International Classification of Disease based Injury Severity Score (ICISS): a comparison of methodologies applied to linked data from New South Wales, Australia.

BACKGROUND: The International Classification of Disease Injury Severity Score (ICISS) provides an efficient method to determine injury severity in hospitalised injury patients. Injury severity metrics are of particular interest for the tracking of road transport injury rates and trends. The aims of this study were to calculate ICISS using linked morbidity and mortality datasets and to compare predictive ability of various methods and metrics. METHODS: This was a retrospective analysis of Admitted Patient Data Collection records from New South Wales, Australia, linked with mortality data. Using a split sample approach, design data (2008-2014; n=1 035 174 periods of care) was used to derive survival risk ratios and calculate various ICISS scales based on in-hospital death and 3-month death. These scales were applied to testing data (2015-2017; n=575 306). Logistic regression modelling was used to determine model discrimination and calibration. RESULTS: There were 12 347 (1.19%) in-hospital deaths and 29 275 (2.83%) 3-month deaths in the design data. Model discrimination ranged from acceptable to excellent (area under the curve 0.75-0.88). Serious injury (ICISS≤0.941) rates in the testing data varied, with a range of 10%-31% depending on the methodology. The 'worst injury' ICISS was always superior to 'multiplicative injury' ICISS in model discrimination and calibration. CONCLUSIONS: In-hospital death and 3-month death were used to generate ICISS; the former is recommended for settings with a focus on short-term threat to life, such as in trauma care settings. The 3-month death approach is recommended for outcomes beyond immediate clinical care, such as injury compensation schemes.

Population-based study of factors associated with severe paediatric drowning events in Maryland.

INTRODUCTION: Paediatric drowning is an injury associated with significant morbidity and mortality. OBJECTIVE: The objective is to describe drowning trends, including associations with inpatient hospitalisation or fatality, in a state-wide paediatric cohort to inform prevention strategies. METHODS: In this retrospective cohort study using the Health Services Cost Review Commission database, we used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify patients aged 0-19 years with an outpatient (including emergency department) or inpatient medical encounter following a non-fatal or fatal drowning event between 2016 and 2019. Descriptive statistics and logistic regression were used to summarise the data and evaluate associations with inpatient hospitalisation or fatality. RESULTS: There were 541 medical encounters for drowning events, including 483 non-fatal outpatient encounters, 42 non-fatal inpatient encounters and 16 fatal cases. Overall, most patients were boys, 0-4 years, white and lived in urban settings. White children accounted for 66% of encounters among those aged 0-4 years, whereas non-white children accounted for 62% of visits among those aged 10-19 years. Non-white children were more likely than white children to experience a fatal drowning (OR 3.6, 95% CI: 1.2 to 11.5). Adolescents were more likely than younger children to be hospitalised (OR 3.1, 95% CI: 1.6 to 6.5) and had higher charges in outpatient (p=0.002) and inpatient settings (p=0.003). DISCUSSION: Our study revealed high fatality rates among non-white children and high admission rates among adolescents.

Comparative analysis of child injuries in passenger vehicles and school buses: a multicentre cross-sectional study.

OBJECTIVE: This study investigated the differences in injury profiles and safety device effectiveness among children with road traffic injuries (RTIs) involving passenger vehicles and school buses. METHODS: Using data from the Emergency Department-based Injury In-depth Surveillance database, this multicentre cross-sectional study investigated the injury profiles of 14 669 children aged 12 years old and younger who experienced RTIs from 2011-2021. Demographic factors, injury distribution, severity and effect of safety device use between RITs involving passenger vehicles and school buses were compared. RESULTS: RTIs in children most frequently occurred between 12:00 and 18:00 hours (46.9%). School bus-related RTIs peaked during school commute hours, that is, from 06:00 to 12:00 hours, and were associated with a higher prevalence of head (63.1% vs 58.9%, p<0.05) and extremity injuries (upper extremity: 8.0% vs 6.4% and lower extremity: 11.1% vs 7.6 %, p<0.05) compared with those involving passenger vehicles. However, passenger vehicle crashes showed higher proportions of neck and chest injuries, along with injuries requiring hospitalisation and intensive care. Safety devices exhibited preventive effects against head and lower extremity injuries in both vehicle types. While safety devices showed effective in reducing hospital admissions and severe injuries in passenger vehicles, their effectiveness in school buses was not observed. CONCLUSION: This study highlights the different epidemiology and injury profiles of RTIs among children involving passenger vehicles and school buses. Improved safety devices, particularly in school buses, are necessary to ensure the comprehensive protection of child passengers and reduce the risk of severe injuries during road traffic incidents.

