Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

Importance: Falls are the most common cause of injury-related morbidity and mortality in older adults. Objective: To systematically review evidence on the effectiveness and harms of fall prevention interventions in community-dwelling older adults. Data Sources: MEDLINE, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Clinical Trials for relevant English-language literature published between January 1, 2016, and May 8, 2023, with ongoing surveillance through March 22, 2024. Study Selection: Randomized clinical trials of interventions to prevent falls in community-dwelling adults 65 years or older. Data Extraction and Synthesis: Critical appraisal and data abstraction by 2 independent reviewers. Random-effects meta-analyses with Knapp-Hartung adjustment. Main Outcomes and Measures: Falls, injurious falls, fall-related fractures, hospitalizations or emergency department visits, people with 1 or more falls, people with injurious falls, people with fall-related fractures, and harms. Results: Eighty-three fair- to good-quality randomized clinical trials (n = 48 839) examined the effectiveness of 6 fall prevention interventions in older adults. This article focuses on the 2 most studied intervention types: multifactorial (28 studies; n = 27 784) and exercise (37 studies; n = 16 117) interventions. Multifactorial interventions were associated with a statistically significant reduction in falls (incidence rate ratio [IRR], 0.84 [95% CI, 0.74-0.95]) but not a statistically significant reduction in individual risk of 1 or more falls (relative risk [RR], 0.96 [95% CI, 0.91-1.02]), injurious falls (IRR, 0.92 [95% CI, 0.84-1.01]), fall-related fractures (IRR, 1.01 [95% CI, 0.81-1.26]), individual risk of injurious falls (RR, 0.92 [95% CI, 0.83-1.02]), or individual risk of fall-related fractures (RR, 0.86 [95% CI, 0.60-1.24]). Exercise interventions were associated with statistically significant reductions in falls (IRR, 0.85 [95% CI, 0.75-0.96]), individual risk of 1 or more falls (RR, 0.92 [95% CI, 0.87-0.98]), and injurious falls (IRR, 0.84 [95% CI, 0.74-0.95]) but not individual risk of injurious falls (RR, 0.90 [95% CI, 0.79-1.02]). Harms associated with multifactorial and exercise interventions were not well reported and were generally rare, minor musculoskeletal symptoms associated with exercise. Conclusions and Relevance: Multifactorial and exercise interventions were associated with reduced falls in multiple good-quality trials. Exercise demonstrated the most consistent statistically significant benefit across multiple fall-related outcomes.

The effectiveness of Q6 and PIPER 6-year-old models on quantification of the change of child sitting posture with AEB and its impact on child's injures in frontal crash.

OBJECTIVE: Automatic Emergency Braking (AEB) has a direct impact on the effectiveness of the restraint systems in providing protection toward child occupants. The objective is to evaluate the effectiveness of Q6 and PIPER 6-year-old models in predicting the kinematic responses of child models, and further to quantify and analyze the child injuries during a frontal crash with and without AEB. METHODS: The finite element model of a booster seat has been validated through a full vehicle test. Based on the validated finite element model, two sled test finite element models for the rear seat booster seat with Q6 and PIPER 6-year-old models were constructed. AEB condition was imposed on above the two models and the kinematic responses of sitting posture including head, neck and chest have been compared in detail. The peak head displacement and neck curvature of Q6 dummy and PIPER 6-year-old models have been compared with the test data from child volunteers. Based on the child model with better predictive capability for kinematic response under AEB, child injuries were evaluated and analyzed for the 50 km/h frontal crash test with and without AEB. Last, this study discussed the effects of internal neck and chest structure difference between Q6 and PIPER 6-year-old models on child kinematic response and the injury risks. RESULTS: Under AEB condition, PIPER 6-year-old model has higher head displacement and lower trunk displacement than Q6 dummy model, and the peak head displacement and neck curvature of PIPER 6-year-old model are similar to the test data of child volunteers. During the 50 km/h frontal crash simulation with pre-crash AEB, the HIC15, Head acceleration 3 ms, Nij decrease 43.7%, 19.6% and 28.8%, respectively and the chest deflection increases 15.5% compared to the simulation without AEB. CONCLUSIONS: This study shows that PIPER 6-year-old model is more suitable for the quantification of sitting posture change under AEB due to its higher biofidelity. The pre-crash AEB can substantially reduce the head, neck injuries. But it also increases the chest injury due to the chest pre-compression. Future efforts are recommended to lower the child chest injury by integrating AEB with active pre-tensioning seatbelts.

