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Developing injury surveillance systems in accident and emergency departments
  1. SIMON LENTON, Specialist Registrar (Public Health)
    1. PHILIP MILNER, Director of Public Health, Wiltshire Health Authority Southgate House, Pans Lane, Devizes, UK

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      Editor,—David Stone and colleagues are to be congratulated for producing a succinct and readable annotation explaining the criteria and pitfalls of injury surveillance systems.1 However, their brevity might lead the unsuspecting reader to underestimate the practical difficulties, and overestimate the value of injury surveillance systems in accident and emergency departments.

      There are no controlled trials, as there have been for other forms of surveillance,2 or studies of effectiveness or cost−benefit of injury surveillance systems3 4 in relation to the objectives stated under “who needs injury surveillance?” The statement that “evidence suggests that injury surveillance systems in accident and emergency departments are worthwhile and achievable” is not tenable even “when coupled with professional commitment and appropriate operational conditions”.

      The cost of injury surveillance systems that meet all the specified criteria is likely to be high,5 and some observers have questioned whether this is the best use of limited resources.6 7 Rather than develop injury surveillance systems in every accident and emergency department, consideration should be given to:

      • Implementing interventions that work8-14

      • Researching the risk factors that are amenable to change in the events leading to injury15

      • Ensuring that routinely collected data (from the health sector, coroners, and emergency services) are used to maximum effect16 17

      • Developing a single nationally representative injury surveillance system to produce good descriptive epidemiology

      • Developing alternative methods to accident and emergency departments injury surveillance systems to meet specific injury control objectives.4 18

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