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Bhatia MB, Keung CH, Hogan J, Chepkemoi E, Li HW, Rutto EJ, Tenge R, Kisorio J, Hunter-Squires JL, Saula PW. Implementation of a pediatric trauma registry at a national referral center in Kenya: Utility and concern for sustainability. Injury 2024:111531. [PMID: 38704346 DOI: 10.1016/j.injury.2024.111531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/04/2024] [Accepted: 04/01/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Pediatric trauma disproportionately affects low- and middle-income countries, particularly the pediatric trauma systems, are frequently limited. This study assessed the patterns of pediatric traumatic injuries and treatment at the only free-standing public children's hospital in East Africa as well as the implementation and sustainability of the trauma registry. METHODS A prospective pediatric trauma registry was established at Shoe4Africa Children's Hospital (S4A) in Eldoret, Kenya. All trauma patients over a six-month period were enrolled. Descriptive analyses were completed via SAS 9.4 to uncover patterns of demographics, trauma mechanisms and injuries, as well as outcomes. Implementation was assessed using the RE-AIM framework. RESULTS The 425 patients had a median age of 5.14 years (IQR 2.4, 8.7). Average time to care was 267.5 min (IQR 134.0, 625.0). The most common pediatric trauma mechanisms were falls (32.7 %) and burns (17.7 %), but when stratified by age group, toddlers had a higher risk of sustaining injuries from burns and poisonings. Over half (56.2 %) required an operation during the hospitalization. Overall, implementation of the registry was limited by the clinical burden and inadequate personnel. Sustainability of the registry was limited by finances. CONCLUSIONS This is the first study to describe the trauma epidemiology from a Kenyan public pediatric hospital. Maintenance of the trauma registry failed due to cost. Streamlining global surgery efforts through implementation science may allow easier development of trauma registries to then identify modifiable risk factors to prevent trauma and long-term outcomes to understand associated disability.
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Affiliation(s)
- Manisha B Bhatia
- Indiana University Department of Surgery, Indianapolis, IN, USA.
| | | | - Jessica Hogan
- University of Alberta, Department of Surgery, Alberta, Canada
| | | | - Helen W Li
- Washington University Department of Surgery, St. Louis, Missouri, USA
| | | | - Robert Tenge
- Moi University, Department of Anesthesia and Surgery, Eldoret, Kenya
| | - Joshua Kisorio
- Moi University, Department of Anesthesia and Surgery, Eldoret, Kenya
| | | | - Peter W Saula
- Moi University, Department of Anesthesia and Surgery, Eldoret, Kenya
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Murphy MC, Stannard J, Sutton VR, Owen PJ, Park B, Chivers PT, Hart NH. Epidemiology of musculoskeletal injury in military recruits: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2023; 15:144. [PMID: 37898757 PMCID: PMC10612319 DOI: 10.1186/s13102-023-00755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Injuries are a common occurrence in military recruit training, however due to differences in the capture of training exposure, injury incidence rates are rarely reported. Our aim was to determine the musculoskeletal injury epidemiology of military recruits, including a standardised injury incidence rate. METHODS Epidemiological systematic review following the PRISMA 2020 guidelines. Five online databases were searched from database inception to 5th May 2021. Prospective and retrospective studies that reported data on musculoskeletal injuries sustained by military recruits after the year 2000 were included. We reported on the frequency, prevalence and injury incidence rate. Incidence rate per 1000 training days (Exact 95% CI) was calculated using meta-analysis to allow comparisons between studies. Observed heterogeneity (e.g., training duration) precluded pooling of results across countries. The Joanna Briggs Institute Quality Assessment Checklist for Prevalence Studies assessed study quality. RESULTS This review identified 41 studies comprising 451,782 recruits. Most studies (n = 26; 63%) reported the number of injured recruits, and the majority of studies (n = 27; 66%) reported the number of injuries to recruits. The prevalence of recruits with medical attention injuries or time-loss injuries was 22.8% and 31.4%, respectively. Meta-analysis revealed the injury incidence rate for recruits with a medical attention injury may be as high as 19.52 injuries per 1000 training days; and time-loss injury may be as high as 3.97 injuries per 1000 training days. Longer recruit training programs were associated with a reduced injury incidence rate (p = 0.003). The overall certainty of the evidence was low per a modified GRADE approach. CONCLUSION This systematic review with meta-analysis highlights a high musculoskeletal injury prevalence and injury incidence rate within military recruits undergoing basic training with minimal improvement observed over the past 20 years. Longer training program, which may decrease the degree of overload experienced by recruit, may reduce injury incidence rates. Unfortunately, reporting standards and reporting consistency remain a barrier to generalisability. TRIAL REGISTRATION PROSPERO (Registration number: CRD42021251080).