New Zealand's Prospective Outcomes of Injury Study-10 years on (POIS-10): descriptive outcomes to 12 years post-injury.

BACKGROUND: The 'Prospective Outcomes of Injury Study-10 years on' (POIS-10) aims to contribute to improving long-term disability, health and well-being outcomes for injured New Zealanders. This brief report describes recruitment, characteristics and key outcomes to 12 years post-injury. METHODS: Between 2007 and 2009, the study recruited 2856 people, including 566 Maori, from New Zealand's Accident Compensation Corporation's entitlement claims register. People experienced a range of injury types, causes and settings; 25% had been hospitalised for their injury. POIS-10 data were primarily collected via interviewer-administered structured questionnaires. RESULTS: Of the original participants, 2068 (92%) were eligible for follow-up in POIS-10. Of these, 1543 (75%) people participated between March 2020 and July 2021, including 240 Maori. Half of the participants (n=757; 50%) reported ongoing problems attributed to their injury 12 years earlier. Most reported difficulties with items assessing disability (WHO Disability Assessment Schedule II). For health-related quality of life (HRQoL), measured using the EQ-5D-5L, the prevalence of problems was higher 12 years post-injury compared with 12 months post-injury for four of five dimensions. Importantly, the prevalence of problems did not reduce to pre-injury levels for any HRQoL dimension. DISCUSSION: POIS-10 highlights the importance of early post-injury interventions to improve health, disability and well-being outcomes of injured New Zealanders.

Home-related and work-related injuries in Makwanpur district, Nepal: a household survey.

OBJECTIVE: To describe the epidemiology of home-related and work-related injuries, their mechanisms, inequalities and costs associated with these injuries. METHODS: A household survey was undertaken in three palikas of Makwanpur district between April and June 2019. Data were collected electronically on non-fatal injuries that occurred in the previous 3 months and fatal injuries that occurred in the previous 5 years. FINDINGS: 17 593 individuals were surveyed from 3327 households. Injury rates were 8.0 per 1000 population for home injuries and 6.4 per 1000 for work-related injuries; 61.0% of home injuries were among women and 69.9% of work-related injuries among men. Falls were the cause of 48% home injuries, affecting 50.9% of men and 46.5% of women. Burns/scalds were higher in women than men, affecting 17.4% of women reporting home injuries. Cuts and piercings accounted for 39.8% of all work-related injuries and 36.3% were falls. Injury incidence varied by ethnic group: home injuries were highest in Brahmin (12.0 per 1000) and work-related injuries highest in Rai groups (21.0 per 1000). The total mean costs (transport and treatment) of work-related injury was US$143.3 (SD 276.7), higher than for home injuries (US$130.4, SD 347.6). The number of home (n=74, 64.9%) and work-related (n=67, 77.9%) injuries were higher in families below the poverty line than families in the next income bracket (home: n=22, 19.3%; work: n=11, 12.8%). CONCLUSIONS: Home-related and work-related fall injuries are common. The inequalities in injury identified in our study by rurality, age, sex, income level and ethnic group can help target injury prevention interventions for vulnerable groups.

Too far to fall: Exploring the relationship between playground equipment and paediatric upper limb fractures.

AIM: Playground equipment, most notably monkey bars, appears to be involved in a high proportion of upper limb fractures (ULFs) in the Australian paediatric population. Despite this, in 2014, Australian playground standards increased the maximum acceptable 'free height of fall' playground equipment from 2.5 to 3.0 m, and maintained monkey bars at 2.2 m. An updated snapshot regarding playground ULFs since these changes is important. This study aimed to determine the number and severity of playground ULFs in a paediatric population, compared to other common activities involved in ULFs. METHODS: Records of all patients aged 0-17 presenting to the Austin Hospital Paediatric Emergency Department with ULFs over a 12-month period were analysed retrospectively. ULFs included fractures to the carpal bones, radius, ulna or humerus. Variables documented included the activity involved with the fracture, and fracture management. Results were analysed using descriptive statistics. RESULTS: A total of 725 ULF cases were collected. Playground equipment was involved in 23% (n = 162/697, missing n = 28) of fractures. Monkey bars were involved in 14% of fractures (n = 100/697, missing n = 28), 1.64 times more than the next most common activity. Monkey bars were involved in 62% (n = 100/162) of all playground fractures. In children aged 5-9, monkey bars were involved in 27% (n = 83/304) of ULFs. Monkey bars were furthermore involved in most cases of 'severe' fractures (requiring reduction/operation) (n = 33), with one-third of monkey bar fractures being severe. CONCLUSION: Given these findings, the authors recommend a renewed focus on measures that reduce the frequency and severity of falls from monkey bars.

