Burden of Sport Injuries in the European Union - Safety in Sports

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6 | February 2012
differentiation in sections of injury surveillance is not always clear-cut. There are
many reasons for this ranging from differences in the organization of the national
health care systems to cultural differences in the reporting of injury causes. The EU
IDB is a selection of cases that come into contact with the hospital accident and
emergency department. As a result certain data limitations and biases must be taken
into account when comparing data sets; specifically differences in sampling, extrapolation
methods and heath care consumption and hospitalisation practices across
countries (accessibility, specialisation of the hospitals causing under- or overrepresentation
of certain injuries, etc.) (Bauer 2005).
Country differences impacts the validity of the injury incidence calculated in each
country. For example, because of the high share of general practitioner treatments in
the Netherlands the incidence of hospital treated injuries in this country is overall
generally lower than in the other EU IDB countries. The extent to which the results
apply to any single or all countries cannot be assessed with the data at hand, in part
because the sample of countries may not be representative of the whole of Europe
and are biased to the north-western part of Europe, which overall includes countries
with higher GDPs than the rest of the European Union countries. In order to be able
to make national comparisons, these biases and comparability between IDB data sets
must be assessed and improved through the use of indicators (e.g. certain types of
fractures that are almost certainly hospital treated in all Member States thus less
sensitive to health care system biases) (Lyons et al. 2006a, Polinder et al. 2008), as
well as the use of additional data sources such as hospital discharge data. Until these
capabilities are achieved it is recommended to use an aggregated incidence as
performed in this study.
For the future of emergency department injury surveillance it is essential to link as
much as possible with relevant standard classifications in health care. The International
Statistical Classification of Diseases and Related Health Problems (ICD) is the
standard classification within health care, but does not provide enough detail for injury
prevention (Kisser et al. 2010). The International Classification of External Causes
of Injuries (ICECI) is related to the External Causes chapter of the ICD and accepted
by the World Health Organization (WHO) as a member of the WHO Family of
International Classifications (WHO 2003b). Therefore, ICECI was the major guideline
for developing the IDB coding manual (Consumer Safety Institute 2005).
The IDB coding manual only includes the data elements for which information will
be sent to a central database of the European Commission. The manual includes 18
data elements and a narrative in the core data set and five modules with in total 11
data elements only to be coded for specific types of injuries. Information on all data
elements included in this coding manual has to be sent to the European Commission