Nonfatal Injuries Research Articles

Health loss after road transport injury – new perspectives

Abstract Background Health loss in the road transport system is a major public health problem. Globally, about a fifth of all fatalities within the road transport system are represented by pedestrians, and bicyclists are the group with the highest number of severe injuries in the EU. Here we strive to add new perspectives of health loss in different road user groups examining sickness absence (SA) and disability pension (DP) and in the case of injuries after car crashes also relating them to permanent medical impairment (PMI). Methods Several register-based studies were conducted, based on microdata linked at individual level from several Swedish nationwide registers. In one study information about PMI from the insurance company Folksam was also used. In the main analyses we included all working individuals aged 20-59 years injured in a road traffic accident (pedestrians, bicyclists, car occupants, and other road users) in 2015 in Sweden and population-based matched references without any traffic-related injury. Diagnosis specific SA and DP were assessed during 1 year before and 4 years following the accident. Results A third of the traffic-related accidents involved bicyclists, 31% car occupants, 16% pedestrian, and 19% were other accidents. The excess SA days/year was elevated for all road user groups the whole study period. Excess SA due to injury diagnoses was 15-35 days/year during the first year following the accident. Among individuals injured in a car crash that reported the injury to Folksam, 2% had a new DP 2 years after the crash, and 8% had injuries resulting in PMI. A distinct trend showed that the proportion granted DP increased with increasing PMI grade. Conclusions Sickness absence is a common outcome among individuals injured in the road transport system. Together, these studies highlight the importance of preventing not only fatalities in the road transport system but also non-fatal injuries.

3.Y.2. Road traffic injuries, disability burden and implications for compensation schemes in Europe

Abstract Reducing traffic fatalities and injuries is a complex challenge, but it is one that is of paramount importance for public health and safety worldwide. In recent years, there have been improvements in trauma care and injury prevention efforts, which reduced mortality rates and increased survival after serious injury. However, an increased heterogeneity in recovery times is observed with survivors of road traffic injuries differing in their adjustment compared to other traumas in terms of symptoms’ onset, variability and chronicity. The recovery trajectory seems to vary widely with a large percentage of survivors in need of extensive time periods for full recovery. Attention has now been shifted towards the adverse effects of non-fatal injuries on functional, mental health, economic and societal outcomes. The capacity of a person to continue functioning, inability to work, sickness absence and reliance on welfare benefits to compensate for loss of income are some of the injury-related long-term consequences, causing great concern for health and social security systems across Europe, as they have been shown to account for more than one third of total road traffic incident costs. These figures fail to include individuals who sustain “minor” injuries, which do not require hospitalisation, yet still impair their ability to work. Despite the rapidly growing epidemiological and clinical attention, there are still several issues missing from research, policy and practice. A universal definition of recovery after a road traffic injury is still missing, and this has been seen as critical for improved understanding of risk factors of poor recovery as well as improved identification of those in need of welfare benefits. Furthermore, long-term sickness absence and disability following road traffic injury in Europe is still understudied and evidence on the different return to work pathways and compensation schemes is scarce. Evidence is still limited on the context in which return to work occurs, the injury profiles most dependent on long term compensation schemes and the policy settings of injury compensation schemes that impact return to work outcomes post injury. Data availability and data linkage issues often cause misclassification errors when granting disability pensions and this remains unattended long after an injury. Welfare benefits are often poorly connected with the injury or other medical diagnoses and this makes it difficult to assess the contribution of injuries on disability pensions and other welfare benefits, especially in comorbid and multimorbid conditions. The current workshop aims to improve our understanding of the long-term consequences and the challenges faced by those injured in road traffic injuries and aid the development of interventions that seek to enable sustained recovery, and help inform policy and practice of healthcare and injury compensation systems. Key messages • Timely access to quality healthcare, rehabilitation therapies, and assistive technologies can significantly improve outcomes and reduce the strain on social security and compensation systems. • Ensuring equitable access to social security benefits for injured individuals, requires efficient compensation schemes that recognize the full impact of the disability on individuals’ life.

