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Regulations, legislation, and classification
  1. I B Pless
  1. Montreal Children's Hospital and McGill University, Montreal, Canada
  1. Correspondence to:
 Professor Pless;

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Barell matrix, Towner report, and Canada's shame


This issue includes two special features whose importance may be overlooked by some readers. Each is a work in progress, but that there is progress to report in these complex areas is highly encouraging. The first is the report by Aharonson-Daniel and her colleagues on the Barell matrix . . . the latest attempt to provide a rational, useful classification system for injuries. The second is the paper by John and Liz Towner describing their efforts to assess the importance of legislation, regulation, and national organizations in determining the injury mortality ranking of various countries.

Apart from urging readers to consider both reports carefully, I want to offer some observations of my own on these diverse topics. As is often the case, I hope to stir things up a bit and invite responses.


Vita Barell was a dynamic Israeli pioneer in the injury prevention field. She died last year at the age of 65. At the time of her death she was head of the Health Services Research Unit in the Department of Health. An important part of her legacy is the matrix for classifying injuries. Classification may not be a captivating topic, but it is essential for most who work in this field. The case of injuries is unlike that of most diseases; to be truly useful we need to know not only what part of the body was hurt, but how the event occurred. In the past, through successive iterations of the International Classifications of Diseases (ICD), this was accomplished by assigning two codes to injuries, the N code to describe the nature of injury—for example, fracture and an E code to describe the external cause—for example, a car crash. Unfortunately, too many who used ICD were content with N coding …

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