Impact of comorbidity on health outcome after a transport-related injury.

INTRODUCTION: Understanding the impact of comorbidity on health outcomes is important given that comorbidities can affect survival, morbidity, service delivery costs and healthcare utilisation. However, little is known about the types of comorbidities affecting specific health outcomes after minor to moderate road trauma. METHODS: This study involved 1574 participants who claimed injury compensation following transport-related injury. Cross sectional data were collected. Health outcomes were assessed using the EQ-5D-3L specific domains and summary score. Twelve self-reported pre-existing chronic conditions were assessed using a multivariate logistic regression, adjusting for demographic and injury characteristics. RESULTS: Out of 1574 participants, only 17 (1%) participants reported no pre-existing comorbidities, 72% reported one, 13% reported two and 14% reported three or more comorbidities. Hypertension (15%), depression (14%) and anxiety (14%) were the most commonly reported comorbidities, followed by arthritis (13%), chronic pain (11%) and asthma (11%). Participants with a history of arthritis (adjusted odds ratio [AOR] 1.90, 95% CI 1.24 to 2.91); chronic back pain (AOR 1.59, 95% CI, 1.04 to 2.43); other chronic pain (AOR 2.73, 95% CI 1.42 to 4.24); depression (AOR 2.55, 95% CI 1.60 to 4.05) and anxiety (AOR 2.08, 95% CI 1.32 to 3.26) were at increased risk of poorer health outcomes, after controlling for age, gender, type of injury and time since injury. CONCLUSION: This study found that comorbidities such as arthritis, chronic back pain, other chronic pain, depression and anxiety significantly increase the odds of poorer health postinjury, regardless of the time since injury. Regular screening of comorbid conditions may help identify people likely to have poorer outcomes, thereby enabling the implementation of interventions to optimise health despite the presence of comorbidities.

PHysical activity Implementation Study In Community-dwelling AduLts (PHISICAL): study protocol.

BACKGROUND: Falls in older people are a leading causes of unintentional injury. Due to an ageing population, injuries are likely to increase unless more is done to reduce older people's falls risk. In clinical trials, the Falls Management Exercise (FaME) programme has reduced the rate of falls and falls-related injuries in community-dwelling older adults. However, the commissioning of FaME is inconsistent across England, potentially due to a lack of evidence that FaME can be delivered effectively in a 'real world' setting. The PHysical activity Implementation Study In Community-dwelling AduLts (PHISICAL) study is designed to study the implementation of FaME in a range of different settings in England. METHODS: The PHISICAL study will use a mixed-methods, triangulation, multilevel design to explore the implementation of FaME. Framework analysis of semistructured interviews with up to 90 stakeholders (exercise programme users, service providers, referrers and commissioners) and observational data from locally led communities of practice will identify the factors that influence FaME's implementation. Quantitative, anonymised, routine service data from up to 650 exercise programme users, including measures of falls and physical activity, will allow assessment of whether the benefits of FaME reported in clinical trials translate to the 'real world' setting. CONCLUSION: The findings from this study will be used to develop a toolkit of resources and guidance to inform the commissioning and delivery of future FaME programmes. This study has the potential to inform public health prevention strategies, and in doing so may reduce the number of falls in the older population while delivering cost savings to health and social care services.

Two years after injury: prevalence and early post-injury predictors of ongoing injury-related problems.

PURPOSE: To determine, in a cohort with injuries classified anatomically as mainly minor or moderate and for which only 25% were hospitalised acutely, the prevalence of ongoing problems attributed by participants to their injury 2 years prior, and to examine whether three-month post-injury experiences and expectations predict such problems. METHODS: Participants (N = 2231; 18-64 years at injury) were those in the Prospective Outcomes of Injury Study who completed the initial three-month and final two-year interviews. The outcome measure was whether participants reported ongoing injury-related problems at 2 years. Possible early post-injury predictors were identified from the first interview; pre-injury and injury-related potential confounders from the first interview, insurer records and hospital discharge records. Multivariable models estimated relative risks. RESULTS: Almost half the participants reported injury-related problems at 2 years. Participants reporting non-recovery at 3 months were more likely than those reporting recovery to have ongoing problems at 2 years, ranging from participants expecting to get better soon [adjusted RR 2.2, 95% CI (1.7,2.8)) to those expecting to never get better (aRR 3.1, 95% CI (2.4,4.0)]. Several three-month post-injury experiences also predicted ongoing problems at 2 years. Participants at highest risk included those with extreme pain [aRR 2.1, 95% CI (1.7,2.5)], and less involvement in usual activities [aRR 1.7, 95% CI (1.5,1.9)]. CONCLUSIONS: Findings indicate that early post-injury characteristics predict longer-term recovery among this cohort, most of who were not classified as seriously injured, and provide guidance for future studies on interventions to reduce poor outcome prevalence, particularly focussing on pain management and enabling return to independence and social participation.

