Differences in Reporting of Violence and Deliberate Self Harm Related Injuries to Health and Police Authorities, Rawalpindi, Pakistan Umar Farooq 1 * . , Mudassir Majeed 1 , Junaid Ahmad Bhatti 2 * . , Jahangir Sarwar Khan 1 , Junaid Abdul Razzak 3 , Muhammad Mussadiq Khan 1 1 Surgical Unit I, Department of Surgery, Holy Family Hospital, Rawalpindi, Pakistan, 2 Equipe «Pre ´vention et Prise en Charge des Traumatismes», Institut National de la Sante ´ et de la Recherche Me ´ dicale Unite ´ 897, Universite ´ Victor Segalen Bordeaux 2, Bordeaux, France, 3 Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan Abstract Background: The aim of study was to assess differences in reporting of violence and deliberate self harm (DSH) related injuries to police and emergency department (ED) in an urban town of Pakistan. Methods/Principal Findings: Study setting was Rawalpindi city of 1.6 million inhabitants. Incidences of violence and DSH related injuries and deaths were estimated from record linkage of police and ED data. These were then compared to reported figures in both datasets. All persons reporting violence and DSH related injury to the police station, the public hospital’s ED, or both in Rawalpindi city from July 1, 2007 to June 30, 2008 were included. In Rawalpindi city, 1 016 intentional injury victims reported to police whereas 3 012 reported to ED. Comparing violence related fatality estimates (N = 56, 95% CI: 46–64), police reported 75.0% and ED reported 42.8% of them. Comparing violence related injury estimates (N = 7 990, 95% CI: 7 322–8 565), police reported 12.1% and ED reported 33.2% of them. Comparing DSH related fatality estimates (N = 17, 95% CI: 4–30), police reported 17.7% and ED reported 47.1% of them. Comparing DSH related injury estimates (N = 809, 95% CI: 101–1 516), police reported 0.5% and ED reported 39.9% of them. Conclusion: In Rawalpindi city, police records were more likely to be complete for violence related deaths as compared to injuries due to same mechanism. As compared to ED, police reported DSH related injuries and deaths far less than those due to other types of violence. Citation: Farooq U, Majeed M, Bhatti JA, Khan JS, Razzak JA, et al. (2010) Differences in Reporting of Violence and Deliberate Self Harm Related Injuries to Health and Police Authorities, Rawalpindi, Pakistan. PLoS ONE 5(2): e9373. doi:10.1371/journal.pone.0009373 Editor: Ehsan Syed, Aga Khan University Hospital, Pakistan Received July 23, 2009; Accepted February 1, 2010; Published February 23, 2010 Copyright: ß 2010 Farooq et al. 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 author and source are credited. Funding: The injury surveillance study was funded by the Government of Punjab, Pakistan. The funding organization had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: dr_umar_farooq@yahoo.com (UF); junaid.bhatti@yahoo.com (JAB) . These authors contributed equally to this work. Introduction Nearly one third of all injuries are intentional, half of which are self-inflicted whereas the other half result from interpersonal and collective violence [1], [2], [3]. In 2002, these injuries resulted in over 1.6 million deaths worldwide with an age adjusted mortality rate of 28.8 deaths per 100 000 inhabitants [2]. Interestingly, this disease burden was distributed differently between high-income (HICs) and low- and middle-income countries (LMICs) as more than 90% of these deaths occurred in LMICs [2], [3]. Mortality rate due to these injuries was twice as high in LMICs as compared to HICs (32.2 versus 14.4 per 100 000 inhabitants) [4]. Official crime statistics were the most common source of information used to assess intentional injury disease burden worldwide [4], [5], [6], [7]. Use of these statistics to compute injury rates was often criticized due to underreporting [4], [6]. Indeed, most of these injuries were never reported to the law enforcement agencies. A South African study showed that only 20 to 50% of intentional injuries were reported to the police [8]. Similarly, in United States only 54% of such victims seeking emergency department (ED) care reported circumstances of events to police [9]. The discrepancies in official statistics for intentional injuries has almost never been assessed in LMICs most probably due to difficulties associated with data collection and linkages [3], [4]. Pakistan with the population of over 160 million inhabitants has a significant intentional injury disease burden [10], [11]. Official statistics showed that assaults resulted in 8.9 injuries per 100 000 inhabitants whereas homicide rate was 6.3 per 100 000 inhabitants [6]. A study in Rawalpindi division, Pakistan, comparing injury numbers reported in newspapers to the police statistics indicated differences in reporting of injury types in both sources during same period [12]. For instance, as compared to newspapers, police reported more non fatal road crashes, assaults, and homicides and fewer fatal crashes, deliberate self harm (DSH) and violence against women related injuries. However, newspapers based injury PLoS ONE | www.plosone.org 1 February 2010 | Volume 5 | Issue 2 | e9373