Canadian Hospitals Injury Reporting and Prevention Program. What is the CHIRPP? How does the CHIRPP work? CHIRPP data in action; A partner in the injury prevention community; Hospitals participating in the CHIRPP; Take Note.
Injuries in the North – analysis of 2. Canadian Hospitals Injury Reporting and Prevention Program. Int J Circumpolar Health. Injury Section, Health Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, ON, Canada. Department of Health and Social Services, Northwest Territories, Canada. Acronym Definition; CHIRPP: Canadian Hospitals Injury Reporting and Prevention Program: CHIRPP: Children's Hospital Injury Research and Prevention Program (Canada).Health and Social Services, Nunavut, Canada*Minh T. Do, Health Surveillance and Epidemiology Division, Public Health Agency of Canada/Agence de Santé Publique du Canada, 7. Carling Ave., Ottawa, ON, K1. A 0. K9, Canada. Tel: (6. Email: ac. cg. cpsa- cahp@o. D. T. hni. MReceived 2. Apr 1. 0; Revised 2. May 3. 1; Accepted 2. May 3. 1. This is an open- access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract. Background. Injury is a major public health concern, particularly for Canadians living in Arctic regions where the harsh physical and social conditions pose additional challenges. Surveillance data collected over the past 2 decades through the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) provide insights into the burden of injuries in certain parts of Canada. Objectives. This study aims to summarize and compare patterns of injuries in the Northwest Territories (NWT) and Nunavut to other southern communities across Canada. Methods. Analysis was based on CHIRPP data covering the period 1. Proportionate injury ratio (PIR) and its 9. Canadians living in the Arctic regions to other CHIRPP sites across Canada. Results. Between 1. Approximately 8. 3% of the cases were unintentional in nature; however, significantly higher proportions were observed for assaults and maltreatment (PIR=2. CI: 2. 7. 2–2. 8. Canadians living in northern communities. Significantly higher proportions were also observed for crushing/amputations (PIR=2. CI: 2. 1. 4–2. 4. PIR=1. 2. 1, 9. 5% CI: 1. PIR=1. 5. 2, 9. 5% CI: 1. PIR=7. 3. 9, 9. 5% CI: 6. The use of all- terrain vehicles or snowmobiles also resulted in significantly higher proportions of injuries (PIR=1. CI: 1. 7. 9–2. 0. Conclusions. This study contributes to the limited literature describing injuries in northern communities where the harsh physical and social climates pose additional challenges. Excesses in the proportions identified in this study could be useful in identifying strategies needed to minimize injury risks in northern communities within Canada. Keywords: injury, CHIRPP, Nunavut, Northwest Territories, surveillance. Although most injuries are predictable and preventable, clinicians of emergency departments across Canada are inundated with injured patients needing medical attention on a daily basis. Injuries have a major impact on the quality of life and also represent a significant burden to the health care system. To date, injury remains the leading cause of death among Canadians between 1 and 4. The seriousness of the problem is magnified among populations living in the northern communities where residents face extreme weather conditions, physical geographic remoteness and acute social issues. In the Northwest Territories (NWT) and Nunavut, many communities are only accessible by air during all or part of the year (4). Also, only a few major population centres have hospitals, with the majority of communities relying on health centres staffed by nurses or nurse practitioners. These health centres have limited diagnostic equipment and treatment capacity. As a result, individuals with serious injuries in many communities need to be evacuated by air to the nearest major centre, an expensive process which can take many hours and be delayed indefinitely by inclement weather (5). In the case of injuries due to interpersonal violence, or self- inflicted injuries, the social environment also poses challenges, as many communities have limited or no mental health or family violence counselling resources or family violence shelters, and some communities have no routine services from the Royal Canadian Mounted Police or local law enforcement, other than on an emergency or fly- in basis (6–8). The social, structural and geographic conditions in the NWT and Nunavut both increase the risk of injury, and complicate the treatment of injury when it occurs. To enhance our understanding of the mechanism of injuries, the Public Health Agency of Canada conducts injury surveillance through the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) (9). For the past 2. 0 years, CHIRPP has been collecting data from different geographic areas including those of the NWT and Nunavut. The CHIRPP is an injury and poisoning surveillance system currently operating in 1. Canada in 1. 99. 