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Affiliation(s)
- Myles C Murphy
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia.
| | - Joanne Stannard
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Vanessa R Sutton
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Brendon Park
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Paola T Chivers
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Nicolas H Hart
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Talmy T, Cohen-Manheim I, Radomislensky I, Gelikas S, Tsur N, Benov A, Koler T, Glassberg E, Almog O, Gendler S. Implications for future humanitarian aid missions: Lessons from point-of injury and hospital care for Syrian refugees. Injury 2023; 54:110752. [PMID: 37142481 DOI: 10.1016/j.injury.2023.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/01/2023] [Accepted: 04/19/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Warzone humanitarian medical aid missions are infrequent and applying lessons from these missions is vital to ensuring preparedness for future crises. Between 2013-2018, the Israel Defense Forces Medical Corps (IDF-MC) provided humanitarian medical aid to individuals injured in the Syrian Civil War who chose to seek medical assistance at the Israeli-Syrian border. Patients requiring care surgical or advanced care were transferred to civilian medical centers within Israel. This study aims to describe the injury characteristics and management of hospitalized Syrian Civil War trauma patients over a five-year period. METHODS Retrospective cohort analysis cross-referencing data from the IDF trauma registry, documenting prehospital care, and the Israel National Trauma Registry, documenting in-hospital care, between 2013 and 2018. Syrian trauma patients hospitalized in Israeli hospitals were cross-referenced between the two registries. Multivariable logistic regression was applied to identify independent factors associated with in-hospital mortality. RESULTS Overall, 856 hospitalized trauma patients were included following definitive cross-matching. The median age was 23 years, and 93.3% were males. Blast (n = 532; 62.1%) and gunshot (n = 241; 28.2%) were the most common injury mechanisms. Injury Severity Score was ≥25 for 28.8% of patients and most common body regions with severe injury (Abbreviated Injury Scale≥3) were the head (30.7%) and thorax (25.0%). Intensive care unit admission was required for 40.1% of patients, and the median hospital stay was 13 days. In-hospital mortality was recorded for 73 (8.5%). Signs of shock upon emergency department admission and severe head injury were significantly associated with mortality in the adjusted model whereas age of <18 years was associated with decreased odds for in-hospital mortality. CONCLUSIONS Trauma patients hospitalized in Israel following injuries sustained in the Syrian Civil War were characterized by a high prevalence of blast injuries with concomitant involvement of several body regions. Future missions should ensure preparedness for complex multi-trauma, often involving the head, and ensure high intensive care and surgical capacities.
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Affiliation(s)
- Tomer Talmy
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel; Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 9112102, Israel.
| | - Irit Cohen-Manheim
- Israel National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, 5265601, Israel
| | - Irina Radomislensky
- Israel National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, 5265601, Israel
| | - Shaul Gelikas
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel; Sheba Medical Center Hospital, Tel Hashomer, Ramat Gan, Israel
| | - Nir Tsur
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel; Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Tel Aviv University, Petach Tiqva, Israel
| | - Avi Benov
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Tomer Koler
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel
| | - Elon Glassberg
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; The Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Ofer Almog
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel; Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 9112102, Israel
| | - Sami Gendler
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel
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Tang Y, Abildso CG, Lilly CL, Winstanley EL, Rudisill TM. Risk Factors Associated With Driving After Marijuana Use Among US College Students During the COVID-19 Pandemic. J Adolesc Health 2023; 72:544-552. [PMID: 36549978 PMCID: PMC9637518 DOI: 10.1016/j.jadohealth.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To assess the sociodemographic and behavioral risk factors associated with driving after marijuana use among US college students. METHODS A secondary analysis used the fall 2020 and spring 2021 American College Health Association- National College Health Assessment III and the dataset was restricted to college students ≥18 years of age who reported recent driving and marijuana use. Associations between risk factors and driving after marijuana use were estimated using multivariable logistic regression. RESULTS A total of 29.9% (n = 4,947) of the respondents reported driving after marijuana use. Males (adjusted odds ratio [AOR]: 1.64, 95% confidence interval [CI]: 1.48-1.82), non-Hispanic Black (AOR: 1.32, 95% CI: 1.02-1.71), sexual minorities (AOR: 1.19, 95% CI: 1.07-1.31), individuals with an alcohol or substance use disorder (AOR: 1.44, 95% CI: 1.08-1.91), anxiety (AOR: 1.20, 95% CI: 1.06-1.36), higher suicidality (AOR: 1.18, 95% CI: 1.07-1.31), and those who also drank and drove (AOR: 3.18, 95% CI: 2.84-3.57) had a higher risk of driving after marijuana use. DISCUSSION Future research should focus on increasing awareness of driving after marijuana use and prevention programs and/or strategies on college campuses regarding driving after marijuana use for these groups to reduce this risky behavior.
