Chamaiparn Santikarn, MD., MPH.1Ministry of Public Health, Thailand From Provincial to National: The...

Chamaiparn Santikarn, MD., MPH.

1Ministry of Public Health, Thailand

From Provincial to National: From Provincial to National:

The Development of The Development of

Thailand Injury SurveillanceThailand Injury Surveillance


Non-communicable Diseases Bureau, Ministry of Public Health

Siriwan Santijiarakul, MSc.Epidemiology Bureau, Ministry of Public Health, Thailand



IntroductionIntroduction

1995, Thailand Provincial Injury

Surveillance started in 5 large sentinel

hospitals

Population under surveillance - all injury

cases presenting at the emergency

rooms (occurred within 7 days)




System objectives: Establish a database

for assessing acute care and referral

services; and facilitate injury prevention

at provincial and national levels

Data flow and responsible Data flow and responsible unitunit

E.R.Nurse

Medical Record DepartmentMedical Statistics Technicians

Diskette to Epidemiology Division

National action

Report distributed within hospital and province

Local action4-6 mnth. 6 mnth.



IntroductionIntroduction Emphasized on local utilization for action

than centralizing the data

Local information users - physicians,

nurses and policymakers

PC software specifically developed for

local processing




Menu of 35 ready-made tabulations

TRISS methodology was used to

estimate survival probability

Screening tool to identify trauma cases

with unexpected outcome for trauma audit

Quality of acute care services monitored




System expanded to 22 large hospitals

In 2001, national coordinating unit proposed reduced reporting criteria, included only severe injuries (deaths, observed and /or admitted)



ObjectivesObjectives

Dr. Chamaiparn Santikarn

Gain better representativeness

of important injury events in

each province

Better data quality

Decrease resource need

เมษายน 18 2566



MethodsMethods To assure the sentinel hospitals

Epidemiology Division used the

available data Identify workload decrease under

the new criteria Information changes due to the

new criteria



15 study sites

7 Other sites

A.D. 2001

22 reporting sentinel sites



MethodsMethods

In December 2000

Workshop for Establishing the

National Injury Surveillance

Analysis results presented



ResultsResults With the new reporting criteria

The number of records to be reported decreased

from 197,140 to 63,607 68 % decrease Total workload would

be decreased by 58 %

0

20000

40000

60000

80000

100000

120000

All emergency presentations

DBA, Dead ER. & Admittedinclude observed

Max. AIS 32 4 5 61

No. of records

Source : 15 sentinel hospitals, provincial injury surveillance, Thailand.

Fig. 1 Distribution of maximum AIS of trauma cases Fig. 1 Distribution of maximum AIS of trauma cases previous vs.. new criteria, 15 sentinel hospitals, 1998



0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000All emergency presentations

DBA, Dead ER. & Admitted includeobserved

No. of records

Max. AIS 2 54 61 3 Source : sentinel hospitals, provincial injury surveillance, Thailand 1998.

Fig. 2 Distribution of maximum AIS of trauma casesFig. 2 Distribution of maximum AIS of trauma casesprevious vs.. new criteria, 13 non -Bangkok hospitals



0

4,000

8,000

12,000

16,000

20,000

24,000

28,000All emergency presentations

DBA, Dead ER. & Admitted includeobserved

No. of records

Max. AIS 1 3 54 62

Source : sentinel hospitals in Bangkok , provincial injury surveillance, Thailand .

