Suicide and mortality following self-harm in Culturally and Linguistically Diverse communities in Victoria, Australia: insights from a data linkage study.

Background: While cultural backgrounds are well-documented to be relevant to intentional self-harm, little is known about how cultural and linguistically diverse (CALD) backgrounds affect mortality outcomes following self-harm. Aim: This study aimed to compare the risk of all-cause mortality and suicide after intentional hospital admissions for self-harm among people from CALD (vs. non-CALD) backgrounds. Method: Linked hospital and mortality data in Victoria, Australia, was used to assess suicide and all-cause death after hospital admissions for self-harm among patients aged 15+ years. All-cause death was identified by following up on 42,122 self-harm patients (hospitalized between 01 July 2007 and 30 June 2019) until death or 15 February 2021. Suicide death was evaluated in 16,928 self-harm inpatients (01 January 2013 and 31 December 2017) until death or 28 March 2018. Cox regression models were fitted to compare mortality outcomes in self-harm patients from CALD vs. non-CALD backgrounds. Outcomes: During the follow-up periods, 3,716 of 42,122 (8.8%) participants died by any cause (by 15 February 2021), and 304 of 16,928 (1.8%) people died by suicide (by 28 March 2018). Compared to the non-CALD group, CALD intentional self-harm inpatients had a 20% lower risk of all-cause mortality (HR: 0.8, 95% CI: 0.7-0.9) and a 30% lower risk of suicide (HR: 0.7, 95% CI: 049-0.97). Specifically, being from North Africa/Middle East and Asian backgrounds lowered the all-cause mortality risk; however, the suicide risk in Asians was as high as in non-CALD people. Conclusion: Overall, people from CALD backgrounds exhibited lower risks of all-cause mortality and suicide following hospital admission for self-harm compared to the non-CALD group. However, when comparing risks based on regions of birth, significant variations were observed. These findings underscore the importance of implementing culturally tailored background-specific suicide preventive actions. The study focussed on outcomes following hospital admission for self-harm and did not capture outcomes for cases of self-harm that did not result in hospital admission. This limits generalisability, as some CALD people might avoid accessing healthcare after self-harm due to cultural factors. Future research that not limited to hospital data is suggested to build on the results.

Hospital-admitted drowning in Victoria, Australia, before and after the emergence of the COVID-19 pandemic.

OBJECTIVES: To examine trends in hospitalisation following drowning in Victoria, Australia, before and after the emergence of the COVID-19 pandemic. DESIGN: Retrospective analysis of administrative hospital admission records. SETTING: Hospital admissions recorded in the Victorian Admitted Episodes Dataset. PARTICIPANTS: Hospital-admitted patients with ≥1 drowning-related International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis code. MAIN OUTCOME MEASURES: Incidence and incidence rate ratios (IRR; 95% CIs) of hospital-admitted drowning that occurred before (July 2017 to June 2019), during (July 2019 to June 2021) and after (July 2021 to June 2022) the onset of the COVID-19 pandemic. RESULTS: There were 736 hospital admissions related to drowning in the study period; the incidence was 2.6 per 100 000 population pre-COVID-19 and dropped to 2.0 per 100 000 during (2019/2020-2020/2021) and after (2021/2022) the onset of the pandemic. Among Victorian residents, drowning was positively associated with younger age, male sex and regional/remote residence. Drowning was negatively associated with the onset of COVID-19 (IRR 0.76 (0.64, 0.90)) as well as the post-COVID-19 period (0.78 (0.64, 0.97)), compared with pre-COVID-19. Natural water drowning rates were consistently higher than pool or bathtub drowning rates. Pool or bathtub drowning rates decreased with the onset of COVID-19; no significant change was observed in the natural water drowning rate. CONCLUSIONS: Pool and bathtub drowning rates declined since the onset of the COVID-19 pandemic, despite more time spent at home, while natural water drowning rates remained consistently high. Hospital admissions provide a valuable data source for monitoring of drowning, which is crucial to ensure a targeted, evidence-based approach to mitigate drowning risk.

Occupational injuries caused by fire and smoke in Victoria, Australia, 2003-2021: a descriptive study.

OBJECTIVES: Hospital attendance related to fire, flame or smoke exposure is commonly associated with work. The aim of this study was to examine time trends and risk factors for work-related fire/flame/smoke injuries in Victoria, Australia. METHODS: This study was based on emergency department (ED) presentation records from the Victorian Emergency Minimum Dataset, 2003-2021. Cases were people aged 15-74 years with injury-related ED presentations, if cause of injury was recorded as fire/flame/smoke, based on coded data and/or narratives. Work-related rates were calculated per employed persons; non-work rates were calculated per population. Work-related and non-work-related cases were compared using logistic regression modelling. RESULTS: There were 11 838 ED presentations related to fire/flame/smoke: 1864 (15.7%) were work-related. Non-work-related rates were 12.3 ED presentations per 100 000 population, and work-related rates were 3.43 per 100 000 employed persons annually. Over the study period, work-related rates decreased annually by 2.0% (p<0.0001), while non-work rates increased by 1.1% (p<0.0001). Work-related cases (vs non-work) were associated with summer (vs winter), but the association with extreme bushfire periods (Victorian 'Black Saturday' and 'Black Summer') was not statistically significant. Work-related cases were less severe than non-work-related cases, evidenced by triage status and subsequent admission. CONCLUSIONS: Rates of occupational fire/flame/smoke-related injury presentations decreased over the past two decades in Victoria, while non-work-related rates increased. This could reflect improved safety in the workplace. Hospital data, however, cannot be used to distinguish occupation or industry therefore, employment data linkage studies are recommended to further inform workplace preventive measures.