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Affiliation(s)
- Yuni Tang
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia
| | - Christiaan G Abildso
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia
| | - Christa L Lilly
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia
| | - Erin L Winstanley
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
| | - Toni M Rudisill
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia.
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Merrick N, Hart NH, Mosler AB, Allen G, Murphy MC. Injury Profiles of Police Recruits Undergoing Basic Physical Training: A Prospective Cohort Study. J Occup Rehabil 2023; 33:170-178. [PMID: 35917080 PMCID: PMC10025230 DOI: 10.1007/s10926-022-10059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Purpose A lack of published epidemiological data among police recruits presents a major challenge when designing appropriate prevention programs to reduce injury burden. We aimed to report the injury epidemiology of Western Australian (WA) Police Force recruits and examine sex and age as injury risk factors. Methods Retrospective analyses were conducted of prospectively collected injury data from WA Police Force recruits between 2018-2021. Injury was defined as 'time-loss' and injury incidence rate per 1000 training days (Poisson exact 95% confidence intervals) was calculated. For each region and type of injury, the incidence, severity, and burden were calculated. The association between age, sex, and injury occurrence were assessed using Cox regression time-to-event analysis. Results A total of 1316 WA Police Force recruits were included, of whom 264 recruits sustained 304 injuries. Injury prevalence was 20.1% and the incidence rate was 2.00 (95%CI 1.78-2.24) injuries per 1000 training days. Lower limb injuries accounted for most of the injury burden. Ligament/ joint injuries had the highest injury tissue/pathology burden. The most common activity injuring recruits was physical training (31.8% of all injuries). Older age (Hazard Ratio = 1.5, 95%CI = 1.2 to 1.9, p = 0.002) and female sex (Hazard Ratio = 1.4, 95%CI = 1.3 to 1.6, p < 0.001) increased risk of injury. Conclusion Prevention programs targeting muscle/tendon and ligament/joint injuries to the lower limb and shoulder should be prioritised to reduce the WA Police Force injury burden. Injury prevention programs should also prioritise recruits who are over 30 years of age or of female sex, given they are a higher risk population.
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Affiliation(s)
- Nicole Merrick
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Nicolas H Hart
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Andrea B Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Garth Allen
- Western Australian Police Academy, Western Australian Police Force, Joondalup, Western Australia, Australia
| | - Myles C Murphy
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
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Rees H, McCarthy Persson U, Delahunt E, Boreham C, Blake C. The incidence of injury in male field hockey players: A systematic review and meta-analysis. Phys Ther Sport 2021; 52:45-53. [PMID: 34411811 DOI: 10.1016/j.ptsp.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Few studies have investigated injury incidence in field hockey. The aim of this systematic review was to determine the incidence and characteristics of injury in male field hockey athletes. DESIGN Prognosis systematic review with meta-analysis. LITERATURE SEARCH MEDLINE via PubMed; EMBASE via Ovid; CINAHL via EBSCO; SPORTDiscus; and Web of Science were searched. STUDY SELECTION CRITERIA Prospective studies and retrospective studies employing video analysis, written in English and published in peer-reviewed journals, expressing the incidence of injury in male field hockey athletes were included. Studies must have been of a duration of a minimum one season or one tournament. Studies were screened by two authors, assessing the eligibility of each record. Following selection of the studies, data were extracted by the two authors. DATA SYNTHESIS Levels of heterogeneity were assessed in aggregate data using the I2 statistic. RESULTS In total, 1722 records were identified. Twelve studies were included in the review. Injury incidence ranged from 4.5 to 57.9/1000h (I2 = 98.5%). Nine studies were undertaken in tournament settings, with the remaining three conducted in club-based athletes in season-long settings. When a medical attention definition was used, there was a pooled incidence rate of 48.1/1000h, all in tournament studies. Contusions and muscle strains were the most frequently reported injury types, while the lower limb was the most common site of injury. Contact injuries were most common in tournament-based studies, while non-contact was more common in season-long studies. CONCLUSION Prospective, season-long epidemiological studies investigating injury incidence in field hockey are lacking.
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Affiliation(s)
- Huw Rees
- Institute for Sport and Health, University College Dublin, Dublin, Ireland; School of Public Health, Physiotherapy and Sport Science, University College Dublin, Ireland.