Effect of 20 mph speed limits on traffic injuries in Edinburgh, UK: a natural experiment and modelling study.

INTRODUCTION: There is limited research evaluating 20 mph speed limit interventions, and long-term assessments are seldom conducted either globally or within the UK. This study evaluated the impact of the phased 20 mph speed limit implementation on road traffic collisions and casualties in the City of Edinburgh, UK over approximately 3 years post implementation. METHODS: We used four sets of complementary analyses for collision and casualty rates. First, we compared rates for road segments changing to 20 mph against those at 30 mph. Second, we compared rates for the seven implementation zones in the city against paired control zones. Third, we investigated citywide casualty rate trends using generalised additive model. Finally, we used simulation modelling to predict casualty rate changes based on changes in observed speeds. RESULTS: We found a 10% (95% CI -19% to 0%) greater reduction in casualties (8% for collisions) for streets that changed to 20 mph compared with those staying at 30 mph. However, the reduction was similar, 8% (95% CI -22% to 5%) for casualties (10% collisions), in streets that were already at 20 mph. In the implementation zones, we found a 20% (95% CI -22% to -8%) citywide reduction in casualties (22% for collisions) compared with control zones; this compared with a predicted 10% (95% CI -18% to -2%) reduction in injuries based on the changes in speed and traffic volume. Citywide casualties dropped 17% (95% CI 13% to 22%) 3 years post implementation, accounting for trend. CONCLUSION: Our results indicate that the introduction of 20 mph limits resulted in a reduction in collisions and casualties 3 years post implementation. However, the effect exceeded expectations from changes in speed alone, possibly due to a wider network effect.

Pedestrian safety on the road to net zero: cross-sectional study of collisions with electric and hybrid-electric cars in Great Britain.

BACKGROUND: Plans to phase out fossil fuel-powered internal combustion engine (ICE) vehicles and to replace these with electric and hybrid-electric (E-HE) vehicles represent a historic step to reduce air pollution and address the climate emergency. However, there are concerns that E-HE cars are more hazardous to pedestrians, due to being quieter. We investigated and compared injury risks to pedestrians from E-HE and ICE cars in urban and rural environments. METHODS: We conducted a cross-sectional study of pedestrians injured by cars or taxis in Great Britain. We estimated casualty rates per 100 million miles of travel by E-HE and ICE vehicles. Numerators (pedestrians) were extracted from STATS19 datasets. Denominators (car travel) were estimated by multiplying average annual mileage (using National Travel Survey datasets) by numbers of vehicles. We used Poisson regression to investigate modifying effects of environments where collisions occurred. RESULTS: During 2013-2017, casualty rates per 100 million miles were 5.16 (95% CI 4.92 to 5.42) for E-HE vehicles and 2.40 (95%CI 2.38 to 2.41) for ICE vehicles, indicating that collisions were twice as likely (RR 2.15; 95% CI 2.05 to 2.26) with E-HE vehicles. Poisson regression found no evidence that E-HE vehicles were more dangerous in rural environments (RR 0.91; 95% CI 0.74 to 1.11); but strong evidence that E-HE vehicles were three times more dangerous than ICE vehicles in urban environments (RR 2.97; 95% CI 2.41 to 3.7). Sensitivity analyses of missing data support main findings. CONCLUSION: E-HE cars pose greater risk to pedestrians than ICE cars in urban environments. This risk must be mitigated as governments phase out petrol and diesel cars.

The development of a road safety policy index and its application in evaluating the effects of road safety policy.

