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  • Cited by 11
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    • Publisher:
      Cambridge University Press
      Publication date:
      October 2009
      November 2000
      ISBN:
      9780511530234
      9780521661522
      9780521100243
      DOI:
      https://doi.org/10.1017/CBO9780511530234
      Dimensions:
      (263 x 185 mm)
      Weight & Pages:
      0.71kg, 316 Pages
      Dimensions:
      (244 x 170 mm)
      Weight & Pages:
      0.47kg, 320 Pages
      • Subjects:
      Epidemiology Public Health and Medical Statistics, Emergency Medicine, Medicine
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    • Selected: Digital
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    Subjects:
    Epidemiology Public Health and Medical Statistics, Emergency Medicine, Medicine
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    Book description

    In the twentieth-century, evidence-based injury prevention and control strategies have contributed to a substantial decline in the number of deaths associated with injury. However, researchers in the field of injury prevention have often gathered their study methods from other disciplines; it can be difficult for injury investigators to locate all of the research tools that can be applied to problems related to injury. Injury Control: A Guide to Research and Program Evaluation addresses the growing need for a comprehensive source of knowledge on all research designs available for injury control and research. Included in this accessible guidebook is information about choices in study design, details about study execution and discussion of specific tools such as injury severity scales, programme evaluations and systematic reviews. Epidemiologists, health service investigators, trauma surgeons and emergency medicine physicians will find this a useful source for understanding, reviewing and conducting research related to injuries.

    Reviews

    "A very useful and thoughtful compendium...the strenght of this book is in its breadth of coverage of issues that concern research in injury control. Although not mentioned as a potential audience, students and others new to the subject would find this a very useful text in a course on injury epidemiology and control." American Journal of Epidemiology

    "Injury Control--A guide to Research and Program Evaluation is the fifth landmark text--one destined to propel the discipline to the next level. It is comprehensive, well written, and carefully edited. The editors are internationally eminent experts, all of whom are American, but the book has a welcome international flavor." International Journal of Epidemiology

    "No source ... had the breadth of coverage, utility, or convenience of this primer. Moreover, none offered such good examples to illustrate the research applications ... Injury Conctrol is at its strongest." BMJ

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    Contents

    Contents
    • 1 - An Overview of Injury Research
      pp 1-14
    • View abstract

      Summary

      During the twentieth century, deaths from infectious diseases have declined dramatically around the world, particularly in industrialized countries. Injury prevention strategies have long existed; however, only relatively recently have these interventions been based on firm scientific evidence and rigorous evaluation. It is the evidence-based approach to advances in injury control that holds the most promise in further reducing the impact of injury on our society. One of the most important milestones in the development of injury research was the publication of Accident Research: Methods and Approaches by Haddon et al. in 1964. Research into violence-related injury has been predominantly conducted by criminologists, psychologists, and sociologists. Injury research must incorporate the scientific advances as it searches for etiologic mechanisms of injury, tests new interventions, especially those based on new technology and laboratory discoveries, and examines the impact of interventions on patient outcomes.
    • 2 - Classifying and Counting Injury
      pp 15-31
    • View abstract

      Summary

      This chapter focuses on how injuries are classified and counted, primarily in health data systems, and how the data can be presented and used in research. The lnternational Classification of Diseases (ICD), a product of world health organization (WHO), is the most widely used classification scheme for coding deaths and morbid conditions. The ICD provides the essential guidelines for the coding and classification of cause-of-death and morbidity data. In addition to the ICD, there are other classification schemes that are unique to a specific survey or surveillance system. It includes Occupational Injury and Illness Classification System (OIICS), Nordic Medico-Statistical Committee (NOMESCO), and the International Classification of External Causes of Injury (ICECI). In order to count injuries, fatal or non-fatal, the researcher must understand the inclusion and exclusion criteria associated with various databases, or with a particular study design.
    • 3 - Measurement of Injury Severity and Co-morbidity
      pp 32-46
    • View abstract

      Summary

      This chapter describes existing measures of injury severity, reviews the rationale for their development, and discusses their use and important limitations. Scoring systems based upon the anatomic injury are an important method of measuring injury severity and are critical to injury epidemiology, injury prevention, trauma system development and outcome analysis. In addition to the information captured by scales of anatomic injury severity, measures of the physiologic response to injury such as heart rate (HR), systolic blood pressure (SBP), respiratory rate (RR), and level of consciousness are also important indicators of the severity of an injury. By combining measures of the severity of anatomic injury with those of acute physiologic derangement and age, it has been possible to provide statistically strong estimates of survival probability following trauma. Finally, the chapter also reviews the measures of co-morbidity, the term used to describe health status factors likely to influence the outcome after injury.
    • 4 - Data Linkages and Using Administrative and Secondary Databases
      pp 47-63
    • View abstract

