Intentional injury mortality in the European Union: how many more lives could be saved?

OBJECTIVE

To explore the scope for reducing the number of intentional injury deaths, hypothesizing that all European Union (EU) countries are able to match the experience of the country with the lowest mortality rate for intentional injuries.

DESIGN

Intentional injury mortality data for the three last available years and denominator population estimates were obtained from the World Health Organisation mortality database for the 22 EU countries with more than one million population. To estimate the potential saving of lives, the yearly average age adjusted injury mortality rates were calculated. This issue done for children (0-14), adults (15-64), and elderly people (65 and over), both including and excluding deaths from undetermined cause.

MAIN OUTCOME MEASURES

Number of lives that might potentially be saved if all EU member states matched the lowest intentional injury rate reported by an EU member state.

RESULTS

Over 73% of all intentional injury deaths could have been avoided if all EU countries matched the country with the lowest intentional injury mortality rate. EU member states would have suffered about 600 fewer intentional injury deaths in children, about 40 000 fewer adult deaths, and over 14 000 fewer intentional injury deaths in the elderly. This amounts to over 55 000 lives in a single year.

CONCLUSIONS

Many lives lost through injury might be saved if all countries were to achieve the lowest intentional injury mortality rates reported in the EU. How this theoretical observation might be translated into practice needs to be further explored as the international variation in intentional injury mortality rates in the EU results from a range of factors.

Measuring socio-economic inequalities in the presentation of injuries to a paediatric A&E department: the importance of an epidemiological approach

OBJECTIVES

To contrast the socio-economic pattern of childhood injuries presenting to a paediatric accident and emergency (A&E) department revealed by using both a numerator-based and a denominator-based approach to the analysis of injury surveillance data.

METHODS

Injury surveillance data collected during 1997-1998 at a Glasgow children's hospital A&E department were analysed. Socio-economic status was measured using Carstairs' deprivation index. Data from West Glasgow postcode sectors only were analysed in order to optimize epidemiological validity. Socio-economic patterning of injury was investigated in two ways-numerator-based and denominator-based.

RESULTS

A total of 12,762 children (0-14 years) living in West Glasgow attended the A&E department of the Royal Hospital for Sick Children over the study period. Both analytical approaches showed a clear and statistically significant excess of injury presentations in children from more deprived postcode sectors, but the variation appeared much greater in the numerator-based rather than the denominator-based approach. In regression analysis, however, only the denominator-derived rates showed a statistically significant linear trend across deprivation categories.

CONCLUSION

The most appropriate and accurate means of measuring the extent of socio-economic (and other) inequalities in injury risk is to adopt a population-based rather than numerator-based perspective on the data collected by injury surveillance systems.

Techniques for improving overall consistency of serial ECG analysis

The techniques that improve the overall repeatability of computer interpretation of electrocardiograms (ECGs) that have been recorded several minutes apart from patients in a clinically stable condition are described. Estimates of the normal amounts of variability present in many ECG parameters that are used in the identification of a variety of cardiac abnormalities have been adopted in conjunction with smoothing techniques to form the basis of the new methodology. When applied to the Glasgow ECG analysis program, these new methods improve overall repeatability by about 31% when tested on a set of 263 pairs of ECGs. Randomly generated noise was added to the test set and an additional technique aimed at removing noise from the ECG tracings was used in conjunction with the smoothing methods. The observed improvement over the original repeatability was 63%.