The paper presents an exploratory study of a road safety policy index developed for Norway. The index consists of ten road safety measures for which data on their use from 1980 to 2021 are available. The ten measures were combined into an index which had an initial value of 50 in 1980 and increased to a value of 185 in 2021. To assess the application of the index in evaluating the effects of road safety policy, negative binomial regression models and multivariate time series models were developed for traffic fatalities, fatalities and serious injuries, and all injuries. The coefficient for the policy index was negative, indicating the road safety policy has contributed to reducing the number of fatalities and injuries. The size of this contribution can be estimated by means of at least three estimators that do not always produce identical values. There is little doubt about the sign of the relationship: a stronger road safety policy (as indicated by index values) is associated with a larger decline in fatalities and injuries. A precise quantification is, however, not possible. Different estimators of effect, all of which can be regarded as plausible, yield different results.

An enhanced method for evaluating the effectiveness of protective devices for road safety application.

This paper presents an enhanced probabilistic approach to estimate the real-world safety performance of new device concepts for road safety applications from the perspective of Powered Two-Wheeler (PTW) riders who suffer multiple injuries in different body regions. The proposed method estimates the overall effectiveness of safety devices for PTW riders by correlating computer simulations with various levels of actual injuries collected worldwide from accident databases. The study further develops the methodology initially presented by Johnny Korner in 1989 by introducing a new indicator, Global Potential Damage (GPD), that overcomes the limitations of the original method, encompassing six biomechanical injury indices estimated in five body regions. A Weibull regression model was fit to the field data using the Maximum Likelihood Method with boundaries at the 90% confidence level for the construction of novel injury risk curves for PTW riders. The modified methodology was applied for the holistic evaluation of the effectiveness of a new safety system, the Belted Safety Jacket (BSJ), in head-on collisions across multiple injury indices, body regions, vehicle types, and speed pairs without sub-optimizing it at specific crash severities. A virtual multi-body environment was employed to reproduce a selected set of crashes. The BSJ is a device concept comprising a vest with safety belts to restrict the rider's movements relative to the PTW during crashes. The BSJ exhibited 59% effectiveness, with an undoubted benefit to the head, neck, chest, and lower extremities. The results show that the proposed methodology enables an overall assessment of the injuries, thus improving the protection of PTW users. The novel indicator supports a robust evaluation of safety systems, specifically relevant in the context of PTW accidents.

Major Traffic Safety Reform and Road Traffic Injuries Among Low-Income New York Residents, 2009-2021.

Objectives. To evaluate the effects of a comprehensive traffic safety policy-New York City's (NYC's) 2014 Vision Zero-on the health of Medicaid enrollees. Methods. We conducted difference-in-differences analyses using individual-level New York Medicaid data to measure traffic injuries and expenditures from 2009 to 2021, comparing NYC to surrounding counties without traffic reforms (n = 65 585 568 person-years). Results. After Vision Zero, injury rates among NYC Medicaid enrollees diverged from those of surrounding counties, with a net impact of 77.5 fewer injuries per 100 000 person-years annually (95% confidence interval = -97.4, -57.6). We observed marked reductions in severe injuries (brain injury, hospitalizations) and savings of $90.8 million in Medicaid expenditures over the first 5 years. Effects were largest among Black residents. Impacts were reversed during the COVID-19 period. Conclusions. Vision Zero resulted in substantial protection for socioeconomically disadvantaged populations known to face heightened risk of injury, but the policy's effectiveness decreased during the pandemic period. Public Health Implications. Many cities have recently launched Vision Zero policies and others plan to do so. This research adds to the evidence on how and in what circumstances comprehensive traffic policies protect public health. (Am J Public Health. 2024;114(6):633-641. https://doi.org/10.2105/AJPH.2024.307617).

Injury risk curves to guide safe speed limits on Swedish roads using German crash data supplemented with estimated non-injury crashes.

