Lecture 12: Introduction to Injury Flashcards
How is injury classified systematically?
Using the International Statistical Classification of Diseases and Related Health Problems (ICD)
- which is a legally mandated health data standard
Summarise the ICD definition of injury
- 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
how are injuries defined and coded?
by asking ‘what’s wrong?’ and how it happened.
e.g. fracture of base of neck of the femur by slipping.
how are injuries classified?
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
what trends are found in this info?
- 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
what trends are shown here?
- 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
what trends are shown here?
- 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
what trends are shown here?
- 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
what trend is shown here
lower SDI countries have higher rates of death per 100,000 compared to high SDI countries
what trend is shown here?
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
what trends are shown here?
rates of death per 100,000 due to drowning are decreasing in many countries
which data sources would you use for fatal injuries? what are the exclusions to this?
NZ Mortality Collection
Excludes:
- sudden unexplained death in infants
- alcohol poisoning
- adverse effects of medical treatment
which data sources would you use for non-fatal hospitalised injury? what are the exclusions to this?
National Minimum Dataset (NMDS)
Exclusions:
- readmissions for an identical injury diagnosis within 90 days
- alcohol poisoning
- adverse effects of medical treatment
which data sources would you use for non-fatal non-hospitalised injury? what are the exclusions to this?
- 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
what trends can we see here?
Males tend to have a higher rate than females across most injuries
what trends can we see here among different injuries?
- 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
what is significant about global injuries?
- injuries are a global health problem
- more than 5 million people die each year due to injuries
what is the injury pyramid?
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
what injury is the leading cause of death is 5-14 year olds?
road traffic
drowning
what injury is the leading cause of death is 15-29 year olds?
road traffic
suicide
homicide
what injury is leading cause of death in 30-49 year olds?
road traffic
suicide
what trend does this show?
men are more at risk of death from injuries and violence
what are the 3 aims of injury prevention and control?
- Reducing the number of events with the potential to cause injury
- Reducing the number of injuries that occur
- Reducing the severity of injury and optimizing outcome
what is the haddon matrix?
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
what does the haddon matrix draw on?
the epidemiological triad
what are active interventions? give some examples relating to bicycle injury prevention
active interventions are behavioural interventions.
- e.g. encouraging use of helmets, cycle training
what are passive interventions? Provide examples on how they relate to bicycle injury prevention.
- interventions that change the environment so you don’t have to rely on individuals to change
e. g. cycleways, speed bumps, improve visibility
what are the benefits of the haddon matrix?
- 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