Home and leisure accidents among children and young people up to 19 years old as an event observed in the EU-IDB surveillance system: 2012-2021 data

Abstract Paediatric injuries are widely acknowledged as a major public health issue among different medical disciplines. In the context of injuries and accidents, the surrounding environment of children and young people remains a major health concern. The present study was developed to extend current knowledge on the characteristics and magnitude of home and leisure accidents in this population. A descriptive, observational, cross-sectional study was developed under the EU-IDB (European Injury Database) collaborative network comprising up to 25 European countries and ten years of data collection (2012 to 2021). The methodology of the EU-IDB is a well consolidated standard for collecting injury data in Emergency departments, in compliance with the Eurostat methodological requirements for European health statistics. During the ten years of data collection in emergency departments, through EU-IDB surveillance 3 603 975 episodes of home and leisure accidents (HLA) were recorded at European level, involving people aged 0-19 years, constituting 34.5 % of hospital ED attendances due to HLA. Children and young people between 10 and 14 years old represented the major age group proportion of HLA(33.0%), the proportion of HLA increased across age groups until fourteen years old, being these differences statistically significant(p < 0,001). Falls were the most common cause of injuries among all age-groups, in the youngest group up to 4-years(54.4%), the 5-9years old (52.2%), the 10-14years old (46.1%) and in the oldest group between 15-19 years(37.5%), representing 47.2% of the total HLA mechanism. As regards to the treatment/follow-up, the vast majority of the HLA episodes were not admitted to hospital (92.9%). Hospital ED Injury data represent very useful information on the health burden of non-fatal injuries in this population of interest. These data could be used for the design of injury prevention policies and regulations for accidents that occur at home, school and outdoor spaces.

Using EMS data to explore community-level factors associated with firearm violence in North Carolina

BackgroundFirearm violence is a significant public health issue. However, it is unclear if there is an association between the Social Vulnerability Index (SVI) and the intent of both fatal and nonfatal firearm injuries, and if these associations are modified by community race and ethnic composition. This study examines the association between community-level social vulnerability and firearm injury incidence in North Carolina (NC) using 2021–2022 emergency medical services (EMS) data. Additionally, it investigates how these associations vary by the intent of injury (assault, self-inflicted, and unintentional), and whether they are modified by community racial/ethnic composition.MethodsThis cross-sectional study utilized NC EMS data, capturing firearm incidents from January 1, 2021, to December 31, 2022. The SVI from the Centers for Disease Control and Prevention (CDC) was used to assess community-level vulnerability. The SVI’s racial/ethnic minority status component was removed for stratification analysis. Firearm injury rates were calculated per 100,000 population, and negative binomial regression models were used to estimate Incidence Rate Ratios (IRRs) for different SVI levels and intents of firearm injuries.ResultsDuring the study period, we identified 7,250 EMS encounters at non-healthcare locations related to firearm injuries, encompassing 2,648 NC census tracts. Assault was the leading cause of firearm injuries (n = 3,799), followed by self-inflicted (n = 1,498), and unintentional injuries (n = 722). High-SVI communities had significantly higher rates of firearm injuries compared to low-SVI communities, particularly for assault-related injuries. When the minority status component was excluded from SVI, racial/ethnic minority status emerged as a significant modifier, with higher rates of firearm injuries being observed in communities with larger racial/ethnic minority populations.ConclusionCommunity-level social vulnerability is significantly associated with firearm injury incidence, with the effect being more pronounced in racial/ethnic minority communities. These findings underscore the need for targeted public health interventions that address underlying social determinants of health (e.g., access to education) to reduce firearm violence. Future research should further explore the intersection of social vulnerability and racial/ethnic composition to develop effective prevention strategies.

General unemployment and serious workplace injury rates: Workers compensation claims analysis from the Canadian province of Saskatchewan, 2007-2018.

There is conflicting published evidence that unemployment impacts workplace safety. Some studies suggest that the workplace injury rate decreases during economic contractions, while others propose an increased rate of injuries during periods of economic contractions. This study investigated the association between unemployment rates and traumatic work-related non-fatal injury (WRNFI) in Saskatchewan, 2007-2018, in order to provide new insight into injury prevention. Saskatchewan's retrospective linked workplace claims data from 2007 to 2018 were grouped by year, season, and worker characteristics (e.g., age and sex). Total employment, total labour force, and the number of unemployed workers from the Statistics Canada Labour Force Survey were grouped by year, season, sex, and age. These data were linked to the worker's compensation board injury claim data to determine the number of people at risk, serving as the denominator (offset term) for WRNFI rates, calculated as WRNFI cases per total employed workers. A negative binomial generalized additive model was used to examine the association between unemployment rates and WRNFI, adjusted for age, sex, industry types, and seasons. The WRNFI rate has declined since 2007. On average, workers aged 20-29years had the highest WRNFI rate (541.6 ± 84.8/100,000). Men had 3.2 times higher WRNFI risk than women (RR = 3.2, 95% CI 3.12-3.22), with the highest WRNFI risk observed in the manufacturing (RR = 1.68, 95% CI 1.63-1.73) and construction (RR = 1.67, 95% CI 1.63-1.72) industries. WRNFI risk decreased non-linearly with an increasing unemployment rate, indicating a pro-cyclic pattern. This analysis showed that WRNFI rates tracked unemployment rates. This suggests a need to increase prevention strategies and reduce disincentives for under-reporting during an economic downturn.

