Mea culpa. Guilty as charged, and very sorry to mislead... certainly
not setting a shining example, as Editors should. I read the original
article too hastily and missed the point. If readers of Lois Fingerhut's
letter agree that my editorial is severely misleading, perhaps we should
print an erratum. What do you think? In any event, please re-read Lois's
letter for an accurate description of the Bare...
Mea culpa. Guilty as charged, and very sorry to mislead... certainly
not setting a shining example, as Editors should. I read the original
article too hastily and missed the point. If readers of Lois Fingerhut's
letter agree that my editorial is severely misleading, perhaps we should
print an erratum. What do you think? In any event, please re-read Lois's
letter for an accurate description of the Barell Matrix and ignore my
editorial -- or at least that part of it!
I just received the latest issue of Injury Prevention (June 2002) and was pleased to note that an editorial had been written about the Barell matrix.[1] However, when I read it, I thought- "no, something has been misunderstood!"
Unfortunately, the editorial gives the reader the impression that the Barell matrix is one whose two dimensions are the: 1. ICD-9 CM injury diagnosis...
I just received the latest issue of Injury Prevention (June 2002) and was pleased to note that an editorial had been written about the Barell matrix.[1] However, when I read it, I thought- "no, something has been misunderstood!"
Unfortunately, the editorial gives the reader the impression that the Barell matrix is one whose two dimensions are the: 1. ICD-9 CM injury diagnosis codes (often referred to as 'N' codes) and 2 ICD-9 CM external cause of injury codes (E-codes). This is not the case. The Barell matrix uses the two dimensions of the diagnosis code: 1 the nature of the injury and 2 the body site of the injury
to describe injuries more completely.
Historically, users of ICD-9 CM have used only the nature of the injury (the fractures, open wounds, burns) to describe patterns of injury. The Barell matrix is useful for allowing the researcher (both the epidemiologist and the clinician) to fully characterize the injury so that demographics and health-related outcomes for patients, for example, with fractures to the lower extremity can be readily distinguished from patients with fractures of the vertebral column.
The Barell matrix says nothing about E-codes. In fact, there is a completely separate matrix of external cause codes that can be found under the title of "frameworks" at http://www.cdc.gov/nchs/about/otheract/ice/projects.htm
Reference
(1) Barell, L Aharonson-Daniel, L A Fingerhut, E J Mackenzie, A Ziv, V Boyko, A Abargel, M Avitzour, and R Heruti An introduction to the Barell body region by nature of injury diagnosis matrix. Inj Prev 2002;8: 91-96.
The study described by Rivara et al., which identifies intervention
research in specific areas that warrant systematic review, needs to
complemented by a similar study which identifies priorities for primary
research.[1] Clearly, the size of the problem would be one criteria. Another
equally important issue would be how many resources are currently being devoted to the issue. For example, drownin...
The study described by Rivara et al., which identifies intervention
research in specific areas that warrant systematic review, needs to
complemented by a similar study which identifies priorities for primary
research.[1] Clearly, the size of the problem would be one criteria. Another
equally important issue would be how many resources are currently being devoted to the issue. For example, drowning is a leading cause of
unintentional injury in many countries. Many developed countries devote
substantial resources to swimming training or water skills training yet
there is no published research which has determined if such training
reduces one’s risk or indeed, as some have argued, may place place one at
risk.
Reference
(1) Research on injury prevention: topics for systematic review. FP Rivara, JM Johansen, DC Thompson Inj Prev 2002;8:161-4.
We welcome the article from Legood and colleagues on visual
impairment and risk of injury.[1] More results from the Blue Mountains Eye
Study which may be of interest o readers have recently been published. In
June 2002 we published a paper in Osteoporosis International detailing
visual and other risk factors for wrist, shoulder and ankle fractures in
the Blue Mountains Eye Study.[2] Although no visual ris...
We welcome the article from Legood and colleagues on visual
impairment and risk of injury.[1] More results from the Blue Mountains Eye
Study which may be of interest o readers have recently been published. In
June 2002 we published a paper in Osteoporosis International detailing
visual and other risk factors for wrist, shoulder and ankle fractures in
the Blue Mountains Eye Study.[2] Although no visual risk factors were
found to be associated with fractures of the wrist or shoulder (possibly
because of limited power) we found that visual field deficits were
significantly associated with an increase in ankle fractures. Another
paper from this cohort study currently in press in the Journal of the
American Geriatric Society will detail associations between visual
impairment and risk of hip fracture.[3]
In addition, we are about to begin recruitment for a randomized trial
to assess the effect of improving vision on risk of falls. This trial will
recruit 1100 community dwelling people aged 75 years and older. We plan to
conduct relatively simple tests of vision (including visual acuity,
contrast sensitivity, and visual fields) and perform an eye examination,
often in subjects’ homes, and then arrange appropriate interventions
(including new spectacles, cataract surgery, laser therapy, and vision-
related home modifications and aids). Falls during 12 months of follow-up
will be ascertained with a falls calendar system.