Fig. 3 Distribution of maximum AIS of trauma casesFig. 3 Distribution of maximum AIS of trauma casesprevious vs.. new criteria, Bangkok,1998



Results Results

5 leading cause of injuries in each

sentinel site

Minor change 2nd - 3rd rank

Tendency towards external causes

with more severe outcome



Five leading cause of injuries, previous criteria vs. new criteria

previous criteria new criteria

cases % cases %

Transp. Acc 93,020 47.2 Transp. Acc 36,922 58.0

Acc. Inan. Frce 36,092 18.3 Acc. Falls * 7,987 12.6

Acc. Falls 25,597 13.0 Acc. Inan. Frce* 7,314 11.5

Assaults 16,106 8.2 Assaults 4,727 7.4

Total 197,140 100.0 Total 63,607 100.0

Self-harm 13,520 6.9 Self-harm 2,619 4.1

Others 12,085 6.5 Others 4,038 6.3



ResultsResults The experts and authorities supported

the new criteria

Local concerns/worries

Data for administration within the

hospital Epidemics detection of some minor

injuries but potential health service burden in the provincial level



Results Results

The new criteria became

minimum data collection standard for national injury surveillance

Hospitals could still use previous

criteria to meet with internal need

and provincial utilization



Results Results

Simple computer technique

needed to manage electronic file

before sending in the data



Results Results (under new criteria)(under new criteria)

The system could continue in spite of

severe manpower crisis in central

coordinating unit (2002-2003)

Could report RTI victims risk behaviors

monthly the Deputy Prime Minister to

monitor the fight against RTI ( 2004 )



28 sentinel hospitals in network

Other 12 provincial hospitals operate this

surveillance model for local use

National project to promote child MC helmet - a

response to surveillance report

14 sentinel hospitals broaden roles to health

promoting hospital for road safety

2005 A.D.2005 A.D.



DiscussionDiscussion



DiscussionsDiscussions

To much workload is common for agency

collecting or managing surveillance data Negative impact on data quality and

timeliness Capacity of computer hardware usually

wasted in developing countries




Report of Surveillance Evaluation in Sentinel provinces (2001) Administration within the hospital

use only total number of the ER cases

Epidemics detection of minor injury

not done, nor investigated




Report of Surveillance Evaluation in Sentinel provinces (2001)

Severe injury data – used for monitoring

referral and intra-hospital trauma care

All hospitals evaluated – still used the

previous criteria !?!



Lesson learnedLesson learned

More difficult to live with less data after having it !



RecommendationsRecommendations Future establishment of national injury

surveillance system in developing countries Focus on severe injuries only Aims for quality of acute care as well as

prevention Sentinel surveillance work ! Sentinel hospitals are great partnership



ConclusionConclusion

This reporting criteria of Thailand National injury Surveillance suitable for developing countries

resources are scarce acute care still needs improvement injury prevention just begun



AcknowledgmentAcknowledgment International Collaborative Effort on Injury Statistics LA Fingerhut, MA U.S. CDC's NCHS, NIH's

NICHD 28 sentinel hospitals Surveillance evaluating

team



Results Results

Investment for the first year (not

including salary) 3.8 million baht approximately 10,000 US $ (according to the

exchange rate at present )



Results Results

Distribution of trauma cases by

severity maximum AIS scale in each patient 161,916 cases - current criteria 47,900 cases - new criteria



0

5000

10000

15000

20000

25000

30000

35000All emergency presentations

DBA,Daed ER. & Admittedinclude observed

current vs. new criteria, 15 sentinel hospitals, 1998Fig. 4 Distribution of age of trauma casesFig. 4 Distribution of age of trauma cases

<1 5-9 15-19 25-29 35-39 45-49 55-59

No. of records

Age [year]



0

10

20

30

40

50

60

70

80

90Percentage

Age [year]

Fig. 5 Distribution of age of trauma casesFig. 5 Distribution of age of trauma casescompared between current v.s. new criteria, compared between current v.s. new criteria, 15 sentinel hospitals, 1998 15 sentinel hospitals, 1998

>1

5-9

15-19

25-29

35-39

45-49

55-59

% of decreased of new criteria cases



ResultsResultsData quality A.D. 2001Data quality A.D. 2001

New national report criteria Report coverage

Observed & admitted 86% Dead cases 77%

Completeness and reliability 89% Timeliness in data entering

within 30 days 46%

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