Urban-rural disparities in fatal and non-fatal paediatric injuries after trauma – A national retrospective cohort study

IntroductionPaediatric trauma is a leading cause of death, with correlations between trauma outcomes and geographical locations. Certain rural regions of Norway face a higher risk of trauma-related fatalities compared to the nationwide population. Among adults, the risk of both fatal and non-fatal injuries rises with increased rurality. The study aimed to investigate whether there is an increased risk of fatal and non-fatal injuries for children in rural areas across the entire country, as well as any changes over two decades. Materials and methodsWe conducted a retrospective cohort study of fatal and non-fatal paediatric injuries by accessing two national registries for all trauma-related patients under the age of 18. All cases were stratified into six groups according to level of centrality based on a national index used as a proxy for rurality. For inter-group comparison, urban-rural disparities were evaluated using Pearson`s Chi-square test, linear regression, and relative risk (RR). Result1,059 paediatric deaths were included in the study period from 2002 to 2021. The mortality rate increased linearly with increased rurality (r = 0.985, p < .001). The overall mortality risk was 2.4 times higher in the most rural group compared to the most urban (RR = 2.37, 95 %CI 1.78 – 3.14, p < .001). Most deaths occurred pre-hospital (73 %), the total number of fatalities was highest in the age group 16 to 17 (42 %), and transport-related injury (32 %) was the most common cause of death. The relative risk of non-fatal injury was significantly higher for all centrality groups compared to most urban, and the highest rate was seen in sub-rural areas (RR = 1.39, 95 %CI 1.37 - 1.42, p < .001). ConclusionThe mortality rate increased linearly across all levels of centrality, and the relative risk was 2.4 times higher in the most rural population compared to the most urban population. To effectively target primary prevention and enhance trauma care for paediatric patients in rural areas, a deeper epidemiological understanding and more comprehensive studies are essential.

Nonfatal Firearm Injury & Subsequent Emergency Department Utilization Among Non-Elderly Adults

IntroductionThe mortality, long-term morbidity, and exacerbated healthcare needs due to firearm injury in the US are significant and growing. However, the relationship between exposure to a nonfatal firearm injury and long-term ED utilization is poorly understood. This study estimates the association between exposure to a nonfatal firearm injury and ED utilization in the subsequent year. MethodsUsing all-payer ED data among non-elderly adults in Georgia and New York, all ED visits for nonfatal firearm injuries from 2017-2018 were identified. Sociodemographic, clinical, and contextual characteristics between nonfatal firearm injury ED patients and the broader population of ED users were compared. ED utilization in the year following a nonfatal firearm injury relative to ED use in the year before, and compared to ED use by a propensity score matched control group was examined, using Poisson and negative binomial multivariable regressions. Analyses were performed in 2024. ResultsNonfatal firearm injury ED patients were disproportionately male, younger, non-Hispanic Black, uninsured, and residents of areas with low median income and high firearm ownership. Compared to a matched control group, multivariable analyses indicated that nonfatal firearm injury ED patients had significantly higher risks of having hospital admissions through the ED (aRR: 1.42), all-cause injury-related ED visits (aRR: 1.47), non-firearm injury-related ED visits (aRR: 1.26), and additional nonfatal firearm injury-related ED visits (aRR: 325.45) in the subsequent year (p<0.001 for all). About one in every eight ED users with a firearm-related injury at index also sought ED care for another nonfatal firearm injury within one year. ConclusionsNonfatal firearm-related injuries contribute to preventable harm, health inequity and increased ED utilization.

