Improve Injury Prevention Research Articles

Prevention of Unintentional Injuries: A Global Role for Pediatricians

In spite of many proven ways to prevent childhood injuries, the relative prevalence of unintentional injury continues to plague the health and well-being of children worldwide. No population groups are spared, with children living in all social and economic circumstances at risk. Dr Hollwarth describes the extent of this injury pandemic. He also cites practical approaches for pediatricians to help advocate for evidence-based injury prevention policies and more consistent inclusion of anticipatory guidance in their daily practice. The simple truth is that children are much more susceptible to unintentional injuries than adults and the societal costs are unacceptably high. This column serves as a call to arms for pediatricians everywhere to work on combating this growing public health challenge. —Jay E. Berkelhamer, MD, FAAP Editor, Global Health Monthly Feature Primary care pediatricians serve as physicians for the entire family because they accompany children from infancy through adolescence, and quite often into adulthood. The pediatrician may be primarily consulted in cases of diseases, but his or her advice with regard to vaccination, healthy nutrition, and a safe environment is usually appreciated by families. Thus, pediatricians can play a significant role in injury prevention, too. Why is injury prevention important? Unintentional injuries constitute a global public health problem and are the leading cause of death in children and adolescents between the ages 5 and 18 years. More than 800 000 children younger than 18 die every year as a result of unintentional injuries.1 In the United States, this is the leading cause of death among children aged 18 and younger, claiming more than 12 000 lives annually.2 For each child who dies as a result of injury, another 553 children are treated at emergency departments, a further 11.2 children need to … Address correspondence to Michael E. Hollwarth, Univ. Prof. Dr., Department of Paediatric and Adolescent Surgery, Medical University, Auenbruggerplatz 34, A-8036 Graz, Austria. E-mail: michael.hoellwarth{at}medunigraz.at

The relationship between vehicle roof crush and head, neck and spine injury in rollover crashes

BackgroundIt is well established that rollover crashes are associated with a higher risk of serious injury and death than other types of crashes. Some of the most serious injuries that can result from a rollover crash are those to the head, neck and spine. The mechanism of injury to these body parts in a rollover is a matter of dispute in the literature. Some authors have concluded that the magnitude of vehicle roof deformation or vertical roof crush resulting from a rollover crash is not causally associated with head and neck injury severity, while others offer support for a causal association between roof crush and the degree of injury. A better understanding of the cause of serious injuries resulting from rollover crashes is important for improving injury prevention. MethodsThis study utilized data from the National Automotive Sampling System – Crashworthiness Data System (NASS-CDS) for the years 1997 through 2007. Both cross-sectional and matched case–control designs along with a new composite injury metric termed the Head, Neck and Spine New Injury Severity Score (HNS-NISS) were used to analyze these data. ResultsThe cross-sectional analysis demonstrated a 64% (95% CI: 26–114%) increase in the odds of a life-threatening injury as estimated by the HNS-NISS with every 10cm of increased roof crush. The results of the matched case–control analysis demonstrated a 44% (95% CI: 8–91%) increase in the odds of sustaining any injury to the head, neck or spine with every 10cm increase in roof crush. ConclusionThese results lend statistical support to a causal association between roof crush and head, neck and spine injury severity. Though they do not constitute definitive proof, they do contradict previously published theories suggesting that roof deformation is unrelated to such injuries.

Is the Societal burden of fatal occupational injury different among NORA industry sectors?

ProblemSince the implementation of the Occupational Safety and Health Act, safety and health in the work environment has seen marked improvement. Although these improvements are laudable, workplace hazards continue to plague the American worker. Understanding the economic burden of fatalities by industry sector is important to setting broad occupational safety and health research priorities. Cost estimates provide additional information about how fatal injuries affect society and hence can improve injury prevention program planning, policy analysis, evaluation, and advocacy. MethodThis study estimated the total, mean, and median societal costs by worker and case characteristic in 2003-2006 for the industry sectors identified in the National Institute for Occupational Safety and Health National Occupational Research Agenda (NORA). Analyses were conducted with restricted access to the Bureau of Labor Statistics Census of Fatal Occupational Injuries data. These data exclude military personnel, decedents with unknown age or sex, and fatalities occurring in New York City. Societal costs were estimated using the cost-of-illness approach, which combines direct and indirect costs to yield an overall cost of an fatal occupational injury. ResultsDuring this period, the cost of the 22,197 fatal occupational injuries exceeded $21 billion. The mean and median costs of these fatalities were $960,000 and $944,000 respectively. Total societal costs by NORA sector ranged from a high of $5.8 billion in Services to a low of $530 million in Healthcare and Social Assistance with mean costs ranging from the nearly $800,000 in Agriculture, Forestry, and Fishing to almost $1.1 million in Mining. DiscussionThe societal costs—total, mean, and median costs—of case and worker characteristics for occupational fatal injuries varied within each NORA sector. Impact on IndustryTo have the greatest societal impact, these costs can be used to target resources for public and private sector research by industry.