| | - Ulrik McCarthy Persson
- Institute for Sport and Health, University College Dublin, Dublin, Ireland; School of Public Health, Physiotherapy and Sport Science, University College Dublin, Ireland
| | - Eamonn Delahunt
- Institute for Sport and Health, University College Dublin, Dublin, Ireland; School of Public Health, Physiotherapy and Sport Science, University College Dublin, Ireland
| | - Colin Boreham
- Institute for Sport and Health, University College Dublin, Dublin, Ireland; School of Public Health, Physiotherapy and Sport Science, University College Dublin, Ireland
| | - Catherine Blake
- Institute for Sport and Health, University College Dublin, Dublin, Ireland; School of Public Health, Physiotherapy and Sport Science, University College Dublin, Ireland
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Dalve K, Gause E, Mills B, Floyd AS, Rivara FP, Rowhani-Rahbar A. Neighborhood disadvantage and firearm injury: does shooting location matter? Inj Epidemiol 2021; 8:10. [PMID: 33678193 PMCID: PMC7938602 DOI: 10.1186/s40621-021-00304-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Firearm violence is a public health problem that disparately impacts areas of economic and social deprivation. Despite a growing literature on neighborhood characteristics and injury, few studies have examined the association between neighborhood disadvantage and fatal and nonfatal firearm assault using data on injury location. We conducted an ecological Bayesian spatial analysis examining neighborhood disadvantage as a social determinant of firearm injury in Seattle, Washington. Methods Neighborhood disadvantage was measured using the National Neighborhood Data Archive disadvantage index. The index includes proportion of female-headed households with children, proportion of households with public assistance income, proportion of people with income below poverty in the past 12 months, and proportion of the civilian labor force aged 16 and older that are unemployed at the census tract level. Firearm injury counts included individuals with a documented assault-related gunshot wound identified from medical records and supplemented with the Gun Violence Archive between March 20, 2016 and December 31, 2018. Available addresses were geocoded to identify their point locations and then aggregated to the census tract level. Besag-York-Mollie (BYM2) Bayesian Poisson models were fit to the data to estimate the association between the index of neighborhood disadvantage and firearm injury count with a population offset within each census tract. Results Neighborhood disadvantage was significantly associated with the count of firearm injury in both non-spatial and spatial models. For two census tracts that differed by 1 decile of neighborhood disadvantage, the number of firearm injuries was higher by 21.0% (95% credible interval: 10.5, 32.8%) in the group with higher neighborhood disadvantage. After accounting for spatial structure, there was still considerable residual spatial dependence with 53.3% (95% credible interval: 17.0, 87.3%) of the model variance being spatial. Additionally, we observed census tracts with higher disadvantage and lower count of firearm injury in communities with proximity to employment opportunities and targeted redevelopment, suggesting other contextual protective factors. Conclusions Even after adjusting for socioeconomic factors, firearm injury research should investigate spatial clustering as independence cannot be able to be assumed. Future research should continue to examine potential contextual and environmental neighborhood determinants that could impact firearm injuries in urban communities.
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Affiliation(s)
- Kimberly Dalve
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA. .,Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA.
| | - Emma Gause
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA.,Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA
| | - Brianna Mills
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA.,Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA
| | - Anthony S Floyd
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Box 354805, Seattle, WA, 98105-4631, USA
| | - Frederick P Rivara
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA.,Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA
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Chandran A, Elmi A, Young H, DiPietro L. Determinants of lower-extremity injury severity and recovery in U.S. High School Soccer Players. Res Sports Med 2021; 30:272-282. [PMID: 33678082 DOI: 10.1080/15438627.2021.1895782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lower-extremity injuries are common among soccer players, yet few studies have attempted to identify determinants of lower-extremity injury severity and recovery within this group. We aim to identify determinants of lower-extremity injury severity and recovery among high school (HS) soccer players in the US. We used soccer-related injury observations recorded within the NATION-SP during 2011/12-2013/14. Odds of a season-ending game-related injury were higher than a season-ending practice-related injury (Adj. OR = 2.64, 95% CI = [1.39, 5.01]). Gender, setting, and playing surface emerged as significant determinants of any time loss following lower-extremity injuries in multivariable logistic regression models, and multivariable random effects Poisson regression models also revealed significant differences in recovery durations across levels of these variables for "similarly severe" injuries. Findings suggest that gender, injury setting, playing surface contribute to injury corollaries differently. Similar multi-method approaches are needed to identify determinants of injury severity and recovery in this group.
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Affiliation(s)
- Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA.,Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington D.C., USA.,Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Angelo Elmi
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Heather Young
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Loretta DiPietro
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
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Abstract
This article focuses on 3 concepts that continue to be investigated in the search for the holy grail of concussion-a valid diagnostic test. Imaging advances are discussed with optimism that functional MRI and diffusion tensor imaging may be available clinically. Biomarkers and the use of genetic tests are covered. Sideline accelerometer use may help steer discussions of head trauma risk once technology exists to accurately estimate acceleration of the brain. In the meantime, strategies including allowing athletes to be substituted out of games for an evaluation and video review in elite sports can improve recognition of sports-related concussion.