A Comparative Study of Different Unorganized Sectors’ Workers in India to Identify Musculoskeletal Disorder Prevalence through Empirical Survey and Deep Learning Methods

Background:: Musculoskeletal disorders (MSDs) are a group of non-fatal injuries that can occur as a result of various repetitive workplace activities, mainly in unorganized sectors. Workers who engage in highly repetitive activities involving constant hand effort, localized mechanical pressure, and vibration are more prone to developing these disorders. Objective:: The objective of this research was to determine the prevalence of MSDs among workers in various unorganized sectors in India who perform hand-intensive occupations. Method:: A cross-sectional study was conducted, involving 340 workers from diverse groups such as sugarcane farmers, footwear industry workers, and tarpaulin weavers, to accomplish this goal. Data for the survey was collected using a questionnaire. Additionally, a comprehensive time study and a deep learning-based posture detection study were conducted on the different activities performed during the workers' occupational tasks. The chi-square test was used to assess the relationship between discomfort and work repetitiveness. Result:: The data analysis revealed that the working activities (especially cutting/harvesting, rubber cutting, etc.) of unorganized sector workers were repetitive, with more than half of each activity’s work cycle involving a similar usage pattern. Furthermore, a significant association was observed between the level of discomfort and work repetitiveness among workers in different sectors (sugarcane farmers: p &lt; 0.01, footwear industry workers: p &lt; 0.05, tarpaulin weavers: p &lt; 0.05). Consequently, it can be concluded that prolonged occupational activities involving repetitive and prolonged standing may contribute to the occurrence of MSDs. Conclusion:: Ergonomic interventions/modifications in the form of patent work will be necessary to prevent these issues in the near future.

Linking Data on Nonfatal Firearm Injuries in Youths to Assess Disease Burden

This cross-sectional study estimates the incidence of nonfatal firearm injuries among children and young adults after linking patient-level police and trauma registry data.

The prevalence of occupational injuries and associated risk factors among workers in iron and steel industries: a systematic review and meta-analysis

BackgroundThe iron and steel industries are among the most dangerous workplaces in the world compared to other manufacturing industries. Workers are exposed to multiple occupational hazards, which predispose them to high risks of both fatal and non-fatal injuries. Currently, the data on the global prevalence and associated risk factors for occupational injuries in the iron and steel industries is fragmented and incomplete. This study was undertaken to address this issue by pooling data relating to the prevalence of occupational injuries and its associated factors among workers in iron and steel industries studies around the world.MethodsThe search was conducted systematically using PubMed, HINARI, EMBASE and Google Scholar for published studies in English that reported on occupational injuries and associated risk factors among workers in iron and steel industries. MetaXL version 5.3 software was used in the meta-analysis to estimate the pooled prevalence of occupational injuries and associated risk factors among workers in the iron and steel industries. The study protocol has been registered with PROSPERO, number CRD42022344258.ResultsOf the 447 articles identified, 15 studies from 9 countries met the inclusion criteria. The pooled prevalence estimate of occupational injury was 0.55 (95% CI: 0.15, 0.93). The pooled results indicated that the odds of having an occupational injury were 4.06 times higher among workers who did not use personal protective equipment compared to those who used such equipment. Likewise the odds of occupational injuries was increased by 1.65 among night shift workers compared to the counterpart.ConclusionsThe global prevalence of occupational injuries in iron and steel industries was 55%. The results indicate that night work shift and the lack of use of personal protective equipment has a higher impact than other factors in the occurrence of occupational injuries in the iron and steel industries.

Evaluating the impact of occupational noise exposure on workplace fatal and nonfatal injuries in the U.S. (2006–2020)

