Evaluation of an emergency department-based injury surveillance project in China using WHO guidelines

To assess an emergency department-based injury surveillance project (S-EDISP) in China using WHO evaluation guidelines. To identify problems and make suggestions for improvement.

According to the methods provided by the WHO injury surveillance guidelines, retrospective evaluation, process evaluation and system environment evaluations were implemented monthly from 1 April 2006 to 31 March 2007.

Results were collected in the three categories provided by WHO. (1) Retrospective evaluation. The injury rate from all emergency department (ED) logs was 40.4%, with no significant difference between weekends and weekdays. The accuracy of S-EDISP (percentage of injuries reported by the project) was 53.7%, and the accuracy rate (percentage of injuries accurately coded) was 79.3%. The differences between weekdays and weekends were significant for the accuracy of S-EDISP (59.0% vs 49.0%, respectively; p<0.05) and the accuracy rate (75.1% vs 88.7%, respectively; p = 0.03). The predictive value of the system was 100%. (2) Process evaluation. 87.0% of surveillance forms were filled out, and the mean (SD) completion time was 29.5 (4.0) min. Rates of incompletion of the forms were 31.6%, 40.0%, 23.8% and 50.0%, respectively, for every 6 h from 00:00 onwards (p = 0.051). (3) System environment evaluation. The staff included doctors (45.8%), interns (20.8%) and students (29.2%). Most of the staff (87.5%) had completed the S-EDISP training, and 41.7% of them reported difficulties with injury surveillance.

The accuracy of S-EDISP and completeness of the forms require improvement. Full-time, professional staff should be hired for monitoring injuries in order to provide a better work environment. The problems identified and suggestions provided should be useful in developing a national injury surveillance system for China and other low-resource regions.