Background
Methods
Protocol and registration
Study eligibility criteria
Information sources
Chinese Journal of Epidemiology |
Chinese Journal of Critical Care; |
Chinese Journal of Traumatology |
Chinese Journal of Industrial Hygiene and Occupational Medicine |
Chinese Journal of Disease Control and Prevention |
Chinese Critical Care Medicine |
Journal of the Fourth Military Medical University |
Journal of Sichuan University (Medical Science Edition) |
Chinese Journal of Hospital Administration |
Chinese Journal of Geriatrics |
Chinese Hospital Management |
Chinese Journal of Neurosurgical Disease |
Journal of Tongji University (Medical Science) |
Journal of Traumatic Surgery |
Shanghai Journal of Preventative Medicine |
Journal of Xinxiang Medical College |
Orthopaedic Journal of China |
Chinese Journal of Emergency Medicine |
Search strategy
Search 1 | |
---|---|
01 | China.mp or China/ |
02 | Emergency Medical Services or emergency medical services.mp |
03 | Emergencies or emergencies.mp |
04 | 2 or 3 |
05 | 1 and 4 |
06 | limit 5 to humans |
07 | limit 6 to Chinese |
Search 2
| |
01 | China.mp or China/ |
02 | Ambulances or Air Ambulances or ambulance.mp or pre-hospital care.mp |
03 | 1 and 2 |
04 | limit 3 to humans |
05 | limit 4 to Chinese |
Search 3
| |
01 | China.mp or China/ |
02 | Emergency Service, Hospital or emergency department.mp. |
03 | 1 and 2 |
04 | limit 3 to humans |
05 | limit 4 to Chinese |
Search 4
| |
01 | China.mp or China/ |
02 | injury.mp. or "Wounds and Injuries"/ |
03 | accident.mp. or Accidents/ |
04 | 2 or 3 |
05 | 1 and 4 |
06 | limit 5 to humans |
07 | limit 6 to Chinese |
Study selection and classification of the identified research
Data items of interest
Study design
|
Factors related to the circumstances of injury
|
---|---|
Design (prospective, retrospective) | Injury mechanism (transport - detail, fall, assault, poisons, burns etc...) |
Setting (location) | Location of injury (road, industrial, home) |
Number of hospital ED's in study |
Injury coding and clinical indicators
|
Data collection source/Survey tool (registry, survey) | Abbreviated Injury Score (AIS) [17] |
Date of study | Injury Severity Score (ISS) [18] |
Sample size | International Statistical Classification of Diseases and Health Related Problems (ICD) coding [19] |
Patient factors
| Glasgow Coma Score (GCS) [20] |
Age | Revised Trauma Score (RTS) [21] |
Gender | Trauma Injury Severity Score (TRISS) [22] |
Occupation |
Outcomes
|
System factors
| Admission to ICU |
Pre-hospital care/mode of arrival | Mortality rate |
Presentation/admission to ED (inclusion criteria of Review)
| Length of stay |
Financial costs |
Data collection process
Results
Focus of article | Number |
---|---|
Emergency Department injury surveillance | 13 |
Inpatient injury surveillance | 3 |
Management of injury, practices | 8 |
Injury secondary to disease | 0 |
Body region specific injury | |
Traumatic brain injury | 4 |
Face | 4 |
Thorco-abdominal | 3 |
Extremities | 2 |
Multi-trauma | 1 |
Age group specific | |