Improving injury prevention research through patient and public involvement—towards working in partnership

BackgroundLay involvement in research has been proved to have advantages both at a national and local level. Hence major research funders require evidence of Patient and Public Involvement (PPI) in...

Rising mortality from injury in urban China: demographic burden, underlying causes and policy implications

In urban China, mortality from injuries has increased over the past five decades. By contrast, life expectancy has continued to increase and has come to nearly equal life expectancy in developed countries. Currently, most of the life expectancy lost due to injury (65%) in urban China would be recovered if injury rates were the same as in countries with low injury-related mortality. Fundamentally, the rising trend in urban injury mortality in China reflects a continued focus on injury treatment rather than prevention in the face of fast socioeconomic development and increasing exposure to risk factors for injury. Despite improved injury prevention legislation and a "Safe Community" campaign, urban China needs to modify its approach to urban injury management and focus on prevention. The gap between urban China and countries with low injury mortality can be closed by means of legislation, strengthened law enforcement and the establishment of safer communities. Risks affecting children and migrants deserve greater attention, and the government needs to allocate more resources to injury prevention, especially to urban areas in the central-west region of China. Based on the population size of urban China, measures for the prevention of injury mortality would save an annual 436.4 million years of life.

Preventing Eye Injuries Among Citrus Harvesters: The Community Health Worker Model

Although eye injuries are common among citrus harvesters, the proportion of workers using protective eyewear has been negligible. We focused on adoption of worker-tested safety glasses with and without the presence and activities of trained peer-worker role models on harvesting crews. Observation of 13 citrus harvesting crews established baseline use of safety eyewear. Nine crews subsequently were assigned a peer worker to model use of safety glasses, conduct eye safety education, and treat minor eye injuries. Safety eyewear use by crews was monitored up to 15 weeks into the intervention. Intervention crews with peer workers had significantly higher rates of eyewear use than control crews. Intervention exposure time and level of worker use were strongly correlated. Among intervention crews, workers with 1 to 2 years of experience (odds ratio [OR] = 2.89; 95% confidence interval [CI] = 1.11, 7.55) and who received help from their peer worker (OR = 3.73; 95% CI = 1.21, 11.57) were significantly more likely to use glasses than were other intervention crew members. Adaptation of the community health worker model for this setting improved injury prevention practices and may have relevance for similar agricultural settings.

Traumatic Spinal Cord Injuries in Horseback Riding

Background: Spinal cord injury (SCI) is a potentially disabling neurologic injury that can occur in horseback riding. To date, no published study has examined the epidemiology of SCI from horseback riding in the United States, and few international studies exist on this topic. Several studies have described traumatic brain injuries, spine fractures, and extremity injuries; however, SCI patterns and outcomes in horseback riders are poorly understood. Purpose: This study was undertaken to characterize the demographics, SCI patterns, and neurologic outcomes of persons with SCIs related to horseback riding. Study Design: Descriptive epidemiologic study. Methods: This is a retrospective review of 121 SCI cases from horseback riding in the National SCI Statistical Center database from 1973 to 2008. The treatment setting was 26 U.S. SCI Model Systems of Care. The number of injuries, gender, age, and SCI type for horseback riding were compared with other sports and activities. The level of preserved neurologic function, SCI completeness, American Spinal Injury Association classification, and mechanical ventilation use at discharge were examined in the horseback riding group. Results: The mean age of injury was 37.8 years (standard deviation, 15.2). The majority of patients were white (88%) and female (50.4%). Compared with diving, motorcycle riding, football, and gymnastics, horseback riding involved a significantly higher number of women (P < .005), a higher mean age of injury, and an equal likelihood of resulting in paraplegia and tetraplegia. The most common levels of preserved neurologic function were C4-C6, T12, and L1. Spinal cord injury from horseback riding most commonly resulted in incomplete tetraplegia (41%) followed by complete paraplegia (24%). Only 4 patients required mechanical ventilation on discharge from acute inpatient rehabilitation. Conclusion: Spinal cord injury from horseback riding affects an equal proportion of women and men, has a wide age range, and most commonly results in incomplete tetraplegia followed by complete paraplegia. Study findings improve awareness of the demographics and neurologic outcomes of individuals with SCI from horseback riding and can help guide future studies evaluating SCI mechanisms in horseback riders to improve injury prevention and management.

