Injury control research has come a long way, but more needs to be done

The question of whether injury control research has come of age and reached international standards of quality has always intrigued me. A decade or two ago, it was uncommon to read articles on injury control from certain parts of the world, particularly from developing countries. However, the same cannot be said today. This issue of the journal features articles from many parts of the world including Ghana, the United Kingdom, New Zealand, China, the United States, Colombia, and Canada. This represents quite an international coverage spanning almost all the continents of the globe. Another amazing characteristic of the featured articles is the breadth of coverage with respect to injury topics – thermal injuries, drowning, sports-related injuries, alcohol-related injuries, and youth injuries, along with two other papers on injury surveillance and the illusion of weightlessness. The science of injury control has indeed come a long way! However, problems with data collection and enforcement of injury control standards still need to be resolved in order to maximize the protection of all persons from injury as shown by two of the articles in this issue.

The first article by Adofo et al. discusses the subject of sustainable improvement in injury surveillance in Ghana using mortuary data. The article shows how data elements from such an important vital statistic data source as the mortuary are incomplete and how simple low-cost improvements can be utilized to improve the reporting of injury-related deaths from it. In fact, incomplete data are a common observation in many injury control research efforts, especially from developing countries, despite recent efforts to improve the situation. Adofo et al. noted many missing information on injury-related deaths by reviewing the mortuary logbooks of one of the teaching hospitals in Ghana. Another equally important finding from this article is the often known problem of collation of data from multiple sources.

In many situations, data from multiple sources need to be concatenated in order to have a complete picture of a particular injury problem. The Crash Outcome Data Evaluation System (CODES) project is an example, where combining hospital discharge data and police crash reports data enable researchers to estimate the benefit of safety helmets and motorcycle helmets. Either dataset has its own unique features. For example, while the hospital discharge dataset enables researchers to describe motor vehicle injuries by mechanism and cost, among others, important information such as the actual occurrence of the motor vehicle crash could only be captured by police crash reports. Therefore, any impediment to these efforts to combine data hampers injury control research. This is a major area of concern in our quest to ensure maximum protection of all persons from injury as well as attain international standards for injury control.

The second article by Foong et al. focuses on a significant preventable health problem – burn injury resulting from a common consumer product, the hair straightening device. The authors reviewed the medical case notes of all patients attending a children's hospital in Manchester, England with burns from heated hair straightening devices by mechanism of injury and healing time, among others. Additionally, they surveyed a random sample of the public in three cities including Manchester on the use of hair straightening devices and awareness of safety measures about these heated devices. They found grabbing and stepping on the heated devices to be the most common mechanism of injury, with a mean healing time of 16 days and a range of 2 to 79 days. Based on their findings, they made a recommendation that calls for appropriate safety measures by manufactures and awareness among users of consumer products to avoid these preventable injuries. However, despite the coming of age of injury control, not all settings are able to do this consumer product policing at this time.

In the United States, the Consumer Product Safety Commission (CPSC) exists to monitor dangerous and potentially harmful or toxic consumer products, issue recalls of products already on the market, and research potential hazards associated with consumer products. The CPSC studies unsafe products in several ways and maintains a consumer hotline and website through which consumers may report concerns about unsafe products or injuries associated with products. In the 1970s, for instance, the CPSC issued regulations on bicycles requiring a number of reflectors, including a white reflector mounted above the handlebar stem to make it visible to other motorists. While similar mechanisms may exist in other developed countries, such agencies are virtually non-existent in many developing countries, leaving consumers of common products exposed to the potentially harmful effects of such products. This is a second area for improvement to ensure maximum protection of all persons from injury and get the science of injury control up to international standards.

Undoubtedly, injury control research has come a long way. However, it is clear from the two cited articles that more needs to be done. Efforts to improve the completion of collected data are a first essential step. Of particular importance are vital statistics such as death certificates or records from mortuaries, police reports of vehicular crashes or other injury producing events, and health services records as pointed out by Adofo et al. Accurate and complete data on the nature of injury and injury-related deaths are sine qua non to our continued efforts at injury control and safety promotion, as is the strict enforcement of injury control standards.