Paediatrics | 1 |
Child | 11 |
Older adults | 6 |
Retrospective prediction mortality model | 6 |
Cause specific | |
Poisoning | 3 |
Total | 65 |
Description of the identified studies: patient characteristics and injury mechanisms
25 ED study | 25 ED study | 25 ED study | NISS RC study | NISS RC study | NISS RC study | NISS RC study | Collab. Study | Collab study | Single centre | Single centre | Single centre | Single centre | Single centre | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Chen et al [23] | Li et al [24] City | Li et al [24] Rural | Zhang & Zhan [25] | Zhou et al [26] | Xu et al [27] | Li et al [28] | Li & Wang [29] | Li et al [30] | Li et al [31] | Qu et al [32] | Zhou et al [33] | Yang et al [34] | Wen et al [35] | |
Design
| Prosp. | Prosp. | Prosp. | Prosp. | Prosp. | Prosp. | Prosp. | Retro. | Prosp. | Prosp. | Retro. | Retro. | Retro. | Retro. (pre/post) |
Setting/location
| Multiple Provinces | Multiple Provinces | Multiple Provinces | Qing-dao, Shangdong | Henan | Guangdong | Gaocheng, He Bei | Guang-dong | Shantou, Guang-dong | Shantou, Guang-dong | Hangzhou, Zhejiang | Guangzhou, Guangdong | Guangzhou, Guangdong | Chonqing |
Number Hospital
| 25 | 14 | 11 | 6 | 3 | 10 | 26 | 332 | 2 | 1 | 1 | 1 | 1 | 1 |
Sample
| 25,019 | 19,906 | 5113 | 1882 | 6948 | 42,567 | 7065 | 1,093,233 | 2611 | 11,472 | 13,008 | 10,654 | 5346 | 8271 |
Survey tool
| Uniform survey | see [23] | see [23] | National CDC RC | National CDC RC | National CDC RC | National CDC RC | Report form | Uniform survey | Uniform survey | Registry log | Not stated | Registry log | Uniform survey |
Date of study
| July 01 Oct 01 Jan 02 April 02 | see [23] | see [23] | 2004 | 2004 | 2004 | Dec 03 to Nov 04 | 1997-2001 | Nov 99 - Nov 00 | 2000-2002 | 1998-2002 | 2000-2005 | Aug 03-Aug 05 | 1996-2004 |
Age
(years)
| 0-14: 12% 15-34: 50% 35-59: 31% 60+: 7% | see [23] | see [23] | < 21: 22% 21-59: 71% > 60: 4% | 0-14: 6%; 15-44: 66% 45-64: 14% 65+: 4% | 12-24: 31% 25-34: 29% | 0-4: 2% 5-14: 8% 15-19: 14% 20-24: 13% 25-44: 39% 45-64: 19% 65+: 5% | - | 20-35: 47% no specific data | 0-19: 25% 20-39: 55% 40-59: 15% 60+: 5% | - | 0-10: 2% 11-20: 7% 21-30: 33% 31-40: 25% 41-50: 20% 51+: 11% | 0-15: 10.3% 15-20: 14% 21-30: 32% 31-40: 20% 41-50: 11% 51-60: 5% 60+: 8% |
Range: Pr: 14-86 Po:16-79
Mean: Pr: 32 Po: 34 |
Sex ratio (M:F)
| 2:1 | 2:1 | 2:1 | 3.1:1 | 2.3:1 | 2.5:1 | 2.5:1 | - | 2.5:1 | 2.6:1 | - | 2.4:1 | 1.9:1 | Pr:1.6:1 Po: 1.9:1 |
Occupation
| - | Yes | Yes | Yes | Yes | - | - | - | - | - | - | - | - | - |
Arrived by EMS
| 14.4% | 14.4% | 14.4% | 29.4% | - | - | - | - | - | - | - | - | - | - |
Mechanism
| Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Location of injury
| - | - | - | Yes | Yes | Yes | - | - | - | - | - | - | - | - |
ISS/AIS severity
| - | - | - | - | - | - | - | - | - | - | - | ISS category | Deaths only | AIS ≥ 3 ISS > 15 |
ICD
| - | - | - | - | - | - | - | - | - | - | - | - | - | - |
GCS
| - | - | - | - | - | - | - | - | - | - | - | - | ||
Injury description
