Comparative evaluation of different modes of a national accident and emergency department-based injury surveillance system: Jamaican experience.

The objective was to conduct a comparative evaluation of two injury surveillance systems in operation in the Accident and Emergency departments of public hospitals in Jamaica. The evaluation was conducted at 12 hospitals across Jamaica offering varying levels of service delivery. It was designed in three phases: (1) a retrospective review of surveillance system data; (2) prospective process evaluation; (3) system environment evaluation. These data were analysed to determine the sensitivity and specificity of the manual Accident & Emergency Statistical Report (A&ESR) versus the computer-based Patient administration system/Jamaica injury surveillance system (PAS/JISS), and to determine an injury registration rate. Results showed a variation from 8% to 27% in injury registration rates at the hospitals reviewed. The sensitivity of the computer-based PAS ranged from 29.7% to 97.1% while the sensitivity of the manual system ranged from 22.1% to 100%. The computer-based system generally detected a greater percentage of injuries. Problems were identified with missing data fields in the computer-based system, while problems of recording and transcription were identified in the manually-based system. Recommendations were made to improve data quality in both data collection systems. Although shortcomings were identified with the A&ESR, the system is performing the function for which it was designed, that of tracking A&E workload. The PAS/JISS is more user-friendly and a truer reflection of the injury situation.

Surveillance of interpersonal violence in Kingston, Jamaica: an evaluation.

Injuries are among the leading causes of death in Jamaica. Homicide rates have been sharply increasing since 1991. In 1997, the rate of homicide (45/100,000) in Jamaica was over five times the US rate in 1997 (7.9/100,000). In response to this problem and the alarming increase in non-fatal assaultive injuries, the Jamaican Ministry of Health together with the CDC established a Violence-Related Injury Surveillance System (VRISS) using patient registration data from Kingston Public Hospital. The VRISS was evaluated for usefulness, and for system attributes: system acceptability, simplicity, flexibility, sensitivity, and predictive value positive (PVP). System-identified cases were compared with clinical records and data from direct patient interviews. The surveillance system was flexible, acceptable to clinical staff and Ministry officials, and moderately sensitive, detecting 62% to 69% of violent injuries identified from clinical records and a patient survey. The system's predictive value positive was high, with 86% of potential cases confirmed as actual cases. Although adequate, system sensitivity was reduced by incomplete or no registration of patients during periods of staff shortage. In conclusion, despite some logistic shortcomings, the system appeared promising for collecting limited information on non-fatal interpersonal violent injuries. With modification and expansion, the system may be capable of collecting unintentional-injury data also.

The establishment of a Jamaican all-injury surveillance system.

The impact of injuries on the Jamaican health care system is a growing problem. Based on the successful implementation of a Violence-Related Injury Surveillance System (VRISS) in the Accident and Emergency (A&E) department of the Kingston Public Hospital (KPH), Ministry of Health (MOH) officials decided to expand the system to the Jamaica Injury Surveillance System (JISS), allowing for the surveillance of both intentional and unintentional injuries. A working group designed the expanded injury surveillance system based on the International Classification of External Causes of Injury. The expanded system allowed for the collection of data on all injuries seen in the A&E departments by adding four injury projects to the computerized A&E registration process. These were (1) unintentional injury, (2) violence-related injury, (3) suicide attempt (also known as intentional self-harm) and (4) motor vehicle-related injuries. The expanded JISS was implemented at the KPH and four additional hospitals across the island. The geographic distribution of these hospitals provided a reflection of rural and urban, highland and coastal communities and their distinctive injury profiles. Data collected at registration were printed on trauma sheets and reviewed by medical staff before being incorporated into the patient's record. Monthly reports detailing demographics and summary statistics were generated and made available at the local and national level. By monitoring the national injury profile, the JISS provides data to support needed policy changes to minimize the impact of injuries on the health services and on the health of the population.

A profile of injuries in Jamaica.

This study analyses 6 months of data from three hospitals participating in the computerized emergency room-based Jamaica Injury Surveillance System (JISS) since 1999. The categories of injuries tracked were unintentional, violence-related and motor vehicle-related. The resultant data showed that injuries comprised 17% (12,179) of all Accident and Emergency (A&E) department registrations for the period. The highest percentage of injuries were violence-related (51%, 6,380), followed by unintentional injuries (33%, 4,030) and motor vehicle-related (15%, 1,769). Injury profiles varied by institution with the majority of Cornwall Regional Hospital's and Kingston Public Hospital's injuries being intentional while that of May Pen Hospital was unintentional. The data also demonstrate that young males are at highest risk for all types of injuries as well as for the more severe injuries requiring hospital admission. The risk factor data provided through the JISS will inform and guide private and public sector efforts to address the problem of injuries in Jamaica.

Implementing a hospital-based violence-related injury surveillance system--a background to the Jamaican experience.

Violence, a leading cause of injuries and death, is recognized as a major public health problem. In 1996, injuries were the second leading cause of hospitalizations in Jamaica. The estimated annual cost of in-patient care for injuries was 11.6 million US dollars. To develop strategies to reduce the impact of violence-related injuries on Jamaican health care resources, the Ministry of Health, Division of Health Promotion and Protection (MOH/DHPP) in collaboration with the Centers for Disease Control and Prevention and the Tropical Metabolic Research Institute, University of the West Indies Mona, designed and implemented a violence-related injury surveillance system (VRISS) at Kingston Public Hospital (KPH). In 1998, the VRISS, based on the International Classification of External Cause of Injury (ICECI), was implemented in the accident and emergency (A&E) department of Jamaica's tertiary care hospital, KPH. VRISS collects demographic, method and circumstance of injury, victim-perpetrator relationship and patient's discharge status data. From 8/1/98 to 7/31/99, data on 6,107 injuries were collected. Injuries occurred primarily among males aged 25-44 years. Most injuries (54%; 3171) were caused by use of a sharp object. Nearly half (49%; 2992) were perpetrated by acquaintances. The majority, 70% (4,252), were the result of a fight or argument and 17% were admitted to the hospital. The VRISS utilized A&E department data to characterize violence-related injuries in Jamaica, a resource-limited environment. These data will be used to guide intervention development to reduce violence-related injuries in Jamaica.

Non-fatal violence-related injuries in Kingston, Jamaica: a preventable drain on resources.

Using data for a one-year period from the Kingston Public Hospital (KPH) in Jamaica, we describe patterns of non-fatal violence-related injuries, and carry out simulation analysis to estimate rates of hospital admission under various injury reduction scenarios, and the potential savings that can be realized by reducing violent crimes. In this period there were 6107 registered violence-related visits to the KPH representing 11.5% of all recorded visits. Of these 16.6% (1001) were admitted. The most common methods of inflicting injury was by stabbing (52.1%), blunt injuries (37.9%) and gunshot wounds (7.3%). Multivariate analyses indicated that gunshot injuries, stab injuries, being male between the ages of 15 and 44 years, receiving the injury in November or December, and being injured by a stranger or unknown assailant, were significant correlates of a higher probability of admission. Simulation analysis with various injury reduction scenarios indicated decreases in the probability of admission ranging from 12% to 44%, with estimated savings of up to 31% of the annual supplies budget of KPH.