This observational, descriptive study of injury epidemiology used routinely collected health data in Barcelona integrated into a city-wide injury surveillance system. The BISS compiles and analyzes data on injuries from multiple existing databases (health, administrative, and police records) in a continuous manner. The study design was cross-sectional and retrospective, using pre-existing data. Key elements of the design include the integration of an established road traffic injury registry (the Barcelona Traffic Injury Information System, now a subsystem called BISS-RTI for road traffic injuries) into a broader all-injury surveillance framework. The analysis presented focused on injury data from the year 2024 for emergencies and hospitalizations, 2023 for mortality, and 2018 onward for trends.
The study was set in the city of Barcelona, Spain, an urban area with approximately 1.6 million residents within a larger metropolitan region. The BISS covers injuries occurring among all persons in Barcelona, including residents, workers, visitors, and commuters within the city. We report on injuries that occurred or were treated in Barcelona during 2024 (with trend analyses from 2018 onward), encompassing incidents across the entire city.
The BISS does not enroll participants directly but instead includes all injury cases meeting specific criteria from each data source. The target population for surveillance is everyone who lives, works, or spends time in Barcelona—effectively the entire population at risk in the city. We included injury episodes (events) rather than unique individuals because one person may suffer multiple injuries over time.
We provide a visual overview of the data and inclusion process:
Pyramidal distribution of injuries due to external causes according to severity and available data sources for all injuries and specifically for traffic collision injuries; blue shading shows the coverage of the Barcelona Injury Surveillance System (BISS). CMBD: Register of the Minimum Basic Data Set in Spain; CMBD-AH: CMBD of hospital discharges; CMBD-AP: CMBD of primary care visits; CMBD-UR: CMBD of hospital emergency department visits; GUB: Register of Accidents and Victims by the Barcelona City Police, which does not include information on the nature and severity of injuries; RMB: Barcelona Mortality Register; RMB-CT: Barcelona Traffic Collision Mortality Register.
BISS covers moderate to fatal injuries by leveraging existing routine data sources in Barcelona, primarily health-related records that document injury diagnoses and mechanisms but also health surveys (no data included here). It includes moderate to critical injuries due to external causes using data from the Register of the Minimum Basic Data Set in Spain (CMBD; acronym in Catalan) for hospital emergencies and discharges. Additionally, fatalities resulting from external causes among Barcelona residents are recorded through the Barcelona Mortality Register (RMB; acronym in Catalan). Currently, milder injuries are not included, despite the availability of CMBD data for primary care, as the quality of injury coding from this source has not yet been assessed. However, this may be considered in future phases of the system.
In the specific case of BISS-RTI, in addition to moderate to critical injuries from the CMBD of emergencies and hospital discharges, there are 2 sources for traffic injuries: the Barcelona Traffic Collision Mortality Register (RMB-CT; acronym in Catalan), which provides information on all individuals who have died from traffic-related incidents in Barcelona including injury diagnoses, and the Road Traffic Collisions Register from the Municipal Police (GUB; acronym in Catalan), which is an exhaustive record of all traffic collisions in Barcelona and the individuals injured, ranging from minor to fatal. Although the GUB does not include injury diagnoses, it provides detailed information on the circumstances of each collision.
Eligibility criteria were defined by injury mechanism and severity using diagnostic codes and external cause codes. In general, BISS covers injuries requiring medical attendance up to fatalities, while minor injuries not requiring medical attention (or only primary care) are not yet captured. Specifically, to be included in BISS analyses, a case had to satisfy the data inclusion criteria for one of the BISS databases as outlined in
Barcelona Injury Surveillance System (BISS) databases and their sources with the inclusion criteria as well as injury subset selection and defined indicators for monitoring each injury subset.
| Data source | Database inclusion criteria | Database | Definition criteria for the injury subset | Injury subset | Indicators |
| CMBD_UR | Hospital in the city of Barcelona, regardless of the municipality of residence of the injured person Any of the following Assistance in hospital emergency departments | ED | Exclude deaths | A_Episodes of nonfatal injuries treated in the hospital emergency departments of Barcelona, including residents and nonresidents of Barcelona | 1 Nonfatal Emergency Department Visits for All Injuries 2 Nonfatal Emergency Department Visits for Severe Injuries 3 Nonfatal Assault-Related Emergency Department Visits 4 Nonfatal Intentional Self-Harm Emergency Department Visits 5 Nonfatal Unintentional Fall-Related Injury Emergency Department Visits 6 Nonfatal Unintentional Motor Vehicle Traffic-Related Emergency Department Visits 7 Nonfatal Unintentional Fire-Related Emergency Department Visits 8 Nonfatal Unintentional Nondrug Poisoning Emergency Department Visits 9 Nonfatal Unintentional Drug Poisoning Emergency Department Visits 10 Nonfatal TBI |
