at a later date

Question 3

how are injuries defined and coded?

Answer 3

by asking ‘what’s wrong?’ and how it happened.

e.g. fracture of base of neck of the femur by slipping.

Question 4

how are injuries classified?

Answer 4

Unintentional Injuries

• falls
• road traffic
• drowning

Intentional Injuries

• Self-harm
• Assault
• Collective violence

Naure and area of Injury

• amputation of thumb
• fracture of pelvis
• injury to eye
• Purpose of activity e.g. work-related, recreational
• Setting of event e.g. home, workplace, road

Question 5

what trends are found in this info?

Answer 5

• in 2019, unintentional injuries moved down to 9th place from 8th in 1990 and contributes to 1,338 DALY’s per 100,000
• In 2019, transport injuries remained at 14th place since 1990 and contributes to 1003 DALY’s per 100,000
• In 2019, self-harm and violence moved up to 16th from 15th place in 1990 and contributes to 877 DALY’s per 100,000

Question 6

what trends are shown here?

Answer 6

• in 2019 unintentional injuries contribute to 22.94 deaths per 100,000 globally
• in 2019 transport injuries contributed to 16.53 deaths per 100,000 globally
• in 2019, self-harm and violence injuries contributed to 16.1 deaths per 100,000 globally

Question 7

what trends are shown here?

Answer 7

• in 2019, unintentional injuries contributed to 2198 DALY’s per 100,000 in NZ
• in 2019, self-harm injuries contributesd to 687 DALY’s per 100,000 in NZ
• in 2019, transport injuries contributed to 580 DALY’s per 100,000 in NZ

Question 8

what trends are shown here?

Answer 8

• unintentional injury contributed to 18.73 deaths per 100,000 in NZ
• self-harm and violence injuries contributed to 12.69 deaths per 100,000 in NZ
• transport injuries contributed to 9 deaths per 100,000 in NZ

Question 9

what trend is shown here

Answer 9

lower SDI countries have higher rates of death per 100,000 compared to high SDI countries

Question 10

what trend is shown here?

Answer 10

deaths per 100,000 due to interpersonal violence is beginning to decline in many countries. rates appear to be higher in lower-middle SDI countries

Question 11

what trends are shown here?

Answer 11

rates of death per 100,000 due to drowning are decreasing in many countries

Question 12

which data sources would you use for fatal injuries? what are the exclusions to this?

Answer 12

NZ Mortality Collection

Excludes:

• sudden unexplained death in infants
• alcohol poisoning
• adverse effects of medical treatment

Question 13

which data sources would you use for non-fatal hospitalised injury? what are the exclusions to this?

Answer 13

National Minimum Dataset (NMDS)

Exclusions:

• readmissions for an identical injury diagnosis within 90 days
• alcohol poisoning
• adverse effects of medical treatment

Question 14

which data sources would you use for non-fatal non-hospitalised injury? what are the exclusions to this?

Answer 14

• ACC claim data

Exclusions

• cases already reported in NMDS
• claims for musculoskeletal disorders, occupational diseases or treatment injury
• claims with only symptoms rather than a diagnosis coded

Question 15

what trends can we see here?

Answer 15

Males tend to have a higher rate than females across most injuries

Question 16

what trends can we see here among different injuries?

Answer 16

• falls appear to be increasing with age, most common in older people
• transport injuries tend to be more common in younger people
• interpersonal violence appears to be more common around middle-aged

Question 17

what is significant about global injuries?

Answer 17

• injuries are a global health problem
• more than 5 million people die each year due to injuries

Question 18

what is the injury pyramid?

Answer 18

a representation of the demand on the health sector caused by injuries and violence.

Most of the cost comes from injuries resulting in hospitalisation/visits to emergency departments

Question 19

what injury is the leading cause of death is 5-14 year olds?

Answer 19

road traffic

drowning

Question 20

what injury is the leading cause of death is 15-29 year olds?

Answer 20

road traffic

suicide

homicide

Question 21

what injury is leading cause of death in 30-49 year olds?

Answer 21

road traffic

suicide

Question 22

what trend does this show?

Answer 22

men are more at risk of death from injuries and violence

Question 23

what are the 3 aims of injury prevention and control?

Answer 23

1. Reducing the number of events with the potential to cause injury
2. Reducing the number of injuries that occur
3. Reducing the severity of injury and optimizing outcome

Question 24

what is the haddon matrix?

Answer 24

a new approach to injury that moves away from blaming the injured person.

it drew on engineering and then epidemiology to conceptualise energy transfer as the hazard causing injury and prevention is needed to focus on environment and equipment as well as the people involved

injuries have more than one cause

Question 25

what does the haddon matrix draw on?

Answer 25

the epidemiological triad

Question 26

what are active interventions? give some examples relating to bicycle injury prevention

Answer 26

active interventions are behavioural interventions.
- e.g. encouraging use of helmets, cycle training

Question 27

what are passive interventions? Provide examples on how they relate to bicycle injury prevention.

Answer 27

• interventions that change the environment so you don’t have to rely on individuals to change
  e. g. cycleways, speed bumps, improve visibility

Question 28

what are the benefits of the haddon matrix?

Answer 28

• recognise that injury is a process
• employ multi-disciplinary thinking
• help to develop creative solutions
• identify range of strategies for prevention planning and resource allocation
• both primary and secondary prevention
• active, passive interventions or combination