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Affiliation(s)
- Hamish Kerr
- Sports Medicine, Department of Medicine, Albany Medical College, 1019 New Loudon Road, Cohoes, NY 12047, USA.
| | - Bjørn Bakken
- Department of Medicine, Albany Medical Center, 1019 New Loudon Road, Cohoes, NY 12047, USA
| | - Gregory House
- Department of Family and Community Medicine, Albany Medical Center, 391 Myrtle Avenue, Albany, NY 12208, USA
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10
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Abstract
Female athletes are participating in collision sports in greater numbers than previously. The overall incidence of concussion is known to be higher in female athletes than in male athletes participating in similar sports. Evidence suggests anatomic, biomechanical, and biochemical etiologies behind this sex disparity. Future research on female athletes is needed for further guidance on prevention and management of concussion in girls and women.
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Brown HA, Skaggs J, Brady C, Tumusiime V, White AS. Injury patterns of patients presenting to a non-governmental hospital in Western Uganda. Afr J Emerg Med 2020; 10:118-122. [PMID: 32923320 PMCID: PMC7474235 DOI: 10.1016/j.afjem.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/04/2020] [Accepted: 02/04/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Injury is a leading cause of morbidity and mortality globally and disproportionately affects low-income countries. While most injury data comes from tertiary care centers in urban settings, the purpose of this study was to describe the characteristics and severity of injury in rural Uganda and the associated treatment patterns and delays in care. Methods This is a retrospective cohort study of a trauma registry that was implemented at Masindi-Kitara Medical Center (MKMC), a rural hospital in Western Uganda. Demographic information, injury characteristics, modified Kampala Trauma Scores (M-KTS), and treatment modalities over a 12 month period were retrospectively collected from paper-based registry forms completed for all injury patients presenting to MKMC. Results A total of 350 patients were entered into the trauma registry. Most patients were male (71.2%) with a median age of 26.5 years. Motorcycle crashes were the most prevalent mechanism of injury (42.3%) with the majority being unhelmeted (83.3%). Soft tissue injury was the most common diagnosis (44.9%). Patients were frequently treated in the outpatient department and then discharged (54.8%). Patients requiring admission or transfer (M-KTS = 11.57 or 11.67) tended to have a lower M-KTS than discharged patients (M-KTS = 12.75). Analgesics (74.6%) and antibiotics (52.9%) were the most common treatments administered. For those patients requiring admission (29.4%), only one in-hospital death was documented. Thirty-nine percent of patients reported a delay in seeking care, most frequently due to lack of transportation (31.5%) with a median time of delay of 11 h. Conclusion Road traffic injuries were the leading cause of injury in Masindi, with a high proportion of injuries associated with unhelmeted motorcycle crashes. Future opportunities to prevent injury and improve care may be seen through improved prehospital care, enforcement of helmet laws, increased access to neurosurgical services, and enactment of hospital quality improvement measures.
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Affiliation(s)
- Heather A Brown
- University of South Carolina, Prisma Health Midlands, Department of Emergency Medicine, 14 Medical Park Dr. Suite 350, Columbia, SC 29203, USA
| | - Joshua Skaggs
- University of South Carolina, Prisma Health Midlands, Department of Emergency Medicine, 14 Medical Park Dr. Suite 350, Columbia, SC 29203, USA
| | - Caroline Brady
- University of South Carolina, Prisma Health Midlands, Department of Emergency Medicine, 14 Medical Park Dr. Suite 350, Columbia, SC 29203, USA
| | - Vincent Tumusiime
- Masindi Kitara Medical Center, Outpatient Department, Kijunjubwa Rd, Masindi, Uganda
| | - Austin S White
- Morristown-Hamblen Healthcare System, Department of Emergency Medicine, 908 W 4th N St. Morristown, TN 37814, USA
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Morrissey PJ, Maier SP, Zhou JJ, Sedaghatpour D, Shah NV, Torre BB, Beaufort A, Chatterjee D, Doran JP, Urban WP. Epidemiology and trends of adult ice hockey injuries presenting to United States emergency departments: A ten-year analysis from 2007-2016. J Orthop 2020; 22:231-236. [PMID: 32425423 DOI: 10.1016/j.jor.2020.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/28/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose The adult population is under-represented in existing ice hockey injury studies, despite the number of United States (US) adult ice hockey players increasing from 103,533 in 2007 to 180,400 in 2016 (74%). This study establishes trends in demographics, injury location, and injury type for adult ice hockey players (≥19 years old) in the United States. Methods The National Electronic Injury Surveillance System (NEISS) was queried for all ice hockey injuries from January 1, 2007 to December 31, 2016. Cases under age 19 were excluded. Each injury's narrative text field was reviewed to determine mechanism of injury. Results A total of 1,653 patients, representing an estimated 68,786 ice-hockey related injuries, presented to NEISS-participating US EDs. The most commonly injured body parts were the face (n = 12,432, 18.1%), head (n = 10,201, 14.8%), shoulder (n = 9,654, 14.0%) and ankle (n = 5,389, 7.8%). The most common diagnoses made were laceration (n = 18,153, 26.4%), strain/sprain (n = 12,202, 17.7%), fracture (n = 10,079, 14.7%), contusion (n = 9,283, 13.5%) and concussion (n = 4,794, 7.0%). The most common mechanisms of injury were falling (n = 11,786, 18.7%), puck contact (n = 10,544, 15.3%) and player contact (n = 9,449, 13.7%). Concussions increased from 46 in 2007 to 928 in 2016 (R2 = 0.8, β = 0.9, p < 0.001). Females (n = 1,852, 32%) had a higher proportion of head injuries than males (n = 8,349, 13.3%) (IPR = 2.4, p < 0.0001). The 50+ year old cohort showed a significant increase in injuries during the study period (n = 146 vs. 982, R2 = 0.75, β = 0.87, p = 0.001). Conclusions Despite changing trends in age and sex-related demographics, the majority of injuries in this population may be preventable with adequate enforcement of protective gear use. Increased education amongst players, coaches, trainers, orthopaedic surgeons and primary care physicians should be encouraged to minimize injuries.