      Summary

      Administrative and other databases originally created for purposes other than research are increasingly being considered for use in injury research. This chapter provides an overview of the benefits and limitations of use of these electronic databases, categories of uses, types of databases that have been employed in injury research, and some of the methods used. A use of secondary data is the linkage of two or more different databases resulting in a new, enriched, database. Issues that must be dealt with, in addition to those of privacy/confidentiality of information, may include the lack of a unique identifier across all databases, handling of diverse file formats, and the final ownership of the linked product. The level of time and effort required to conduct data linkages depends on the amount and type of information available to conduct a linkage, but always seems to be underestimated in the planning stages of a project.
    • 5 - Rates, Rate Denominators, and Rate Comparisons
      pp 64-74
    • View abstract

      Summary

      Rates can account for population size and time intervals. To generate a rate, the population from which the counts arose must be defined. Population size is a common choice for a denominator. Many geopolitical regions, such as cities or countries, create estimates of the population during a given year. Cumulative incidence is commonly used when the entire population from which the incident cases arise can be counted and followed to the conclusion of the observation period. Proportional incidence or proportional mortality is sometimes used when an accurate denominator is not available. A more formal statistical test of a difference in two proportions is the chi-squared test; large sample and exact methods are available in virtually any statistical package. To compare the rates of injury in two or more regions, or between time periods, it is sometimes desirable to adjust for other factors, which may confound the comparison.
    • 6 - Data Collection Methods
      pp 75-88
    • View abstract

      Summary

      The study question, logistical, sampling, and budget issues determine the data collection method. This chapter considers the suitability of various methods for different research questions. It addresses issues of feasibility, logistics of instrument design, and methods to enhance response rates and data quality. The design and use of data collection instruments are central activities in quantitative studies. Data collection instruments can be fully structured or semistructured. Semistructured instruments allow both quantitative and qualitative analysis. The chapter discusses three major categories of data collection, namely self-administered surveys, in-person interviews, and direct observation. The computerized self-administered questionnaire (CSAQ) or audio computer-assisted self-interviewing (audio-CASI) approach to data collection has recently been developed to facilitate the private collection of sensitive data by allowing respondents to interact with a computer rather than an interviewer. Computer-assisted telephone interviewing systems (CATI) are also available to improve the efficiency of data collection tasks.
    • 7 - Selecting a Study Design for Injury Research
      pp 89-103
    • View abstract

      Summary

      This chapter provides an overview of the major study designs for the injury-related research project, and highlights factors that guide the investigator to an appropriate design choice. It illustrates the application of several commonly used study designs to injury research through examples. The descriptive study design is a narrative account of a specific clinical injury case. Descriptive epidemiologic studies can be a rich source of hypotheses that can be followed up in analytic studies. An analytic study focuses on one or more hypotheses to be tested. Among analytic study designs, a key distinction is between intervention studies and observational studies. An important methodological issue in all observational studies is confounding. A variety of other analytic study designs are available for injury research. Most were developed for specialized research purposes and hence are less commonly used. Finally, the chapter discusses two other analytic study designs, namely case-crossover design and regression-discontinuity design.
    • 8 - Qualitative Methods in Injury Research
      pp 104-115
    • View abstract

      Summary

      This chapter concentrates on the potential roles of qualitative research in the conduct of injury research investigations. It presents an overview of methodologic issues in qualitative research with reference to three major qualitative research traditions: ethnography (and ethnographic interviewing), participant observation, and focus groups. Participant observation is commonly used by anthropologists to study a culture in depth. Ethnographic interviews can be nested in participant observation activities but are always conducted in the subject's community setting. Focus groups provide a relatively efficient method to elicit beliefs and attitude from multiple individuals simultaneously. The chapter discusses sampling, data collection, and measures to ensure reliability and validity of qualitative studies. The validity of findings can also be enhanced when the researcher shares the interpretation of data with subjects from the study. Qualitative research methods can be effectively combined with quantitative methods to both derive and test hypotheses regarding human aspects of injury control.
    • 9 - Randomized Trials
      pp 116-128
    • View abstract

