Definitions of serious injury in long-term residential care: a systematic review protocol

Background: Evidence indicates that the reporting of serious injury in long-term residential care has increased substantially over the past decade. However, what constitutes a serious injury in residential care is poorly and inconsistently defined. This may result in incidences being unnecessarily reported as a serious injury. It is therefore, crucial to develop a consistent definition of serious injury to reduce reporting burden and to facilitate comparison between different residential care settings and across jurisdictions. This protocol describes the methods for a systematic review of existing definitions from the literature to inform the development of a consistent definition of serious injury in long-term residential care. Methods: A wide range of published peer-reviewed and grey literature will be sought for this review, including guidance and policy documents. Searches will be conducted of databases including MEDLINE, CINAHL, SocINDEX, Academic Search Ultimate, and Westlaw International. Grey literature database searches will include Trip and Social Care Online. Country specific searches of government and health and social care websites will be conducted. Quality appraisal will be facilitated using the Quality Assessment for Diverse Studies (QuADS) tool and Tyndall's checklist. The level of confidence in the findings will be assessed using the GRADE CERQual approach. A customised data extraction form will be used to extract data to reduce the risk of bias. Conceptual content analysis of data will facilitate identification of definitions of serious injury and their frequency within texts. Conclusions: The findings will inform the development of a consistent definition of serious injury in long-term residential care that will reduce reporting burden, facilitate the accuracy of data collected and allow for comparison across jurisdictions. A more universal and consistent definition will enable regulators, policy makers, service providers and researchers to develop policy and practical interventions to prevent the occurrence of serious injury in long-term residential care.

Social indicators with serious injury and school bullying victimization in vulnerable adolescents aged 12-15 years: Data from the Global School-Based Student Survey

OBJECTIVE

The prevalence rates of injury and bullying victimization in adolescents are continuing to rise; however, little is known about the influence of social determinants, especially for vulnerable adolescents. We aimed to estimate the prevalence of serious injury and bullying victimization in vulnerable adolescents with mental health issues or poor social support and examine the associations between social indicators and these two outcomes.

METHOD

We used the most recent datasets from the Global School-based Student Health Survey, and vulnerable adolescents aged 12-15 years from 54 countries were included. The pooled overall and regional estimates were obtained by random-effects models. Multivariable logistic regression was performed to estimate the adjusted association between five common social indicators and the two outcomes. Dose-response association was estimated by using a restricted cubic spline.

RESULTS

The prevalence rates of serious injury and bullying victimization were high in vulnerable adolescents, with apparent variation between regions and countries. The pooled prevalence of serious injury ranged from 45.10 % to 50.11 %, whereas the pooled prevalence of bullying victimization ranged from 35.54 % to 45.21 %. Social indicators of national wealth, health status, income and gender inequality were significantly associated with the prevalence of serious injury and bullying victimization in vulnerable adolescents.

CONCLUSIONS

Serious injury and school bullying victimization are prevalent in vulnerable adolescents aged 12-15 years. Social indicators were prominent associated factors of serious injury and bullying victimization in vulnerable adolescents. The results emphasize the importance of social environment when developing intervention measures to address injury and bullying among disadvantaged teenagers.

Estimating the effects of physical violence and serious injury on health-related quality of life: Evidence from 19 waves of the Household, Income and Labour Dynamics in Australia Survey

Objective

This study aims to investigate the effect of physical violence and serious injury on health-related quality of life in the Australian adult population.

Methods

This study utilised panel data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. HRQoL was measured through the physical component summary (PCS), mental component summary (MCS), and short-form six-dimension utility index (SF-6D) of the 36-item Short-Form Health Survey (SF-36). Longitudinal fixed-effect regression models were fitted using 19 waves of the HILDA Survey spanning from 2002 to 2020.

Results

This study found a negative effect of physical violence and serious injury on health-related quality of life. More specifically, Australian adults exposed to physical violence and serious injury exhibited lower levels of health-related quality of life. Who experienced physical violence only had lower MCS (β = −2.786, 95% CI: −3.091, −2.481) and SF-6D (β = −0.0214, 95% CI: −0.0248, −0.0181) scores if switches from not experiencing physical violence and serious injury. Exposed to serious injury had lower PCS (β = −5.103, 95% CI: −5.203, −5.004), MCS (β = −2.363, 95% CI: −2.480, −2.247), and SF-6D (β = −0.0585, 95% CI: −0.0598, −0.0572) score if the adults not experiencing physical violence and serious injury. Further, individuals exposed to both violence and injury had substantially lower PCS (β = -3.60, 95% CI: -4.086, -3.114), MCS (β = −6.027, 95% CI: −6.596, −5.459), and SF-6D (β = −0.0716, 95% CI: −0.0779, −0.0652) scores relative to when the individuals exposed to none.