| CMBD_UR | Hospital in the city of Barcelona, regardless of the municipality of residence of the injured person Any of the following Assistance in hospital emergency departments | ED | Any of the following codes in any of the external cause fields: Exclude deaths | B_Episodes of nonfatal injuries due to traffic collisions treated in the hospital emergency departments of Barcelona, including residents and nonresidents of Barcelona | 23 Nonfatal Emergency Department Visits for Road Traffic–Related Injuries 24 Nonfatal Emergency Department Visits for Road Traffic–Related Severe Injuries 25 Nonfatal Emergency Department Visits for Road Traffic–Related Pedestrian Injuries 26 Nonfatal Emergency Department Visits for Road Traffic–Related Pedestrian Transport User Injuries 27 Nonfatal Emergency Department Visits for Road Traffic–Related Cyclist Injuries 28 Nonfatal Emergency Department Visits for Road Traffic–Related Motorcyclist Injuries 29 Nonfatal Emergency Department Visits for Road Traffic–Related Car User Injuries 30 Nonfatal Emergency Department Visits for Road Traffic–Related TBI |
| CMBD_AH | Hospital in the city of Barcelona, regardless of the municipality of residence of the injured person Any of the following Urgent health care (unscheduled) | HOSP | Exclude deaths | C_Episodes of nonfatal injury discharged by admission to a hospital in Barcelona, including residents and nonresidents of Barcelona | 11 Nonfatal Hospitalizations for All Injuries 12 Nonfatal Hospitalizations for Severe Injuries 13 Nonfatal Assault-Related Hospitalizations 14 Nonfatal Intentional Self-Harm Hospitalizations 15 Nonfatal Unintentional Fall-Related Injury Hospitalization 16 Nonfatal Unintentional Motor Vehicle Traffic-Related Hospitalizations 17 Nonfatal Unintentional Fire-Related Injury Hospitalizations 18 Nonfatal Unintentional Nondrug Poisoning Hospitalizations 19 Nonfatal Unintentional Drug Poisoning Hospitalizations 20 Nonfatal TBI Hospitalizations 21 Nonfatal Hospitalizations for Long Bone Fracture 22 Nonfatal Fall-Related Hip Fracture Hospitalizations in Persons ≥65 Years Old |
| CMBD_AH | Hospital in the city of Barcelona, regardless of the municipality of residence of the injured person Any of the following Urgent health care (unscheduled) | HOSP | Any of the following codes in any of the external cause fields: Exclude deaths | D_Episodes of nonfatal injuries due to traffic collisions discharged due to admission to a hospital in Barcelona, including residents and nonresidents of Barcelona | 31 Nonfatal Hospitalizations for Road Traffic–Related Injuries 32 Nonfatal Hospitalizations for Road Traffic–Related Severe Injuries 33 Nonfatal Hospitalizations for Road Traffic–Related Pedestrian Injuries 34 Nonfatal Hospitalizations for Road Traffic–Related Pedestrian Transport User Injuries 35 Nonfatal Hospitalizations for Road Traffic–Related Cyclist Injuries 36 Nonfatal Hospitalizations for Road Traffic–Related Motorcyclist Injuries 37 Nonfatal Hospitalizations for Road Traffic–Related Car User Injuries 38 Nonfatal Hospitalizations for Road Traffic–Related TBI |
| RMB | Any of the following | MORTALITY | Municipality of death: Barcelona | E_People residing in Barcelona who died from injuries due to external causes in Barcelona | 39 Injury Fatalities 40 Unintentional Drowning Fatalities 41 Unintentional Fall-Related Fatalities 42 Unintentional Fire-Related Fatalities 43 Unintentional Motor Vehicle Traffic Fatalities 44 Unintentional Nondrug Poisoning Fatalities 45 Unintentional Drug Overdose Fatalities 46 Unintentional Suffocation Fatalities 47 Suicides 48 Homicides |
| RMB_CT | Death in Barcelona due to traffic collision | MORTALITY_RTI | Place of collision: Barcelona | F_Residents and nonresidents of Barcelona who died in Barcelona due to road traffic injuries that occurred in Barcelona | 49 Road Traffic–Related Injury Fatalities 50 Pedestrian Road Traffic–Related Injury Fatalities 51 Cyclist Road Traffic–Related Injury Fatalities 52 Motorcyclist Road Traffic–Related Injury Fatalities 53 TBI Road Traffic–Related Injury Fatalities |
| GUB | People involved in a road traffic collision who have been injured according to police criteria (who have required some type of medical assistance) | INJURED_RTI | For people injured in the same collision, information about the collision summarized in a single record | G_Road traffic collisions in Barcelona in which a person, resident or nonresident of Barcelona, has been injured (required some type of medical assistance) | 54 Road Traffic–Related Injury Collisions |
| GUB | People involved in a road traffic collision who have been injured according to police criteria (who have required some type of medical assistance) | INJURED_RTI | People injured | H_Residents and nonresidents of Barcelona injured (required some type of medical assistance) due to a traffic collision in Barcelona | 55 Road Traffic–Injured People 56 Road Traffic–Injured Pedestrian 57 Road Traffic–Injured Pedestrian Transport Users 58 Road Traffic–Injured Motorcyclist 59 Road Traffic–Injured Cyclist 60 Road Traffic–Injured Car User |
aCMBD_UR: register of the Minimum Basic Data Set of hospital emergency department visits.
b
cEmergency department visit data.
dTBI: traumatic brain injury.
eCMBD_AH: register of the Minimum Basic Data Set of hospital discharges
fHospital discharge data.
gRMB: Barcelona Mortality Register.
hCBD: basic cause of death.
iInjury-related mortality data.
jRMB_CT: Barcelona Traffic Collision Mortality Register.
kRoad traffic injury–related mortality data.
lGUB: Register of Accidents and Victims by the Barcelona City Police.
mData for people with a road traffic–related injury.
Multiple data sources were used to construct the BISS databases, each providing information on different segments of the injury pyramid. All sources consist of routinely collected administrative or medical records (and police records for road traffic injuries). The sources and their use in BISS are described in the following sections.