| - | - | - | - | Yes | Yes | - | - | - | - | - | - | - | - |
RTS
| - | - | - | - | - | - | - | - | - | - | - | - | - | - |
TRISS
| - | - | - | - | - | - | - | - | - | - | - | - | - | - |
ICU admission
| - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Mortality rate
| 0.5% P: 1.1% AI: 0.5% | 0.5% | 1.29% | - | - | - | 0.8% | 1.6% | 4% (within 3 months) | - | 1.3% | Pre-hosp: 3.4%; ED:NR | 0.3% | Pr: 7.6% Po: 3.2% |
Length of stay
| - | - | - | - | - | - | - | 16 days | - | - | - | - | - | - |
Financial cost
| - | - | - | - | - | - | - | Yes | - | - | - | - | - | - |
The '25 emergency departments' study
Parameter | % of studies (number of references) | Comments and detail |
---|---|---|
Patient Factors
| ||
Age distribution (years) | 84% (11 of 13) | |
Sex distribution (M:F) | 84% (11 of 13) | |
Occupation | 23% (3 of 13) | • Transportation worker, student, farmer, technical worker, service workers [24] • Worker, farmer, fisher [25] • Worker, student, farmer/forester/fisher [33] |
System Factors
| ||
Pre-hospital care | 23% (3 of 13) | |
Factors related to circumstances of injury
| ||
Mechanism | 100% | • 'Super-categories' (i.e., unintentional, transport) • Non-uniform use of transport/traffic |
Location | 23% (3 of 13) | • Industrial, road/street, home, school [25] • Road/street; family, operational site [26] • Operational site; road street [27] |
Injury Coding and clinical indicators
| ||
Abbreviated Injury Score severity [35] | 7.7% (1 of 13) | • For isolated trauma AIS ≥ 3 [35] |
Injury Severity Score [17] | 23% (3 of 13) | • For those admitted to ED, ISS: < 16; 16-24 [33] • For deaths only [34] • For multi-trauma ISS ≥ 15 [35] |
ICD [18] | None | |
'Other injury' description | 15% (2 of 13) | • Superficial; open; fracture (not by region) [26] • Superficial; open; fracture (not by region) [27] |
GCS [16] |
None
| |
RTS [19] |
None
| |
TRISS [20] |
None
| |
Outcomes
| ||
Mortality | 69% (9 of 13) | • Overall mortality plus traffic separately [29] • % within 3-months [30] • Pre-hospital mortality only [33] • Based on registry log only [34] |
Admission to ICU |
None
| |
Length of stay | 7.7% (1 of 13) | • Mean given [28] |
Costs | 7.7% (1 of 13) | • Costs per stay [28] |
Prospective Studies using the National Injury Surveillance System Reporting Card
'Review' Study | Author | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
---|---|---|---|---|---|---|---|---|
'25 Emergency Departments' study
| Chen et al [23] | Machine (29.9%) | Transport (24.6%) | Assault (17.8%) | Falls (16.7%) | Poisons (8.6%) | ||
Li et al [24]: City | Machine (32.9%) | Transport (21.8%) | Falls (17.9%) | Assault (13.5%) | Poisons (4.7%) | |||
Li et al [24]: Rural | Transport (35.3%) | Machine (18.2%) | Falls (12%) | Poisons (7.9%) | Assault (7.1%) | |||
NISS Reporting Card studies
| Zhang & Zhan [25] | Blunt (28.6%) | Traffic (26.8%) | Falls (16.5%) | Cutting/piercing (8.9%) | |||
Zhou et al [26] | Blunt (28.1%) | Transport (23.8%) | Falls (18.3%) | Cutting/piercing (10.3%) | Poison (6.5%) | |||
