Evaluation of a hospital-based injury surveillance system for monitoring road traffic deaths in Phuket, Thailand

Abstract

Objectives: The objective of this study was to evaluate and injury surveillance (IS) system's ability to monitor road traffic deaths and the coverage of road traffic injury and death surveillance in Phuket, Thailand. Methods: U.S. Centers for Disease Control and Prevention guidelines on surveillance system evaluation were used to qualitatively and quantitatively evaluate IS. Interviews with key stakeholders focused on IS's usefulness, simplicity, flexibility, acceptability, and stability. Active case finding of 2014 road traffic deaths in all paper and electronic hospital record systems was used to assess system sensitivity, positive predictive value, and data quality. Electronic data matching software was used to determine the implications of combining IS data with other provincial-level data sources (e.g., death certificates, electronic vehicle insurance claim system). Results: Evaluation results indicated that IS was useful, flexible, acceptable, and stable, with a high positive predictive value (99%). Simplicity was limited due to the burden of collecting data on all injuries and use of paper-based data collection forms. Sensitivity was low, with IS only identifying 55% of hospital road traffic death cases identified during active case finding; however, IS cases were representative of cases identified. Data accuracy and completeness varied across data fields. Combining IS with active case finding, death certificates, and the electronic vehicle insurance claim system more than doubled the number of road traffic death cases identified in Phuket. Conclusion: An efficient and comprehensive road traffic injury and death surveillance system is critical for monitoring Phuket's road traffic burden. The hospital-based IS system is a useful system for monitoring road traffic deaths and assessing risk behaviors. However, the complexity of data collection and limited coverage hinders the ability of IS to fully represent road traffic deaths in Phuket Province. Combining data sources could improve coverage and should be considered.

Keywords: Phuket; Road traffic death; Thailand; injury surveillance system; surveillance evaluation.

Figure 1.

Active case finding of road traffic deaths* at the provincial hospital in Phuket, Thailand, 2014: (A) Active case finding using electronic data sources and (B) active case finding using paper-based data sources. *Records were excluded if they contained an incorrect hospital number, ill-defined cause of death, cause of death not injury related, or otherwise did not meet the road traffic death surveillance case definition. Cases from both active case finding of electronic and paper-based sources were merged for a total of 187 records that met the road traffic death surveillance case definition.

Figure 2.

Flow of road traffic crash victims and IS system data collection at the provincial hospital in Phuket, Thailand, 2014.

Figure 3.

Representativeness of age and sex in the IS system as compared to active case finding at the provincial hospital in Phuket, Thailand, 2014: (A) Age group distribution of road traffic deaths in IS vs. active case finding and (B) gender distribution of road traffic deaths in IS vs. active case finding. IS system: n = 103; active case finding at provincial hospital: n = 187.