The Urgencies Register (CMBD-UR) is a component of the regional CMBD and captures all ED visits in hospitals and emergency centers. For BISS, we extracted all ED records with an injury-related diagnosis or external cause code representing moderate or serious nonfatal injuries that received medical treatment. Each ED record includes up to 8
The Hospital Discharge Register, another part of the CMBD, records all inpatient admissions in Catalonia’s hospitals. We included records of patients hospitalized for injury (again identified via
The RMB collects data on all deaths of Barcelona residents, with cause of death coded in
The RMB-CT is a specialized subset of the mortality data focusing on road traffic injury–related deaths in Barcelona. It is compiled by deterministically linking multiple sources: the general mortality data, records from the Institute of Legal Medicine and Forensic Sciences of Catalonia (ie, autopsy and forensic reports), civil death certificates, and police reports. This person-level data linkage allows the collection of detailed information on each traffic fatality, including injury diagnoses from an autopsy, circumstances of the crash, and victim details. The RMB-CT thus provides rich verification of road traffic death cases beyond the death certificate alone. Data from RMB-CT feed into the BISS MORTAL-RTI database (fatal road traffic injuries). The RMB includes all deaths of individuals residing in Barcelona, regardless of whether the death occurred within the city or elsewhere (manual available at [
The GUB records all traffic collisions in Barcelona that result in personal injury (from minor to fatal). This source does not include medical information like injury diagnoses, but it captures the context of each collision (eg, date, location, types of vehicles, road conditions) and basic information on persons injured (age, sex, road user role). The police criteria consider a [
Therefore, the BISS-RTI is fed by the 3 data sources from the Barcelona Traffic Injuries and Accidents Information System [
The CMBD-AH and CMBD-UR, using an injury definition for traffic-related incidents established by the “Working Group of the Spanish Society of Epidemiology on the measurement of the health impact of injuries in Spain” [
The GUB, which is based on traffic collision reports from the Barcelona City Police, providing comprehensive information on the circumstances of collisions that occur within the city
The RMB-CT
Based on the data sources from the CMBD-UR, CMBD-AH, RMB, RMB-RTI, and GUB and applying the data inclusion criteria outlined in
From these 5 databases (ED, HOSP, MORTALITY, MORTAL-RTI, and INJURED-RTI), 8 subsets of injuries to be monitored were generated (one for general injuries and another for traffic collision injuries) and labeled as A, B, C, D, E, F, G, and H.
The primary outcomes of interest were counts and rates of injury cases across various categories (nonfatal injuries treated in EDs, nonfatal injuries requiring hospitalization, and fatal injuries). Rather than traditional “exposures” and “confounders” as in an etiologic study, this surveillance system tracked descriptive variables such as demographics, injury mechanisms, and severities for each case. Key variables included in BISS databases are listed in
Variables included in each of the Barcelona Injury Surveillance System (BISS) databases.
| Variables | Databases | ||||
| ED | HOSP | MORTALITY | MORTAL-RTI | INJURED-RTI | |
| Admission date | ✓ | ✓ | N/A | N/A | N/A |
| Discharge date | ✓ | ✓ | N/A | N/A | N/A |
| Date of death | N/A | N/A | ✓ | ✓ | N/A |
| Collision date | N/A | N/A | N/A | ✓ | ✓ |
| Sex | ✓ | ✓ | ✓ | ✓ | ✓ |
| Age | ✓ | ✓ | ✓ | ✓ | ✓ |
| Country of origin | N/A | N/A | ✓ | ✓ | ✓ |
| Municipality of residence | ✓ | ✓ | Only includes residents of Barcelona | ✓ | ✓ |
| Basic primary health care area (ABS) | ✓ | ✓ | ✓ | ✓ | ✓ |
| Neighborhood of residence for Barcelona residents | N/A | N/A | ✓ | N/A | ✓ |
| Economic financing regime | ✓ | ✓ | N/A | N/A | N/A |
| Situation of the person injured at discharge | ✓ | ✓ | N/A | N/A | N/A |
| Diagnosis of the lesion ( | ✓ (8 diagnostic fields) | ✓ (15 diagnostic fields) | N/A | ✓ (15 diagnostic fields) | N/A |
| External cause ( | ✓ (8 fields of external cause) | ✓ (5 fields of external cause) | N/A | N/A | N/A |
| Basic cause of death ( | N/A | N/A | ✓ | ✓ | N/A |
| Type of lesion and anatomical region affected | ✓ | ✓ | N/A | ✓ | N/A |
| Mechanism and intentionality of the injury | ✓ | ✓ | ✓ | N/A | N/A |
| Type of user | ✓ | ✓ | N/A | ✓ | ✓ |
| Severity | ✓ | ✓ | N/A | ✓ | ✓ |
| Collision variables (eg, type of collision, type of road, time, use of safety accessories, type of lighting) | N/A | N/A | N/A | N/A | ✓ |
aEmergency department visit data.
bHospital discharge data.
cInjury-related mortality data.
dRoad traffic injury–related mortality data.
eRoad traffic injury data from the Register of Accidents and Victims by the Barcelona City Police (GUB).
fN/A: not applicable.
g
hSeverity according to police criteria, which considers that a person involved in the collision is injured if they require some type of medical attention
Description and values of variables considered in the Barcelona Injury Surveillance System (BISS).
