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Applicability of CDC guidelines toward the development of an injury surveillance system in the Caribbean
  1. U A Ezenkwele,
  2. Y Holder
  1. Caribbean Epidemiology Center, Trinidad, West Indies
  1. Correspondence and reprint requests to:
 Dr Ugo A Ezenkwele, Department of Emergency Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA

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Deaths from injuries worldwide are expected to increase 65% from 5.1 million in 1990 to 8.4 million by 2020.1 This projection is based on increases in population size and age, particularly in young adult men who are at the highest risk of injury related death. Injuries constitute 7.6% of all age adjusted deaths in the developed world and 10.7% in the developing world.1 In the Caribbean, injuries (intentional or unintentional) are the leading cause of premature death as calculated by years of potential life lost.2 This is most likely an underestimate because many Caribbean countries do not monitor injuries, data sources are limited, and there is an inadequate infrastructure for reporting injuries. Improved economic conditions, in addition to increased industrialization and tourism highlight the need for injury prevention and care.

The Caribbean Epidemiology Center (CAREC) of the Pan American Health Organization/World Health Organization (PAHO/WHO) established an injury surveillance system in three countries—Trinidad and Tobago: Port of Spain General Hospital and San Fernando General Hospital; Bahamas: Princess Margaret Hospital; and Barbados: Queen Elizabeth Hospital. The system is based on Center for Disease Control and Prevention (CDC) guidelines which include simplicity, flexibility, acceptability, sensitivity, positive predictive value, representativeness, and timeliness.3 This paper describes system implementation and evaluates the applicability of these guidelines to developing countries.


The structure of the system and ease of operation is measured in seven areas—namely, staff training requirements, time management, data analysis, data transmission, reporting sources, number of organizations receiving reports, and amount of information needed to establish the case diagnosis.

Staff was trained using a train-the-trainer approach. Reporting sources were hospital accident and emergency departments (A&E) where most injuries present.4,5 Data analysis and transmission consisted of general summary reports that were sent by mail and facsimile machine.

The initial data collection …

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