Vision Zero postulates that no one should be killed or seriously injured in road traffic; therefore, it is necessary to define evidence-based speed limits to mitigate impact severity. The overall aims to guide the definition of safe speeds limits by establishing relations between impact speed and the risk of at-least-moderate (MAIS2+) and at-least-severe (MAIS3+) injuries for car occupants in frontal and side crashes in Sweden. As Swedish in-depth data are unavailable, the first objective was to assess the applicability of German In-depth Accident Study (GIDAS) data to Sweden. The second was to create unconditional injury risk curves (risk of injury given involvement in any crash), rather than risk curves conditional on the GIDAS sampling criterion of suspected-injury crashes. Thirdly, we compared the unconditional and conditional risk curves to quantify the practical implications of this methodological choice. Finally, we provide an example to demonstrate how injury risk curves facilitate the definition of safe, evidence-based speed limits in Sweden. Characteristics important for the injury outcome were similar between GIDAS and Swedish data; therefore, the injury risk curves using German GIDAS data are applicable to Sweden. The regression models yielded the following results for unconditional injury risk curves: 10 % MAIS2+ at 25 km/h impact speed for frontal head-on crashes, 20 km/h for frontal car-to-object crashes, 55 km/h in far-side crashes, and 45 km/h in near-side crashes. A 10 % MAIS3+ risk was reached between 70 and 75 km/h for all crash types. Conditional injury risk curves gave substantially different results; the 10 % MAIS3+ risk in near-side crashes was 140 km/h, twice the unconditional value. For example, if a 10 % MAIS3+ risk was acceptable, treating remaining uncertainty conservatively, assuming compliance with speed limits and that Automated Emergency Braking takes 20 km/h of the travel speed before impact in longitudinal traffic, the safe speed limit for car occupants on most Swedish roads would be 80 km/h and 60 km/h in intersections.

The Injury Prevention Program to Reduce Early Childhood Injuries: A Cluster Randomized Trial.

BACKGROUND AND OBJECTIVES: The American Academy of Pediatrics designed The Injury Prevention Program (TIPP) in 1983 to help pediatricians prevent unintentional injuries, but TIPP's effectiveness has never been formally evaluated. We sought to evaluate the impact of TIPP on reported injuries in the first 2 years of life. METHODS: We conducted a stratified, cluster-randomized trial at 4 academic medical centers: 2 centers trained their pediatric residents and implemented TIPP screening and counseling materials at all well-child checks (WCCs) for ages 2 to 24 months, and 2 centers implemented obesity prevention. At each WCC, parents reported the number of child injuries since the previous WCC. Proportional odds logistic regression analyses with generalized estimating equation examined the extent to which the number of injuries reported were reduced at TIPP intervention sites compared with control sites, adjusting for baseline child, parent, and household factors. RESULTS: A total of 781 parent-infant dyads (349 TIPP; 432 control) were enrolled and had sufficient data to qualify for analyses: 51% Hispanic, 28% non-Hispanic Black, and 87% insured by Medicaid. Those at TIPP sites had significant reduction in the adjusted odds of reported injuries compared with non-TIPP sites throughout the follow-up (P = .005), with adjusted odds ratios (95% CI) of 0.77 (0.66-0.91), 0.60 (0.44-0.82), 0.32 (0.16-0.62), 0.26 (0.12-0.53), and 0.27 (0.14-0.52) at 4, 6, 12, 18, and 24 months, respectively. CONCLUSIONS: In this cluster-randomized trial with predominantly low-income, Hispanic, and non-Hispanic Black families, TIPP resulted in a significant reduction in parent-reported injuries. Our study provides evidence for implementing the American Academy of Pediatrics' TIPP in routine well-child care.

Statistical estimation of fatal and serious injuries saved by iRAP protocols in 74 countries.

OBJECTIVE: Road traffic crashes cause 1.19 million deaths and millions more injuries annually. The persistently high burden has drawn attention from national and international stakeholders worldwide. Unsafe road infrastructure is one of the major risk factors for traffic safety, particularly in low- and middle-income countries. METHODS: Aiming to eliminate high-risk roads in all countries, the International Road Assessment Programme (iRAP) developed a robust and evidence-based approach to support country transportation agencies. RESULTS: Thus far, the iRAP protocols have been used to collect 1.8 million kilometers of Crash Risk Mapping and 1.5 million kilometers of Star Rating and FSI estimations in 128 countries. Deploying an observational before-and-after (or pre-post) study design, this report estimated the fatal and series injuries (FSI) saved through use of the iRAP protocols. The study is based on 441,753 kilometers of assessed roads from 1,039 projects in 74 countries. Our results show that the implementation of iRAP's proposed countermeasures saves about 159,936 FSI annually. Throughout the lifetime of the implemented countermeasures, a total of 3.2 million FSI could be saved. CONCLUSION: While quantifying the success of the iRAP protocols, our results suggest an opportunity to save many millions more lives on the roads through expanding iRAP implementation to more regions and countries.