      Summary

      This chapter orients the injury researcher to important methodologic issues in applying the randomized trial design, and illustrates how the design has been applied in injury research. It provides entry points into the literature on randomized trial methodology. The idea for a randomized trial usually originates from interest in the effects of a particular intervention, which becomes one arm of the trial. Random allocation, the feature that distinguishes a randomized trial from other study designs, is responsible for the substantial advantages of this design. Two issues of randomization are at stake. One is whether the assignment sequence that specifies which subject goes to which intervention arm is truly random. The other is allocation concealment, whether the intervention assignment of a subject is adequately hidden from persons involved in deciding whether and when the subject enters the trial. The data analysis is usually to compare the intervention groups on baseline characteristics.
    • 10 - Cohort Studies in Injury Research
      pp 129-138
    • View abstract

      Summary

      This chapter discusses a number of potentially useful measures with application to cohort studies of injuries. It reviews analytic methods for cohort studies that include crude estimates of risk and relative risk, risk difference or attributable risk, etiologic fraction percent or attributable fraction percent, and multivariate techniques. For illustration purposes, the chapter presents data from a report by Felson and associates on the Framingham Study Cohort that are used to show the effect of impaired vision on hip fracture in older adults. Cohort studies used in injury research are classified into three groups, based on the criteria for assembling the cohort: cohorts based on broad inclusion criteria that do not require an illness or injury (the cohort may represent persons in a defined population), cohorts formed from persons with a non-injury illness, and cohorts which include only persons who have been injured.
    • 11 - Case–Control Studies in Injury Research
      pp 139-156
    • View abstract

      Summary

      To study exposures which cannot be randomly assigned, we usually turn to comparative observational study designs: either cohort or case-control studies. The chapter describes the design and analysis of case-control studies. In planning a case-control study, it is helpful to think of the study as being set in a specific population or cohort, even though most members of that population will not participate in the study. In selecting cases, we should consider the step in the causal chain that we wish to study. In principle, controls should be a sample of persons from the same population from which the cases were derived. The chapter also discusses two special case-control designs, proportional mortality studies and case-crossover studies. Matching controls to cases may be justified if it promises to enhance study efficiency or to control for factors that cannot otherwise be measured.
    • 12 - Ecologic Studies
      pp 157-167
    • View abstract

      Summary

      This chapter considers only observational ecologic studies. Exploratory ecologic studies are a useful source of hypotheses about individual-level associations that can be followed up in studies that use individuals as the units of measurement and analysis. A narrow focus on individual-level associations may miss important spillover effects. Ecologic studies, in contrast, may detect them. Studies of the effectiveness of community-based intervention programs may involve determining whether presence of the law, policy, or program in a population is associated with a lower rate of adverse outcomes in that population. Because primary scientific interest focuses on group-level associations, ecologic studies are well matched to this purpose. The chapter discusses the design considerations in ecologic studies. It also focuses on concerns of special relevance to ecologic studies particularly when they are used for evaluating legal interventions, drawing freely on the Campbell and Stanley formulation.
    • 13 - Case Series and Trauma Registries
      pp 168-182
    • View abstract

      Summary

      This chapter explores the uses of case series data for the assessment of clinical care, as well as understanding the etiology of injuries. An extension of the case series is the trauma registry. The main difficulties with analysis of case series data, in general, and with trauma registry data in particular, are in attempting to make generalizations about all injury victims and about injury risk factors from patients admitted to one hospital. When attempting to obtain data on the full spectrum of injuries occurring in a given community or area, supplemental data on minor injuries will be needed. Trauma registries are an extension of case series and offer many advantages to both clinical care and the study of injury mechanisms. However, for both case series and trauma registry studies, considerable caution must be exercised in attempting to make inferences about injury risk factors and about injury characteristics of the population.
    • 14 - Systematic Reviews of Injury Studies
      pp 183-195
    • View abstract

      Summary

      This chapter focuses on systematic reviews of injury studies and discusses the structured process of reviews that involve several steps. A well focused question allows clear decisions to be made about what research to include in the systematic review and how to summarize it. The most commonly used sources are electronic bibliographic databases. Consultation with an experienced librarian helps to identify electronic databases likely to contain citations relevant to the specific research questions. Once identified, studies must be assessed to determine whether they meet inclusion criteria. Titles, abstracts, and keywords may be sufficient to exclude many studies. The chapter explains why a systematic review is done. It presents a meta-analysis of randomized controlled trials of the effect of albumin supplementation on mortality in critically ill and injured patients. Protocols for systematic reviews and completed reviews are peer reviewed and published in the Cochrane Library.
    • 15 - Evaluating an Injury Intervention or Program
      pp 196-216
    • View abstract