ObjectivesThis study assessed the relationship between occupational noise exposure and the incidence of workplace fatal injury (FI) and nonfatal injury (NFI) in the United States from 2006 to 2020. It also examined whether distinct occupational and industrial clusters based on noise exposure characteristics demonstrated varying risks for FI and NFI. MethodsAn ecological study design was utilized, employing data from the U.S. Bureau of Labor Statistics for FI and NFI and demographic data, the U.S. Census Bureau for occupation/industry classification code lists, and the U.S./Canada Occupational Noise Job Exposure Matrix for noise measurements. We examined four noise metrics as predictors of FI and NFI rates: mean Time-Weighted Average (TWA), maximum TWA, standard deviation of TWA, and percentage of work shifts exceeding 85 or 90 dBA for 619 occupation-years and 591 industry-years. K-means clustering was used to identify clusters of noise exposure characteristics. Mixed-effects negative binomial regression examined the relationship between the noise characteristics and FI/NFI rates separately for occupation and industry. ResultsAmong occupations, we found significant associations between increased FI rates and higher mean TWA (IRR: 1.06, 95% CI: 1.01–1.12) and maximum TWA (IRR: 1.10, 95% CI: 1.07–1.14), as well as TWA exceedance (IRR: 1.04, 95% CI: 1.01–1.07). Increased rates of NFI were found to be significantly associated with maximum TWA (IRR: 1.06, 95% CI: 1.04–1.09) and TWA exceedance (IRR: 1.03, 95% CI: 1.01–1.05). In addition, occupations with both higher exposure variability (IRR with FI rate: 1.49, 95% CI: 1.23–1.80; IRR with NFI rate: 1.40, 95% CI: 1.14–1.73) and higher level of sustained exposure (IRR with FI rate: 1.27, 95% CI: 1.12–1.44; IRR with NFI rate: 1.21, 95% CI: 1.05–1.39) were associated with higher rates of FI and NFI compared to occupations with low noise exposure. Among industries, significant associations between increased NFI rates and higher mean TWA (IRR: 1.05, 95% CI: 1.02–1.08) and maximum TWA (IRR: 1.06, 95% CI: 1.04–1.08) were observed. Unlike the occupation-specific analysis, industries with higher exposure variability and higher sustained exposures did not display significantly higher FI/NFI rates compared to industries with low exposure. ConclusionsThe results suggest that occupational noise exposure may be an independent risk factor for workplace FIs/NFIs, particularly for workplaces with highly variable noise exposures. The study highlights the importance of comprehensive occupational noise assessments.

Public Mass Shootings: Counterfactual Trend Analysis of the Federal Assault Weapons Ban.

Assault weapon and large-capacity magazine bans are potential tools for policy makers to prevent public mass shootings. However, the efficacy of these bans is a continual source of debate. In an earlier study, we estimated the impact of the Federal Assault Weapons Ban (FAWB) on the number of public mass shooting events in the United States. This study provides an updated assessment with 3 additional years of firearm surveillance data to characterize the longer-term effects. This study aims to estimate the impact of the FAWB on trends in public mass shootings from 1966 to 2022. We used linear regression to estimate the impact of the FAWB on the 4-year simple moving average of annual public mass shootings, defined by events with 4 or more deaths in 24 hours, not including the perpetrator. The study period spans 1966 to 2022. The model includes indicator variables for both the FAWB period (1995-2004) and the period after its removal (2005-2022). These indicators were interacted with a linear time trend. Estimates were controlled for the national homicide rate. After estimation, the model provided counterfactual estimates of public mass shootings if the FAWB was never imposed and if the FAWB remained in place. The overall upward trajectory in the number of public mass shootings substantially fell while the FAWB was in place. These trends are specific to events in which the perpetrator used an assault weapon or large-capacity magazine. Point estimates suggest the FAWB prevented up to 5 public mass shootings while the ban was active. A continuation of the FAWB and large-capacity magazine ban would have prevented up to 38 public mass shootings, but the CIs become wider as time moves further away from the period of the FAWB. The FAWB, which included a ban on large-capacity magazines, was associated with fewer public mass shooting events, fatalities, and nonfatal gun injuries. Gun control legislation is an important public health tool in the prevention of public mass shootings.

Factors Associated With Recurrent Pediatric Firearm Injury : A 10-Year Retrospective Cohort Analysis.

Firearm injuries are the leading cause of death among children aged 0 to 17 years in the United States. To examine the factors associated with recurrent firearm injury among children who presented with acute (index) nonfatal firearm injury in the St. Louis region. Multicenter, observational, cohort study. 2 adult and 2 pediatric level I trauma hospitals in St. Louis, Missouri. Pediatric patients aged 0 to 17 years presenting with an index firearm injury between 2010 and 2019. From the St. Louis Region-Wide Hospital-Based Violence Intervention Program Data Repository, we collected data on firearm-injured patient demographics, hospital and diagnostic information, health insurance status, and mortality. The Social Vulnerability Index was used to characterize the social vulnerability of the census tracts of patients' residences. Analysis included descriptive statistics and time-to-event analyses estimating the cumulative incidence of experiencing a recurrent firearm injury. During the 10-year study period, 1340 children presented with an index firearm injury. Most patients were Black (87%), non-Hispanic (99%), male (84%), and between the ages of 15 and 17 years (67%). The estimated risk for firearm reinjury was 6% at 1 year and 14% at 5 years after initial injury. Male children and those seen at an adult hospital were at increased risk for reinjury. Our data set does not account for injuries occurring outside of the study period and for reinjuries presenting to nonstudy hospitals. Children who experience an initial firearm injury are at high risk for experiencing a recurrent firearm injury. Interventions are needed to reduce reinjury and address inequities in the demographic and clinical profiles within this cohort of children. National Institutes of Health.

