Marco Giustini

Marco Giustini

Epidemiologist. Researcher at the Italian National Institute of Health (ISS). I worked in the Environmental and Social Epidemiology Unit of the ISS, dealing with injury prevention and control. Authors of 36 scientific papers (H-Index 17) and scientific manager of 5 projects at national and international levels, currently I manage the European Injury Database, the surveillance system (hosted by ISS) based on injury attendance at Emergency Department

5 October 2023 16:00 - 16:45
Room A

The EU-IDB (European Injury Database) is a surveillance system focused on external causes of injuries. It is based on hospital’s Emergency Department (ED) registers and is complementary to health population-based registries. The IDB data are collected by national agencies and provided to the Italian National Institute of Health (ISS). Objectives. To describe the EU-IDB contents and its main results.

The surveillance has two registration levels: the Minimum Dataset (MDS) based on a simplified list of items with larger coverage for incidence rates estimate; the Full Dataset (FDS) with more analytical information, including involved products and a narrative description of the event. Both systems include information on: where and how the injury occurred, what activity the victim was doing and nature and body-part injured. MDS covers entire territories or Regions, FDS is based on convenience sampling.

In the years 2008-2020, 19 European countries provided 4,254,654 FDS records. MDS 23,387,255 cases were produced by 25 countries. The respective figures for year 2020 were 312,309 FDS cases (Austria, Latvia, Luxembourg, Netherlands, Portugal, Turkey) and 1,004,188 MDS cases (Estonia, Finland, Lithuania, Luxembourg, Netherlands, Sweden). Denmark and Norway provided aggregated data for 577,578 cases. All injuries ED attendances (55.1% male and 44.9% female): 24.6% involve people aged 0-14 years, 16.8% people aged 15-24 years, 41.4% people aged 25-64 years and 17.2% people≥ 65 years. Overall, 13.0% of the ED attendances have been hospitalized. The most frequent injuries are: contusion/bruise (26.5%), fracture (23.8%) and open wound/abrasion (18.2%).  Concussion/brain injury and poisoning are less frequent events (3.6% and 1.5%, respectively) but with high severity. Falls (44.3%) and cut/pierce (6.4%) are the prevalent mechanisms of Injuries. 50,3% of injuries occurred at home or during leisure time, 7.6% in sports accidents, 5.1% in road traffic accidents, 4.9% in accidents at workplace, 1.5% in interpersonal violence and 1.2% in deliberate self-harm. In case of self-arm, the main products associated with injury were poisoning from substances: alcohol (13.4%), antidepressants (9.5%), analgesic, antipyretic or anti-rheumatic (7.3%), benzodiazepine (4.4%), cocaine or crack (1.3%). Noteworthy is the presence of knives (1.8%), and other sharp objects (1.7%).

Data show great differences by Country not only due to different injury morbidity but also to the organisation of health care systems, with different accessibility of secondary health care. The methodology of the EU-IDB provides elaborated standards having the potential to fulfil the Eurostat-methodological requirements for European health statistics.

Keywords: Injury surveillance, Emergency Departments.

Other info: Italian National Institute of Health - Rome - Italy - Gianni Fondi, Alessio Pitidis, MDS & FDS Reference Groups

A first assessment of the impact of Covid19 pandemic

The EU-IDB (European Injury Database) is a data source containing standardized data on the external causes of injuries treated in hospitals' Emergency Department (ED). The EU-IDB uses two data sets of different complexity: Full Data Set (IDB-FDS) and Minimum Dataset (IDB-MDS). Objectives. To make a first assessment of the effect of covid-19 pandemic on the injury rates in Europe using the MDS databank. Methods. For each Country, IDB Rates were estimated by dividing the number of cases by the reference population provided by each National Database Administrator (NDA). Results. All-Injury rates trend is flat in 2013-2019 (6232 per 100.000 in 2019), with a dramatic drop in 2020 (4999 per 100.000, -19.8%), consistent with the -17.1% decrease in nonfatal injury-related ED visits in the U.S. between 2019 and 2020. The change in all-injury rates between 2019 and 2020 shows huge variability, ranging from -50.8% (Austria) to +23.4% (Finland). All but one (i.e. deliberate self-harm accidents) the prevention domains showed a dramatic decrease, ranging from -25.6% in Home accidents, to -34.3% in School accidents. Consistent with other studies which for the US estimate a reduction of 23%-29%, the EU IDB Road Traffic Accidents-related rates decreased by 26.2%. Both the all-injury rates for ED attendance and for hospitalizations dropped, but the former decreased by 18.9% while hospitalisations fall by 31.0%. All age groups show a decrease in all-injury rates: the 15-24 age group shows a dramatic decrease (-25.5%), while the decrease in the 0-14 years (-18.6%) and 25-64 years (-18.6%) is less significant.

Covid-19 changed health-seeking behaviours because individuals became hesitant to seek potentially necessary medical care. As such, there were potential changes in the pattern of injuries and access to emergency departments for injuries. The different impacts of covid-19 on the health status of different countries as well as the different organizations of the healthcare systems can explain only part of the observed variability. Unlike the general trend, isolation, uncertainty, and stress due to the pandemic probably contributed to keeping high ED attendance for self-harm injuries. Conclusion. Injury data from ED are a unique information source on external sources of injury risk and societal costs of injuries, indispensable at the national level for targeted prevention actions. The methodology of the EU-IDB provides a well-elaborated standard for collecting injury data in ED, which has the potential to fulfil the Eurostat-methodological requirements for a European health statistic. Keywords: surveillance, injury, covid19, trends.

Other info:  Italian National Institute of Health - Rome - Italy:  Gianni Fondi, Carlo Mamo, Alessio Pitidis, MDS Reference Group

6 October 2023 10:15 - 11:45
Room B

The Full Data Set (FDS) of the EU-IDB (European Injury DataBase) is a source of information covering many details on the external causes of injury, including objects/substances/products involved in injuries. The FDS includes more than 4,2 million of attendances recorded in a sample of Emergency Department (ED) in 19 European countries between 2008 and 2020. Objectives. To estimate the relationship between the chance of detecting alcohol in Road Traffic Accidents (RTA) with more predictors. Methods. Multivariate logistic regression using the IDB-FDS databank was carried out. Alcohol was the binary outcome and 4 categorical variables were the predictors (SexOfPatients, AgeGroupOfPatients, Treatment and ModeOfTransport).

Overall, alcohol has been detected in 4.3% of ED attendances due to RTAs and in 6.3% of admissions. In RTA, alcohol is more likely to be detected in males (OR= 2.67; IC95% 2.54-2.80; p

Other info: Italian National Institute of Health - Rome - Italy - Gianni Fondi, Carlo Mamo, Alessio Pitidis, FDS Reference Group