In the Netherlands, direct medical costs
of road traffic accidents resulting in an ED-visit or hospital admission are
high, comprising €400 million. This is 21% of the total direct medical costs in
the Netherlands (€1,9 milliard). Understanding causes and risk groups
provides important information for improving road safety and reducing high
costs of health care. For several authorities, but especially at regional and
local level, acquiring road traffic accident data is an important issue. It is
known that the Registered Crashes database - containing the Dutch police data - does not provide sufficient data. The Dutch Injury Surveillance System
(DISS) of the Consumer Safety Institute registers the number of injury-related
ED-visits in the Netherlands due to different causes, such as occupational –and
road traffic injuries. The goal of this study was to establish risk groups and
risk factors for road traffic accidents.
The Dutch Injury Surveillance System
(DISS) registers data of individuals who visit Emergency Departments (EDs) of a
selection of 13 hospitals in the Netherlands, injured due to an accident, an
act of violence or self-harm. These hospitals form a representative sample of
the general and university hospitals in the Netherlands providing a 24 hour
accident and emergency service. This enables extrapolation of the recorded
injury cases and of subsets of cases to national estimates. The quotient-estimate
method is used, for extrapolation, given the auxiliary variable ‘number of
ED-visits in the Netherlands.
In DISS a variety of variables is
registered, for example demographic characteristics, referral to the ED and
circumstances of the accident. In terms of road traffic injuries, the most
important variables are ‘mechanism of transport accident’, ‘mode of transport
victim’, ‘transport function victim’, ‘injury mechanism’ and ‘type of injury’.
In addition to these variables DISS registers a description of accident
circumstances and location, if present. In the participating hospitals ED staff
registers the data for every injury patient in the Electronic Medical Record
(EMR). To minimize the workload of the ED staff, existing data (e.g. gender, age,
admission date and referral to the ED) of the EMR are used as much as possible.
More specific variables like ‘means of transport’ require an additional
registration of the ED staff in the EMR. The ‘injury mechanism’ (e.g. collision
with an obstacle) and ‘type of injury’ (e.g. bone fracture) are filtered out
from an open-text field by an automatic text processor. In order to obtain the
best possible quality and completeness of data, the ED staff is instructed by
the Consumer Safety Institute about encryption and how to fill in the open-text
fields. In order to ensure the patients privacy an opt-out procedure is part of
the data collection procedure.
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