Robert Bauer

Injury data needs and opportunities in Europe

Targeted injury prevention needs information, and the basis is data. The EU Council Recommendation on injury prevention of 2007 recommends that Member States make better use of the existing data, and that they implement additional injury surveillance, when appropriate, in order to obtain comparable information. In almost all Member States, some data on injuries are available: on deaths, hospital discharges, external causes of injuries, traffic accidents and workplace accidents. It is examined how far these data meet the information needs of key stakeholders in injury prevention. General information about the health burden of injury, based on mortality and hospital discharges, is available and sufficient for identifying injury as a priority for health policy. Health indicators like lost life years, rates of hospitalisation, estimated rates of disabilities or health care costs could be derived, but are not widely available yet. Information about external circumstances (causes) of injuries is indispensible for targeted prevention, but only 12 countries have a harmonised surveillance system on external causes in place (European Injury Database IDB 2009). It is recommended that the harmonised collection of data on fatalities, hospital discharges and external causes of injuries should become compulsory within the new European health information system. The provision of harmonised injury indicators should be promoted. The surveillance system on external causes (IDB) should be implemented in countries without such system. National injury data administrators (‘clearing houses’) should be established for the provision of comprehensive injury reports and for serving the needs of key stakeholders in injury prevention.

Scope and patterns of tourist injuries in the European Union

European Union (EU) countries are among the leading tourist destinations in the world. Despite growing consumer demands on the safety of travelling, injuries amongst tourists remain an essentially invisible problem. Unique national and regional data sources are the only means by which the important negative impact of injuries on the health of non-domestic tourists in the EU-15 is underlined. With an estimated number of 3800 tourists dying each year, injuries account for up to 30% of fatalities during vacation. This toll reflects an increased risk of mortality in tourists compared to the domestic population. Amendments to national and EU health and injury monitoring are suggested in order to enable authorities to examine personal risks to travellers in more detail.

Unintentional child home injury incidence and patterns in six countries in Europe

This study investigates the incidence and patterns of child home injuries in six European Union countries. Emergency department and inpatient injury data on injuries to children aged 0–18 years in the home (n = 88,567) for the years 2003–2004 were extracted from the European Injury Database in Austria, Denmark, France, Netherlands, Portugal and Sweden. The incidence of child home injuries was 44.9/1000 inhabitants Six age-dependent injury patterns were identified using cluster analysis: 1) open wound head injuries; 2) hospital admissions for bruises, contusions, abrasions; 3) falls on stairs indoors; 4) fractures and sprains of the upper extremities; 5) crush/cut/piercing of the fingers; 6) miscellaneous injuries. Child home injuries are a considerable public health problem, particularly in the ages 0 to 4 years. The findings are useful for injury surveillance at the European level yet do not allow for designing testable countermeasures for prevention within home safety initiatives.

SM 04-1272 Under-reporting of vulnerable road users in official eu road accident statistics – implications for road safety and added value of eu idb hospital data

The EU road safety policy aims to cut European road deaths by 50% by 2020 compared to 2010 and reduce non-fatal injuries accordingly. To do so, it also seeks to make vulnerable road users (VRU) safer by improving communication; and improving tools for collecting and analysing accidents. However, official data for assessing road safety seems to be considerably biased against VRU. According to police records about 1.4 million road traffic users were injured in the EU in 2014, 135 000 of which were seriously injured. In contrast, according to recent estimates of the hospital-based EU Injury Database (IDB), 3.4 million road traffic injuries occur annually, 625 000 of which must be admitted to hospital. This indicates a considerable under-reporting of road traffic injuries in police records. Under-reporting in police records is particularly high for cyclists (by a factor of 4.5), pedestrians (1.8), and powered two-wheelers (1.9). As a result, VRU account for almost 70% of road accident casualties attending hospital, as opposed to ‘ only’ about 50% in police records. IDB data for twelve EU countries further reveal that under-reporting is especially high for senior pedestrians (65+ years). A safe and healthy environment is a crucial factor for people to choose cycling and walking as their preferred choice of individual travel. To adequately address the safety needs of these modes of transport, the real scope and pattern of VRU accidents need to be known. In this respect, the use of hospital data in road safety management, complementary to police data, is strongly recommended.

226 Using Long bone fractures as an injury incidence indicator in Europe

Background It is important to select robust injury indicators for international comparisons and evaluation of preventive interventions. Emergency department data provide the best opportunity for robust indicators with the greatest utility. Previous analyses have suggested that long bone fracture (LBF) incidence should be a robust population indicator for use by emergency department surveillance systems (Lyons et al. 2006 & Polinder et al. 2008). The purpose of this study was to compare between country variation in incidence using all incidence (AI) and LBF indicators in the development of robust indicators. Methods This study was carried out using data supplied to the European Injury Data Base (IDB) from 2009–2013 as part of the Joint Action on Monitoring Injuries in Europe (JAMIE) project and now part of the BRIDGE-Health (BRidging Information and Data Generation for Evidence-based Health Policy and Research) development. Data were supplied by 26 countries. More detailed analyses were possible using data from 16 countries. European age-standardised incidence rates were calculated using estimated catchment populations. Results The proportion of LBFs varied from 31% to 2%. There was greater (15x) variability in the LBF indicator than in the AI indicator (3x). The impact of a number of health service system effects was obvious. Conclusions The results indicated variation in incidence that is largely due to differences in health service provision, sample data collection and estimates of catchment areas. Further work is ongoing to correct for these issues in deriving more robust indicators, e.g. using variation between observed and expected hip fracture rates as a potential correction factor.