The unrecognized danger of a new transportation mechanism of injury – Pedicabs

Objective Pedicabs are a new and controversial transportation innovation for tourists in congested areas in several U.S. cities. Scant literature on this trauma mechanism exists. The purpose of this study is to identify the incidence, demographics, morbidity, mortality, and potential for injury prevention of pedicab incidents amongst major trauma admissions at an urban, academic Level I Trauma Center. Patients & Methods Researchers conducted a retrospective review of the Trauma Registry from 2000 to 2009. All patients identified as being injured in a pedicab incident were reviewed. Demographics, diagnoses, toxicology, treatments, and injury severity scale (ISS) were collected. Outcomes included mortality, ICU, and hospital length of stay (LOS), discharge disposition, and hospital charges. A photographic survey of 50 local pedicabs was examined for the presence and use of safety equipment. Results During the period of January 2000 to July 2009 there were 15 major trauma victims from identified pedicab incidents. Falling from the pedicab was the mechanism of injury in 14 of 15 cases. There were two fatalities in victims following severe traumatic brain injury. Traumatic brain injury, skull fracture, or loss of consciousness was seen in 11/15 victims. Ethanol ingestion was detected in blood tests of 10 of the 14 adult victims. Median charges of hospitalization due to a pedicab related injury was US$29,956 ± 77,482. A photographic survey of 50 local pedicabs reveals very limited use of safety belts by passengers despite existing city ordinances. Conclusions Major trauma victims of pedicab incidents in the United States suffer significant injuries and death. Most cases occurred in passengers falling from the pedicab at night after alcohol ingestion. There is an opportunity for implementation of strategies toward improved injury prevention with this new form of transport.

A Randomized Trial of a Home Safety Education Intervention Using a Safe Home Model

Young children are at risk for injuries in the home. This study was to compare a safe house model to The Injury Prevention Program (TIPP) sheet for providing injury prevention information. Parents of children who were younger than 6 years were randomized to injury prevention education using a safe home model or an age appropriate TIPP sheet. There was a pretest before the intervention. The recall of injury prevention information was assessed by a telephone posttest 4 weeks to 6 weeks after the intervention. To obtain a sample broadly representative of community demographics, we recruited families in the dermatology clinic of a teaching hospital. We collected complete information for 371 families of which 181 were in the safe home model group and 190 were in the TIPP group. There were no differences between groups in percent minority race, education, or insurance; the parents in the safe home group were slightly older (34.4 ± 6.5 vs. 32.9 ± 5.8). More than 80% in each group had education beyond high school. There was no difference between groups in pretest scores, 8.0 ± 1.3 for the safe home model group and 8.1 ± 1.1 for the TIPP group. There was no difference between groups in posttest scores, 9.0 ± 0.8 for the safe home model group and 9.1 ± 0.9 for the TIPP group. The safe home model and the TIPP sheets were both effective in improving safety knowledge. The use of a safe home model complements current strategies to improve injury prevention knowledge.

