Injury surveillance guidelines
Injuries, unintentional or intentional, constitute a major public health problem, killing more than 5 million people worldwide each year and causing many more cases of disability. People from all economic groups suffer fatal injuries, but death rates due to injury tend to be higher in those in the lower income groups. The poor are also less likely to make a full recovery following an injury.
Historically, the injury problem has been neglected, largely because injuries were viewed as accidents or random events. Today, however, injuries are known to be preventable. The use of seat belts, car seats for children, designated drivers, fencing around water areas, flame-resistant clothing and smoke detectors, together with early childhood education and family counselling to prevent violence have all proved to be effective measures for preventing injuries.
To date, injury prevention has tended to be an issue only in wealthier countries. The highest rates of death and permanent disability due to injury are, however, currently found in the poorer nations; it is these countries therefore that have the most urgent need for prevention strategies that are appropriate, cost-efficient and effective. In this context, “appropriate” means taking into account the complexities of the problem, the availability of resources and, furthermore, what strategies have been shown to work elsewhere.
To develop effective prevention strategies, most countries need better information. In particular, countries need to know about the numbers and types of injuries that occur and about the circumstances in which those injuries occur. Such information will indicate how serious the injury problem is, and where prevention measures are most urgently needed.
To assist, the Injuries and Violence Prevention Department of the World Health Organization (WHO) has collaborated with agencies from all continents to develop the tools needed for collecting data on injuries. The first product of this collaboration is the International Classification for External Causes of Injuries (ICECI), a detailed classification scheme for injuries that complements the existing International Classification of Diseases (ICD). It provides guidance, to both dedicated researchers and practitioners in the field, on how to classify and code data on injuries according to agreed international standards.
The present manual is also aimed at researchers and practitioners and its purpose is to provide practical advice on how to develop information systems for the collection of systematic data on injuries. It is the result of collaboration between experts from the WHO and the US Centers for Disease Control and Prevention (CDC) who work, or have worked, in settings where resources, including trained staff and electronic equipment, are limited. In addition, experts from other organizations in more than 50 countries have commented on draft versions of the manual. The work has taken two years to complete.
Although the primary objective was to produce a manual applicable to all settings, it is hoped that the manual will be especially useful to those in settings where resources are scarce. The manual thus shows how to set up systems for collecting, coding and processing data even if there is no electronic equipment, few staff, and/or staff with many other demands on their time and no expertise in research. We hope it will lead to better information on injuries and, in turn, to prevention programmes which reduce the incidence of death and disability due to injuries.
Dr Etienne Krug
Director, Injuries and Violence Prevention Department
World Health Organization