Table 3 Summarized notes from interview with stakeholders

Integrated Disease Surveillance Programme (IDSP): IDSP has been able to collate weekly disease surveillance data through IDSP portal from 91% of the districts in the country; data on epidemic-prone diseases are being collected from reporting units such as sub-centres, primary health centres, and community health centres, hospitals including government and private sector hospitals and medical colleges. At the moment two types of injuries are collected under the systems namely “dog bite” and “snake bite”. A piggy back of 3–4 key variables to guide state led interventions may be considered. This would include key identifiers, mechanism of injury and mode of transportation to the health facility. Additionally based on stakeholder capacity “I Form” for details injury information may be piloted in some districts for each state.

Standardize coding systems: Utilize common definitions of injury and a coding system that is transferable across the data sources.

Sample Registration System: Data from Sample Registration System is ideal for looking into trends for all unintentional injuries mortality – a representative sample with high validity for identifying cause of injury deaths. Whilst the data is inadequate to guide interventions it provides robust data on regional and national injury burden, helping identify high risk populations.

Police data source improvements: Police have the capacity to include pre-event and at the time of injury events in their dataset; some of these are covered for road injuries through the tools developed by the Transport Research Wing, however quality of data varies and also further work is needed to develop tools relevant for each type of injury.

Civil Registration System: Proportionate mortality data can also be explored through Civil Registration System in states like Maharashtra, Punjab and like with high coverage can also be explored. Strengthening through “Form 4b- Lay Man” reporting of death certification. Injury deaths are unlikely to be misclassified, reporting on cause of death by next of kin has good validity.

Single unique patient identifiers: or where available ADHAR card number, the date of injury, date of birth, gender- as applicable National Identification Number (NIN) for health facilities to generate a UID. Essentially a common Health management Information System would have an overarching benefit across all disease surveillance systems such RNTCP (Revised national tobacco control programme), NACO (National AIDS control organisation) or in cases of an epidemic or an outbreak of communicable diseases, IDSP.

Special surveys: Technical experts for injuries should be consulted in development of special surveys such as District Level Health Survey (DLHS), National Sample Survey Office (NSSO) and National Family Health Survey (NFHS); this would assist in mitigating limitations such as lack the standardisation of question which inhibits data utilisation

Injury severity coding: Whilst there is clearly a need for strengthening ICD training and coding, injury morbidity data is also essential for evaluating trauma services. Injury severity coding such as AIS, ISS or NISS should be incorporated at district and tertiary care centres.

Police or Transport data: Reporting bias in police data is difficult to address, however for the purpose of reporting injuries it would be beneficial to include all First Information Reports (FIR)/ cases in daily dairies and not only cases registered under Indian Penal Code, so as to report a more representative data in the annual report.

Use of Insurance data: Insurance data is extensive and uses multiple informants using police, vehicle registration, hospital, injured person and cost data. However it is important to ensure completeness, standardisation of data, and reporting of data are essential to guide future health and social insurance initiatives.

Research from academic institutes: Several project work related to injuries are taken up at post-graduate medical and research institutes in India. Most of them report on retrospective medical record review, with methodological limitations. Research using prospective longitudinal methods should be encouraged.

Major trauma registrations: Injuries resulting in major trauma such as traumatic brain injury, spinal cord injury, burns, amputations and other impairments require rehabilitation, a registry at major trauma centre following on recovery post discharge should be explored.