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Injury surveillance in a pediatric emergency department
T A Adirim1, J L Wright, E Lee
1Department of Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA.
Insights
Emergency physicians struggle to collect injury data, with only 51% of forms completed. Combining physician data with chart review captures nearly all cases, highlighting the need for better emergency department surveillance systems.
Area of Science:
- Pediatrics
- Emergency Medicine
- Public Health
Background:
- Accurate injury data collection is crucial for understanding public health.
- Emergency departments (EDs) are key sites for treating pediatric injuries.
- Current data collection methods by physicians may be insufficient.
Purpose of the Study:
- To assess physician success in collecting pediatric injury data during ED visits.
- To compare data completeness between initial physician collection and subsequent chart review.
- To identify common injury mechanisms in children presenting to the ED.
Main Methods:
- Prospective data collection from 2,156 children (0-18 years) treated for injuries.
- Data gathered at the time of visit and via chart review the next day.
- Analysis of physician completion rates and common injury mechanisms.
Main Results:
- Physicians completed only 51% of injury data forms, with lower rates on weekends.
- Falls were the most common injury mechanism (34%) across all age groups.
- Combining physician data with chart review achieved near 100% patient capture.
Conclusions:
- Emergency physicians are not fully successful in collecting comprehensive injury data.
- Active ED surveillance, potentially without added physician burden, is vital for accurate injury problem assessment.
- Falls represent a larger proportion of ED injuries than transportation-related causes.
Abstract:
In this study we have tried to determine physician success in the collection of injury data during the emergency department visit. Prospective data were collected from all children between the ages of 0 to 18 treated for an injury. Data were collected at the time of the visit and by chart review the next day. At an urban, university-affiliated, children's hospital, data were collected on 2,156 injured children. Fifty-one percent of the data forms were completed by the treating physician. Physician completion rate was lower on the weekends (46%) than on weekdays (52%, P = .02). The most common mechanisms of injury were falls (34%), motor-vehicle crashes or pedestrians struck (13%), and nonintentional struck by blunt object (12%). The most common mechanism of injury in all age groups was falls. Our results demonstrate that emergency physicians are not successful data collectors. However, when physician data collection is combined with next-day review of patient records, virtually 100% of patients are captured. Active emergency department data collection is important because in contrast to studies which use hospital discharge and mortality data, we found that overall falls account for more injuries presenting to the ED than transportation-related causes. An active surveillance system in emergency departments that does not require extra work on the part of the treating physician would be ideal and may give a more comprehensive description of the scope of the injury problem.