Comparing pediatric intentional injury surveillance data with data from publicly available sources: consequences for a public health response to violence

Abstract

Objective-A hospital based intentional injury surveillance system for youth (aged 3-18) was compared with other publicly available sources of information on youth violence. The comparison addressed whether locally conducted surveillance provides data that are suYciently more complete, detailed, and timely that clinicians and public health practitioners interested in youth violence prevention would find surveillance worth conducting. Setting-The Boston Emergency Department Surveillance (BEDS) project was conducted at Boston Medical Center and the Children's Hospital, Boston. Method-MEDLINE and other databases were searched for data sources that report separate data for youth and data on intentional injury. Sources that met these criteria (one national and three local) were then compared with BEDS data. Comparisons were made in the following categories: age, gender, victim-oVender relationship, injury circumstance, geographic location, weapon rates, and violent injury rates. Results-Of 14 sources dealing with violence, only four met inclusion criteria. Each source provided useful breakdowns for age and gender; however, only the BEDS data were able to demonstrate that 32.6% of intentional injuries occurred among youth aged 12 and under. Comparison data sources provided less detail regarding the victim-oVender relationship, injury circumstance, and weapon use. Comparison of violent injury rates showed the diYculties for practitioners estimating intentional injury from sources based on arrest data, crime victim data, or weapon related injury. Conclusions-Comparison suggests that surveillance is more complete, detailed, and timely than publicly available sources of data. Clinicians and public health practitioners should consider developing similar systems. (Injury Prevention 1999;5:136-141)

Focus on pediatric intentional trauma

“…6 We also need to have in place, as part of our pediatric trauma team, access to pediatric psychiatry, social services, and child abuse intervention team before patient discharge. 7 Specifically, for the prevention of shaken baby syndrome, there have been several local programs, and one such champion has been the PURPLE intervention. 8,9 Educational materials given to new mothers before they leave the hospital with their babies does change knowledge and behavior about crying and shaken baby syndrome as described in the randomized controlled trial by Barr et al Interestingly, the bimodal pattern of intent injuries that we observe as child abuse in the very young (Ͻ1 year) and suicide in teens (Ͼ15 years) is also reported by others.…”

Pediatric Violence-Related Injuries in Boston

“…The detailed methods and rationale of this surveillance program have been previously published 6 and are summarized below.…”

“…6 All hospitals, as a matter of policy, accept patients older than 18 years. The 2 hospitals that contributed the greatest number of patients to the study routinely accept patients up to the age of 21 years.…”

“…1,2 However, our understanding of youth violence is based largely on deaths, criminal justice statistics, and public surveys. [3][4][5][6] Analyses of the incidence of violence-related injuries seen at a single site 7 or during a brief period 8 provide a snapshot of violence-related injury and cannot yield stable incidence estimates. Recently, a city-wide surveillance in Washington, DC, demonstrated a decline in violence-related morbidity and mortality in the late 1990s.…”

The Validity of Injury Surveillance System Measures of Assault

“…Although these public health measures are seen as avoiding many of the problems associated with more traditional measures (Stone et al, 1999), their validity and reliability have yet to be given the scrutiny traditional measures of intentional violence have received. In this article the validity of measures from a specific injury surveillance system, the Alaska Trauma Registry (ATR), is considered.…”