Examining Ontario Deaths Due to All-Terrain Vehicles, and Targets for Prevention

All-terrain vehicle (ATV) use is increasingly popular among people of all ages. Although ATV use is known to cause significant morbidity due to head and neck trauma, there is a lack of published data detailing ATV-related fatalities. We examined all ATV-related fatalities in Ontario from 1996 - 2005 to determine the epidemiology and risk factors as a guide for improved injury prevention strategies. All ATV-related fatalities from 1996 - 2005 in Ontario were examined through Coroner's reports in the Office of the Chief Coroner of Ontario. Epidemiologic information and risk factors relating to the driver, environment, and vehicle were recorded. There were 74 ATV-related fatalities from 1996 - 2005. There was only one fatality per year in 1996 and 1997 and a peak of 16 per year in 2004 and 2005. Head and neck injuries were the commonest causes of death. Males comprised 90.5% of the cases. The highest risk was from age 15 - 29, and 21% of fatalities occurred in children under 16. Northeastern Ontario had the highest fatality rate. There was a major increase in the incidence of ATV-related fatalities in Ontario from 1996 - 2005 with the majority due to head trauma. Notable risk factors included alcohol use, riding at night, lack of helmet use, and excessive speed. We recommend the adoption of laws that focus on helmet requirements, a minimum driver age of 16, and certified training courses. Aggressive injury prevention efforts should be targeted toward males aged 15 - 29.

The Global Burden of Unintentional Injuries and an Agenda for Progress

According to the World Health Organization, unintentional injuries were responsible for over 3.9 million deaths and over 138 million disability-adjusted life-years in 2004, with over 90% of those occurring in low- and middle-income countries (LMIC). This paper utilizes the year 2004 World Health Organization Global Burden of Disease Study estimates to illustrate the global and regional burden of unintentional injuries and injury rates, stratified by cause, region, age, and gender. The worldwide rate of unintentional injuries is 61 per 100,000 population per year. Overall, road traffic injuries make up the largest proportion of unintentional injury deaths (33%). When standardized per 100,000 population, the death rate is nearly double in LMIC versus high-income countries (65 vs. 35 per 100,000), and the rate of disability-adjusted life-years is more than triple in LMIC (2,398 vs. 774 per 100,000). This paper calls for more action around 5 core areas that need research investments and capacity development, particularly in LMIC: 1) improving injury data collection, 2) defining the epidemiology of unintentional injuries, 3) estimating the costs of injuries, 4) understanding public perceptions about injury causation, and 5) engaging with policy makers to improve injury prevention and control.

Development and Evaluation of a Safety Education Program for Injury Prevention in Elementary School Students

Purpose: The purpose of this study was to develop and evaluate the effects of a safety education injury prevention program in elementary school students. Methods: To develop the safety education program, Dick & Carey's teaching model and Keller's ARCS theory were applied. A safety education programs was developed for lower grade students (1st-3rd) and for higher grade students (4th-6th). To evaluate the effect of the safety education program, a pre-post test questionnaire was used with experimental and control groups. The participants were 238 (119 in the experimental group, 119 in the control group) lower (3th) grade and 296 (148 in the experimental group, 148 in the control group) higher (5th) grade elementary school students. For students in each experimental group, safety education was provided for 40 min once a week for 10 weeks. Results: There were significant differences in the level of injury prevention knowledge, attitude, and practice between the experimental group and control group in both the lower and higher grade elementary students. Conclusion: The findings of this study indicate that safety education is an effective nursing intervention to improve injury prevention knowledge, attitude, and practice in elementary school students.

Fatigue-Induced ACL Injury Risk Stems from a Degradation in Central Control

Fatigue contributes directly to anterior cruciate ligament (ACL) injury via promotion of high risk biomechanics. The potential for central fatigue to dominate this process, however, remains unclear. With centrally mediated movement behaviors being trainable, establishing this link seems critical for improved injury prevention. We thus determined whether fatigue-induced landing biomechanics were governed by a centrally fatiguing mechanism. Twenty female NCAA athletes had initial contact (IC) and peak stance (PS) three-dimensional hip and knee biomechanics quantified during anticipated and unanticipated single-leg landings, before and during unilateral fatigue accumulation. To induce fatigue, subjects performed repetitive (n = 3) single-leg squats and randomly ordered landings, until squats were no longer possible. Subject-based dependent factors were calculated across prefatigue trials and for those denoting 100%, 75%, 50%, and 25% fatigue and were submitted to three-way mixed-design analyses of covariance to test for decision, fatigue time, and limb effects. Fatigue produced significant (P < 0.01) decreases in IC knee flexion angle and PS knee flexion moment and increases in PS hip internal rotation and knee abduction angles and moments, with differences maintained from 50% fatigue through to maximum. Fatigue-induced increases in PS hip internal rotation angles and PS knee abduction angles and loads were also significantly (P < 0.01) greater during unanticipated landings. Apart from PS hip moments, significant limb differences in fatigued landing biomechanics were not observed. Unilateral fatigue induces a fatigue crossover to the contralateral limb during single-leg landings. Central fatigue thus seems to be a critical component of fatigue-induced sports landing strategies. Hence, targeted training of central control processes may be necessary to counter successfully the debilitative impact of fatigue on ACL injury risk.

