Study objective: To describe the development and completeness of an el
ectronic injury-surveillance system, the Rural Injury Surveillance Sys
tem (RISS). Methods: The emergency departments of nine rural Iowa hosp
itals submitted information on all patients treated from May 1993 thro
ugh June 1994. Results: The EDs submitted information on 23,594 patien
ts with 32,445 different injury, disease, or fellow-up visits. On the
basis of comparison with the handwritten ED logbook, 90% of visits wer
e also available in the RISS. Of the visits recorded in the RISS, 99%
were also recorded in the logbook. The proportion of missing diagnosti
c codes decreased from a high of 22.6% in May 1993 to 8.1% in June 199
4. The proportion of missing external cause codes was about 25% at the
end of the study period. The proportion of missing industry and occup
ational codes was less than 5% at the end of the study period. Conclus
ion: Our findings show that complete, computerized, ED-based injury su
rveillance in rural EDs is possible and should be developed further.