B - 53 Neuropsychological Functioning after a Bi-Parietal Penetrating Traumatic Brain Injury in a 28-Year-Old Hispanic Male

Abstract Objective In the U.S. there are approximately 115,000 non-fatal firearm injuries each year, resulting in an annual cost of over $229 billion. Of these injuries, some result in penetrating brain injuries where an object enters and lodges within the cranial cavity, with the severity of damage determined by the shape, mass, and energy released of the projectile as it passes through the brain. This case follows a 28-year-old right-handed Hispanic male with no premorbid medical history, 16 years of education, who experienced bi-parietal lesions as a result of a gunshot wound to the head one year prior. This trajectory is rare, with little literature detailing the effects of penetrating injuries to both parietal lobes. Method The gunshot wound resulted in a bullet trajectory from the left frontoparietal region to the right parietal calvarium with multiple displaced ballistic fragments. Since the injury, he presented with resolving right-sided weakness and sensory changes, reduced balance, memory complaints, and bilateral parietally mediated findings. Results Neuropsychological testing showed right-sided suppression (tactile, auditory, and visual in the lower quadrant), reduced sensation in his right hand, alexia with agraphia, acquired apraxia of speech without aphasia, Gerstmann’s Syndrome, topographical disorientation, visuospatial dysgnosia, and constructional apraxia. There was also indication of inattentiveness, memory impairments, and processing speed deficits. Conclusions The present case study delineates the neuropsychological sequalae after a penetrating brain injury to the right parietal lobe and left frontoparietal region, resulting in significant cognitive deficits consistent with pronounced bilateral parietal lobe findings.

Towards an Evidence-Based Critical Incidents and Suicides Response Program in Australian Construction

Fatal and non-fatal accidents and suicides at work pose a substantial threat to workers’ physical and psychological safety, particularly within the construction industry. Managing these incidents is an essential component of workplace health and safety (WHS). Additionally, a formal program to support workers and provide feedback to improve the existing WHS management system is increasingly important. However, knowledge of the factors contributing to an effective critical incident (CI) or postvention response is limited by the lack of published evidence-based interventions, especially for occupations and industries that are exposed to higher rates of fatal and non-fatal injuries due to accidents and suicides. In addition, broader concerns surrounding the effectiveness of conventional critical incident programs highlight the need to develop innovative and evidence-based critical intervention and postvention responses addressing acute stress symptoms arising from exposure. This research outlines the development of the MATES Respond Training Program, a component of the WHO-endorsed MATES in Construction program, which is a charity charged with the task of improving mental health and suicide prevention in the construction industry in Australia and New Zealand. Development of the MATES Respond Training Program was informed by the following three key sources: a rapid literature review, interviews with 11 workers trained in peer support suicide prevention interventions, and an analysis of site notes on 193 critical incident and postvention construction site attendances by MATES in Construction field officers, case managers and social workers. Insights and recommendations obtained from these sources, along with the resulting program, are discussed in this paper.

Fatal and Nonfatal Firearm Injury Rates by Race and Ethnicity in the United States, 2019 to 2020.

