ICECI application in ICECI application in Injury Surveillance in Injury Surveillance in

Cali, ColombiaCali, Colombia

Andrés Fandiño-LosadaAndrés Fandiño-LosadaEdgar Muñoz Edgar Muñoz

María Isabel Gutiérrez MartínezMaría Isabel Gutiérrez Martínez

MethodologyMethodology►Testing of Injury Surveillance Testing of Injury Surveillance

Systems in Latin-American.Systems in Latin-American.►WHO/ PAHO & CDC initiative.WHO/ PAHO & CDC initiative.► In Cali, 2 Hospitals were selected.In Cali, 2 Hospitals were selected.

Commitment, level of care, ease in Commitment, level of care, ease in working in emergency departments.working in emergency departments.

Hospital San Juan de Dios (Level 2).Hospital San Juan de Dios (Level 2). Hospital Primitivo Iglesias (Level 1).Hospital Primitivo Iglesias (Level 1). In Colombia: 3 levels of care. 3d is the most In Colombia: 3 levels of care. 3d is the most

complex.complex.

MethodologyMethodology► ICECI Pilot data collection form was ICECI Pilot data collection form was

designed with physicians participation designed with physicians participation from Emergency Departments.from Emergency Departments.

►Data CollectionData Collection March 26 through July 26 2002.March 26 through July 26 2002. 5377 cases collected.5377 cases collected.

►Quality control during the process:Quality control during the process: Constant review of forms during field Constant review of forms during field

work.work. Correction of mistakes in the forms.Correction of mistakes in the forms. Double-entry process during typing.Double-entry process during typing.

MethodologyMethodology

►Seventeen Seventeen ICECI V.1.0.ICECI V.1.0. variables variables were used in pilot test.were used in pilot test. ICECI level 2 codes for designing the ICECI level 2 codes for designing the

General Data Set.General Data Set. ICECI level 1 codes for designing the ICECI level 1 codes for designing the

Specific Data Set.Specific Data Set. Total: Total: 485485 ICECI V.1.0. codes in 17 ICECI V.1.0. codes in 17

variables. variables. Avrg: 28.5Avrg: 28.5 codes per variable. codes per variable.

► ICECI Pilot form used 174 codes:ICECI Pilot form used 174 codes: Avrg: 10.2Avrg: 10.2 codes per variable. codes per variable.

ICECI Variables collected in Pilot ICECI Variables collected in Pilot TestTest

1.1. IntentIntent

2.2. MechanismMechanism

3.3. Object / SubstanceObject / Substance

4.4. PlacePlace

5.5. ActivityActivity

6.6. Alcohol useAlcohol use

7.7. Psychoactive drug usePsychoactive drug use

8.8. Previous suicide Previous suicide attemptattempt

9.9. Risk Factor for SuicideRisk Factor for Suicide

10.10. Perpetrator / Victim Perpetrator / Victim RelationshipRelationship

11.11. Sex of perpetratorSex of perpetrator

12.12. Context of AssaultContext of Assault

13.13. Type of Legal Type of Legal InterventionIntervention

14.14. Type of ConflictType of Conflict

15.15. Mode of TransportMode of Transport

16.16. Role of Injured PersonRole of Injured Person

17.17. CounterpartCounterpart

PILOT TEST RESULTS

►ANALYSIS OF ANALYSIS OF SURVEILLANCE DATASURVEILLANCE DATA

►APPLICATION OF APPLICATION OF VARIABLES AND VARIABLES AND CODES OF ICECI CODES OF ICECI CLASSIFICATIONCLASSIFICATION

Pilot Test of ICECI. PAHO/ CDC/ CISALVA Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del– Universidad del Valle. 2002 Valle. 2002

Age groups by Sex (%)Age groups by Sex (%)

15.4

6.65.7

4.1

20.5

29.1

17.2

21.1

16.6 15.8

3.2

11.510.4

31.4 0.8

5.6

12.1

0

5

10

15

20

25

30

35

0-9 10_19 20-29 30-39 40-49 50-59 60-69 70-79 80+

%

Females (1567)Males (3810)

Pilot Test of ICECI. PAHO/ CDC/ CISALVA Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad– Universidad del Valle. 2002 del Valle. 2002

Intent by Sex (%)Intent by Sex (%)

80.3

0.5 0.21.1

37.4

0.6 0.53.7

15.3

60.4

0

10

20

30

40

50

60

70

80

90

NonIntentional

SelfInflicted

Violence Other Unknown

%

Females (1567)Males (3810)

Pilot Test of ICECI. PAHO/ CDC/ CISALVA Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002– Universidad del Valle. 2002

Object that caused injury by Sex (%)Object that caused injury by Sex (%)

