1Ministry of Public Health, Thailand

1
From Provincial to National The Development of
Thailand Injury Surveillance

• Chamaiparn Santikarn, MD., MPH.
• Non-communicable Diseases Bureau, Ministry of
  Public Health
• Siriwan Santijiarakul, MSc.
• Epidemiology Bureau, Ministry of Public Health,
  Thailand

2
Introduction

• 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)

3
Introduction

• System objectives Establish a database for
  assessing acute care and referral services and
  facilitate injury prevention at provincial and
  national levels

4
Data flow and responsible unit
E.R. Nurse
Medical Record Department Medical Statistics
Technicians
Diskette to Epidemiology Division
Report distributed within hospital and province
6 mnth.
4-6 mnth.
National action
Local action
5
Introduction

• Emphasized on local utilization for action than
  centralizing the data
• Local information users - physicians, nurses and
  policymakers
• PC software specifically developed for local
  processing

6
Introduction

• 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

7
Introduction

• System expanded to 22 large hospitals
• In 2001, national coordinating unit proposed
  reduced reporting criteria, included only severe
  injuries (deaths, observed and /or admitted)
  
  

8
Objectives

• Gain better representativeness of important
  injury events in each province
• Better data quality
• Decrease resource need

Dr. Chamaiparn Santikarn
19 ??????? 2554
9
Methods

• 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

10
A.D. 2001 22 reporting sentinel sites
15 study sites
7 Other sites
11
Methods

• In December 2000
• Workshop for Establishing the National Injury
  Surveillance
• Analysis results presented

12
Results

• 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

13
Fig. 1 Distribution of maximum AIS of trauma
cases
previous vs.. new criteria, 15 sentinel
hospitals, 1998
No. of records
1
3
2
4
5
6
Max. AIS
Source 15 sentinel
hospitals, provincial injury surveillance,
Thailand.
14
Fig. 2 Distribution of maximum AIS of trauma
cases
previous vs.. new criteria, 13 non -Bangkok
hospitals
No. of records
2
5
4
6
1
3
Max. AIS
Source sentinel hospitals,
provincial injury surveillance, Thailand 1998.
15
Fig. 3 Distribution of maximum AIS of trauma cases
previous vs.. new criteria, Bangkok,1998
No. of records
1
3
5
4
6
2
Max. AIS
Source sentinel hospitals
in Bangkok , provincial injury surveillance,
Thailand .
16
Results

• 5 leading cause of injuries in each sentinel site
  
• Minor change 2nd - 3rd rank
• Tendency towards external causes with more
  severe outcome

17
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
Self-harm 13,520 6.9
Self-harm 2,619 4.1
Others 12,085 6.5
Others 4,038 6.3
Total 197,140 100.0 Total
63,607 100.0
18
Results

• 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

19
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

20
Results

• Simple computer technique
  needed to manage electronic file
  before sending in the data

21
Results (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 )

22
2005 A.D.

• 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

23
Discussion
24
Discussions

• 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

25
Discussions

• 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

26
Discussions

• 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 !?!

27
Lesson learned

• More difficult to live with less data
  after having it !

28
Recommendations

• 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

29
Conclusion

• This reporting criteria of
  Thailand National injury
  Surveillance suitable for developing countries
  
• resources are scarce
• acute care still needs improvement
• injury prevention just begun

30
Acknowledgment

• International Collaborative Effort on Injury
  Statistics
• LA Fingerhut, MA
• U.S. CDC's NCHS, NIH's
  NICHD
• 28 sentinel hospitals
• Surveillance evaluating
• team

31
Results

• Investment for the first year (not including
  salary)
• 3.8 million baht
• approximately 10,000 US
  (according to the exchange rate
• at present )

32
Results

• Distribution of trauma cases by
• severity
• maximum AIS scale in each patient
• 161,916 cases - current criteria
• 47,900 cases - new criteria

33
Fig. 4 Distribution of age of trauma cases
current vs. new criteria, 15 sentinel
hospitals, 1998
No. of records
Age year
lt1
5-9
15-19
25-29
35-39
45-49
55-59
34
Fig. 5 Distribution of age of trauma cases
compared between current v.s. new criteria,
15 sentinel
hospitals, 1998
Percentage
5-9
25-29
45-49
gt1
15-19
35-39
55-59
of decreased of new criteria cases
Age year
35
ResultsData 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