Racial disparities in firearm injury death in the United States are well established. Less is known about the magnitude of nonfatal and total firearm injury. To combine health care data with death certificate data to estimate total firearm injuries in various racial and ethnic groups. Retrospective, cross-sectional study. Fatal injury data were collected from the Centers for Disease Control and Prevention. Data on nonfatal injuries were collected from the Nationwide Emergency Department Sample (NEDS), a 20% stratified sample of U.S. emergency department visits, weighted to provide national estimates for the United States, 2019 to 2020. All firearm injuries and deaths in the United States. Race and ethnicity were classified into 5 mutually exclusive categories: Asian or Pacific Islander, Black, Hispanic, Native American, and White. International Classification of Diseases, 10th Revision codes were used to classify firearm injury intent. Incidence of fatal and nonfatal injury in the U.S. population and case-fatality ratios (CFRs). There were 252 376 total firearm injuries, including 84 908 deaths from firearm injures. Of all firearm injuries, 37.8% were unintentional, 37.3% were assault related, 21.0% were self-harm, and 1.3% were law enforcement associated. Self-harm had the highest CFRs (90.9% overall). Unintentional injuries accounted for just 1021 (1.2%) deaths but 94 433 (56.4%) of nonfatal injuries. Rates of self-harm were highest among White persons (11.0 per 100 000 population in 2020) followed by Native Americans (8.6 per 100 000). Rates of assault were highest among Black persons (70.1 per 100 000), as were unintentional injuries (56.1 per 100 000). Findings are limited by the accuracy of discharge coding in NEDS, particularly regarding injury intent and patient race and ethnicity. From 2019 to 2020, the total burden of firearm injuries amounts to an average of 1 injury every 4 minutes and 1 death every 12 minutes in the United States. Racial disparities in firearm injury death are mirrored in nonfatal injury. None.

Socioeconomic disparities based on shooting intent in pediatric firearm injury.

Pediatric firearm injury is often associated with socioeconomically disadvantaged neighborhoods. Most studies only include fatal injuries and do not differentiate by shooting intent. We hypothesized that differences in neighborhood socioeconomic disadvantage would be observed among shooting intents of fatal and nonfatal cases. A linked integrated database of pediatric fatal and nonfatal firearm injuries was developed from trauma center and medical examiner records in Harris County, Texas (2018-2020). Geospatial analysis was utilized to map victim residence locations, stratified by shooting intent. Area Deprivation Index (ADI), a composite measure of neighborhood socioeconomic disadvantage at the census tract level was linked to shooting intent. Differences in high ADI (more deprived) versus low ADI among the shooting intents were assessed. Unadjusted and adjusted regression models assessed differences in ADI scores across shooting intent, adjusted models controlled for age, gender, and race/ethnicity. Of 324 pediatric firearm injuries, 28% were fatal; 77% were classified as interpersonal violence, 15% unintentional, and 8% self-harm. Differences were noted among shooting intent across the ADI quartiles; with increases in ADI score, the odds of interpersonal violence injuries compared with self-harm injuries significantly increased by 5%; however, when adjusting for individual-level variables of age, gender, and race and ethnicity, no significant differences in ADI were noted. Our results suggest that children living in disadvantaged neighborhoods are more likely to be affected by interpersonal firearm violence compared with self-harm; however, when differences in race/ethnicity are considered, the differences attributable to neighborhood-level disadvantage disappeared. Resources should be dedicated to improving structural aspects of neighborhood disadvantage, which disproportionately impact racial/ethnic minoritized populations. Furthermore, firearm self-harm injuries occurred among children living in the less disadvantaged neighborhoods. Understanding the associations among individual and neighborhood-level factors are important for developing streamlined injury prevention interventions by shooting intent. Prognostic and Epidemiological; Level IV.

PREDICTING RISK OF EMPLOYEE INJURY IN A PEDIATRIC HOSPITAL

PURPOSEHealthcare has one of the highest rates of non-fatal occupational injury as compared to other industries. Yet, evaluation of risk determinants and prediction algorithms in hospital settings remains limited. METHODSThis study examines risk factors for employee injuries in a large pediatric hospital and evaluates prediction algorithms using hospital surveillance data, incident reports, and work unit measures such as patient density and employee workload. We employed multiple statistical models and machine learning tools, including logistic regression (LR), random forest (RF), penalized logistic regression (PLR), Naïve Bayes, neural network (NN), XGBoost (XG), and mixed-effects logistic regression (GLMER) to predict employee injury risk for specific time periods. We used cross-validation and receiver-operator characteristic (ROC) curve analyses to assess model performance. RESULTSGLMER, LR, and PLR were superior to other models, with higher AUC values (∼0.76), indicating good discrimination ability, though accuracy and specificity varied across models. RF showed high accuracy and specificity and comparable AUC with the top performing models. Further analyses using GLMER revealed variability in employee injury risk across months, days, and hospital units, identifying peaks on Tuesdays and Saturdays and in April and July, with lows in March and June. CONCLUSIONOur findings highlight the significance of monitoring specific risk factors within pediatric hospital settings and pairing them with appropriate predictive algorithms to effectively predict and mitigate employee injuries. These insights indicate that continuous monitoring may help enhance employee safety. Future work should evaluate additional predictors that may be obtained from individual hospital units, which may inform targeted prevention strategies.