| Variables | Description | Values |
| Sex | N/A | Female, male |
| Age (years) | N/A | 0‐14, 15‐24, 25‐44, 45‐64, 65‐74, ≥75 |
| Country of origin | Country according to National Statistic Institute codes | N/A |
| Municipality of residence | N/A | Barcelona, outside Barcelona |
| Basic Health Area (ABS; acronym in Catalan) | Elementary territorial unit through which primary health care services are organized | 67 areas |
| Neighborhood residence | For residents of Barcelona | 73 neighborhoods |
| Economic financing regime | N/A | Work accident insurance, traffic collision insurance, CatSalut, and other |
| Situation of the person injured at discharge | N/A | Death, hospital admission, discharge at home, others |
| Injury diagnoses | 8 fields for the ED | |
| External cause | 8 fields for the ED database; 5 fields for the HOSP database | |
| Basic cause of death | N/A | |
| Type of injury | Derived from the injury diagnostic | N/A |
| Anatomical region affected | Derived from the injury diagnostic | N/A |
| Mechanism and intentionality of fatal injuries | Derived from the Basic Cause of Death | N/A |
| User type for RTI | Derived from the external cause V-codes in nonfatal RTI from the ED and HOSP databases; in contrast, a dedicated variable already included in the MORTAL-RTI and INJURED-RTI | Pedestrian, passenger car users, motorcyclist, cyclist, van or truck user, bus user, and other users |
| Severity | Derived from the MAIS | MAIS<3; MAIS≥3 |
| Collision variables | The INJURED-RTI database, managed by the Barcelona Urban Police, includes a wide range of variables related to traffic collisions and their circumstances, such as the type of collision, type of road, time of the incident, type of lighting, weather conditions, and the use of safety accessories by the individuals involved. | N/A |
aN/A: not applicable.
b
cEmergency department visits.
dHospital discharges.
eFatal road traffic–related injuries in Barcelona.
fCDC: Centers for Disease Control and Prevention.
gRTI: road traffic injury.
hPolice-reported traffic collision injuries in Barcelona.
iMAIS: Maximum Abbreviated Injury Score.
jAIS: Abbreviated Injury Score.
In addition to these variables, the BISS defines a set of surveillance indicators. Each indicator corresponds to a specific subset of injuries (eg, by severity, mechanism) and a measure (number of cases, rates). For example, indicators include counts of nonfatal hospital-treated injuries, counts of traffic-related injuries, counts of severe injuries, mortality counts by cause, and population-based rates for these events. These indicators were carefully selected to ensure comparability at the international level, aligning with global standards. The system relies on standard classifications, as outlined in the previous section, to provide a consistent and reliable framework for injury surveillance and analysis.
The selection of the indicator package for the BISS was conducted through an extensive review of scientific literature and official sources. The process involved searches in PubMed, as well as portals of the Spanish Ministry of Health, the European Commission, and the US CDC. Key reference publications included the report by the Spanish Ministry of Health,
Additionally, publications and tools from the European Injury Database of the European Commission [
The BISS compiles a comprehensive set of 60 indicators organized into 5 categories to monitor the morbidity and mortality associated with injuries from external causes and to track their temporal evolution (
Nonfatal injury indicators (indicators 1‐22): These indicators track nonfatal injury episodes based on the type of health care required (eg, hospital emergency or hospitalization departments), the mechanism and intentionality of the injury, and the severity.
Traffic collision nonfatal injury indicators (indicators 23‐38): This subset includes 16 indicators specific to nonfatal injuries resulting from traffic collisions and classified by health care requirements (eg, hospital emergency or hospitalization), severity, and user type (eg, pedestrian, cyclist, driver).
Mortality indicators for external causes (indicators 39‐48): These 10 indicators focus on mortality caused by external factors and are categorized by the mechanism of the basic cause of death.
Traffic collision mortality indicators (indicators 49‐53): This set includes 5 indicators specific to traffic collision–related mortality distinguished by the type of user involved.
Traffic collision and injury indicators (indicators 54‐60): These 7 indicators measure the total number of traffic collisions where medical assistance was required and the total number of injured persons without differentiating severity or type of assistance but classified by the type of user.
Injury indicators, subset, definitions, and limitations of each indicator from the Barcelona Injury Surveillance System (BISS).