Preventable Pediatric Trauma Deaths in Ontario: A Comparative Population-Based Study

Previously, we demonstrated that 21% of pediatric (<16 years) trauma deaths in the Province of Ontario during the period 1985 to 1987 were potentially preventable. Since then many trauma system changes have occurred including field triage, designation of trauma centers, and improved injury prevention. This study aims to examine the current preventable trauma death rate in our system using identical methodology to our previous study. The records of all children (<16 years) who died in Ontario from 2001 to 2003 after blunt or penetrating trauma were obtained from the Chief Coroner and compared with those in our previous report. In both series, we excluded cases where care was not sought and all deaths due to asphyxia. Deaths were considered unpreventable if the Injury Severity Score, based on Abbreviated Injury Scale 1985, was >59; or if there was a head injury that received an Abbreviated Injury Scale score of 5 with the exception of isolated extra-axial hematomas. Eleven preventable deaths were identified. The preventable death rate was 7%, a significant decline from the 21% previously identified (p < 0.001; relative risk reduction for preventable death, 68% [95% confidence interval, 42-83%]; number needed to treat, 7). There has been a threefold decline in the preventable death rate, which we believe is related to improvements in the trauma system. We estimated that, for every seven deaths from fatal injuries, system changes between the two study periods eliminated one preventable death.

Do We Have Enough Information? How ICD-10-AM Activity Codes Measure UP

This research explored the usage of activity codes introduced into the International Statistical Classification of Diseases and Related Health Problems, Tenth revision, Australian Modification (ICD-10-AM) Third Edition and examined the data quality of activity coding, explicitly, completeness and specificity. Injury separations for years 2001/02 to 2005/06 specifying a 'true injury' were extracted for descriptive analyses. Part A investigated the usage of activity codes and compared the usage of the 236 activity codes available in the Activity block (U50-U73) present in the ICD-10-AM Third Edition against the 16 codes present in the second edition. Part B examined the level of completeness of external cause coding and the degree of activity coding specificity in the 2005/06 dataset. It was found that the additional activity codes were used extensively with only 46 codes seldom assigned. Codes present in the second edition were extensively used in the third and fourth editions and the new additional activity codes represent 10% of all activity codes assigned per year. All five datasets demonstrated high levels of completeness, recording completeness levels greater than 97%, where missing activity codes attributed to the majority of missing codes. Fourteen out of the 24 activity categories demonstrated a strong reliance on non-specific codes and Team ball sports and Wheeled non-motor sports illustrated that activity codes assigned lacked detail in the code. Clinicians and coders need to acknowledge the importance of quality clinical documentation for research and policy-making purposes so that circumstances surrounding injury events can be coded to the highest level of specificity to improve injury prevention and control activities. Missing activity codes and the abundance of non-specific coding hinders the usefulness of the data.

Smooth handling: The lack of safety-related consumer information in car advertisements

Objective:To examine the content and trends of safety-related consumer information in magazine vehicle advertisements, as a case study within the worldwide marketing of vehicles.Methods:Content analysis of popular current affairs magazines...