223 Are register-based data better than surveys in estimating burden of injuries among adults? results from Luxembourg

Background Injury is a major cause of mortality and morbidity. The emergency department (ED) registry based data, provides a cost-effective way to estimate the burden of injuries. Previous studies in general population have suggested that survey based data collection is not efficient and suffers from recall or selection bias. The aim of this study was to compare the yearly incidence of home, leisure, traffic and work injuries estimated by survey-based and registry based methods among adults in Luxembourg. Methods Survey based data on 1529 residents aged 25–64, were collected during 2013/2014 in the frame of the European Health Examination Survey (EHES). Luxembourgish ED registry based data supplied to the European Injury Data Base (IDB) for the period 2013–2014 were used for the comparison. Both IDB and EHES are now part of the BRIDGE-Health (BRidging Information and Data Generation for Evidence-based Health Policy and Research) development. Results The estimated incidence rate of all the selected injuries from registry-based data was 8.4% in 2013 and 8.3% in 2014. From survey based data the incidence of; injuries treated in hospital (CI: 95%) was 8.8% (7.7%; 10.4%), treated outside the hospital was 3.6% (2.8%: 4.7%) and not medically treated was 2.7% (2.0%: 3.7%). Conclusions Both survey and registry based data are concordant in estimating ED treated injury incidence among 25–64 years old in Luxembourg.

246 Five years of mandatory bicycle helmets for children in Austria – a post hoc evaluation

Background In Austria, bicycle helmets have been mandatory on public roads for children under 12 years of age since May 31, 2011 (23rd amendment to the road safety act). The regulation was introduced as an awareness measure and is primarily designed to protect children from head injuries. Thus, there are no consequences for violation of the regulation. Methods Post hoc evaluation of the effect of the helmet wearing legislation comprised the use of existing data sources about helmet wearing and the rate of head injuries. The main data source used for the analysis, the Injury Databases (IDB Austria), is quite unique for this purpose as it provides information on both the type of road user and the type of injury. The results on helmet wearing are based on regularly conducted counts, performed bi-annually since 2005. Results After the introduction of the regulation a significant increase of the helmet wearing rate was observed in the target group: before the introduction about 65% of children under 12 wore a helmet, by 2014 the rate was 87%. This trend in helmet wearing was mirrored also in the development of the rate of head injuries of child bicyclists who were treated in hospital after an accident: before the helmets became mandatory 47% of the children under 12 years had head injuries, by 2014 the rate was 38%. Conclusions As intended by the regulation, an increase in the proportion of children wearing a helmet and a decrease in the rate of head injuries was observed. However, both trends need to be further observed in order to evaluate the supposed effect of the legislation in the long run. By the time of the Safety2016 taking place, the most recent data on both indicators will be presented in addition to results given above.

220 The European injury data base: supporting injury research and policy across Europe

Background Although various injury data sources exist in Europe; many lack sufficient size, scope, detail or comparability, to support injury prevention research or policy development. Emergency department (ED) records offer one of the most comprehensive sources of injury data; however, heterogeneous hospital data collection systems prevent comparative analyses between countries. Methods As part of the Joint Action on Monitoring Injuries in Europe (JAMIE) project, and now the BRIDGE-Health (BRidging Information and Data Generation for Evidence-based Health Policy and Research) development; the European Commission (EC) funded the development of a standardised European Injury Data Base (IDB). The IDB comprises two datasets: the Full Data Set (FDS) and Minimum Data Set (MDS). Although the MDS collects less detail than the FDS; it is simpler for countries to adopt, and still sufficient to allow enumeration of injuries in key areas such as the home, leisure, work, road, falls, sports, and self-harm. Training, guides and rigorous quality checks, ensure consistency across participating countries. Results To date, 26 countries have submitted 7,170,069 ED records (years 2009–2014) to the IDB in MDS format, and 20 countries have provided reference population data, enabling the calculation of incidence rates. As an exemplar, in 2013, incidence rates for all injuries varied between 11.43% in Luxembourg to 3.98% in Finland; the reasons behind these variations will be discussed at the conference. The MDS has provided a valuable source of data for several organisations across Europe, and can be accessed via several channels, including an online tool. The MDS strives to contribute data to the “European Core Health Indicators” (ECHI), “home, leisure and school accidents” (ECHI29) indicator. Conclusions The MDS provides Europe with a valuable source of comparable injury data. Work is currently underway to ensure the MDS data is as valid and representative as possible.