      Summary

      This chapter emphasizes the importance of linking an injury intervention with an evaluation plan at the outset. Evaluation is often described as having one or more of three purposes: to establish or clarify program effectiveness; to improve program implementation; and to address administrative needs. Logic or causal models suggest where to intervene. Subsequently, it is helpful to have the specific implementation intervention strategies developed on the basis of conceptual planning models. The level (practice, organization, and/or community) at which the intervention is applied, plays a major part in dictating the design of the evaluation. The chapter discusses two broad categories to describe evaluation: process evaluation and outcome evaluation. The chapter summarizes the Seattle, Washington area bicycle safety helmet campaign and the statewide childhood injury prevention program (SCIPP) in Massachusetts to demonstrate some of the choices entailed in selecting process and outcome measures.
    • 16 - The Development of Clinical Decision Rules for Injury Care
      pp 217-235
    • View abstract

      Summary

      This chapter provides injury researchers with a guide to the methodologic standards for developing high-quality clinical decision rules. It also serves as a guide to help readers critically appraise the methodologic quality of a paper or papers describing a clinical decision rule. The chapter considers the six major stages in the development and testing of a new clinical decision rule and discusses a number of standards within each stage. It uses examples from injury care and from the own research on clinical decision rules for radiography in trauma. Few clinical decision rules have been successfully derived, validated, and adopted into clinical practice. This is because development of an effective decision rule is an expensive process. Medicine has many clinical situations which would benefit from a decision rule and this provides many research opportunities. This chapter outlines important methodologic issues for both the critical reader and the clinical researcher to consider.
    • 17 - Trauma Performance Improvement
      pp 236-249
    • View abstract

      Summary

      Trauma performance improvement takes its roots from the surgical audit, which began in the nineteenth and earlier twentieth century as a system of counting procedures, complications and deaths. This chapter investigates the development of performance improvement from preventable mortality studies. These studies relied on labor intensive reviews of charts by a panel of experts; assessments were based on empiric knowledge and experience. The concept of trauma audit filters to identify specific cases was based on the use of ideal criteria against which actual performance could be measured. The chapter also investigates institutional trauma registries which have been used to provide an ongoing database of all or various subsets of trauma patients. Evidence-based medicine (EBM) provides the scientific basis for guidelines from which institution specific pathways, protocols, or care plans can be developed. This chapter also discusses the need for better system-wide approaches and measures of quality of life outcomes.
    • 18 - Measuring Disability and Quality of Life Postinjury
      pp 250-269
    • View abstract

      Summary

      This chapter discusses the epidemiology of injury outcome, and reviews the most widely used measures of disability and health-related quality of life (HRQOL). It focuses on a selected review of consumer reported measures of disability and HRQOL that are relevant to the study of injury outcomes. The emphasis on these measures as opposed to those of impairment or functional limitations reflects the growing recognition that the consumer's perspective of his or her health and well-being is central to the development and evaluation of cost-effective programs and policy. HRQOL measures are generally characterized as either psychometric measures or health status profiles, or preference based or utility measures. It should be noted that the functional capacity index (FCI) was developed specifically for measuring outcomes post-injury; its scope, however, is limited to physical and cognitive functioning. Population norms provide some benchmarks against which to compare post-injury outcomes.
    • 19 - Economic Evaluation of Injury Control
      pp 270-282
    • View abstract

      Summary

      The purpose of economic evaluation is to assist decision makers in allocating resources efficiently by taking into account the costs and effects (or consequences) of an intervention compared with the status quo or the most-likely alternative to the intervention. Economic evaluation is classified into three techniques such as cost minimization, cost effectiveness and cost benefit. It is impossible to compare cost-effectiveness ratios of alternative interventions when different units have been employed in their evaluation. In injury prevention, this becomes particularly limiting if one tries to compare the fatal and non-fatal injury prevention benefits of different interventions. An economic evaluation is only as good as the input values that one uses for the analysis. Fortunately, scientific progress in recent years has made it possible to apply economic evaluation techniques to a variety of injury control interventions.
    • 20 - Ethical Issues
      pp 283-296
    • View abstract

      Summary

      Injury control research may involve healthy control subjects as well as injured cases. Three topics emerge as particularly important ethical considerations in injury control research: the protection of vulnerable subjects, variations on the informed consent process, and maintaining the confidentiality of research data. This chapter examines each of these topics in the context of injury control research and provide examples of the ethical issues involved in each. The types of vulnerable populations in injury research include: victims of intimate partner violence, cognitively impaired subjects, critically injured trauma patients, minors, incarcerated persons or ones involved in illegal activities, and non-English or non-native speakers. The ethical issue of respect also comes in to play with regard to confidentiality and sharing of data. Research data may be obtained by a variety of methods, whether primary or secondary data, and from public and nonpublic sources.

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