11

19.1 19.4

9.4

0.4

9.6

38.3

2.2

25

0.6

13.817.3

22.7

11.2

0

5

10

15

20

25

30

35

40

45

Floor Sharp Blunt Vehicle Firearm Other Unknw

%

Females (1567)Males (3810)

Pilot Test of ICECI. PAHO/ CDC/ CISALVA Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002– Universidad del Valle. 2002

Mechanism by Sex (%)Mechanism by Sex (%)

29.7

10.2

23.1

0.1

13.6

21.3

2

9

20.4

0.1

17

10.3

17.6

25.6

0

5

10

15

20

25

30

35

Transp Falls Pierce Blunt Firearm Other Unknw

%

Females (1567)Males (3810)

Pilot Test of ICECI. PAHO/ CDC/ CISALVA Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002– Universidad del Valle. 2002

Perpetrator/ Victim Relationship by Sex Perpetrator/ Victim Relationship by Sex (%)(%)

19.4

5.6 4.5

26.3

44.1

0.11.4

71

7.6

2

17

10

10

20

30

40

50

60

70

80

Stranger Friend Partner Relative Other Unknw

%

Females (226)Males (1342)

Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Pilot Test of ICECI. PAHO/ CDC/ CISALVA – Universidad del Valle. 2002Universidad del Valle. 2002

Risk Factors for Intentional Self-Harm by Sex Risk Factors for Intentional Self-Harm by Sex (%)(%)

Multiple Response VariableMultiple Response Variable

10.7

1.9

5.6 11.1

1.9

75.9

1317.9

75

3.67.5

7.13.6

00

10

20

30

40

50

60

70

80

Fam/ partConflict

Fam/ partDeath

UnwtdPregnancy

Psychocondition

FinancialProblem

Other Unknw

%

Females (55)Males (38)

Simplifying ICECI Collecting Simplifying ICECI Collecting FormForm

1.1. Excluding categories (codes) below a Excluding categories (codes) below a cut off point, into each ICECI variable.cut off point, into each ICECI variable.

2.2. Establishing correspondences among Establishing correspondences among categories from different variables categories from different variables for exclusion.for exclusion.

Excluding ICECI CategoriesExcluding ICECI Categories

►Statistical Criteria:Statistical Criteria: They don’t apply for “Other” and They don’t apply for “Other” and

“Unknown” codes.“Unknown” codes. Cut off point: To Exclude codes with a Cut off point: To Exclude codes with a

frequency less than 1%.frequency less than 1%. Count the number of codes for exclusion.Count the number of codes for exclusion.

►Other Criteria:Other Criteria: ConceptualConceptual PracticalPractical

Frequency of ICECI CodesFrequency of ICECI Codes

► Frequency lists for Frequency lists for each ICECI variable each ICECI variable used in pilot test.used in pilot test.

► For example,For example, Intent:Intent: 2 / 7 (28.6%) codes 2 / 7 (28.6%) codes

will be eliminated.will be eliminated.

INTENTINTENT %%UnintentionalUnintentional 66.266.2Intentional self-Intentional self-harmharm

1.81.8

AssaultAssault 31.031.0Legal InterventionLegal Intervention 0.20.2War / ConflictWar / Conflict 0.00.0OtherOther 0.30.3UnknownUnknown 0.50.5

Codes below cut-off for each Codes below cut-off for each VariableVariable

VariableVariable CodesCodes Below cut-offBelow cut-off %%

IntentIntent 77 22 28.628.6

MechanismMechanism 4141 2626 63.463.4

Object / SubstanceObject / Substance 1717 77 41.241.2

PlacePlace 1414 55 35.735.7

ActivityActivity 99 11 11.111.1

Alcohol useAlcohol use 44 00 00

Psychoactive drug Psychoactive drug useuse 44 00 00

Previous suicide Previous suicide attemptattempt 44 00 00

Risk Factor for Risk Factor for SuicideSuicide 1212 22 16.716.7

Codes below cut-off for each Codes below cut-off for each VariableVariable

VariableVariable CodesCodes Below cut-offBelow cut-off %%

Perpetrator / Perpetrator / Victim Victim RelationshipRelationship

1010 44 4040

Sex of perpetratorSex of perpetrator 44 00 00

Context of AssaultContext of Assault 1212 44 33.333.3

Type of Legal Type of Legal InterventionIntervention 44 44 100100

Type of ConflictType of Conflict 44 44 100100

Mode of TransportMode of Transport 1111 33 27.327.3

Role of Injured Role of Injured PersonPerson 77 00 00

CounterpartCounterpart 1414 11 7.17.1

Excluding ICECI VariablesExcluding ICECI Variables

► Injury Surveillance System InstrumentInjury Surveillance System Instrument► Context Dimensions used:Context Dimensions used:

MechanismMechanism ObjectObject

► Number of categories in each variable of Number of categories in each variable of dimension:dimension: Mechanism: 41 categories.Mechanism: 41 categories. Object: 17 categories.Object: 17 categories. Total: 58 categories.Total: 58 categories.