Unveiling workplace safety and health empowerment: Unraveling the key elements influencing occupational injuries

Introduction: Millions of workers globally experience work-related injuries, leading to fatalities, injuries, job loss, and wider societal implications. This study utilizes both the U.S. database and the General Social Survey (GSS) to delve into the factors linked to occupational injuries. Methods: In this study, 30 questions from the GSS between 2002 and 2014 were used. The sample included 5,914 workers from various sectors, distributed between both female and male, and were of 18 years and above. The analysis encompasses several dimensions: demographics, job-related characteristics, administrative factors, and health and safety measures. The study particularly focuses on assessing the prevalence of three common work-related injuries: nonfatal injuries, back pain and arm pain. Logistic regression models were constructed to gauge the effects of identified factors. Results: Significant insights emerge from the analysis. Factors such as age, gender, race, working hours, overtime work, trust in management, coworker support, and workflow smoothness were identified as having notable impacts on work-related injuries. For each model, the study quantifies these impacts through odds ratio and relative effects. For example, in the nonfatal injuries model, the relative effects of age showed that workers aged 65 years or older experience a 2.56% decrease in the frequency of nonfatal injuries compared to younger workers. Furthermore, in the back pain model, the estimated odds of having back pain in males are 0.90 lower than that in females. Moreover, in the arm pain model, workers who have sufficient time to complete their tasks have estimated odds of experiencing arm pain that are 0.85 lower than those who don’t have adequate time, etc. Conclusions: Understanding the intricate interplay of various factors influencing workers’ safety and health is vital for addressing occupational injuries. By addressing these factors, there’s potential for reducing work-related injuries, enhancing work environment, and minimizing costs. Practical Applications: Organizations can use the study’s findings for reducing work related injuries. Flexible work arrangements, tailored training programs, and ergonomic improvements might highlight factors such as age, gender, and working hours. Enhancing communication, fostering a positive work culture, and prioritizing safety and health measures could reduce risks associated with trusting management and coworker support. Cost-benefit analysis and continuous monitoring ensure these interventions’ effectiveness, reduce back and hand pain incidents, minimize cost, and create safer workplaces, thereby boosting the overall well-being of workers and organizational success.

Firearm injury hospitalizations and handgun purchaser licensing laws: longitudinal evaluation of state-level purchaser licensure requirements on firearm violence, 2000–2016

BackgroundHandgun purchaser licensing (HPL) laws mandate individuals to obtain a license from law enforcement before buying a firearm. Research indicates these laws effectively reduce various forms of fatal firearm violence, including homicides, suicides, and mass shootings. Our study sought to assess the impact of HPL laws on non-fatal firearm violence.MethodsUtilizing the augmented synthetic control method (ASCM), we estimated the average treatment effect on the treated (ATT) resulting from a full repeal of an HPL law in Missouri (2007), a partial repeal in Michigan (2012), and an adoption on HPL law in Maryland (2013) on firearm injury hospitalizations. We utilized RAND's healthcare cost and utilization project-based dataset from 2000 to 2016 for our outcome variable. We conducted in-time placebo testing and leave-one-out donor pool testing as sensitivity analyses.ResultsMaryland’s adoption was associated with a statistically significant 32.3% reduction in firearm-related injury hospitalization (FIH) rates (ATT = − 0.497, standard error (SE) = 0.123); Missouri’s repeal was associated with a statistically significant 35.7% increase in FIH rates (ASCM = 0.456, SE = 0.155); and Michigan’s partial repeal showed no statistically significant associations with FIH rates (ATT = − 0.074, SE = 0.129). Sensitivity analyses confirm the robustness of the estimated HPL effects.DiscussionHPL laws appear to be protective against hospitalizations for nonfatal firearm injuries. These findings align with prior research indicating that HPL laws are effective in reducing fatal firearm violence. States without such licensing systems ought to consider these robust policies as a means to address firearm violence.