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Affiliation(s)
- Patrick J Morrissey
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Stephen P Maier
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Department of Orthopaedic Surgery, Boston, MA, USA
| | - Jack J Zhou
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Dillon Sedaghatpour
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Barrett B Torre
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Andrew Beaufort
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Dipal Chatterjee
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - James P Doran
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - William P Urban
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
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Moriarty C, Charnoff J, Felix ER. Injury rate and pattern among Brazilian jiu-jitsu practitioners: A survey study. Phys Ther Sport 2019; 39:107-113. [PMID: 31288212 DOI: 10.1016/j.ptsp.2019.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/22/2019] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the 6-month incidence rate and pattern of Brazilian jiu-jitsu (BJJ)-related injuries and characterize associations between injuries and experience level, demographic factors, and training variables. DESIGN Descriptive epidemiology study. SETTING Online survey. PARTICIPANTS 1287 adult BJJ practitioners. OUTCOME MEASURES 6-month BJJ-related injury incidence, anatomical pattern of injuries, and injury-associated demographic and training variable identification. RESULTS 59.2% of practitioners reported at least one injury over 6 months. The knee was the most common site. Logistic regression analysis demonstrated 6-month injury incidence was negatively associated with years of training and body weight, and positively associated with training days per week and instructor status. More experienced athletes were more likely to report low back injury, while less experienced athletes more frequently reported head, upper extremity, and elbow injuries. None of the following variables were predictive of injury risk: gi preference, instruction on break-falling, and participation in a structured beginner's program. CONCLUSIONS The risk factor analysis is applicable to BJJ instructors interested in reducing student injury risk. The widespread pattern of injuries and the distinction between types of injuries sustained at different levels of experience are notable findings that sports medicine practitioners should keep in mind when working with BJJ athletes.
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Affiliation(s)
- Christopher Moriarty
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, USA.
| | - Jesse Charnoff
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, USA
| | - Elizabeth Roy Felix
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, USA
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Chandran A, Barron MJ, Westerman BJ, DiPietro L. Multifactorial examination of sex-differences in head injuries and concussions among collegiate soccer players: NCAA ISS, 2004-2009. Inj Epidemiol 2017; 4:28. [PMID: 29067629 PMCID: PMC5655387 DOI: 10.1186/s40621-017-0127-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/06/2017] [Indexed: 11/24/2022] Open
Abstract
Background While head injuries and concussions are major concerns among soccer players, the multifactorial nature of head injury observations in this group remains relatively undefined. We aim to extend previous analyses and examine sex-differences in the incidence of head injuries, odds of head injuries within an injured sample, and severity of head injuries, among collegiate soccer players between 2004 and 2009. Methods Data collected within the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) between the years of 2004 and 2009, were analyzed in this study. Unadjusted rate ratios (RR), compared incidence rates between categories of sex, injury mechanism, setting and competition level. We also examined sex-differences in head injury incidence rates, across categories of the other covariates. Multivariable logistic regression and negative binomial regression modeling tested the relation between sex and head injury corollaries, while controlling for contact, setting, and competition level. Results Between 2004 and 2009, head injuries accounted for approximately 11% of all soccer-related injuries reported within the NCAA-ISS. The rate of head injuries among women was higher than among men (RR = 1.23, 95% CI = [1.08, 1.41]). The rate of head injuries due to player-to-player contact was comparable between women and men (RR = 0.95, 95% CI = [0.81, 1.11]). Whereas, the rate of injury due to contact with apparatus (ball/goal) was nearly 2.5 times higher (RR = 2.46, 95% CI = [1.76, 3.44]) and the rate due to contact with a playing surface was over two times higher (RR = 2.29, 95% CI = [1.34, 3.91]) in women than in men. In our multifactorial models, we also observed that the association between sex and head injury corollaries varied by injury mechanism. Conclusions Sex-differences in the incidence, odds (given an injury), and severity (concussion diagnosis, time-loss) of head injuries varied by injury mechanism (player-to-player contact vs. all other mechanisms) in this sample.