Xu et al [27] | Blunt (25.8%) | Falls (25.8%) | Traffic (16.8%) | Cutting/piercing (15.6%) | Other (6.7%) | |||
Li et al [28] | Transport (36%) | Blunt (25%) | Falls (17%) | Cutting/piercing (9%) | Poisons (6.4%) | |||
Collaborative studies
| Li & Wang [29] | MVA (36.1%) | Falls (15.3%) | Industrial (11.9%) | Assault (16.8%) | Other (25.1%) | ||
Li et al [30] | Unintentional (80.8%) | Assault (15.6%) | Suicide (3.6%) | |||||
Single-centre studies
| Li et al [31] | Traffic (38.4%) | Suicide (15.9%) | Assault (12.8%) | Falls (12.2%) | Cutting/piercing (6.2%) | ||
Qu et al [32] | Transport (77.8%) | Machine (9.6%) | Falls (8.5%) | Cutting/piercing (1.2%) | ||||
Zhou et al [33] | Transport (39.2%) | Assault (32.7%) | Machine 12.9%) | Burns (2.6%) | ||||
Yang et al [34] | Cutting/piercing (41.4%) | Falls (27.6%) | Transport (23%) | Machine (3.7%) | Burns (3.1%) | |||
Wen et al [35] | Traffic (53.4%) | Falls (20.9%) | Cutting/piercing (9.7%) | Assault (10.3%) | Machine (4.5%) | Firearms (0.21%) | ||
Comparator studies
| ||||||||
Global Burden Disease (WHO Regions) [46] | The Americas | Violence (35.9%) | Other unintentional‡ (27.8%) | Falls (19.8%) | Road traffic crashes (13.3%) | Poisoning (2%) | Fires (1%) | Drowning (0.1%) |
Europe | Falls (36.4%) | Other unintentional‡ (33.9%) | Road traffic crashes (12.4%) | Violence (11.1%) | Fires (3.7%) | Poisoning (2.3%) | Drowning (0.1%) | |
South-East Asia (incl. India) | Other unintentional ‡ (40.4%) | Falls (28.4%) | Road traffic crashes (16.9%) | Fires (8.3%) | Violence (4.3%) | Poisoning (1.6%) | Drowning (0.1%) | |
Western Pacific (incl China, Aust) | Other unintentional ‡ (34.9%) | Road traffic crashes (19.2%) | Violence (4.7%) | Poisoning (2.5%) | Fires (1.8%) | Drowning (0.1%) | ||
Country specific
| Australia [47] (hospitalisation) | Falls (36%) | Transportation (14%) | Intentional self-harm (6%) | Assault (6%) | Poisoning, pharmaceuticals (2%) | Fires, burns and scalds (1%) | |
United States [48] (hospitalisation) | Motor vehicle, cyclist, pedestrian (39.8%) | Falls (30.2%) | Struck by, against (6.7%) | Transport, other (5.3%) | Firearm (5.3%) | Cut/pierce (4.9%) | Fire/burn + flame (2%) | |
EU-region
| EU-27 [49] (fatal) | Self-inflicted (23%) | Road Traffic (20%) | Falls (17%) | Poisoning (5%) | Drowning (3%) | Interpersonal violence (2%) | Fires (2%) |
EU-27 [49], hospital admissions | Home, leisure (63%) | Road Traffic (14%) | Sports (8%) | Suicide, self-harm (6%) | Homicide/assault (4%) | Workplace (4%) | School (1%) |
Collaborative studies
Single centre studies
Isolated injury | Multiple injuries | |||
---|---|---|---|---|
Index | Mild, AIS < 3 | Severe, AIS ≥ 3 | Mild, ISS < 15 | Severe, ISS > 15 |
Time from admission to diagnosis (min) | 52% (34) | 59.7% (31) | 57% (36) | 58% (36) |
Time from admission to operation (min) | 63% (41) | 71% (37) | 64% (44) | 72% (37) |
Length of stay (days) | 48% (7) | 26% (14) | 48% (8) | 28.6% (15) |
Mortality (%) | No deaths (0) | 63% (3.4) | 66% (2.8) | 52% (6.3) |
Complication rate (%) | 14% (1.3) | 30% (8.5) | 23% (15.3) | 36% (23.7%) |