Emergency presentations by vulnerable road users: implications for injury prevention

Health system and law enforcement synergies for injury surveillance, control and prevention: a scoping review

BACKGROUND

Healthcare providers and law enforcement (LE) officers are among the most common first responders to injuring events. Despite frequent interface between the health system (HS) and LE sectors, the published evidence that supports their collaboration in injury surveillance, control and prevention has not been comprehensively reviewed.

METHODS

We conducted a scoping review of literature published from 1990 to 2016 that focused on local and regional HS and LE collaborations in injury surveillance, control and prevention. Our aim was to describe what is known and what remains unexplored about these cross-sector efforts.

RESULTS

128 articles were included in the final review. These were categorised by their focus on either surveillance activities or partnerships in injury control and prevention programmes. The majority of surveillance articles focused on road traffic injuries. Conversely, articles describing partnerships and programme evaluations primarily targeted the prevention of interpersonal violence.

DISCUSSION

This review yielded two major findings: overall, the combination of HS and LE injury data added value to surveillance systems, especially as HS data augmented LE data; and HS and LE partnerships have been developed to improve injury control and prevention. However, there are few studies that have evaluated the impact and sustainability of these partnerships.

CONCLUSIONS

The current evidence to support HS and LE collaboration in injury surveillance and control and prevention programmes is heterogeneous. Notable gaps suggest ample opportunity for further research and programme evaluation across all types of injury.

Fatal and serious injuries related to vulnerable road users in Canada

INTRODUCTION

The goals of this study were to analyze possible trends of fatal and serious injuries related to vulnerable road users in Canada (pedestrians, cyclists and motorcyclists) from 1990 to 2012 and the role of alcohol and drugs in these cases. Drugs have rarely been documented with respect to vulnerable road users.

METHOD

The Traffic Injury Research Foundation's National Fatality and Serious Injury Databases and the Public Health Agency of Canada's Canadian Hospitals Injury Reporting and Prevention Program databases were used. Numbers and rates of fatalities and serious injuries among vulnerable road users were analyzed and regression models were used to assess changes over time.

RESULTS

The analyses show that while the absolute number of fatalities and the rate per 100,000 population among vulnerable road users may be decreasing, no such trends are apparent when looking at the proportions of these road user fatalities out of all motor-vehicle fatalities. The trend for the proportion of motorcyclist fatalities is significantly increasing (coef.=0.16, p<0.001). The elderly (76years or older) are overrepresented among pedestrian fatalities, and serious injuries (they represent 18.5% of all pedestrian fatalities but only 5.8% of the population), while those 15years or younger are overrepresented among cyclists (they represent 23.3% of cyclist fatalities but 19.5% of the population), and those 16 to 25years old are overrepresented among motorcyclists (27.2% of motorcyclists fatalities and 13.6% of population). Alcohol and drug use among fatally injured vulnerable road users were significant problems, especially among pedestrians. Among fatally injured pedestrians tested for alcohol and drugs, 39.7% and 43.4% tested positive, respectively.

CONCLUSIONS

With the promotion of walking and cycling as forms of exercise and the popularity of motorcycling, the safety of vulnerable road users is an important issue. The results corroborate previous research and extend our understanding about the influence of alcohol and drugs in vulnerable road user injuries.

PRACTICAL APPLICATIONS

These findings can help better inform prevention and mitigation initiatives for vulnerable road users.

Epidemiological and Clinical Characteristics of Fall Injuries in East Azerbaijan, Iran; A Cross-Sectional Study

OBJECTIVE

To describe the epidemiological and clinical characteristics of fall injuries in East Azerbaijan, Iran.

METHODS

This cross-sectional study was based on Hospital Information System (HIS) data for patients referred to the Imam Reza Hospital between 2008 and 2013. We recorded the demographic characteristics and epidemiological patterns of patients who were admitted to our center due to fall injuries. To standardize the reports the International Classification of Diseases (ICD), the International Classification of Diseases 9 Clinical Modification (ICD-9-CM) was used. Equally, the hospitalization period and number, admission ward, and the final status of victims after discharge from the hospital were extracted from the HIS.

RESULTS

Overall we included a total number of 3397 patients with mean age of 39.2±22.7 years. There were 2501 (73.6%) men among the patients. Long bone fracture (48.1%) and intracranial injury (24.2%) were the most frequent injuries among fall injury victims. Operations on spinal cord and spinal canal structures (12.0%), Operations on nose (11.6%) were the most common operations being performed in these patients. The survival was significantly lower in patients with age more than 60 years when compared to other age groups (p=0.001). The survival rate was significantly lower in age group of >60 years, compared to other age groups (p=0.001).