Prevalence, recovery patterns and predictors of quality of life and costs after non-fatal injury: the Brabant Injury Outcome Surveillance (BIOS) study.

INTRODUCTION: Trauma is a major public health problem worldwide that leads to high medical and societal costs. Overall, improved understanding of the full spectrum of the societal impact and burden of injury is needed. The main purpose of the Brabant Injury Outcome Surveillance (BIOS) study is to provide insight into prevalence, predictors and recovery patterns of short-term and long-term health-related quality of life (HRQoL) and costs after injury. MATERIALS AND METHODS: This is a prospective, observational, follow-up cohort study in which HRQoL, psychological, social and functional outcome, and costs after trauma will be assessed during 24 months follow-up within injured patients admitted in 1 of 10 hospitals in the county Noord-Brabant, the Netherlands. Data will be collected by self-reported questionnaires at 1 week (including preinjury assessment), and 1, 3, 6, 12 and 24 months after injury. If patients are not capable of filling out the questionnaires, proxies will be asked to participate. Also, information about mechanism and severity of injury, comorbidity and indirect and direct costs will be collected. Mixed models will be used to examine the course of HRQoL, functional and psychological outcome, costs over time and between different groups, and to identify predictors for poor or good outcome. RELEVANCE: This study should make a substantial contribution to the international collaborative effort to assess the societal impact and burden of injuries more accurately. The BIOS results will also be used to develop an outcome prediction model for outcome evaluation including, besides the classic fatal, non-fatal outcome. TRIAL REGISTRATION NUMBER: NCT02508675.

The role of intersection and street design on severity of bicycle-motor vehicle crashes.

BACKGROUND: Safety concerns are a major barrier to cycling. Intersection and street design variables such as intersection angles and street width might contribute to the severity of crashes and the safety concerns. In this study we examined whether these design variables were associated with bicycle-motor vehicle crashes (BMVC) severity. METHODS: Using the geographical information system and latitudes/longitudes recorded by the police using a global positioning device, we extracted intersection angles, street width, bicycle facilities, posted speed limits and annual average daily traffic from 3266 BMVC data from New York City police records. Additional variables about BMVC, including age and sex of the bicyclist, time of the day, road surface conditions, road character, vehicle type and injury severity, were obtained from police reports. Injury severity was classified as severe (incapacitating or killed) or non-severe (non-incapacitating, possible injury). The associations between injury severity and environment design variables were examined using multivariate log-binomial regression model. FINDINGS: Compared with crashes at orthogonal intersections, crashes at non-orthogonal intersections had 1.37 times (95% CI 1.05 to 1.80) and non-intersection street segments had 1.31 times (95% CI 1.01 to 1.70) higher risk of a severe injury. Crashes that involved a truck or a bus were twice as likely to result in a severe injury outcome; street width was not significantly associated with injury severity. CONCLUSION: Crashes at non-orthogonal intersections and non-intersection segments are more likely to result in higher injury severity. The findings can be used to improve road design and develop effective safety interventions.

Subsequent Injury Study (SInS): Improving outcomes for injured New Zealanders.

BACKGROUND: Subsequent injury (SI) is a major contributor to disability and costs for individuals and society. AIM: To identify modifiable risk factors predictive of SI and SI health and disability outcomes and costs. OBJECTIVES: To (1) describe the nature of SIs reported to New Zealand's no-fault injury insurer (the Accident Compensation Corporation (ACC)); (2) identify characteristics of people underaccessing ACC for SI; (3) determine factors predicting or protecting against SI; and (4) investigate outcomes for individuals, and costs to society, in relation to SI. DESIGN: Prospective cohort study. METHODS: Previously collected data will be linked including data from interviews undertaken as part of the earlier Prospective Outcomes of Injury Study (POIS), ACC electronic data and national hospitalisation data about SI. POIS participants (N=2856, including 566 Maori) were recruited via ACC's injury register following an injury serious enough to warrant compensation entitlements. We will examine SI over the following 24 months for these participants using descriptive and inferential statistics including multivariable generalised linear models and Cox's proportional hazards regression. DISCUSSION: Subsequent Injury Study (SInS) will deliver information about the risks, protective factors and outcomes related to SI for New Zealanders. As a result of sourcing injury data from New Zealand's 'all injury' insurer ACC, SInS includes people who have been hospitalised and not hospitalised for injury. Consequently, SInS will provide insights that are novel internationally as other studies are usually confined to examining trauma registries, specific injuries or injured workers who are covered by a workplace insurer rather than a 'real-world' injury population.