| Indicator | Injury subset | Indicator-specific definition | Limitations |
| 1_Nonfatal_Emerg_All | A | All episodes | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH |
| 11_Nonfatal_Hosp_All | C | All episodes | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 2_Nonfatal_Emerg_Severe | A | Episodes with MAIS | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 12_Nonfatal_Hosp_Severe | C | Episodes with MAIS ≥3 | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 3_Nonfatal_Emerg_Assault | A | Episodes with any of the following codes in any diagnosis or external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 13_Nonfatal_Hosp_Assault | C | Episodes with any of the following codes in any diagnosis or external cause field: | isodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 4_Nonfatal_Emerg_Self-Harm | A | Episodes with any of the following codes in any diagnosis or external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 14_Nonfatal_Hosp_Self-Harm | C | Episodes with any of the following codes in any diagnosis or external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 5_Nonfatal_Emerg_Unint_Fall | A | Episodes with any of the following codes in external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances f the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 15_Nonfatal_Hosp_Unint_Fall | C | Episodes with any of the following codes in external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 6_Nonfatal_Emerg_Unint_MVT | A | Episodes with any of the following codes in external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 16_Nonfatal_Hosp_Unint_MVT | C | Episodes with any of the following codes in external cause field. | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 7_Nonfatal_Emerg_Unint_Fire | A | Episodes with any of the following codes in external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 17_Nonfatal_Hosp_Unint_Fire | C | Episodes with any of the following codes in external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 8_Nonfatal_Emerg_Unint_Nondrug | A | Episodes with any of the following codes in any diagnosis or external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 18_Nonfatal_Hosp_Unint_Nondrug | C | Episodes with any of the following codes in any diagnosis or external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 9_Nonfatal_Emerg_Unint_Drug | A | Episodes with any of the following codes in any diagnosis or external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 19_Nonfatal_Hosp_Unint_Drug | C | Episodes with any of the following codes in any diagnosis or external cause field: | • Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 10_Nonfatal_Emerg_TBI | A | Episodes with any of the following codes in any diagnosis field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 20_Nonfatal_Hosp_TBI | C | Episodes with any of the following codes in any diagnosis field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 21_Nonfatal_Hosp_Long-Bone | C | Episodes with any of the following codes in any diagnosis field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 22_Nonfatal_Hosp_Fall-Hip-65 | C | Episodes in people >65 years old with any of the following hip fracture codes in any diagnosis field and any of the following unintentional fall codes in any external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. There may be assists from the same episode that are separated by >31 days and are considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 23_Nonfatal_Emerg_RTI | B | All episodes | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 31_Nonfatal_Hosp_RTI | D | All episodes | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 24_Nonfatal_Emerg_Severe-RTI | B | Episodes with MAIS ≥3 | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 32_Nonfatal_Hosp_Severe-RTI | D | Episodes with MAIS ≥3 | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 25_Nonfatal_Emerg_Pedestrian | B | Episodes with any of the following codes in any external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 33_Nonfatal_Hosp_Pedestrian | D | Episodes with any of the following codes in any external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances of the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 26_Nonfatal_Emerg_PedesTransp | B | Episodes with any of the following codes in external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances of the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 34_Nonfatal_Hosp_PedesTransp | D | Episodes with any of the following codes in external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 27_Nonfatal_Emerg_Cyclist | B | Episodes with any of the following codes in external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 35_Nonfatal_Hosp_Cyclist | D | Episodes with any of the following codes in external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 28_Nonfatal_Emerg_Motorcyclist | B | Episodes with any of the following codes in any external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances of the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 36_Nonfatal_Hosp_Motorcyclist | D | Episodes with any of the following codes in any external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 29_Nonfatal_Emerg_CarUser | B | Episodes with any of the following codes in any external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 37_Nonfatal_Hosp_CarUser | D | Episodes with any of the following codes in any external cause field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 30_Nonfatal_Emerg_TBI-RTI | B | Episodes with any of the following codes in any diagnosis field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 38_Nonfatal_Hosp_TBI-RTI | D | Episodes with any of the following codes in any diagnosis field: | Episodes of injury treated in hospitals in Barcelona are included, but it is unknown whether the incident took place in the city or outside. As an international consensus criterion, different attendances by the same person <31 days apart are considered part of the same episode. However, there could be assists derived from the same episode that are separated in time by >31 days and are being considered different episodes. Conversely, the same episode could be considered care separated by <31 days that belong to different episodes, in case you are not well informed whether they are successive visits or due to sequelae. The CMBD-AH is a register of hospital discharges; therefore, there may be cases of people with the injury and were admitted in the year of study but who do not appear because they were registered the following year. |
| 39_Fatal_All | E | All deaths | Only the deaths of people residing in Barcelona are available. People who died in Barcelona are selected regardless of where the episode of injury took place, since this information is not available. The RMB |
| 40_Fatal_Unintent-Drowning | E | Deaths with any of the following codes in the underlying cause of death field: | Only the deaths of people residing in Barcelona are available. People who died in Barcelona are selected regardless of where the episode of injury took place, since this information is not available. The RMB does not have information on injuries, so it is not possible to define mortality indicators based on diagnostic codes, such as TBI fatalities. |
| 41_Fatal_Unintent-Fall | E | Deaths with any of the following codes in the underlying cause of death field: | Only the deaths of people residing in Barcelona are available. People who died in Barcelona are selected regardless of where the episode of injury took place, since this information is not available. The RMB does not have information on injuries, so it is not possible to define mortality indicators based on diagnostic codes, such as TBI fatalities. |
| 42_Fatal_Unintent-Fire | E | Deaths with any of the following codes in the underlying cause of death field: | Only the deaths of people residing in Barcelona are available. People who died in Barcelona are selected regardless of where the episode of injury took place, since this information is not available. The RMB does not have information on injuries, so it is not possible to define mortality indicators based on diagnostic codes, such as TBI fatalities. |