Assessing the impact and implications of the revised Act on the Aggravated Punishment of Specific Crimes in preventing child traffic injuries in school zones in Korea: an interrupted time series analysis.

In 2019, a child's death in Korea led to legislation that imposed stricter penalties for school zone traffic violations. We assessed the impact of that legislation using 2017-2022 Traffic Accident Analysis System data. Adjusted analyses revealed a significant decline in severe injuries in school zones, decreasing from 11 cases to 8 cases per month (p=0.017). The legislation correlated with a reduced risk of all child traffic injuries (risk ratio, 0.987; 95% confidence interval, 0.977 to 0.997; p=0.002), indicating its efficacy in curbing accidents.

Voices from the Ground: Community Perspectives on Preventing Unintentional Child Injuries in Low-Income Settings.

Unintentional injuries significantly contribute to mortality and morbidity among children under five, with higher prevalence in low- and middle-income countries (LMICs). Deprived communities in these regions face increased injury risks, yet there is limited research on child safety tailored to their unique challenges. To address this gap, we conducted focus group discussions in rural Uganda, involving parents, village health workers, community leaders, teachers, and maids. The objective was to understand community perceptions around child safety and determine what culturally and age-appropriate solutions may work to prevent child injuries. Analysis of discussions from ten focus groups revealed five main themes: injury causes, child development and behavior, adult behavior, environmental factors, and potential safety kit components. Common injuries included falls, burns, drowning, and poisoning, often linked to environmental hazards such as unsafe bunk beds and wet floors. Financial constraints and limited space emerged as cross-cutting issues. Participants suggested educational resources, first aid knowledge, and practical devices like solar lamps as potential solutions. The study presents invaluable insights into child safety in rural Ugandan homes, emphasizing the role of community awareness and engagement in designing effective, accessible interventions. It underscores the importance of context-specific strategies to prevent childhood injuries in similar resource-constrained environments.

The immediate effects of vision-zero corridor upgrades on pedestrian crashes in New York: A before-and-after spatial point process approach.

The long-term effects of the Vision-Zero (VZ) approach in Scandinavia are well documented. In contrast, information regarding the immediate effects of VZ at the starting phase upon gradual implementation is scarce. Taking New York City as the case study, we analyzed both the local and global effects of the Vision-Zero gradual implementation on pedestrian crashes in the early stage of implementation starting from 2014. The data analysis comprised 8,165 pedestrian injury crashes. Using location data, the crashes were matched to VZ infrastructure improvement location, start and completion dates. The experimental design included a treatment and two types of control conditions, and we controlled for well-known covariates including traffic exposure, land use, and risk-prone areas. We estimated a Geyer Saturation model and kernel density function for modeling the effect of Vision-Zero on crash intensity and dispersion two years before and after the implementation of Vision-Zero. The results reveal a significant global decrease of 6.1 % (p = 0.004) in pedestrian crash incidence in the treated sections compared with the control group two years after the treatment, and a greater dispersion of pedestrian injuries following the policy implementation.

Relationships Between Alcohol Policies and Infant Morbidities and Injuries.