► By logic, mechanism and object By logic, mechanism and object dimensions are closely related.dimensions are closely related.

Correspondence AnalysisCorrespondence Analysis

► Statistical Method for reducing the number Statistical Method for reducing the number of categories or dimensions used in a of categories or dimensions used in a classification system.classification system.

► Components of each studied variable are Components of each studied variable are located into a n dimension cloud.located into a n dimension cloud.

► Image of that cloud is projected in 2 Image of that cloud is projected in 2 dimension space.dimension space.

► Correspondences among categories are Correspondences among categories are determined.determined.

► It’s possible to define a new unique It’s possible to define a new unique dimension from initial ones.dimension from initial ones.

Correspondence Correspondence Analysis Results …Analysis Results …

Correspondence Analysis 1

Dimension 1

12

11

10

9

8

7

6

5

4

3

2

1

0

-1

-2

-3

-4

-5

-6

-7

-8

Dim

ensi

on 2

10

0

-10

-20

-30

Object

Mechanism

Explosive materialStruck by explosive blast

FireBurn

Correspondence Analysis 2

Dimension 1

43210-1-2-3-4-5-6

Dim

ensi

on 2

10

8

6

4

2

0

-2

Object

Mechanism

Hot LiquidBurn

FirearmShot by firearm

Correspondence Analysis 3

Dimension 1

5

4

3

2

1

0

-1

-2

-3

-4

-5

-6

-7

Dim

ensi

on 2

10

0

-10

-20

Object

Mechanism

SmokeInhalation of smoke

Análisis de Correspondencias 4

Dimensión 1

3

2

1

0

-1

-2

-3

Dim

en

sió

n 2

2

1

0

-1

-2

-3

-4

-5

Objeto

Mecanismo

VehicleRoad traffic injury

AnimalStinging-Biting

PersonStruck-kickedSexual assault

Knife or cutting armsCuttingTearingBlunt force

Correspondence Analysis 4

Object

Mechanism

Análisis de Correspondencias 5

Dimensión 1

2

1

0

-1

-2

-3

Dim

ensi

ón 2

2,5

2,0

1,5

1,0

,5

0,0

-,5

-1,0

-1,5

-2,0

Objeto

Mecanismo

Blunt objectBlunt force

FloorFalls

MedicinePesticideStreet drugPoisoning

NS ObjectNS Mechanism

Correspondence Analysis 5

Object

Mechanism

Final ProposalFinal Proposal

► New dimension with a mixed variable:New dimension with a mixed variable: Mechanism / ObjectMechanism / Object

► Number of Categories in the variable of Number of Categories in the variable of each dimension:each dimension: Mechanism: 3 categories are eliminated.Mechanism: 3 categories are eliminated. Object: 10 categories are eliminated.Object: 10 categories are eliminated. Total: 13 categories eliminated.Total: 13 categories eliminated. Unique Final Variable with 45 categories.Unique Final Variable with 45 categories.

► A SIMPLER INSTRUMENT.A SIMPLER INSTRUMENT.

Pilot Test ConclusionsPilot Test Conclusions

► ICECI is a conceptual advance for ICECI is a conceptual advance for injury surveillance and injury control.injury surveillance and injury control.

►There are a lot of items in each There are a lot of items in each dimension of ICECI.dimension of ICECI.

► It’s necessary a balance between It’s necessary a balance between needs of data and instrument needs of data and instrument complexity.complexity.

►Countries with less resources need a Countries with less resources need a simpler injury surveillance system.simpler injury surveillance system.

Injury Surveillance SystemInjury Surveillance System

► Injury surveillance system continues in …Injury surveillance system continues in …

► City of Cali:City of Cali: Hospital San Juan de Dios (HSJD) – level 2Hospital San Juan de Dios (HSJD) – level 2 Hospital Mario Correa Rengifo (HMCR) – level 2Hospital Mario Correa Rengifo (HMCR) – level 2 H. Universitario del Valle (HUV) – level 3H. Universitario del Valle (HUV) – level 3 Foundation Valle del Lili Clinic (FCVL) – level 3Foundation Valle del Lili Clinic (FCVL) – level 3 Siloe Health Center (CSS) – level 1Siloe Health Center (CSS) – level 1

► City of Santander de Quilichao:City of Santander de Quilichao: H. Francisco de Paula Santander (HFPS) – level 1H. Francisco de Paula Santander (HFPS) – level 1

CISALVACISALVAInstitute for Peace Promotion and Injury / Institute for Peace Promotion and Injury /

Violence Prevention Violence Prevention