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Affiliation(s)
- Avinash Chandran
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, Suite 200, Washington, DC, 20052, USA.
| | - Mary J Barron
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, Suite 200, Washington, DC, 20052, USA
| | - Beverly J Westerman
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, Suite 200, Washington, DC, 20052, USA
| | - Loretta DiPietro
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, Suite 200, Washington, DC, 20052, USA
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Bell TM, Qiao N, Jenkins PC, Siedlecki CB, Fecher AM. Trends in Emergency Department Visits for Nonfatal Violence-Related Injuries Among Adolescents in the United States, 2009-2013. J Adolesc Health 2016; 58:573-5. [PMID: 26907850 DOI: 10.1016/j.jadohealth.2015.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Violence-related injuries are a major cause of death and disability among adolescents in the United States. The objective of this study was to examine trends in adolescent violence-related injuries between 2009 and 2013. METHODS This study examined data from the National Electronic Injury Surveillance System-All Injury Program for years 2009-2013. Linear regression was used to assess trends in rates of violence-related injuries among adolescents aged between 10 and 19 years. RESULTS We found overall rates of nonfatal violence-related injuries among all adolescents did not change significantly across the study years (p = .502). However, self-harm injury rates have significantly increased among female and younger adolescents during the period (p = .001 and .011, respectively). CONCLUSIONS Our results indicate that the overall intentional injury rates in adolescents have been stable; however, rates of self-injury have significantly increased in younger adolescents and females. Future research should focus on exploring causes of increases in self-harm injuries in these subpopulations.
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Affiliation(s)
- Teresa M Bell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Nan Qiao
- Department of Economics, Indiana University, Indianapolis, Indiana
| | - Peter C Jenkins
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Charles B Siedlecki
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alison M Fecher
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Fortington LV, Twomey DM, Finch CF. Concussion in community Australian football - epidemiological monitoring of the causes and immediate impact on play. Inj Epidemiol 2015; 2:20. [PMID: 27747752 PMCID: PMC5005765 DOI: 10.1186/s40621-015-0052-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Head injuries, particularly concussion, are a major cause of concern in many sports, particularly the football codes, driving a need to better understand injury mechanisms and potential methods of prevention. The aim of this study was to describe the mechanisms and follow up care of concussion injuries sustained in adult male community Australian football to identify target areas for prevention and management. METHODS Secondary analysis of injury data collected in a cluster randomised controlled trial in community Australian football across two states of Australia in 2007 and 2008. There were 1564 players from 18 clubs. The main outcome measures were the number and rate of head/neck/face (HNF) injuries and concussion sustained in games. A specific description of the mechanisms of the concussion injuries is presented along with the immediate return-to-play status of concussion cases. RESULTS 143 HNF injuries were sustained by 132 players. The game HNF injury incidence was 4.9 per 1000 game hours (n = 138; 95 % confidence interval 4.1; 5.7). Just under a quarter (n = 34) of all HNF injuries were recorded as concussion. All concussions occurred during games (none in training), with all but one related to body contact with other players. Overall, 68 % of the concussions were considered within game rules, while 32 % were either outside of the rules or unclear. Most (88 %) players left the field immediately following concussion but 47 % later returned to play in the same game. CONCLUSIONS Prevention strategies for concussion need to be based on knowledge of the mechanisms of injury. Most concussions in community Australian football occurred through body contact with other players or during tackling. Management of players post-concussion was generally poor with over half of the cases continuing to play in the same game. Therefore, new primary prevention strategies that target body-contact/tackling skills and improved secondary prevention measures relating to compliance with return-to-play protocols would be valuable.