1. The CHIRPP system currently contains over 2. Narrative fields provide information to further refine the coding and identify rare events. Although only selected hospitals report to CHIRPP, previous work has shown that the data collected through the programme represent general injury patterns among Canadian Youth (1. The purpose of this study is to report on CHIRPP injury data collected from 2 territories of Canada over the past 2 decades. Specifically, this study aims to describe patterns of injury in order to better understand the burden of injuries in the North and to identify opportunities for improvement. Method. Data source and handling. Analyses were based on data collected by the CHIRPP. CHIRPP is an emergency department- based injury surveillance system operating in different health centres across Canada since 1. Within the NWT and Nunavut, CHIRPP collected injury data from Stanton Regional Hospital as well as Fort Smith Health, Inuvik, Gjoa Haven, Baffin Nurse station (in Iqaluit) and Arctic Bay health centres. For each recorded injury, demographic information as well as time, place, nature, intent and activity at the time of injury were also extracted for analysis. Given that some individuals may have multiple injuries in a given event, the unit of analysis in this study is the injury event. All data are coded consistently across CHIRPP sites. Coding of injury data in CHIRPP has been described elsewhere and data from CHIRPP have been validated and are considered good quality (9–1. Statistical analysis. Injury records with missing information on sex (n=2. Proportionate injury ratios (PIRs) were used to compare injuries of northern communities to age- specific proportions (5- year age groups) of other CHIRPP sites across Canada (1. The 9. 5% confidence interval (α=0. Breslow and Day (1. A PIR of 1 indicates that the observed proportion of cases for a given injury is the same as the sum of the age- specific proportions of that injury. For example, a PIR of 1. PIR of 0. 5 indicates 5. Analyses were conducted using SAS Version 9. Microsoft Excel tools. Results. Between 1. CHIRPP from 8 health care facilities located within the NWT and Nunavut. Figure 1 shows the age distribution of injury by sex. Overall, males sustained almost twice the number of reported injuries (n=4. Age and gender distributions of injuries reported to the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) from communities within the Northwest Territories (NWT) and Nunavut, 1. Of the injuries reported to CHIRPP (Table I), more than 9. NWT. This was expected given that the largest territorial data collection sites and the only hospital were located in NWT. Of all the injuries reported, 8. However, more than 4,0. While almost half of the injuries were relatively minor, some were more serious, involving fractures (1. Injuries resulting in poisoning (2%) and drowning/near drowning or asphyxiations (0. Distribution of injury characteristics reported to the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) from communities within the Northwest Territories (NWT) and Nunavut, 1. The distribution of injuries and the PIRs for the intent, nature, activity at the time of injury and admission status due to the injury are presented in Table II. Based on the intent of the injury, the PIR for assault and maltreatment in the North was disproportionately larger than all of the other CHIRPP sites across Canada combined, particularly for women (PIR=3. CI: 3. 4. 0–3. 7. Among the nature of injuries examined, significantly elevated proportions were observed in the North for the more serious injuries, namely poisonings, burns, crushing/amputations, and drowning/near drowning or other asphyxiations. Frostbite was also highly significant; however, this was based on relatively few cases. Based on the distribution of the activities engaged in at the time of the injury, the PIRs for organized sports, use of all- terrain vehicles (ATVs) and snowmobiles, and pedestrian- related activities were significantly higher in the North. When compared to the other CHIRPP sites across Canada, the proportion of injuries in the North being admitted or transferred to a hospital was significantly lower. Discussions. In this study, we described the cause- specific injuries (1. Canadians living in the North. Based on the analysis of 2. CHIRPP, our findings reaffirm the importance of assaults and maltreatment (PIR=2. Canadians living in northern communities as previously reported elsewhere (2. Consistent with other reports, injuries relating to ATV and snowmobiling are reported in significantly higher proportion than in the south (PIR=1. CI: 1. 7. 9–2. 0. In southern Canada, ATV and snowmobiles are often used for recreational purposes. However, in many northern and remote communities, these are used as a main method of transportation. In the NWT alone, ATV and snowmobiling account for 5% of all injury- related hospitalizations (2. Hospitalizations for ATV and snowmobiling- related injuries are much higher in the Territories than that of Canada combined (2. Our analysis of CHIRPP data also showed gender differences in ATV and snowmobiling- related injuries.
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