GBD Injury Group Symposium

Meeting Minutes

When and Where: July 29^{th 2009} in Melbourne Australia. This was a post-meeting of the 9^th National Injury Prevention and Safety Promotion Conference.

Attended by: James Harrison, Kavi Bhalla, Jerry Abraham, Claire Bryan-Hancock, Theo Vos, Jed Blore, Lois Fingerhut, Jenn Taylor, Yvette Holder, Margie Peden, Tim Driscoll, Clare Bradley, Shanthi Ameratunga, Belinda Gabbe, Wendy Watson, Cameron Willis, Gordon Smith, Joan Ozane-Smith, Rod McClure, Ingrid Jaegers, Debbie Scott, Kirsten McKenzie, Mark Stevenson, Soufiane Boufos, and Phillip Schluter.

Purpose of the meeting:

This meeting was a chance for members of the Injury Expert Group and other interested injury prevention scientists to discuss aspects of the GBD project which have been worked on extensively over the past few months, and those that were fast approaching their completion date. There was a chance for discussion amongst members in terms of both technical/research issues and logistical issues related to collaboration. Participation in data collection and literature reviews was sought.

Issues Discussed:

Introduction to the GBD Injury Expert Group

Session leaders: Kavi Bhalla and James Harrison

Kavi discussed the background and significance of the GBD 2005 project and how the project differs from past work. Kavi also mentioned how the Injury Group operates and the guiding philosophy; that best estimates should be generated by analysis of all available data sources in a region.

James spoke about the framing of injury in the GBD project. He discussed the processes and methods involved with the project and the terms used to estimate and compare the burden of injury (YLL, YLD and DALY). James gave described ways in which injury can be defined for GBD, and how this relates to project aims, the ICD, and the practicability of obtaining data. . He also described the results of the Group’s work on revising reporting categories (framed in terms of ICD external cause codes) and GBD ‘sequelae’ (framed in terms of ICD injury codes) and gave examples of the changes that have been made after criticisms and responses from the Injury Expert Group. The new categories for the GBD 2005 project were explained, especially in terms of the division between injuries considered priority states and the levels of treatment and functioning that can be acquired by people with the same injury classification.

Injury Data for GBD

Session leaders: Kavi Bhalla and Jerry Abraham

Kavi opened the topic by discussing the global availability of data sources for GBD 2005, and the specifications of such data. This included a summary of availability of mortality data, survey data and hospital admissions data in the 21 GBD regions. Next he sketched the process of filling information gaps. In particular, Kavi described the plans for estimating the burden of injuries in sub-Saharan Africa, which will be a primary area of work for his group over the next year.

Jerry used data from Mozambique as an example of how burden of injuries could be constructed in settings that are particularly information poor. Jerry discussed the process for estimating deaths and injuries In one urban and one rural area in Mozambique and extrapolating to the country level. Jerry went on to summarise all the data sources identified this far for use in constructing regional burden of injury estimates.

The discussion that followed the presentations focussed on pointers to other potential global data sources (in particular from S. East Asia) and the possible use of forensic medicine data.

Deaths Data: Not as Straight Forward as You Might Think

Session leader: Lois Fingerhut

In this presentation Lois highlighted the implications of gathering deaths data. She discussed the fact that deaths data was not as easy to collect as once thought, and that this can be due to discrepancies between differing databases, and the misclassification of deaths to certain causes. These issues were emphasised through the examples of road traffic casualties and suicides. Lois illustrated the ways in which some of these limitations can be overcome through the use of multiple databases and by estimating the suicide rate which is classified to “undetermined intent”. This lead into discussions about the use of ICD-10 code X59 and the complications that have arisen from the use of this classification code.

GBD Disability and Injury Outcomes

Session leaders: Wendy Watson and Belinda Gabbe

Other presenters: Shanthi Ameratunga and Cameron Willis

Wendy began the presentation by discussing the validation of methods for assessing burden of injury. She discussed the fact that there are differences between the GBD weights and other systems such as III and FCI; however, outlined that it is difficult to determine whether any of these systems provide a valid estimate. Wendy also mentioned the differences that were found in measured and observed values in a hospital cohort to GBD, III, and FCI values.

Belinda gave an overview of the Victorian State Trauma Registry (Vstorm), outlining the data that is collected, outcome measures utilised, data sources, inclusion criteria, and data elements. Belinda presented data which assessed the 10 most common GBD categories seen within the trauma registry and the mean Glasgow Outcome Scale Extended (GOS-E) results for patients at 6 and 12 month follow-ups within each of these categories. She also explained data on the number of GBD categories seen per patient. This raised issues in terms of how the GBD categories can be assessed in terms of morbidity when there is a high rate of comorbidity between GBD categories.

GBD Literature Reviews on Injury: What, How, and Why Should You Do One

Session leaders: Claire Bryan-Hancock and James Harrison

Claire opened the discussion by identifying the scope of literature reviews available to conduct through the injury group involvement with the GBD project. She gave a list of the projects available in terms of injury Sequelae, and Kavi outlined the External Causes projects and Tim Driscoll commented on the Comparative Risk Assessment reviews. Claire outlined the benefits to researchers for completing a GBD literature review and the work that has been completed to help those undertaking the reviews. The steps that will be taken within a literature review were discussed in depth and symposium participants were given the chance to indicate reviews which they would have data for, or the ability to write and research the topic. Participants were encouraged to participate in the literature reviewing aspect of the project, either by starting reviews on topics on which no-one is yet working or by joining a group already working on a topic, especially one of the topics for which a large body of literature must be assessed. People interested in working on a review should contact Claire at Claire.BryanHancock@flinders.edu.au.

Meeting Presentations

Introduction Kavi Bhalla

Introduction James Harrison

Kavi Bhalla GBD Data

Jerry Abraham GBD Data Mozambique

Jerry Abraham Estimating Injury in Africa

Lois Fingerhut GBD Deaths Data

Belinda Gabbe and Wendy Watson GBD Disability and Injury Outcomes

Claire Bryan-Hancock GBD Literature Reviews