Epidemiology of work-related fall injuries resulting in hospitalisation: individual and work risk factors and severity.

OBJECTIVES: Injuries at work are common and costly for individuals and employers. A common mechanism of workplace injury is through falls, but there have been few epidemiological studies of risk factors. This study aimed to identify patient, work and injury factors associated with injuries causing hospitalisation after falling at work in Victoria, Australia. METHODS: Data came from work-related hospitalised injury admissions, identified by International Classification of Diseases and Related Health Problems, Tenth Revision Australian Modification codes and compensation status, from Victorian Admitted Episodes Dataset between 1 July 2017 and 30 June 2022. Multivariate logistic regression analyses were conducted to identify factors associated with same-level falls and falls from height. RESULTS: This study included 42 176 work-related injury admissions: 8669 (20.6%) fall injuries and 33 507 (79.4%) other injuries. Rates of high falls were more common in males than females (0.44 (95% CI: 0.43, 0.46) vs 0.08 (0.08, 0.09) admissions per 1000 employed), while same-level falls were more common in females than males (0.21 (0.20, 0.22) vs 0.18 (0.17, 0.18)). Patients with same-level fall injuries, relative to all other work injuries, were more likely to be older women, and have at least one chronic condition; falls from height were associated with male sex and construction work and more likely to result in intracranial, internal organ injuries and fractures and longer hospital stay than non-fall injuries. CONCLUSION: Work-related falls were common and relatively severe. Same-level falls are relatively likely to occur in older women, the fastest-growing workplace demographic, and therefore the incidence is expected to increase. Comorbidities are an important fall risk factor. Employers could consider industry-relevant high and same-level fall prevention strategies for reducing the workplace injury burden.

In-hospital complications of work-related musculoskeletal injuries.

BACKGROUND, OBJECTIVES: Work-related musculoskeletal (MSK) injuries are a major contributor to morbidity worldwide and frequently result in hospitalisation. Hospital complications are common, costly, and largely preventable, but relevant data is required to address this. This study aimed to identify the incidence and factors associated with in-hospital complications of work-related MSK injuries. METHODS: This study is based on work-related MSK hospital admission data from Victorian Admitted Episodes Database, 2016-2022. Complications were identified based on ICD-10-AM coding using CHADx (Classification of Hospital Acquired Diagnoses). Negative binomial and logistic regression analyses were performed to identify factors related to in-hospital complications. RESULTS: In-hospital complications occurred in 6.3 % of work-related MSK injury admissions. In the adjusted models, ages ≥45 years, female sex, and area-level disadvantage were associated with in-hospital complications. Stay at public (vs private) hospitals, comorbidity, emergency admissions, and general anaesthesia were also associated. Complication rates were higher in hospitalised workers with direct head, neck, and trunk injuries and cumulative MSK disorders than those with direct extremities injuries and acute MSK conditions. The most common complications were cardiovascular, gastrointestinal complications and adverse drug events. CONCLUSION: This study identified patient, injury and hospital-related characteristics associated with in-hospital complications of work-related MSK injuries for informing prevention strategies and risk estimation by hospital staff and workers' compensation schemes. The results demonstrate a sizable rate of complications given the relatively young and healthy study population.

Personality, perceptions and behavior: A study of speeding amongst drivers in Victoria, Australia.

INTRODUCTION: Road crashes present a serious public health issue. Many people are seriously or fatally injured every year in avoidable crashes. While these crashes can have multiple contributing factors, including road design and condition, vehicle design and condition, the environment and human error, the performance of illegal driving behavior, including speeding, may also play a role. The current study aimed to examine the mediating influence that four potential deterrents (perceptions towards enforcement, crash risk, social norms and disapproval, and negative personal/emotional affect) have between the Big Five personality traits (conscientiousness; extraversion; agreeableness; neuroticism; openness) and expectations to speed. METHODS: A total of 5,108 drivers in Victoria, Australia completed an online survey in 2019. A mediated regression analysis was used to examine pathways in a conceptual model developed for the study. RESULTS: The results showed that perceptions towards the four potential deterrents examined did mediate the relationship (either completely or partially) between personality and expectations to speed. CONCLUSIONS: The results of this study suggest that if interventions to deter illegal driving behavior are to be successful, one factor that could be taken into account is the personality traits of drivers who may be at greatest risk of the performance of illegal driving behaviors.

