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Injury mortality indicators: recommendations from the International Collaborative Effort on Injury Statistics
  1. Colin Cryer1,
  2. Lois Fingerhut2,
  3. Maria Segui-Gomez3 on behalf of the ICE Injury Indicators Working Group
  1. 1Injury Prevention Research Unit, University of Otago, Otago, New Zealand
  2. 2International Collaborative Effort on Injury Statistics, Washington, DC, USA
  3. 3European Center for Injury Prevention, Universidad de Navarra, Pamplona, Spain
  1. Correspondence to Professor Maria Segui-Gomez, European Center for Injury Prevention, Universidad de Navarra, 31080 Pamplona, Spain; msegui{at}


Background The International Collaborative Effort (ICE) on Injury Statistics called for an effort ‘to reach consensus on what are the 10 most important indicators of injury incidence that offer the potential for international comparisons and for regional or global monitoring.’

Objectives To describe the process of developing the ICE indicators and to present the specifications of selected injury mortality indicators, along with comparisons between selected countries for those specified indicators.

Methods Participants on the ICE list had been asked to send to one of the authors what they considered the most important five indicators of injury incidence. These were synthesised and presented under six themes: mortality indicators (general); mortality indicators (motor vehicle); mortality indicators (other); hospital data-based (overall); hospital data-based (traumatic brain injury (TBI)); long-term disability (overall). Following two work group discussions and after drafting and revising indicator specifications, agreement was reached on mortality indicators and specifications. Specifications for those mortality indicators are presented. Morbidity indicators are still to be agreed.

Results The mortality indicators proposed were age-adjusted rates of injury death; motor vehicle traffic crash-related death; self-harm/suicide; assault/homicide; and TBI death. The empirical work highlighted difficulties in identifying TBI in countries where mortality data do not capture multiple injuries, prompting us to drop the mortality indicator related to TBI and moving us instead to introduce an indicator to monitor the use of undetermined intent in the classification of injury mortality.

Conclusion The ICE has reached a consensus on what injury mortality indicators should be used for comparison between countries. Specifications for each of these have been applied successfully to the mortality data of seven countries.

  • Injury
  • indicators
  • mortality
  • international comparison
  • biostatistics
  • methods
  • surveillance
  • international
  • e-code
  • terminology
  • policy
  • severity
  • score
  • international
  • developing nations

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.