Injury Epidemiology

Injury Subcommittee

CSTE members have experience and expertise in injury epidemiology and can partner with other public health agencies in order to build surveillance capacity within states, conduct surveys, write reports, and engage in other activities related to injury prevention and control. CSTE recognizes that injury prevention and control activities are strengthened when epidemiology is linked closely with organizations representing other public health disciplines and agencies. For that reason, many Subcommittee projects and publications have arisen through collaborative activities with a host of other partners, including the Safe States Alliance, the American Public Health Association (APHA), the Association of State and Territorial Health Officials (ASTHO), the Children’s Safety Network (CSN), the Society for the Advancement of Violence and Injury Research (SAVIR), the Public Health Data Standards Consortium (PHDSC), and of course CDC/NCIPC. Currently, the Injury subcommittee is working to suggest priority action items for future injury activities at CSTE.

Workgroup for External Cause Coding Improvement

The Workgroup for External Cause Coding Improvement (WECCI) is a forum led by CSTE and includes CDC, STIPDA, ASTHO, PHDSC, APHA, and other injury epidemiologists. WECCI hosts monthly conference calls and members have outlined a comprehensive agenda to improve access to quality external cause codes for injury, document the extent of deficiencies in external cause coding, and prevent federal pre-emption of external cause coding mandate with implementation of ICD10. As part of the agenda, the group developed an assessment to further specify the current and planned activities of state injury programs in their attempt to get quality data from providers, and has submitted position statements to several organizations regarding the use of external cause codes.

Members have partnered with CDC/NCIPC, CDC/NCHS, and other partners to produce an MMWR Recommendations and Reports about external cause coding [released on March 27, 2008]. The group has also has worked with partners to conduct surveys, such as the survey on external cause coding in states (How States Are Collecting and Using Cause of Injury Data: 2004 Update to the 1997 Report). WECCI is currently working to coordinate the efforts of partner organizations to increase momentum to address deficiencies in external cause coding.

Cross Cutting Projects

ISW 6- The Injury Surveillance Workgroup (ISW 6) is a collaborative led by Safe States Alliance, with participation from CSTE, CDC and SAVIR (Society for the Advancement of Violence and Injury Research). CSTE will continue to participate in ISW 6, now in its sixth “generation”, through monthly conference calls. Currently, the Workgroup is using these calls as a forum to explore the appropriate definition for an injury in hospital discharge data. The 2003 definition recommended by ISW3 only counts as cases those with a primary diagnosis of an injury while the National Center for Health Statistics (NCHS) national emergency department database counts injury codes or E-codes in other fields.

Injury Subcommittee Fact Sheet

The CSTE Injury Surveillance & Control Subcommittee was established in order to link state-based expertise in epidemiology and surveillance with injury prevention and control activities
and organizations.

Injury Surveillance Workgroup (ISW) Reports

Since 1999 CSTE has partnered with the Centers for Disease Control and the State and Territorial Injury Prevention Director’s Association (now known as Safe States) on a series of workgroups addressing injury surveillance needs at state health departments. Click on link above to see the reports

External Cause-of-Injury Coding

“The external cause of injury describes the vector that transfers the energy to the body (e.g. fall, motor vehicle traffic accident, or poisoning) and the intent of the injury (e.g. whether the injury was inflicted purposefully).

External cause–of–injury codes, also known as E–codes, are the ICD codes used to classify injury incidents by mechanism of injury (e.g., motor vehicle, fall, struck by/against, firearm, or poisoning) and intent (e.g., unintentional, homicide/assault, suicide/self–harm, or undetermined). Click on the link above for more information.

Injury Indicators

Based on CSTE’s “Blueprint for a National Public Health Surveillance System for the 21st Century”, in the late 1990s CSTE worked to create surveillance indicators for occupational health, environmental health, chronic disease and injury prevention. The recommendations from the Injury Surveillance Workgroups (see reports from those workgroups above) were used to create these indicators. With publication of each injury indicators report the indicators have evolved to include more states and additional indicators. To see the indicators, click on the link above.