CONCLUSION

Given the high rate of fall injuries and death among the elderly that increases with age, appropriate measures must be taken to control and prevent injuries while prioritizing the elderly.

A longitudinal cohort study of the impact of first- and both-eye cataract surgery on falls and other injuries in Vietnam

Aim

Little information exists on the impact of cataract surgery on falls and other injuries in Vietnam. The aim of this study was to determine the impact of first and both eye cataract surgery on the number of falls and other injuries among bilateral cataract patients in Ho Chi Minh City, Vietnam.

Materials and methods

A longitudinal cohort study was conducted involving 413 bilateral cataract patients aged 50+ years. Participants were assessed at three time points: 1 week before, 1–3 months after, and 1 year after first-eye cataract surgery. Visual measures (visual acuity, contrast sensitivity and stereopsis) were taken, and self-reported falls and injury data were collected. A multilevel longitudinal Poisson regression model was used to investigate change in the number of falls after surgery.

Results

The risk of falls decreased by 78% (incidence-rate ratio [IRR] 0.22, 95% confidence interval [CI] 0.06–0.77; P=0.018) in the year after cataract surgery for participants who had first-eye surgery only and 83% (IRR 0.17, 95% CI 0.04–0.69; P=0.012) for participants who had the second eye operated on compared to before surgery. The risk of falls was three times higher for females than males (IRR 3.13, 95% CI 1.53–6.40; P=0.002). Improved binocular contrast sensitivity was also associated with a decrease in falls (IRR 0.40, 95% CI 0.17–0.97; P=0.042). The prevalence of other injuries also decreased after cataract surgery.

Conclusion

Cataract surgery reduced the number of falls and other injuries in Vietnam. Contrast sensitivity may be important for ophthalmologists to consider when prioritizing patients for surgery and assessing their fall risk.

Environmental determinants of bicycling injuries in Alberta, Canada

This study examined environmental risk factors for bicycling injuries, by combining data on bicyclist injuries collected by interviews in the emergency department (ED) with street-level environmental audits of injury locations, capturing path, roadway, safety, land use, and aesthetic characteristics. Cases were bicyclists struck by a motor vehicle (MV) or with severe injuries (hospitalized). Controls were bicyclists who were not hit by a car or those seen and discharged from the ED, matched on time and day of injury. Logistic regression odds ratios (ORs) adjusted for age, sex, peak time, and bicyclist speed with 95% confidence intervals (CIs) were estimated to relate injury risk to environmental characteristics. Factors contributing to MV events included greater traffic volume (OR 5.13; 95% CI [1.44, 18.27]), intersections (OR 6.89; 95% CI [1.48, 32.14]), retail establishments (OR 5.56; 95% CI [1.72, 17.98]), and path obstructions (OR 3.83; 95% CI [1.03, 14.25]). Locations where the road was in good condition (OR 0.25; 95% CI [0.07, 0.96]) and where there was high surveillance from surrounding buildings (OR 0.32; 95% CI [0.13, 0.82]) were associated with less severe injuries. These findings could be used by bicyclists and transportation planners to improve safety.

Road environment, crash type and hospitalisation of bicyclists and motorcyclists presented to emergency departments in Western Australia

Emergency presentations by bicyclists and motorcyclists are often the result from a fall or non-motor vehicle collision that occurred in off-road locations. Consequently, they are unlikely to be captured by police records. If the injury is not severe enough to warrant hospitalisation, they will also not be captured by the hospital admission system. To ascertain the nature and type of these crash events, a 6-month prospective study was undertaken of bicyclists and motorcyclists who presented to emergency departments in Perth, Western Australia, due to involvement in a crash or non-motor vehicle collision. Of the 330 eligible presentations, 151 bicyclists and 104 motorcyclists agreed to participate in a structured interview, representing a response rate of 77.3%. Among them, 120 (79%) bicyclists and 71 (68%) motorcyclists had a fall or non-motor vehicle collision, and many of the crashes (88 (58%) and 47 (45%), respectively) occurred off-road. Moreover, 26.5% of bicyclist and 62.5% of motorcyclist presentations led to hospital admissions. Multivariate logistic regression analysis further showed that the crash location and road type affected hospitalisation for both groups. Although, crashes occurring in rural areas contributed 14% of the events overall, their adjusted risk of hospitalisation increased five times when compared to metropolitan locations. Crash preventive measures targeting rural areas should be considered to further improve the safety of bicyclists and motorcyclists.