An Evaluation of the Utah Injury Reporting System By Bryan Gibson,DPT Neelam Zafar, MD, MHA

‹#› How this Project started Catherine Staes approached Sam LeFevre for a real world problem which students in the Public Health Informatics class could use as a project Students chose an Injury class, identified relevant surveillance systems, interviewed stakeholders and presented a paper describing the system This is a summary of those papers which are related to injury classes included in the Utah Injury Reporting Rule

‹#› The Utah Injury Reporting rule The Utah Legislature passed the Utah Injury Reporting Rule (UIRR) in 1997 The UIRR authorizes the Utah Department of Health (UDOH) to perform surveillance of twelve classes of injury Cases are defined by death or hospitalization Injuries must be reported to UDOH within 60 days Case report content is specified but limited

‹#› Injury Systems Evaluated UIRR Injury ClassRelated Surveillance system Implications For the Utah Injury Reporting Rule TBI/ SCIInjury prevention program AT UDOHCaptures the population required by the UIRR, but data requires significant manual processing and reporting is delayed. Utah Trauma Registry at IICRCUTR includes UIRR data fields and information about many relevant cases which are already abstracted by hospital- based trauma registrars. Blunt Force InjuryNEISS ( National Environmental Injury Surveillance System) NEISS includes only one community Hospital in Utah, therefore limited value for statewide surveillance. Captures completed suicide events, but misses attempted suicide events which are included in the the UIRR. SIRS ( School Injury Reporting System)SIRS is population based and includes less severe injuries that may be useful for identifying prevention strategies, reporting is voluntary and paper based. BurnsWork related Burns surveillance performed by Environmental Epidemiology program ( ) Implemented for 5 years but not sustainable due to single injury data system, not integrated with other data.

‹#› Injury Systems Evaluated Cont. UIRR Injury ClassRelated Surveillance systemImplications For the Utah Injury Reporting Rule SuicideUtah Violent Death Reporting SystemCaptures completed suicide events, but misses attempted suicide events which are included in the the UIRR. Chemical PoisoningUDOH- Environmental Public Health Tracking Network- Carbon monoxide Captures population indentified by the UIRR using ED, Hospital Discharge and Death records, but there are problems linking ED/Death/hospital records. Reporting latency is more than 1 year, so it is not useful for real time surveillance. HSEES (Hazardous Substances Emergency Events Surveillance)- Environmental exposures Captures potential exposures regardless of morbidity or mortality. Very useful for Public Health prevention programs. AAPCC (American Association of Poison Control Centers) Identifies acute poisoning in the population, has potential for real time surveillance. No local data storage, No UID for persons, non-standard data format.

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Conclusions/Reccomendations Utah hospitals must meet redundant and overlapping reporting requirements These reporting requirements create non- standard and redundant data silos Public Health practitioners were not aware of all existing data sources available for surveillance

‹#› Conclusions Cont. Many systems use non standard data formats which then require manual data abstraction, entry, and re-entry. Data collected under the authority of the Utah Injury Reporting Rule is not currently used. The timeliness required by the Utah Injury Reporting Rule is not consistent with the public health response indicated (CO poisoning should be more timely, TBI could be reported less frequently).

‹#› Recomendations Re-evaluate need for Utah Injury Reporting Rule Harmonize reporting requirements and create adequately explicit case definitions to enable automation Enhance use of Utah Trauma Registry

Traumatic Brain Injury Surveillance in Utah

‹#› Background  Traumatic brain injury (TBI) is a leading cause of death and disability  Each year, 1.4 million persons sustain a TBI, 50,000 die. 5.3 million Americans live with permanent TBI- related disability¹  The Utah Department of Health (UDOH) collects information about TBI-related injuries under several different reporting rules

‹#› Objective Evaluate current TBI surveillance processes, identify gaps and inefficiencies, and align Utah Injury Reporting Rule with stakeholder needs.

‹#› Methods  Identified potential data sources, described data flow, and interviewed key stakeholders including epidemiologist, educators from Violence and Injury Prevention Program at UDOH, a trauma registrar from University Hospital, and researchers from Intermountain Injury Control Research center(IICRC).

‹#› Methods  Compared current reporting case definition with definitions defined or implied by other potential data sources.  Compared current data elements used for TBI surveillance with data elements that are collected under different reporting rules

‹#› Findings  We identified three major potential data sources for surveillance of TBI-related injuries, including mortality data and hospital discharge data stored at the UDOH, and trauma registry data stored at the Intermountain Injury Control Research Center under contract by UDOH.  Public health stakeholders interviewed were unaware of the Utah Trauma Registry under contract by UDOH

‹#› Findings  CDC-funded TBI surveillance is a manual intensive process which results in the review of a 55% stratified sample and excludes non- hospitalized cases. We identified 44 data fields used.  Utah Trauma Registry captures data for admissions lasting at least 24 hours, deaths due to traumatic injury and EMS data for patients transferred from one hospital to another or by air ambulance. The Utah Trauma Registry includes all data fields required for TBI surveillance, additional data, from all Utah hospitals. At trauma level I and II hospitals a trauma registrar with direct access to the clinical Information system abstracts required information.

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Recommendation  We recommend exploring use of the Utah Trauma Registry for TBI surveillance in Utah  Eliminate requirement of reporting TBI as part of the Utah Injury Reporting Rule

‹#› References:  1. CDC. Traumatic Brain Injury in the United States: A Report to Congress. Atlanta (GA): Department of Health and Human Services, National Center for Injury Prevention and Control; 1999  2. Updated guidelines for evaluating public health surveillance systems. MMWR 2001; 50 (RR-13): 1-35.

‹#› Acknowledgements Catherine Staes, University of Utah Sam Lefevre, UDOH NLM (# LM for CJS,NZ) VA (VA special fellowship program, Office of Academic Affiliations for BG) CDC Center of Excellence in Public Health Informatics (#1P01CD for CJS). Utah Department of Health Intermountain Injury Control and Research Center.