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Surveillance alone is not the answer
  1. Barry Pless
  1. Dr B Pless, Clinical Research, Montreal Childrens Hospital, 2300 Tupper, F259 Montreal, Canada H3H1P3; barry.pless{at}mcgill.ca

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One popular theme in the injury prevention literature is the perceived need for more and better surveillance. This arises because of the belief that surveillance is a prerequisite for preventive programs. I have serious reservations about this belief and I could even argue that an undue emphasis on surveillance could be harmful. That, admittedly extreme, view applies when surveillance fails to achieve its most critical objective while consuming resources that could be better directed elsewhere. Two papers in this issue identify limitations in one such emergency department (ED)-based system, the Canadian Injury Reporting and Prevention Program (CHIRPP), but neither speaks directly to my main concern.1 2

CHIRPP is modeled on a similar program (VISS) in Victoria, Australia.3 When I helped to initiate CHIRPP 18 years ago, our primary goal was to use the results to raise the profile of injuries among children.4 Because many more injured children are treated in EDs than die or are hospitalized, we naively assumed that once the public and policy makers became aware of the larger numbers, they would be moved to improve prevention.

Unfortunately, despite all the fanfare at its birth and the long interval since then, CHIRPP has prompted few preventive actions. I suspect the same is true for most other such systems. Consequently, I question whether there is any evidence that a surveillance system—even one that operates perfectly—actually contributes to prevention. If not, are there alternatives we should consider?

Before going further, let’s agree on the vocabulary: surveillance, surveys, and registries are closely related activities, but are not identical. Unfortunately, the terms are often mistakenly used interchangeably. Surveys are either one-off, episodic, or occur at regular intervals. Most surveys are able to collect detailed data, although recall problems may compromise the accuracy of some of the details.5 Registries …

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