Conclusion

Our findings indicate that interventions to improve Australian adults’ quality of life should pay particular attention to those who have experienced physical violence and serious injury. Our findings suggest unmet mental health needs for victims of physical violence and serious injuries, which calls for proactive policy interventions that provide psychological and emotional therapy.

Travel speed and the risk of serious injury in vehicle crashes

While there is a large quantity of prior research on speed and road safety, no previous studies have quantified the absolute risk of serious injury in a crash relative to travel speed. This study aimed to produce risk curves that relate travel speed to the risk of serious injury in light vehicle impacts in order to contribute to the process of selecting acceptable travel speeds. Serious injury was defined in this study as any injury having a maximum abbreviated injury scale (MAIS) of three or greater, or a fatal injury (MAIS3+F). In the context of a crash, travel speed is defined as the vehicle's speed before the driver reacts to the crash situation. Travel speed was determined by selecting the highest pre-impact speed recorded by an Event Data Recorder (EDR) in the seconds before the crash. A total of 1,618 light vehicle impacts were analysed using logistic regression. Individual risk curves were produced for front, head on, side, rear and single vehicle impacts. The analysis found significant positive relationships between the risk of serious injury and travel speed for all of these impact types. The travel speeds at which the risk of serious injury reached one per cent were 63 km/h across all impacts, 17 km/h for head on impacts, 48 km/h for single vehicle impacts, 58 km/h for side impacts, 81 km/h for front impacts and 96 km/h for rear impacts. These results have implications for the setting of speed limits and other measures that influence the speed at which vehicles travel.

Estimated number of seriously injured road users admitted to hospital in France between 2010 and 2017, based on medico-administrative data

BACKGROUND

In France, like in most developed countries, the number of road accident fatalities is estimated from police data. These estimates are considered to be good-quality, unlike estimates of road injuries admitted to hospital, and especially serious injuries.

METHODS

The present study aimed to supply such data from French hospital medical information data-bases (PMSI). In the PMSI data-bases, road accident victims are identified by external causes of morbidity and mortality, which should be systematically recorded in case of injury, but are often missing. We therefore modeled presence/absence of external cause from the relevant subset of the medicine-surgery-obstetrics PMSI data-base using a logistic regression, and then weighting the results by inverse estimated probability. As ICD-10 coding does not include injury severity, we used the AAAM10 conversion instrument developed by the American Association for Automotive Medicine, originators of the Abbreviated Injury Scale, so as to conform to the European Commission's definition of serious injury.

RESULTS

The number of road-accident related hospital admissions is estimated to be about 100000 per year; serious injuries increased from about 18000 in 2010 to almost 20000 in 2017, with almost 17000 in 2012 and 2013, with a mean of one fatality per 5 serious injury admissions.

CONCLUSIONS

These serious injury estimates are close to those obtained by our team from other data and with a different estimation method. The present method has the advantage of using ICD codes for injured people admitted to hospital. This classification and data source (hospital discharge registry) are also used by most european countries reporting serious injury estimates to the Commission. It allows cost estimation of hospital care, and could be applied to other types of accidental injury.

Aging is only significant factor causing CPR-induced injuries and serious injuries

BACKGROUND

Cardiopulmonary resuscitation (CPR) sometime cause severe injuries and can affect quality of life, lead to long-term disabilities or death of the patient. The aim of this study is to identify the risk factors causing CPR-induced injuries and those of serious injuries.

METHODS

This was a retrospective forensic autopsy study in a single institution. Among 885 forensic autopsies undertaken between 2011 and 2018, those in which the victim had undergone CPR immediately after cardiac arrest were recorded. 'Serious injuries' were defined as an Abbreviated Injury Scale (AIS) score ≥ 3. CPR-induced injuries were evaluated by three experienced forensic pathologists. With the background and history of the patient, the circumstances of cardiac arrest and risks of causing CPR-induced injuries were determined by multivariate analyses.

RESULTS

Seventy-five victims comprised the study cohort. CPR-induced injuries were found in 52 victims (69.3%). Rib fracture was the most common (60.0%), followed by sternal fracture (37.3%), heart injury (21.3%) and liver injury (8.0%). Multivariate analysis revealed higher age to be an independent factor causing CPR-induced injuries (odds ratio [OR], 1.07, P < 0.001). Thirty-six victims had 39 serious injuries in the chest or abdomen: fracture of ≥ 3 ribs (35 cases), aortic dissection (two), lung contusion (one) and rupture of the heart (one). Multivariate analysis revealed higher age to be an independent factor causing CPR-induced serious injuries (OR, 1.09; P < 0.001).

CONCLUSION

Aging was the significant factor causing CPR-induced injuries and serious injuries.

