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Reducing the Burden of Injury: Advancing Prevention and Treatment
surveillance systems used to evaluate interventions must be relevant to the scope of the intervention in terms of the geography and the population involved. If the intervention is federally mandated (e.g., a driver's side airbag), then a national-level injury surveillance system is appropriate. If, however, an injury problem and its associated risk factors are initially identified by national-level surveillance but the intervention is conducted locally, then state and local data systems are needed to determine the effectiveness of an intervention. Use of local surveillance data, for instance, played a critical role in the design and evaluation of the intervention to reduce burns and fatalities from residential house fires in Oklahoma City (Mallonee et al., 1996). The type and availability of state and local data vary substantially by area and locale.
Vital statistics data are available for all injury-related deaths. As discussed above, however, these data are limited in the information they provide about the nature and circumstances of the injury and risk factors associated with the death, and potentially helpful medical examiner and coroner reports vary in their completeness and quality.
A potentially powerful source of data for states and local communities in identifying injury risks and priorities for prevention is routine review of selected deaths by multiagency teams of experts, generally referred to as death review teams. Multiagency review of unexplained deaths among children began in Los Angeles County in 1978. In the mid-1980s, in response to the increasing awareness of severe violence against children in the United States, more teams began to emerge across the country. By June 1997, there were multiagency state and/or local teams in every state and the District of Columbia.
A challenge facing many death review teams is the management of the data collected during review sessions, which are essential for establishing prevention goals and for future evaluation of the initiative. The Center on Children and the Law of the American Bar Association has provided leadership in developing guidelines and training modules for child death review teams. These guidelines should be reviewed as a possible basis for establishing similar programs for reviewing deaths other than those of children. Surveillance systems could be supplemented with the detailed data gathered from child death review teams and similar death review teams.
State and local data on injury hospitalizations are generally available from two principal sources: trauma registries and uniform hospital discharge data. The scope and quality of hospital-based trauma registries have improved significantly over the past several years, and nearly one-half of all states now maintain such registries on a statewide basis (Shapiro et al., 1994; Rutledge, 1995). They provide detailed information about the nature and severity of the injury, its treatment, and the status of the patient on discharge from the hospital. Although basic information about the cause of the injury is always included, most registries do not collect detailed information about the event or the circumstances surrounding the event. Although inclusion criteria vary from hospital to hospital and from