INTRODUCTION: Previous research has found that policies specifically focused on pregnant people's alcohol use are largely ineffective. Therefore, the purpose of this study is to analyze the relationships between general population policies regulating alcohol physical availability and outcomes related to pregnant people's alcohol use, specifically infant morbidities and injuries. METHODS: Outcome data were obtained from Merative MarketScan, a longitudinal commercial insurance claims data set. Policy data were obtained from the National Institute on Alcohol Abuse and Alcoholism's Alcohol Policy Information System, the National Alcohol Beverage Control Association, and Liquor Handbooks and merged using policies in effect during the estimated year of conception. Relationships between state-level policies regulating sites, days/hours, and government monopoly of liquor sales and infant morbidities and injuries were examined. Analyses used logistic regression with individual controls, fixed effects for state and year, state-specific time trends, and SEs clustered by state. The study analysis was conducted from 2021 to 2023. RESULTS: The analytic sample included 1,432,979 infant-birthing person pairs, specifically people aged 25-50 years who gave birth to a singleton between 2006 and 2019. A total of 3.1% of infants had a morbidity and 2.1% of infants had an injury. State government monopoly on liquor sales was associated with reduced odds of infant morbidities and injuries, whereas gas station liquor sales were associated with increased odds of infant morbidities and injuries. Allowing liquor sales after 10PM was associated with increased odds for infant injuries. No effect was found for allowing liquor sales in grocery stores or on Sundays. CONCLUSIONS: Findings suggest that limiting alcohol availability for the general population may help reduce adverse infant outcomes related to pregnant people's alcohol use.

Investigating pedestrian-vehicle crashes on interstate highways: Applying random parameter binary logit model with heterogeneity in means.

In the U.S., the interstate highway system is categorized as a controlled-access or limited-access route, and it is unlawful for pedestrians to enter or cross this type of highway. However, pedestrian-vehicle crashes on the interstate highway system pose a distinctive safety concern. Most of these crashes involve 'unintended pedestrians', drivers who come out of their disabled vehicles, or due to the involvement in previous crashes on the interstate. Because these are not 'typical pedestrians', a separate investigation is required to better understand the pedestrian crash problem on interstate highways and identify the high-risk scenarios. This study explored 531 KABC (K = Fatal, A = Severe, B = Moderate, C = Complaint) pedestrian injury crashes on Louisiana interstate highways during the 2014-2018 period. Pedestrian injury severity was categorized into two levels: FS (fatal/severe) and IN (moderate/complaint). The random parameter binary logit with heterogeneity in means (RPBL-HM) model was utilized to address the unobserved heterogeneity (i.e., variations in the effect of crash contributing factors across the sample population) in the crash data. Some of the factors were found to increase the likelihood of pedestrian's FS injury in crashes on interstate highways, including pedestrian impairment, pedestrian action, weekend, driver aged 35-44 years, and spring season. The interaction of 'pedestrian impairment' and 'weekend' was found significant, suggesting that alcohol-involved pedestrians were more likely to be involved in FS crashes during weekends on the interstate. The obtained results can help the 'unintended pedestrians' about the crash scenarios on the interstate and reduce these unexpected incidents.

Injury hospitalisations for children and young people: a 20-year review.

BACKGROUND: Childhood injuries can have significant lifelong consequences. Quantifying and understanding patterns in injury severity can inform targeted prevention strategies and policies. This study examines the characteristics of child injury hospitalisations in the Australian Capital Territory over 20 years. METHODS: This study is a retrospective analysis of Admitted Patient Care Collection data for persons aged 0-24 years who were hospitalised for an injury between July 2000 and June 2020. Injury severity was assessed using International Classification of Injury Severity Scores based on survival risk ratios. RESULTS: The age standardised rate for injury hospitalisations increased significantly from 10.2 per 1000 in 2000/2001 to 21.0 per 1000 in 2019/2020, representing an average annual per cent change of 3.6%. Almost two-thirds of injuries were for men, however the rate of injury hospitalisations increased more rapidly in women. The majority of injuries (81.8%) were classified as minor. The proportion of injuries classified as serious increased with age. For moderate and serious injuries, injuries to the head were the most common type of injury, while falls were the leading cause. Self-harm injuries emerged as a leading contributor to the increase in injuries in young people aged 13-24 years old. CONCLUSION: This study emphasises the concerning upward trend in injury hospitalisations among children and young people over the past two decades. Given Australia is yet to formalise a national injury prevention strategy, understanding the patterns and characteristics of injuries is vital to developing effective prevention interventions to reduce harm and improve child safety.