Childhood injury prevention: The views of health visitors and nursery nurses working in deprived areas

Aim The aim of this study was to ascertain the views of health visitors and nursery nurses about childhood injury prevention in deprived areas. Method A survey was carried out amongst 51 health visitors and 7 nursery nurses attached to practices (n=47) from deprived areas who participated in a large injury prevention randomised controlled trial. Results The response rate was 97%. The most commonly cited barrier to injury prevention work in deprived areas was finance/cost to families and this was mentioned by 59% (n=32) of the respondents. Parental attitudes and understanding was considered to be important for nearly half (48%, n = 26) the respondents. Their views about what actions could be initiated at national and local levels to improve injury prevention work in deprived areas are described. At a national level 52% (n=27) of respondents suggested public awareness should be raised, and 14 (25%) of these mentioned using television for this purpose. Approximately one-third (32%, n=17) commented that at a local level, parental awareness should be raised in as many places as possible. Conclusions Health visitors and nursery nurses who responded appear to focus on child injury prevention at the micro level rather than at a broader public health level. In addition, many commented on barriers or constraints placed upon them. Further support will be needed if they are to develop a family centred public health approach.

In vivo pons motion within the skull

Finite element (FE) models are used to identify head injury mechanisms and design new and improved injury prevention schemes. Although brain–skull boundary conditions strongly influence the model mechanical responses, limited experimental data are available to develop an informed representation. We hypothesize that the spinal cord tension and gravity contribute to the pons displacement in vivo. Static high-resolution T1-weighted sagittal MR images of the inferior portion of the head in neutral and flexion positions were acquired in 15 human volunteers in both supine and prone postures. Boundaries of the pons and clivus were extracted with a gradient-based algorithm, and the pontes were fitted into ellipses. Assuming rigid body motion of the skull, image pairs in different postures were co-registered with an autocorrelation technique. By comparing images before and after the motion, we found that while the rotation of the pons is negligible relative to the skull, the pons displaces significantly at the foramen magnum, on the order of ∼2 mm. When the spinal cord tension and gravity act in concert, the pons moves caudally; when opposed, superiorly, such that the influence of gravity on the pons is six times that of the spinal cord tension. Based on these findings, we recommend that the brainstem–skull interface be treated as a sliding (with or without friction) boundary condition in FE models of the human head.

Relationship between Injury Occurrence and Workplace Organization in Small-sized Manufacturing Factories

Objective: This study evaluated the relationship between injury occurrence and workplace organization in small-sized, manufacturing factories in Korea. Methods: Using data from the 2004 Occupational Safety and Health Survey in Korea, this study compared workplace organizational factors (general characteristics, employee characteristics and health and safety characteristics) with injury occurrence of 1,866 small-sized, manufacturing factories (65,921 population factories after weighting). General characteristics of factories comprised location, type and classification of industry. Employee characteristics comprised proportion of manual workers and female workers, average working hours per week and shiftwork. Health and safety characteristics comprised type of safety and health manager, committee for occupational safety and health, labor union, health and safety regulation, monthly health and safety training time, score of health and safety activity and score of safety culture. Results: The following characteristics of injury-occurrence in small-sized, manufacturing factories were determined by multivariate analysis. In terms of general characteristics, the risk of injury-occurrence was higher in Jeolla area than Gyeongin area in outside associate than other enterprises and in coke, refined petroleum products and nuclear fuel, wood and products of wood, food products and beverages and fabricated metal products, except machinery and furniture industries than television and communication equipment and apparatus industries. In terms of employee characteristics, injury-occurrence significantly increased in factories with greater proportion of manual worker and with a higher rate of working hours per week. But significantly decreased in factories with a higher proportion of female workers. In terms of health and safety characteristics, injury-occurrence significantly increased in factories with a self-appointed safety manager, with unorganized union, with a more active committee for occupational safety and health, with unimplemented health and safety regulations, with longer monthly safety and health training time, and with a lower score of safety culture. Conclusions: This study demonstrated that several factors of workplace organization were significantly related with injury-occurrence in factories. These findings are supposed to raise the need for making efforts in workplace organization to improve injury prevention.

Paediatric trauma

Trauma remains the most common cause of death in childhood after the first year of life. It accounts for considerable morbidity that may extend into adult life at great cost to the community. Despite the scale of the disease, paediatric trauma and injury prevention research attract little funding. International data indicate that children in Australia and New Zealand would benefit from improved injury prevention strategies and the introduction of a more formalized paediatric trauma system. Such a system would need to take account of Australasian geographical and population distribution characteristics, which mandate local provision of expert and immediate care in rural areas. There would appear to be economic and clinical arguments for the introduction of an ambulance trauma bypass system for stable but severely injured children in metropolitan areas with a paediatric trauma centre.