Vehicle registration year, age, and weight - Untangling the effects on crash risk

The aim of the present study was to investigate the effects of passenger cars' first year of registration, weight, and age on the number of killed or seriously injured (KSI) car drivers, pedestrians, and cyclists. Poisson regression models were developed of injury crashes involving passenger cars in Norway in 2000-2016, with the following predictor variables: The cars' first year of registration and weight, either crash year or car age, the drivers age and gender, and in models for car-car collisions the crash partner cars' weight and either registration year or age. The results show that there are fewer KSI car drivers in more recent, newer, and heavier cars. It is estimated that the number of KSI car drivers in all types of crashes on average decreases by 6.7% for each consecutive registration year (-7.2% in car-car collisions and -6.0% in single vehicle crashes), increases by 3.7% for each consecutive year of age (+2.1% in car-car collisions and +5.3% in single vehicle crashes), and decreases by 4.9% on average for each 100 kg weight increase (-11.1% in car-car collisions and -2.3% in single vehicle crashes). In car-car collisions there are fewer KSI car drivers when the crash partner car is more recent (-4.4% for each consecutive registration year), and more KSI car drivers when the crash partner car is older (+4.1% for each consecutive year of age), or heavier (+6.8% per 100 kg weight increase). In collisions with pedestrians or cyclists, there are fewer KSI pedestrians/cyclists when the car is more recent (-3.3% per consecutive registration year) and more KSI pedestrians/cyclists when the car is heavier (+4.6% per 100 kg weight increase). Due to the large effects of safety improvements in more recent cars, an increased renewal rate in the passenger car fleet can be expected to contribute to large safety improvements. The increasing weight of more recent cars may contribute to improved safety for those who drive heavier cars, but overall the effect of increasing weight is probably small or even negative because heavier vehicles impose greater risk on other car drivers, pedestrians, and cyclists.

Trends in the crash involvement of older drivers in Australia

Research from the USA and Great Britain indicates that the number of fatal crashes (as well as the rates of crashes of all levels of injury and property damage) involving older drivers declined between approximately 1997 and 2010 despite increases in the number of older drivers on the road and in their driving exposure. Differing results have been found in Australian research with the number of older driver fatalities having been steady and even slightly increasing between 2004 and 2013. The present study further examined trends in the crash involvement of older drivers in Australia to determine whether their involvement has been increasing or decreasing, and how this compares to trends for younger aged drivers. Crash, injury, population and licensure data were examined by age group for the years 2003-2012. There were increases in the population and licensure of drivers aged 65 years and older, while the total crashes, serious injuries, and fatalities remained steady for drivers aged 65-84 and increased for the oldest group (85+) between 2003 and 2012. Increasing trends were also found for drivers 85 and older for rates of serious or fatal injuries per head of population and per licensed driver. Population and licensure among younger age groups also increased but their crash numbers and crash rates remained steady or declined. The stable or slightly increasing fatal crash involvement of older drivers in Australia contrasts with the declining trends in the USA and Great Britain. Therefore, greater attention should be given to the road safety of older drivers in Australia.

Predicting lethal entanglements as a consequence of drag from fishing gear

Large whales are frequently entangled in fishing gear and sometimes swim while carrying gear for days to years. Entangled whales are subject to additional drag forces requiring increased thrust power and energy expenditure over time. To classify entanglement cases and aid potential disentanglement efforts, it is useful to know how long an entangled whale might survive, given the unique configurations of the gear they are towing. This study establishes an approach to predict drag forces on fishing gear that entangles whales, and applies this method to ten North Atlantic right whale cases to estimate the resulting increase in energy expenditure and the critical entanglement duration that could lead to death. Estimated gear drag ranged 11-275N. Most entanglements were resolved before critical entanglement durations (mean±SD 216±260days) were reached. These estimates can assist real-time development of disentanglement action plans and U.S. Federal Serious Injury assessments required for protected species.

How would increasing seat belt use affect the number of killed or seriously injured light vehicle occupants?

The expected effects of increasing seat belt use on the number of killed or seriously injured (KSI) light vehicle occupants have been estimated for three scenarios of increased seat belt use in Norway, taking into account current seat belt use, the effects of seat belts and differences in crash risk between belted and unbelted drivers. The effects of seat belts on fatality and injury risk were investigated in a meta-analysis that is based on 24 studies from 2000 or later. The results indicate that seat belts reduce both fatal and non-fatal injuries by 60% among front seat occupants and by 44% among rear seat occupants. Both results are statistically significant. Seat belt use among rear seat occupants was additionally found to about halve fatality risk among belted front seat occupants in a meta-analysis that is based on six studies. Based on an analysis of seat belt wearing rates among crash involved and non-crash involved drivers in Norway it is estimated that unbelted drivers have 8.3 times the fatal crash risk and 5.2 times the serious injury crash risk of belted drivers. The large differences in crash risk are likely to be due to other risk factors that are common among unbelted drivers such as drunk driving and speeding. Without taking into account differences in crash risk between belted and unbelted drivers, the estimated effects of increasing seat belt use are likely to be biased. When differences in crash risk are taken into account, it is estimated that the annual numbers of KSI front seat occupants in light vehicles in Norway could be reduced by 11.3% if all vehicles had seat belt reminders (assumed seat belt wearing rate 98.9%), by 17.5% if all light vehicles had seat belt interlocks (assumed seat belt wearing rate 99.7%) and by 19.9% if all front seat occupants of light vehicles were belted. Currently 96.6% of all (non-crash involved) front seat occupants are belted. The effect on KSI per percentage increase of seat belt use increases with increasing initial levels of seat belt use. Had all rear seat occupants been belted, the number of KSI front seat occupants could additionally be reduced by about 0.6%. The reduction of the number of KSI rear seat occupants would be about the same in terms of numbers of prevented KSI.

