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Injury outcome indicators: the development of a validation tool
  1. C Cryer1,
  2. J D Langley2,
  3. S N Jarvis3,
  4. S G Mackenzie4,
  5. S C R Stephenson2,
  6. P Heywood5,
  7. on behalf of the International Collaborative Effort on Injury Statistics Injury Indicators Group
  1. 1Centre for Health Services Studies, University of Kent, Canterbury, UK and Injury Prevention Research Unit, University of Otago, Dunedin, New Zealand
  2. 2Injury Prevention Research Unit, University of Otago, Dunedin, New Zealand
  3. 3Community Child Health, University of Newcastle, Newcastle upon Tyne, UK
  4. 4Health Surveillance and Epidemiology Division, Health Canada, Ottawa, Canada
  5. 5School of Population and Health Sciences, University of Newcastle, Newcastle upon Tyne, UK
  1. Correspondence to:
 Associate Professor Colin Cryer
 Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand;


Background: Researchers have previously expressed concern about some national indicators of injury incidence and have argued that indicators should be validated before their introduction.

Aims: To develop a tool to assess the validity of indicators of injury incidence and to carry out initial testing of the tool to explore consistency on application.

Methods: Previously proposed criteria were shared for comment with members of the International Collaborative Effort on Injury Statistics (ICE) Injury Indicators Group over a period of six months. Immediately after, at a meeting of Injury ICE in Washington, DC in April 2001, revised criteria were agreed over two days of meetings. The criteria were applied, by three raters, to six non-fatal indicators that underpin the national road safety targets for Canada, New Zealand, and the United Kingdom. Consistency of ratings were judged.

Consensus outcome: The development process resulted in a validation tool that comprised criteria relating to: (1) case definition, (2) a focus on serious injury, (3) unbiased case ascertainment, (4) source data for the indicator being representative of the target population, (5) availability of data to generate the indicator, and (6) the existence of a full written specification for the indicator. On application of these criteria to the six road safety indicators, some problems of agreement between raters were identified.

Conclusion: This paper has presented an early step in the development of a tool for validating injury indicators, as well as some directions that can be taken in its further development.

  • indicators
  • incidence
  • validity

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  • * Important events, in this context, are those that result in injury that are associated with significant threat-to-life, threat-of-disablement, loss of quality of life, or increased cost.

  • Some of the “non-fatal” injury indicators include fatal and non-fatal injuries. They are described as non-fatal injury indicators since the vast majority of the injuries captured by these indicators are non-fatal.

  • * Defined as comprising people involved in a traffic crash who suffer non-fatal injuries that result in hospitalization, including for observation only, for a period of at least 24 hours. (Based on police registered crashes. Police make a judgment regarding which injuries result in a hospital stay of at least 24 hours.)

  • In parenthesis are the short form names for the indicators that are used in the text.

  • Serious injury includes fracture, internal injury, severe cuts, crushing, burns (excluding friction burns), concussion, severe general shock requiring hospital treatment, detention in hospital as an inpatient, either immediately or later, injuries to casualties who die 30 or more days after the accident from injuries sustained in that accident. (Based on police attendances or notifications of a crash, not on hospital records.)

  • § Slight injury include sprains, including neck and whiplash injury, not necessarily requiring medical treatment, bruises, slight cuts, slight shock requiring roadside attention. Persons who are merely shaken and who have no other injury should not be included unless they receive or appear to need medical treatment.