10.D. Workshop: Injury Severity Classification and burden of disability measurement

Abstract   Globally, injuries cause over 4.3 million deaths per year with incalculable costs for the health, legal, and social systems. Burden of disease analyses are being conducted across the world in order to map the health status of injured population, run comparisons and enable prioritization of preventive and interventional measures. Metrics of injury burden are therefore important indicators of population health that are increasingly being incorporated into national and international health information systems. To prevent injuries and their disabling health consequences, and to effectively reduce injury burden, it is essential to provide policy makers and health system planners with detailed measurements and assessments that allow them to focus resources where they are most needed and areas where more targeted policy attention might be required. However, efforts to fully understand the health outcomes of trauma patients remain inconsistent and insufficient, specifically for certain injury populations and health outcome domains. A wide variety of measures are available to track outcomes after injury in various health domains. Reaching consensus is an important step in benchmarking of outcomes across institutions and injury types to improve quality and advance the field of injury care. Modern, validated measures that are feasible and usable in both research and clinical contexts are needed to facilitate the improvement of quality and comparability of research. The workshop aims to discuss trends and variation of injury burden, which is critical to health system planning. The high human and societal costs as well as inequalities of injury mortality and burden will be highlighted based on comparisons with long-term trends. The workshop will discuss the latest developments in injury severity classification and disability measurement. The most efficient measures to calculate the valid burden of injuries will be presented and comparative measurements across EU countries will be promoted. Limitations of injury classifications and factors introducing uncertainty and potential bias in estimation of disability, will be identified. The workshop will contribute to the identification of evidence-informed tools and measurements of injury burden. Key messages • Some injury outcomes are responsible for huge individual and societal burden but are still difficult to measure. • Multiple measures are developed to assess severity and outcomes: e.g. AIS/ ISS/New ISS/ ICD-10. Efficient prevention and quality care requires validated and easy to use measures.

Politicians and policy makers often assert that they are following the science and the evidence in their decision making. Public health is proud of its rigorous scientific and evidence-based approaches and providing the numbers and facts. It is clear though that such numbers and facts, as during the pandemic, have resulted in diverse policies in different countries. Some commentators have noted that public health has lost its way, arguing that its leadership is failing, lacks courage and not sufficiently concerned with issues about social reform and political accountability and change. Is providing facts and the science sufficient to fulfil our mandate and obligations in public health? What should be our role in advocacy and engagement in politics and policy-making to promote and protect the public's health and tackle health inequalities? The purpose of the roundtable is to explore questions of whether public health is ''just science'': is it built merely on a scientific skillset; or is it about justice-promoting science? This question goes to the heart of public health's mandate, with direct implications for public health practice. The questions will be considered largely from the perspective and evidence from the Covid pandemic. There will be presentations by senior distinguished academics and public health practitioners and leaders who have been researching and advising policy makers on wide range of public health issues.
They will share their research and experience in particular from membership of the UK Independent Scientific Advisory Group (Indie_ SAGE) for the pandemic and on the Pandemic Ethics Accelerator, as well as other groups advising the government and public organisations on the analysis and implementation of policy options during the pandemic. This will be followed by reflections and discussion with the workshop participants and their reflections and insights on these critical questions.

Key messages:
Public health is not merely a technical, scientific discipline; it incorporates norms and values, and operates in a political environment where value-judgments are fundamental to decision making. Public health practitioners and leaders need to consider advocacy and engagement, and the moral foundations of public health, as key to their mandate and professional obligations.
Globally, injuries cause over 4.3 million deaths per year with incalculable costs for the health, legal, and social systems. Burden of disease analyses are being conducted across the world in order to map the health status of injured population, run comparisons and enable prioritization of preventive and interventional measures. Metrics of injury burden are therefore important indicators of population health that are increasingly being incorporated into national and international health information systems. To prevent injuries and their disabling health consequences, and to effectively reduce injury burden, it is essential to provide policy makers and health system planners with detailed measurements and assessments that allow them to focus resources where they are most needed and areas where more targeted policy attention might be required. However, efforts to fully understand the health outcomes of trauma patients remain inconsistent and insufficient, specifically for certain injury populations and health outcome domains. A wide variety of measures are available to track outcomes after injury in various health domains. Reaching consensus is an important step in benchmarking of outcomes across institutions and injury types to improve quality and advance the field of injury care. Modern, validated measures that are feasible and usable in both research and clinical contexts are needed to facilitate the improvement of quality and comparability of research. The workshop aims to discuss trends and variation of injury burden, which is critical to health system planning. The high human and societal costs as well as inequalities of injury mortality and burden will be highlighted based on comparisons with long-term trends. The workshop will discuss the latest developments in injury severity classification and disability measurement. The most efficient measures to calculate the valid burden of injuries will be presented and comparative measurements across EU countries will be promoted. Limitations of injury classifications and factors introducing uncertainty and potential bias in estimation of disability, will be identified. The workshop will contribute to the identification of evidence-informed tools and measurements of injury burden. Measuring the burden of disease due to injury is a similar process compared to the disease burden. However, burden calculations for injuries impose an extra complexity for the non-fatal burden, as it is important to consider both the 'cause' and the 'nature' of the injury. Cause of injury (e.g., road injuries, falls, drowning) have historically been used for assigning cause of death as opposed to the 'nature' of injury, which more directly specifies the pathology that resulted in death or disability. However, precisely estimating the disability as a result of an injury requires a mapping of, for example, individuals that have suffered a fracture hip ('nature' of the injury) because of falling ('cause' of the injury). This process would require a matrix of the nature-cause relation of injuries, which are only scarcely available, because they required dualcoded data registers. The presentation will zoom into the differences between disease and injury estimations and will appraise the methodological considerations for the estimations of injury-related burden of disease estimates.
The population health impact of injuries can be measured with a range of metrics. ranging from incidence and mortality to disability adjusted life years and cost-of-illness. Cost of illness gives insight into the societal burden of injury, and factors and characteristics that are associated with higher costs. Assessment of the economic burden of health care is important, because this information allows us to understand main cost drivers of health care and to monitor the impact of injury prevention and interventions. However, comparability of cost-of-illness is hampered by differences in included and excluded health care resources, the perspective and time horizon that is applied in the cost-of-illness studies and inclusion or exclusion of productivity costs. Productivity costs refer to that are caused by work absence. In our injury cost of injuries studies, we found that, among working age injury patients, productivity costs are a significant contributor to the total costs related to injury. We also found that there is a lot of variety in the health care and productivity costs in injury patients, and these costs are not solely dependent on injury severity. In this presentation, we will discuss data sources that can be used to assess the cost of illness of injuries, methodological choices that can be made and risk factors for high health care and high productivity costs.