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Affiliation(s)
- Lauren V. Fortington
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, SMB Campus, PO Box 663, Ballarat, VIC 3353 Australia
| | - Dara M. Twomey
- Faculty of Health, Federation University Australia, Ballarat, Australia
| | - Caroline F. Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, SMB Campus, PO Box 663, Ballarat, VIC 3353 Australia
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Vallmuur K. Machine learning approaches to analysing textual injury surveillance data: a systematic review. Accid Anal Prev 2015; 79:41-49. [PMID: 25795924 DOI: 10.1016/j.aap.2015.03.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 12/01/2014] [Accepted: 03/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To synthesise recent research on the use of machine learning approaches to mining textual injury surveillance data. DESIGN Systematic review. DATA SOURCES The electronic databases which were searched included PubMed, Cinahl, Medline, Google Scholar, and Proquest. The bibliography of all relevant articles was examined and associated articles were identified using a snowballing technique. SELECTION CRITERIA For inclusion, articles were required to meet the following criteria: (a) used a health-related database, (b) focused on injury-related cases, AND used machine learning approaches to analyse textual data. METHODS The papers identified through the search were screened resulting in 16 papers selected for review. Articles were reviewed to describe the databases and methodology used, the strength and limitations of different techniques, and quality assurance approaches used. Due to heterogeneity between studies meta-analysis was not performed. RESULTS Occupational injuries were the focus of half of the machine learning studies and the most common methods described were Bayesian probability or Bayesian network based methods to either predict injury categories or extract common injury scenarios. Models were evaluated through either comparison with gold standard data or content expert evaluation or statistical measures of quality. Machine learning was found to provide high precision and accuracy when predicting a small number of categories, was valuable for visualisation of injury patterns and prediction of future outcomes. However, difficulties related to generalizability, source data quality, complexity of models and integration of content and technical knowledge were discussed. CONCLUSIONS The use of narrative text for injury surveillance has grown in popularity, complexity and quality over recent years. With advances in data mining techniques, increased capacity for analysis of large databases, and involvement of computer scientists in the injury prevention field, along with more comprehensive use and description of quality assurance methods in text mining approaches, it is likely that we will see a continued growth and advancement in knowledge of text mining in the injury field.
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Affiliation(s)
- Kirsten Vallmuur
- Centre for Accident Research and Road Safety - Queensland, School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove 4059, Brisbane, Queensland, Australia.
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Abstract
This brief commentary describes key events in the development of Dr. Jess Kraus's professional career in injury epidemiology from the 1950s to the 2000s. It highlights the interactions with Dr. William Haddon Jr. and other researchers that were instrumental to his contributions to the field of injury epidemiology.
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Affiliation(s)
- Jess F Kraus
- Department of Epidemiology, University of California, Los Angeles, California.
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Gosling CM, Forbes AB, Gabbe BJ. Health professionals' perceptions of musculoskeletal injury and injury risk factors in Australian triathletes: a factor analysis. Phys Ther Sport 2013; 14:207-12. [PMID: 23177357 DOI: 10.1016/j.ptsp.2012.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study investigated health professional perceptions of triathlon-related injury risk factors and injury prevention strategies, to inform prospective cohort studies investigating injury in triathletes. DESIGN Exploratory factor analysis. METHODS A questionnaire was developed and distributed to Australian sports medicine health professionals (n = 504). Information was collected about their perceptions of factors contributing to injury and injury prevention strategies relating to Sprint/Olympic (S/O) and Ironman/Long Course (I/LC) athletes. Factor analysis was performed to identify the number and nature of the constructs (factors) underlying the responses to the questions, and to ascertain whether these factors were similar for S/O and I/LC athletes. RESULTS The response rate was 22.4% (n = 113). Five factors were extracted for injury risk accounting for 53% (S/O) and 56% (I/LC) of the variance. The factors were common across S/O and I/LC groups; biomechanics and technique, training factors, demographics, injury prevention and personal factors. Three common factors accounted for 54% (S/O) and 55% (I/LC) of the variance for injury prevention strategies; designated training regimes, health and medical monitoring and preparation of the triathlete. CONCLUSIONS These results indicate that future studies into triathlon injuries should include, at a minimum, detailed training load and demographic factors to test their impact as injury risk factors in triathlete populations.
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Elliott MR, Durbin DR, Winston FK. A propensity score approach to estimating child restraint effectiveness in preventing mortality. Stat Interface 2009; 2:437-447. [PMID: 29963219 PMCID: PMC6020704 DOI: 10.4310/sii.2009.v2.n4.a5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Confounding between the child's restraint use and driver behavior can bias restraint effectiveness estimates away from the null if survivable crashes are more common in certain restraint types. Analyzing only fatal crashes may introduce selection bias toward the null because any protective effects of a restraint type will underrepresent children in that restraint. A marginal-structural-model-type estimator suggests a 17% reduction in fatality risk for children aged 2 through 6 in child restraint systems relative to seat belts. This reduction is estimated at 22% when severe misuse of the restraint is excluded.
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Affiliation(s)
- Michael R. Elliott
- Department of Biostatistics, University of Michigan School of Public Health, M4041, SPH II, 1420 Washington Heights, Ann Arbor, MI 48109, USA
| | - Dennis R. Durbin
- TraumaLink Injury Research Center, The Children’s Hospital of Philadelphia, Division of Emergency Medicine, Department of Pediatrics Center for Clinical Epidemiology and Biostatistics University of Pennsylvania
| | - Flaura K. Winston
- TraumaLink Injury Research Center The Children’s Hospital of Philadelphia, Division of General Pediatrics, Department of Pediatrics Leonard Davis Institute for Health Economics University of Pennsylvania
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