| 43_Fatal_Unintent-MVT | E | Deaths with any of the following codes in the underlying cause of death field: | Only the deaths of people residing in Barcelona are available. People who died in Barcelona are selected regardless of where the episode of injury took place, since this information is not available. The RMB does not have information on injuries, so it is not possible to define mortality indicators based on diagnostic codes, such as TBI fatalities. |
| 44_Fatal_Unintent-Nondrug | E | Deaths with any of the following codes in the underlying cause of death field: | Only the deaths of people residing in Barcelona are available. People who died in Barcelona are selected regardless of where the episode of injury took place, since this information is not available. The RMB does not have information on injuries, so it is not possible to define mortality indicators based on diagnostic codes, such as TBI fatalities. |
| 45_Fatal_Unintent-Drug | E | Deaths with any of the following codes in the underlying cause of death field: | Only the deaths of people residing in Barcelona are available. People who died in Barcelona are selected regardless of where the episode of injury took place, since this information is not available. The RMB does not have information on injuries, so it is not possible to define mortality indicators based on diagnostic codes, such as TBI fatalities. |
| 46_Fatal_Unintent-Suffocation | E | Deaths with any of the following codes in the underlying cause of death field: | Only the deaths of people residing in Barcelona are available. People who died in Barcelona are selected regardless of where the episode of injury took place, since this information is not available. The RMB does not have information on injuries, so it is not possible to define mortality indicators based on diagnostic codes, such as TBI fatalities. |
| 47_Suicide | E | Deaths with any of the following codes in the underlying cause of death field: | Only the deaths of people residing in Barcelona are available. People who died in Barcelona are selected regardless of where the episode of injury took place, since this information is not available. The RMB does not have information on injuries, so it is not possible to define mortality indicators based on diagnostic codes, such as TBI fatalities. |
| 48_Homicide | E | Deaths with any of the following codes in the underlying cause of death field: | Only the deaths of people residing in Barcelona are available. People who died in Barcelona are selected regardless of where the episode of injury took place, since this information is not available. The RMB does not have information on injuries, so it is not possible to define mortality indicators based on diagnostic codes, such as TBI fatalities. |
| 49_Fatal_RTI | F | All deaths | The IMLCFC |
| 50_Fatal_Pedestrian | F | Deaths selected according to information about the type of user from the 2 sources from which it is fed: GUB and/or IMLCFC; based on the information on the vehicle in which the person was traveling at the time of the collision or by which they were hit and the position they occupied in relation to the vehicle, the type of user variable is generated using the following categories: pedestrian, passenger car user, motorcyclist, cyclist, van or truck user, bus user, and other user | The IMLCFC selects the cases and includes some cases in which the CBD code according to the judicial mortality register of Barcelona is a code that does not correspond to traffic, such as V43.0, V29.3, and V79.3. |
| 51_Fatal_Cyclist | F | Deaths selected according to information about the type of user from the 2 sources from which it is fed: GUB and/or IMLCFC; based on the information on the vehicle in which the person was traveling at the time of the collision or by which they were hit and the position they occupied in relation to the vehicle, the type of user variable is generated using the following categories: pedestrian, passenger car user, motorcyclist, cyclist, van or truck user, bus user, and other user | The IMLCFC selects the cases and includes some cases in which the CBD code according to the judicial mortality register of Barcelona is a code that does not correspond to traffic, such as V43.0, V29.3, and V79.3. |
| 52_Fatal_Motorcyclist | F | Deaths selected according to information about the type of user from the 2 sources from which it is fed: GUB and/or IMLCFC; based on the information on the vehicle in which the person was traveling at the time of the collision or by which they were hit and the position they occupied in relation to the vehicle, the type of user variable is generated using the following categories: pedestrian, passenger car user, motorcyclist, cyclist, van or truck user, bus user, and other user | The IMLCFC selects the cases and includes some cases in which the CBD code according to the judicial mortality register of Barcelona is a code that does not correspond to traffic, such as V43.0, V29.3, and V79.3. |
| 53_Fatal_TBI-RTI | F | Deaths with any of the following codes in any diagnosis field: | The IMLCFC selects the cases and includes some cases in which the CBD code according to the judicial mortality register of Barcelona is a code that does not correspond to traffic, such as V43.0, V29.3, and V79.3. |
| 54_RTI_Colisions | G | For people who were injured in the same collision, information about the collision summarized in a single record | N/A |
| 55_RTI_Injured_People | H | All injured people | N/A |
| 56_RTI_Injured_Pedestrian | H | People selected according to information about the type of user from the GUB; based on the information on the vehicle in which the person was traveling at the time of the collision or by which they were hit and the position they occupied in relation to the vehicle, the type of user variable is generated using the following categories: pedestrian, passenger car user, motorcyclist, cyclist, van or truck user, bus user, and other user | N/A |
| 57_RTI_Injured_PedestrianTransport | H | People selected according to information about the type of user from the GUB; based on the information on the vehicle in which the person was traveling at the time of the collision or by which they were hit and the position they occupied in relation to the vehicle, the type of user variable is generated using the following categories: pedestrian, passenger car user, motorcyclist, cyclist, van or truck user, bus user, and other user | N/A |
| 58_RTI_Injured_Motorcyclist | H | People selected according to information about the type of user from the GUB; based on the information on the vehicle in which the person was traveling at the time of the collision or by which they were hit and the position they occupied in relation to the vehicle, the type of user variable is generated using the following categories: pedestrian, passenger car user, motorcyclist, cyclist, van or truck user, bus user, and other user | N/A |
| 59_RTI_Injured_Cyclists | H | People selected according to information about the type of user from the GUB; based on the information on the vehicle in which the person was traveling at the time of the collision or by which they were hit and the position they occupied in relation to the vehicle, the type of user variable is generated using the following categories: pedestrian, passenger car user, motorcyclist, cyclist, van or truck user, bus user, and other user | N/A |
| 60_RTI_Injured_Car | H | People selected according to information about the type of user from the GUB; based on the information on the vehicle in which the person was traveling at the time of the collision or by which they were hit and the position they occupied in relation to the vehicle, the type of user variable is generated using the following categories: pedestrian, passenger car user, motorcyclist, cyclist, van or truck user, bus user, and other user | N/A |
aOnly codes (both diagnostic and external cause) ending in A, B, C, or missing (reflects initial encounter, active treatment) were included.
bEpisodes of nonfatal injuries treated in the hospital emergency departments of Barcelona, for both residents and nonresidents of the city.
cCMBD-AH: Register of the Minimum Basic Data Set of hospital discharges.
dEpisodes of nonfatal injuries discharged after admission to a hospital in Barcelona for both residents and nonresidents of the city.