Improving vision is likely to have other benefits besides preventing
falls, including improved physical and social function and improved health
-related quality of life. If the intervention proves effective, our
project has great potential to improve the health of many older people.
References
(1) R Legood, P Scuffham, and C Cryer. Are we blind to injuries in the
visually impaired? A review of the literature. Inj Prev 2002;8:155-60.
(2) Ivers RQ, Cumming RG, Mitchell P et al. Risk factors for fractures of
the wrist, shoulder and ankle. Osteoporos Int 2002;13:513-8.
(3) Ivers RQ, Cumming RG, Mitchell P et al. Visual Risk Factors for Hip
Fracture in Older People:the Blue Mountains Cohort. J Am Geriatr Soc 2002;
in press.
Lyman et al. report an increasing trend for the over 70s to be
involved in fatal crashes in the US. It is possible to replicate part of
their study for England using the Office of National Statistics (ONS)
Death Statistics. These data are coded using ICD9 and hence a motor
vehicle accident is coded in the range E810 to E819.
The death rates per 100,000 population were calculated using O...
Lyman et al. report an increasing trend for the over 70s to be
involved in fatal crashes in the US. It is possible to replicate part of
their study for England using the Office of National Statistics (ONS)
Death Statistics. These data are coded using ICD9 and hence a motor
vehicle accident is coded in the range E810 to E819.
The death rates per 100,000 population were calculated using ONS
annual population estimates for the years 1979 to 1999, for those aged 70
and over, and are reported below
Table 1 Deaths as a result of a motor vehicle accident, counts and
rates per 100,000, 1979 to 1999.
Male
Female
Overall
Year
Deaths
Rate per 100,000
Deaths
Rate per 100,000
Deaths
Rate per 100,000
1979
475
41.6
631
45.3
1106
43.7
1980
529
46.4
632
45.5
1161
45.9
1981
396
35.2
395
28.9
791
31.8
1982
486
44.6
521
39.4
1007
41.7
1983
449
43.6
491
39.2
940
41.2
1984
476
48.5
508
42.7
984
45.3
1985
472
45.9
528
42.7
1000
44.2
1986
514
48.0
482
37.6
996
42.3
1987
465
41.5
497
37.3
962
39.2
1988
415
35.4
481
34.7
896
35.0
1989
480
39.6
515
36.0
995
37.6
1990
506
43.1
517
37.7
1023
40.2
1991
423
36.8
467
35.2
890
36.0
1992
422
37.4
420
32.5
842
34.8
1993
372
33.3
349
27.5
721
30.2
1994
352
31.7
296
23.6
648
27.4
1995
314
28.4
334
26.8
648
27.5
1996
309
28.0
261
21.1
570
24.3
1997
327
29.6
251
20.5
578
24.8
1998
296
26.9
235
19.3
531
22.9
1999
322
29.4
236
19.7
558
24.3
When plotted these data demonstrate that in England the death rate in
the over 70s has been declining since the early 1980s and are now stable.
There has not been the 34 % increase observed in the US. The data
available for this response does not allow an exploration of why this is
so, it is possible that road speeds are slower, response times by
emergency services are faster, the cars older people drive are safer, or
that our older people are just safer drivers.
References
S Lyman, S A Ferguson, E R Braver, and A F Williams.
Older driver involvements in police reported crashes and fatal crashes:
trends and projections
Inj Prev 20028:116-20.
Office for National Statistics. (1999) 20th Century Mortality (England & Wales 1901-1995) CD-ROM (with updates). London.
I would suggest that if there is a risk compensation affect with
respect to bicycle helmets it would be very short lived. As any cyclist
knows even with a helmet it still hurts like hell when you fall off!
I welcome the paper by Chotani et al on violence in Pakistan and the empirical nature of the exploration.[1] It is also encouraging to see Injury Prevention raise the issue of violence in developing countries, as it is a neglected health problem. However, from the Pakistani context, there are several contextual and explanatory points that are needed to clarify some of the issues raised in the paper...
I welcome the paper by Chotani et al on violence in Pakistan and the empirical nature of the exploration.[1] It is also encouraging to see Injury Prevention raise the issue of violence in developing countries, as it is a neglected health problem. However, from the Pakistani context, there are several contextual and explanatory points that are needed to clarify some of the issues raised in the paper and also to add to them.