Recovery from injury: the UK burden of injury multicentre longitudinal study.

OBJECTIVES: To estimate the likelihood of recovery at 1, 4 and 12 months post injury and investigate predictors of recovery in injured people attending an emergency department (ED) or admitted to hospital in the UK. METHODS: Participants completed questionnaires at recruitment and 1, 4 and 12 months post injury or until recovered. Data were collected on injury details, sociodemographic characteristics, general health prior to injury and recovery. We compared three age groups: 5-17, 18-64 and 65 years and above. Modified Poisson regression estimated the relative risk of recovery. Multivariable models were built using backward stepwise regression. Sensitivity analyses assessed the effect of missing data. RESULTS: We recruited 1517 participants, 55% (n=836) ED attenders and 44% (n=661) hospital admissions. By 1 month after injury, 28% (285/968) had fully recovered, 54% (440/820) at 4 months and 71% (523/738) at 12 months. Recovery was independently associated with gender, admission status, injury severity, body region injured and place of injury for 5-17 year olds and 18-64 year olds and with gender, admission status, injury severity and long-term illness for those aged 65+. Injury severity and hospital admission were associated with recovery across all age groups, but not at every time point in each age group. Other factors varied between age groups or time points. Results were generally robust to imputing missing data. CONCLUSIONS: A range of factors was found to predict recovery among injured people. These could be used to identify those at risk of delayed recovery and to inform the design of interventions to maximise recovery.

Associations between childhood obesity and upper and lower extremity injuries.

OBJECTIVES: To estimate the overall and age-specific associations between obesity and extremity musculoskeletal injuries and pain in children. METHODS: This cross-sectional study used information from electronic medical records of 913178 patients aged 2-19 years enrolled in an integrated health plan in the period 2007-2009. Children were classified as underweight, normal weight, overweight, or moderately/extremely obese and, using multivariable logistic regression methods, the associations between weight class and diagnosis of upper or lower extremity fractures, sprains, dislocations and pain were calculated. RESULTS: Overweight (OR 1.18, 95% CI 1.15 to 1.20), moderately obese (OR 1.24, 95% CI 1.20 to 1.27) and extremely obese (OR 1.34, 95% CI 1.30 to 1.39) children had statistically significantly higher odds of lower extremity injuries/pain compared to normal weight, adjusted for sex, age, race/ethnicity and insurance status. Age-stratified analyses yielded similar results. No consistent association was observed between body mass index and injuries/pain of the upper extremities. CONCLUSIONS: Greater body mass index is associated with increased odds of lower extremity injuries and pain issues. Because the benefits of physical activity may still outweigh the risk of injury, attention should be paid to injury prevention strategies for these children at greater risk for lower extremity injuries.

[Changes in serum levels of the key factors of angiogenesis in different outcomes of combined injuries in children]. / Izmeneniia kontsentratsii v syvorotke krovi kliuchevykh faktorov angiogeneza pri razlichnykh iskhodakh sochetannoi travmy u detei.

AIM: To study the changes in the key angiogenic factors VEGF-A and angiogenin (ANG) in children with different outcomes of combined injuries. MATERIAL AND METHODS: Contents of VEGF-A and ANG in blood serum were determined by enzyme immunoassay. The study included 40 patients, 21 boys and 19 girls. Patients were divided into 4 groups according to the outcome of injury: 1 - the recovery or mild residual symptoms; 2 - disabled; 3 - vegetable state; 4 - death. Patients were examined at different times after injury: 1-6 days, 7-11 days, 12-19 and 20-33 days. RESULTS AND CONCLUSION: In the first days after injury, the content of VEGF-A in patients of 1-3 groups was at the level of the reference group, moreover, in patients of the 3rd group it was close to the top edge. In group 4, the content of VEGF-A was maximal in the first days after injury and then gradually decreased to the point of death. In groups 1 and 3, the level of VEGF-A increased significantly starting from the 2nd week while in group 2 this indicator was slightly increased approaching later (up to 33 days of observation) to the upper values in the reference group. In the 3rd group, the content of VEGF-A reached the plateau on the 19th day after injury and was higher than the reference data, but lower than in patients of the 1st group. No correlation between the changes in ANG content at different times after combined injuries and outcome was found. There was a trend towards decreased levels of ANG, especially after 3-4 weeks after injury. The data obtained are important for the control over processes of vascular and tissue reparation after injury and for searching for effective ways of treatment of altered angiogenesis in such patients.