eMAIS: Maximum Abbreviated Injury Score.
f
gMVT: motor vehicle traffic.
hTBI: traumatic brain injury.
iCDC: Centers for Disease Control and Prevention.
jRTI: road traffic injury.
kEpisodes of nonfatal injuries due to traffic collisions treated in the hospital emergency departments of Barcelona, for both residents and nonresidentsof the city.
lEpisodes of nonfatal injuries due to traffic collisions discharged after admission to a hospital in Barcelona, for both residents and nonresidents of the city.
mIndividuals residing in Barcelona who died from injuries due to external causes within the city.
nRMB: Barcelona Mortality Register.
oIndividuals, both residents and nonresidents of Barcelona, who died in Barcelona due to traffic collision–related injuries.
pIMLCFC: L'Institut de Medicina Legal i Ciències Forenses de Catalunya.
qCBD: basic cause of death.
rTraffic collisions in Barcelona where a person, either a resident or nonresident of the city, has been injured (requiring some form of medicalassistance).
sNot applicable.
tIndividuals, both residents and nonresidents of Barcelona, injured in traffic collisions in Barcelona (requiring some form of medical assistance).
Several continuous or quantitative variables in the dataset were categorized or summarized for analysis.
Age was analyzed in age groups rather than as a continuous variable. We used the following standard age bands: 0‐14 years, 15‐24 years, 25‐44 years, 45‐64 years, 65‐74 years, and ≥75 years. These groupings align with public health reporting standards and facilitate age-specific rate calculations and comparisons across demographic subpopulations.
Injury severity (as derived from
Time variables such as dates (admission date, discharge date, and collision date) were mainly used for record criteria and calculating durations (eg, length of hospital stay, time trends by year). For annual surveillance reporting, we aggregated data by calendar year. No seasonal nor monthly analyses are presented in this paper, so dates were not explicitly categorized by month or season in this analysis.
Population denominators for rate calculations (number of residents of Barcelona) were treated as continuous counts but were effectively fixed values for each year and each demographic stratum. For standardization, we used the average population of Barcelona across the analysis period as a standard population.
All other variables (eg, sex , mechanism categories, intent) were analyzed as categorical variables, with categories as defined in
Because this study was based on routinely collected data, we considered several potential sources of bias and took steps to address them where possible.
The BISS was designed to be population-based and exhaustive for the defined inclusion criteria, minimizing selection bias. All eligible injury events recorded in the source databases were included (no sampling). However, by design, we excluded minor injuries not captured in hospital or police records, which could bias the overall injury counts toward more severe cases. We acknowledge that the current system underrepresents minor injuries (those only seen in primary care or not treated), an issue we plan to address in future expansions of BISS. In terms of geographic inclusion, hospital records included injuries treated in Barcelona hospitals even if the injury occurred outside the city; thus, there was potential overinclusion of cases not actually stemming from Barcelona incidents. To mitigate this, for mortality, we restricted to city residents, and for nonfatal indicators, we interpreted results with caution, noting that some hospital-treated injuries might be from outside incidents (this is listed as a limitation in relevant indicators, and population rate denominators use city residents who could slightly overestimate true incidence). Conversely, some injuries that occurred in Barcelona may have been treated outside the city (eg, in neighboring municipalities), leading to underascertainment of certain cases. This was likely minimal for serious injuries given the concentration of tertiary hospitals in Barcelona.
We relied on coding in administrative data, which could have led to misclassification of injuries or causes (eg, errors in
Since this was primarily a descriptive study, confounding (as in risk factor/outcome relationships) was not a major concern. We were not examining an exposure-outcome causal hypothesis but rather summarizing injury occurrence. Therefore, we did not need to control for confounders via stratification or modeling. However, when comparing subgroups (eg, injury rates by sex), we used age-standardized rates to account for confounding by age structure in sex comparisons.
In summary, the design inherently covered the population of interest and used robust data sources, which helped mitigate selection bias. We made efforts to ensure consistency and accuracy in case definitions to minimize information bias.
No a priori sample size calculation was needed because this study included the entire target population of injury events meeting the inclusion criteria in 2018 through 2024. The effective sample size was determined by the number of eligible injury cases recorded in the data sources. By leveraging whole-population data, the study aimed for comprehensive coverage rather than a targeted enrollment number. The study size was thus fixed by data availability: All relevant records for the year were included. This yielded sufficient numbers to produce stable estimate rates for most indicators at the city level. Where certain subcategory counts were small (for rare causes of injury or specific subpopulations), the results were still reported but interpreted with caution.
All statistical methods applied in this study were descriptive and were planned with the goal of comprehensive surveillance reporting. We did not use inferential statistical tests or complex models; instead, we produced frequency distributions and rate calculations as described in the following paragraphs.
We generated annual summary tables of injury counts and proportions stratified by key variables. For example, we tabulated the number of injury cases by sex, age group, injury mechanism, and injury severity. In these tables, each cell shows the absolute number of cases and its percentage of the column or row total (eg, the proportion of all injuries that falls represent or the percentage of injuries occurring in a given age group). Separate tabulations were done for males and females to facilitate sex-specific insights.
For each of the defined indicators, we calculated the annual incidence rate per 100,000 population. The population denominators were drawn from the Barcelona Municipal Register of Inhabitants (Padron) for the corresponding year. We produced two main types of rate tables for each indicator: (1) overall and sex-specific rates (including crude and age-standardized rates for males and females) and (2) age-specific rates by sex. Age standardization was done using the direct method and the combined 2018‐2024 Barcelona population as the standard, to adjust for differences in age distribution when comparing sexes.
