Problems and Solutions

Population Based Studies

As many reviewers have pointed out, for some countries and regions within the world it is not possible to gain population data surrounding certain types of injury. In these cases it is best to evaluate data that has come from clinical samples, particularly within hospitals. This data will help us to gain at least some understanding of the rates of injury that are seen within hospitals in that particular region. While these are not the estimates we were hoping to gain, it is best to have some idea of the injury rate in comparison to none.

If possible take a look at injury estimations for your particular injury review and compare the rate that is given for hospital admissions and population incidence. This may give an understanding of whether, for the particular injury of interest, hospital data could be seen as a near estimate of the true incidence levels.

Hospitals data may also give an indication of how long patients are likely to suffer with particular injuries and to what extent sufferers will require out-patient care such as rehabilitation and in what countries these facilities are offered and available.

Sequelae topics which are comprised of multiple injury types

Some of the sequelae topics that are being reviewed can comprise of multiple injuries, an example of this is “severe chest injury”, which can include, aortic injuries, rib fractures, lung contusions, etc. For these topics the data should be gathered in terms of each individual injury where necessary and practical. In all other cases simply refer to the incidence rates of the topic as a whole. For countries where there is substantial data in terms of the rates for each individual injury covered within the review topic, a breakdown of representative regions can be given within the literature review. This can give readers an idea of the extent of injuries that are encompassed within the particular review topic.

Denominator Value

In some studies the denominator will be a choice between either patients that have been seen within a selection of trauma centres and hospitals, or the population for the specific town/region/country. In this situation using the amount of patients recorded with a certian injury as found within the selected trauma centres and hospitals will cause either a severe over-estimate or a severe under-estimate.

At present we are working with an over-representation although this will need to be evaluated prior to the submission of data. In these cases it may be best to compare the rate that is derived from both possible denominators and compare with other studies within the same country and GBD region.