Estimating the human recovery costs of seriously injured road crash casualties

Road crashes result in substantial trauma and costs to societies around the world. Robust costing methods are an important tool to estimate costs associated with road trauma, and are key inputs into policy development and cost-benefit analysis for road safety programmes and infrastructure projects. With an expanding focus on seriously injured road crash casualties, in addition to the long standing focus on fatalities, methods for costing seriously injured casualties are becoming increasingly important. Some road safety agencies are defining a seriously injured casualty as an individual that was admitted to hospital following a road crash, and as a result, hospital separation data provide substantial potential for estimating the costs associated with seriously injured road crash casualties. The aim of this study is to establish techniques for estimating the human recovery costs of (non-fatal) seriously injured road crash casualties directly from hospital separation data. An individuals' road crash-related hospitalisation record and their personal injury insurance claim were linked for road crashes that occurred in New South Wales, Australia. These records provided the means for estimating all of the costs to the casualty directly related to their recovery from their injuries. A total of 10,897 seriously injured road crash casualties were identified and four methods for estimating their recovery costs were examined, using either unit record or aggregated hospital separation data. The methods are shown to provide robust techniques for estimating the human recovery costs of seriously injured road crash casualties, that may prove useful for identifying, implementing and evaluating safety programmes intended to reduce the incidence of road crash-related serious injuries.

Trend of elevator-related accidents in tehran

BACKGROUND

Elevator-related accidents are uncommon, but can cause significant injury. However, little data exist on these types of accidents. To compile and analyze accident data involving elevators in an effort to eliminate or at least significantly reduce such accidents.

METHODS

In this retrospective study we investigated 1,819 cases of elevator-related accidents during a four-year period (1999-2003) in Tehran. The data were obtained from the Tehran Safety Services & Fire Fighting Organization (TSFO) that is officially and solely responsible to conduct rescue missions of civilians in Tehran.

RESULTS

The number of elevator accidents has increased steadily during the four year study period. During these four years there was a positive upward trend for serious injuries and mortality resulting from elevator accidents. Technical problems were the main cause with 74.5%, followed by power loss and overcapacity riding with 11.5% and 7.9% respectively. Sixty-three individuals sustained serious injury and 15 people died as a result of elevator accidents. The number of accidents was significantly higher in summer (x2=18.32, P=0.032) and a considerable proportion of incidences (54%, 947 cases out of 1819) occurred between 5 and 12 pm.

CONCLUSIONS

Establishment of an organization to inspect the settings, maintenance, and repair of elevators is necessary.

The rising burden of serious thoracic trauma sustained by motorcyclists in road traffic crashes

In many countries increased on-road motorcycling participation has contributed to increased motorcyclist morbidity and mortality over recent decades. Improved helmet technologies and increased helmet wearing rates have contributed to reductions in serious head injuries, to the point where in many regions thoracic injury is now the most frequently occurring serious injury. However, few advances have been made in reducing the severity of motorcyclist thoracic injury. The aim of the present study is to provide needed information regarding serious motorcyclist thoracic trauma, to assist motorcycling groups, road safety advocates and road authorities develop and prioritise counter-measures and ultimately reduce the rising trauma burden. For this purpose, a data collection of linked police-reported and hospital data was established, and considerable attention was given to establishing a weighting procedure to estimate hospital cases not reported to police and fatal cases not admitted to hospital. The resulting data collection of an estimated 19,979 hospitalised motorcyclists is used to provide detailed information on the nature, incidence and risk factors for thoracic trauma. Over the last decade the incidence of motorcyclist serious thoracic injury has more than doubled in the population considered, and by 2011 while motorcycles comprised 3.2% of the registered vehicle fleet, one quarter of road traffic-related serious thoracic trauma cases treated in hospitals were motorcyclists. Motor-vehicle collisions, fixed object collisions and non-collision crashes were fairly evenly represented amongst these cases, while older motorcyclists were over-represented. Several prevention strategies are identified and discussed.