Background It is important to select robust injury indicators for international comparisons and evaluation of preventive interventions. Emergency department data provide the best opportunity for robust indicators with the greatest utility. Previous analyses have suggested that long bone fracture (LBF) incidence should be a robust population indicator for use by emergency department surveillance systems (Lyons et al. 2006 & Polinder et al. 2008). The purpose of this study was to compare between country variation in incidence using all incidence (AI) and LBF indicators in the development of robust indicators.

Methods This study was carried out using data supplied to the European Injury Data Base (IDB) from 2009–2013 as part of the Joint Action on Monitoring Injuries in Europe (JAMIE) project and now part of the BRIDGE-Health (BRidging Information and Data Generation for Evidence-based Health Policy and Research) development. Data were supplied by 26 countries. More detailed analyses were possible using data from 16 countries. European age-standardised incidence rates were calculated using estimated catchment populations.

Results The proportion of LBFs varied from 31% to 2%. There was greater (15x) variability in the LBF indicator than in the AI indicator (3x). The impact of a number of health service system effects was obvious.

Conclusions The results indicated variation in incidence that is largely due to differences in health service provision, sample data collection and estimates of catchment areas. Further work is ongoing to correct for these issues in deriving more robust indicators, e.g. using variation between observed and expected hip fracture rates as a potential correction factor.