Uniform Definitions and Data Elements for Surveillance

Uniform definitions and data elements are intended to promote and improve consistency of surveillance for public health practices. If recommended data elements can be uniformly recorded and the data made available to numerous users, then better estimates of the incidence and prevalence can be obtained and problems such as data incompatibility and high costs of collecting, linking, and using data can be substantially reduced. For more information, click on the link above.

Injury and Violence Surveillance Tools

This compendium provides researchers and prevention specialists with a collection of tools to assess injury- and violence-related beliefs, behaviors, and influences, as well as to evaluate programs.

National Injury Data Systems

This inventory of data systems contains links to systems containing injury-related data.

Cost of Injury

Injury is costly to the nation in terms of productivity loss due to premature death and long term disability, medical resources used for care, treatment, and rehabilitation and in pain and suffering of the affected parties. For many people, the injury causes temporary pain and inconvenience; for others, the injury leads to suffering, disability, chronic pain, and a profound change in life circumstances, including substantial financial consequences. For more resources on the cost of injury, click on the link above.

The Council of State and Territorial Epidemiologists (CSTE) and the Association of State and Territorial Health Officials (ASTHO) has developed a series of webinars to promote the application of data in the development of injury policies, programs and prevention initiatives.

On Wednesday, July 14, 2010, the first webinar in this series was held to address the role of data in developing injury policy. Speakers from academia, the Centers for Disease Control and Prevention, and state health departments gave a brief overview of the topic from a public health and academic perspective and shared their experience. At the conclusion of the webinar, participants had a better understanding of the role that data plays in policy and decision making and learned about resources and strategies implemented by their colleagues.
Featured speakers included:

Shannon Frattaroli, PhD, MPH, Assistant Professor, the Johns Hopkins Bloomberg School of Public Health

Sara Patterson, M.A., Acting Associate Director for Policy, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention

Christopher Maylahn, MPH, New York State Department of Health

Susan Hardman, Director, Bureau of Injury Prevention, New York State Department of Health

The moderators of the webcast were Christopher Maylahn, NY State Department of Health and Denise Osborn, Director of Injury Prevention, ASTHO.

For Dr. Frattaroli’s slides, click here.

For Ms. Patterson’s Slides, click here.

For Ms. Harmand’s slides, click here.

On Wednesday, June 1, 2011, a second webinar was hosted and focused on using data in developing injury policies and prevention programs. The webinar specifically focused on motor vehicle-related injuries and included presentations from federal and state public health experts about using injury data to develop legislation, plan prevention programs, target intervention strategies, and conduct evaluation.

Featured speakers included:

Randy W. Elder, PhD, MEd
Dr. Elder is the Scientific Director for Systematic Reviews for The Guide to Community Preventive Services, an evidence-based resource of recommendations to improve public health released by CDC. He previously worked in the CDC’s National Center for Injury Prevention and Control. He presented an overview of the Community Guide and how it can be used in choosing evidence-based policies and program interventions. The presentation also highlighted his experiences developing injury programs while working in the Injury Center.

Gwen Bergen, PhD, MPH
Dr. Bergen is the Behavioral Scientist on the Motor Vehicle Team in the Division of Unintentional Injury Prevention at the CDC. Her main interest is in preventing alcohol-related motor vehicle injury. She provided an overview of the following topics handled by her team: Seatbelt use, child restraints, alcohol-impaired driving, and Graduated Drivers Licensing for Teens along with suggestions for tools to use in moving from data to policy implementation.

Linda Scarpetta, MPH
Ms. Scarpetta is the Manager of the Injury and Violence Prevention Program at the Michigan Department of Community Health. She is also the current President of the Safe States Alliance, a national non-profit organization and professional association whose mission is to serve as the national voice in support of state and local injury and violence prevention professionals engaged in building a safer, healthier America. She described Michigan's experience in passing a primary enforcement seat belt law and provided examples of how data were used to successfully influence legislation, target interventions, and assess the impact of the law.

The webinar was moderated by Christopher Maylahn, MPH, Program Research Specialist with the New York State Department of Health.

To view a recording of the webinar, click here.

For Dr. Elder’s slides, click here.

For Dr. Bergen’s slides and handouts, click here for slides. Click here for handout.

For Ms. Scarpetta’s slides, click here.