Macro-economic changes have affected the Pakistani society for the past two decades with important impacts on the health and social sectors.[2] One of the impacts is on the levels of violence and unintentional injuries - trends that have not been appropriately studied in the developing world. The imapact of adjustment programs like the Social Action Program in Pakistan therefore merit discussion in a dialogue exploring the nature and patterns of violence.
I disagree with the claim made in the paper that there have been no comparisons of police data with other data sources in Pakistan. National burden of disease analysis for Pakistan included all types of injuries and used such a comparative analysis.[3] Moreover, innovative sources of data have also been compared to police data on violence, in the literature.[4] Indeed more work needs to be done in this area to enhance the internal consistency of data from Pakistan - a research agenda for the country.
I was surprised to note the lack of attention to the role of firearms in the discussion and prevention part of the paper. The influx of firearms since the eighties, the relationship with substance abuse, and the drug trade are important considerations for exploring violence in Pakistan. There are major economic relationships between these factors and all of them facilitate and potentiate the occurence and impact of violence in the country, including political and ethnic violence. Most importantly, the control of firearms and their use is a potential preventive strategy which needs to be explored in the Pakistani context.
Although not the intent of the study, it is worth reflecting that there are enormous costs to violence everywhere. In addition to the direct and indirect medical and treatment costs to those injured or dead, there are societal costs in the form of preventive, rehabilitative, structural, and quality of life factors. If such an assessment was to be done in Karachi, I am sure one could attribute a large cost amount to violence. We must begin to use economic arguments as well, to enhance the case for greater attention to violence in the developing world.
As suggested by the authors, it is time to analyze the causes and consequences of violence in Pakistan systematically. The use of evidence in doing such analysis is critical; the development of a framework to link the different causative and impact pathways is vital; and finally the ability to mobilize Pakistani society to reject such violence and develop their own capacity for preventing it, is probably the most important.
References
(1) Chotani HA, Razzak JA, Luby SP. Patterns of violence in Karachi, Pakistan. Injury Prevention 2002;8:57-59
(2) Bhutta Z. Structural adjustment and the impact on health and society: perpsective from Pakistan. Int J Epidemiol 2001;30:712-16
(3) Hyder AA, Morrow RH. Applying burden of disease methods in developing countries: a case study from Pakistan. Am J Public Health 2000;90:1235-40
(4) Ghaffar A, Hyder AA, Bishai D. Newspaper reports as a source for injury data in developing countries. Health Policy Planning 2001;16(3):322-325
Editor's Reply
Mea culpa. Guilty as charged, and very sorry to mislead... certainly not setting a shining example, as Editors should. I read the original article too hastily and missed the point. If readers of Lois Fingerhut's letter agree that my editorial is severely misleading, perhaps we should print an erratum. What do you think? In any event, please re-read Lois's letter for an accurate description of the Bare...
Dear Editor
I just received the latest issue of Injury Prevention (June 2002) and was pleased to note that an editorial had been written about the Barell matrix.[1] However, when I read it, I thought- "no, something has been misunderstood!" Unfortunately, the editorial gives the reader the impression that the Barell matrix is one whose two dimensions are the:
1. ICD-9 CM injury diagnosis...
Dear Editor
The study described by Rivara et al., which identifies intervention research in specific areas that warrant systematic review, needs to complemented by a similar study which identifies priorities for primary research.[1] Clearly, the size of the problem would be one criteria. Another equally important issue would be how many resources are currently being devoted to the issue. For example, drownin...
Dear Editor
We welcome the article from Legood and colleagues on visual impairment and risk of injury.[1] More results from the Blue Mountains Eye Study which may be of interest o readers have recently been published. In June 2002 we published a paper in Osteoporosis International detailing visual and other risk factors for wrist, shoulder and ankle fractures in the Blue Mountains Eye Study.[2] Although no visual ris...
Dear Editor
Lyman et al. report an increasing trend for the over 70s to be involved in fatal crashes in the US. It is possible to replicate part of their study for England using the Office of National Statistics (ONS) Death Statistics. These data are coded using ICD9 and hence a motor vehicle accident is coded in the range E810 to E819.
The death rates per 100,000 population were calculated using O...
Dear Editor
I would suggest that if there is a risk compensation affect with respect to bicycle helmets it would be very short lived. As any cyclist knows even with a helmet it still hurts like hell when you fall off!
I welcome the paper by Chotani et al on violence in Pakistan and the empirical nature of the exploration.[1] It is also encouraging to see Injury Prevention raise the issue of violence in developing countries, as it is a neglected health problem. However, from the Pakistani context, there are several contextual and explanatory points that are needed to clarify some of the issues raised in the paper...
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