BACKGROUND: Public health officials have identified injury as an important public health issue. Despite published guidelines, injury surveillance at the local level is complicated by poorly interoperable injury documentation systems within and across health jurisdictions. Data standards, designed for reporting at the state or federal level, may inform locally-driven injury surveillance and control efforts. This study catalogued local-level injury information systems and relevant data standards. Local health department injury-focused use cases illustrated each system’s strengths and weaknesses.
METHODS: Data sources for Denver, CO were identified and evaluated for quality, representativeness and timeliness. Data sources assessed included: 1) Denver’s 911 call center, 2) Denver’s primary EMS provider, 3) emergency department (ED) data aggregated by a state hospital association, and 4) trauma registry data from a safety-net hospital (Denver Health). Related data standards include those codified by the National EMS Information System and the National Trauma Data Bank. Data sources were then selected to satisfy a series of information requests made to the department.
RESULTS: Only 2 sites, the 911 call center and trauma registry actively employed processes to improve and maintain data quality. When collected, fields relevant to the use cases were relatively complete (<10% missing for most variables). However, each information system was missing variables important to epidemiological analysis. Data from the 911 call center included detailed geographic location, measurements a record of each call, but limited demographic or clinical information. EMS systems integrated geographic data from the 911 call center with a paramedic’s field observations and clinical procedures performed. ED data contained clinical and administrative data, but no data collected by EMS. Trauma registrars combine data from all these information sources (and others), but only for selected, relatively severe cases. Data collected at the local level were generally more timely and less representative, than data aggregated at the level of the state.
CONCLUSIONS: Public safety agencies, EMS providers, hospitals and trauma registries maintain complementary information systems relevant to their professional objectives which may serve local-level injury epidemiology and control. Information systems have complementary strengths. Pending more efficient system integration, epidemiologists should assess a spectrum of injury information systems, to find the one most relevant to the primary question of interest. Efforts to harmonize and fully integrate local injury data are needed.