Developing injury surveillance in accident and emergency departments

Injuries are the leading cause of death among children and young people in the industrialised world and are a major contributor to disability.1 2 In the early 1990s, both the UK Department of Health3 and the Scottish Office4identified accidents as a priority area for action in their respective policy statements. However, efforts to formulate and implement local, national, and international preventive policies have been hindered, at least in part, by the paucity of reliable data on injury frequency, cause, and outcome. Many countries compile routine data on injuries derived from mortality statistics, occupational records, or through incident reporting—for example, to police and fire departments.2 5-7 These data are of variable relevance and quality, however, and are often inaccessible. The establishment of specially designed injury surveillance systems is widely advocated as a prerequisite for the development and evaluation of injury prevention strategies, particularly at a local level.4 7 8 This paper reviews the published literature on injury surveillance based at accident and emergency departments and attempts to identify the characteristics of a successful injury surveillance system (ISS). Surveillance has been defined as the “continuous analysis, interpretation and feedback of systematically collected data”.9 It implies a proactive mechanism for identifying problems and implementing appropriate preventive strategies on a routine basis. Injury surveillance may be regarded as a specific form of public health audit. It can be designed to generate information on both the numbers and characteristics of injuries, such as the injury location, circumstances, cause, and mechanism. This information is crucial for detecting trends in injury incidence, identifying risk factors, developing injury control measures, and assessing their impact. This process is thus an epidemiological means to a public health end, namely prevention. As it is likely that most moderate and serious injuries present to hospital …