There were very few missing data for core variables due to the nature of the sources (eg, age and sex are almost always recorded in administrative data). If any key variable was missing, those records were still included in overall counts but excluded from stratified analyses requiring that variable. We did not need to apply any imputation, as missingness was minimal and not central to the indicators.
We did not perform analyses of subgroups or interactions beyond the stratifications by sex and age already described. The design of the indicators inherently stratified certain subgroups. We did not explicitly test interactions or perform subgroup hypothesis tests, since our focus was on reporting descriptive metrics rather than estimating effect sizes.
Given that our study was descriptive, we did not conduct formal sensitivity analyses. However, we did examine whether results were consistent over the time series (2018‐2024) as an informal check.
All analyses were performed using Stata 16 statistical software. Data cleaning and rate calculations were done using standard Stata procedures and validated by cross-checking selected results with an independent calculation. The statistical outputs (tables and figures) were then compiled for reporting, with no adjustments for multiple comparisons and no derivation of
This study was based exclusively on anonymized secondary data collected within the routine mandate of public health authorities, which did not require review by a research ethics committee. All data were processed in compliance with applicable data protection regulations.
Access to the underlying data was governed by institutional agreements, but within the research team, the investigators had full access to all relevant de-identified records used to create the study datasets. Specifically, the Public Health Agency of Barcelona has authorized access to the CMBD and mortality databases for surveillance purposes as well as to the police collision database through a collaboration with the city police. All data were handled in compliance with privacy regulations. Therefore, although raw data cannot be made public, the authors (analysts) could use the complete datasets for the purposes of this study. We also note that details on how to access supplemental materials (eg, coding lists or aggregate data tables) are provided in the manuscript or
Data cleaning procedures were carried out to ensure a high-quality analytic dataset. Key steps included filtering and case selection, merging and deduplication, coding harmonization, missing or inconsistent values, and linkage quality (if applicable).
For filtering and case selection, we applied the inclusion criteria algorithms (per
For merging and deduplication, records are uniquely identified within each data source. In the health datasets (ED and HOSP), it is possible that the same patient’s care could generate multiple records (eg, an ED visit followed by an admission). Currently, due to the unavailability of a common patient ID, it was not possible to avoid double counting. We treated ED and HOSP data as separate strata and did not merge them at the patient level; an ED visit that became an admission would appear in both ED and HOSP databases. It was expected that, in the future, patient ID will be available for BISS and consequently, no double-counting would occur across ED versus HOSP indicators, making them mutually exclusive. In contrast, we ensured that deaths were only counted in the mortality datasets and not simultaneously in ED or HOSP (for example, if a person died in hospital, that case is recorded in the mortality register and in the HOSP data; for BISS reporting, we counted it as a death, not a nonfatal hospitalization). In the police data, each injured person in a collision is a separate record; if one person had multiple injury-causing collisions, they would appear multiple times, but each corresponds to a distinct event (this is consistent with the definition of counting episodes, not unique individuals).
Regarding coding harmonization, we standardized variable coding across data sources. For instance, we created common categorical variables for mechanism and intent of injury using
We also performed checks for impossible, inconsistent, or missing values (eg, negative ages, admission dates after discharge dates). No systematic issues were found; any obvious data errors were minimal, and those records were either corrected if possible or excluded if not critical. For example, if an ED record was missing age or sex, it would not contribute to age- or sex-specific analyses but would still be counted in total injuries.
Regarding linkage quality, in the RMB-CT (traffic fatality), data linkage between sources (forensic, police, and death certificate) is managed by a deterministic match (using identifiers like national ID, name, date of birth, and date of incident). The quality of these linkages is maintained by the Public Health Agency’s longstanding procedures; for this study, we did not perform independent linkage, but we trusted the quality control in the existing RMB-CT process. All traffic deaths included have been vetted through that system. We did not link the police nonfatal records with hospital records due to lack of identifiers; thus, no probabilistic linkage procedure was required beyond what is done within the RMB-CT for fatalities.
Throughout, the data cleaning process was thoroughly documented. The code used for data processing and analysis is available upon request, and the study protocol and variable code lists are provided in
A wide range of stakeholders were involved in the development, implementation, and use of the injury surveillance system. These included public health officials, hospital and emergency care providers, epidemiologists, injury prevention specialists, data analysts, policy-makers, researchers, and representatives from affected communities. Each stakeholder group played a critical role in ensuring that the system generates accurate, relevant, and timely data to inform prevention strategies and health policies. Their active engagement enhanced the system’s relevance, facilitated data interpretation, and support the translation of findings into effective public health action.
The surveillance system will be evaluated following CDC guidelines to assess its performance and alignment with public health objectives. Key attributes—such as usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, predictive value, representativeness, timeliness, and stability—will be analyzed to identify strengths and areas for improvement. Evaluation findings will guide targeted recommendations, developed in consensus with stakeholders, and communicated in formats adapted to relevant audiences to support system enhancement.
The dissemination of results from the BISS is a critical step to ensure that collected data translate into effective public health action. Results will be shared systematically with key stakeholders. The planned dissemination includes a web-based dashboard featuring indicators displayed in tables, graphs, and maps across multiple years; reports, infographics, and policy briefs; peer-reviewed publications; and oral and poster presentations, including those at individual, community, and professional meetings. Efforts will be made to ensure that the results are communicated in a timely, accessible, and actionable manner, facilitating data-driven decision-making and strengthening injury prevention strategies across sectors.