Transition between social protection systems for workers with long term health problems: A controlled retrospective cohort study.

Many nations have established workers' compensation systems as a feature of their social protection system. These systems typically provide time-limited entitlements such as wage replacement benefits and funding for medical treatment. Entitlements may end for workers with long-term health conditions before they have returned to employment. We sought to determine the prevalence of transitions to alternative forms of social protection, specifically social security benefits, among injured workers with long-term disability, when workers' compensation benefits end. We linked Australian workers' compensation and social security data to examine receipt of social security payments one year before and after workers' compensation benefit cessation. Study groups included (1) injured workers whose workers' compensation benefits ceased due to reaching a 260-week limit introduced by legislative reform (N = 2761), (2) a control group of injured workers with at least 104 weeks workers compensation income support (N = 3890), and (3) a matched community control group (N = 10,114). Adjusted binary logistic regression examined the odds of transitions to social security in the injured worker groups relative to the community control group. Within 12 months of workers' compensation benefit cessation, 60% (N = 1669) of the exposed group received social security payments, of which 41% (N = 1120) received the unemployment allowance and 19% (N = 516) the disability pension. Among the work injured control group, 42% (N = 1676) received social security payments after workers compensation benefits ceased. Transitions to social security payments were significantly more common than community levels for both exposed (OR 25.0, 95%CI = 20.7, 30.1) and work injured control groups (OR 4.7, 95%CI = 4.2, 5.3). Many injured workers with long-term health problems transition to social security when their workers' compensation benefits cease. Transitions were more common among workers whose claims ended due to legislative reform which time-limited benefits. Design and implementation of system level policy reform should consider the social and economic impacts of transitions between separate social protection systems.

Repeat self-harm and mental health service use after self-harm in Culturally and Linguistically Diverse communities: Insights from a data linkage study in Victoria, Australia.

PURPOSE: To examine the associations between Culturally and Linguistically Diverse backgrounds (vs non-Culturally and Linguistically Diverse) and in-hospital death due to self-harm, repeat self-harm and mental health service use after self-harm. METHOD: A retrospective study of 42,127 self-harm hospital inpatients aged 15+ years in Victoria, Australia, from July 2008 to June 2019. Linked hospital and mental health service data were used to assess in-hospital death, repeat self-harm and mental health service use in the 12 months following index self-harm hospital admission. Logistic regression and zero-inflated negative binomial regression models were used to estimate associations between cultural background and outcomes. RESULTS: Culturally and Linguistically Diverse people accounted for 13.3% of self-harm hospital inpatients. In-hospital death (0.8% of all patients) was negatively associated with Culturally and Linguistically Diverse background. Within 12 months, 12.9% of patients had self-harm readmission and 20.1% presented to emergency department with self-harm. Logistic regression components of zero-inflated negative binomial regression models showed no differences in the odds of (hospital-treated) self-harm reoccurrence between Culturally and Linguistically Diverse and non- Culturally and Linguistically Diverse self-harm inpatients. However, count components of models show that among those with repeat self-harm, Culturally and Linguistically Diverse people (e.g. born in Southern and Central Asia) made fewer additional hospital revisits than non-Culturally and Linguistically Diverse people. Clinical mental health service contacts following self-harm were made in 63.6% of patients, with Culturally and Linguistically Diverse people (Asian backgrounds 43.7%) less likely to make contact than the non-Culturally and Linguistically Diverse group (65.1%). CONCLUSIONS: Culturally and Linguistically Diverse and non-Culturally and Linguistically Diverse people did not differ in the likelihood of hospital-treated repeat self-harm, but among those with self-harm repetition Culturally and Linguistically Diverse people had fewer recurrences than non-Culturally and Linguistically Diverse people and utilised mental health services less following self-harm admissions.

Trends in mortality outcomes of hospital-admitted injury in Victoria, Australia 2001-2021.

Due to advancements in trauma treatment methods, it is expected that survivability of hospital-admitted injuries gradually improves over time. However, measurement of trends in all-cause injury survivability is complicated by changes in case mix, demographics and hospital admission policy. The aim of this study is to determine trends in hospital-admitted injury survivability in Victoria, Australia, taking case-mix and patient demographics into account, and to explore the potential impact of changes in hospital admission practices. Injury admission records (ICD-10-AM codes S00-T75 and T79) between 1 July 2001 and 30 June 2021 were extracted from the Victorian Admitted Episodes Dataset. ICD-based Injury Severity Score (ICISS) calculated from Survival Risk Ratios for Victoria was used as an injury severity measure. Death-in-hospital was modelled as a function of financial year, adjusting for age group, sex and ICISS, as well as admission type and length of stay. There were 19,064 in-hospital deaths recorded in 2,362,991 injury-related hospital admissions in 2001/02-2020/21. Rates of in-hospital death decreased from 1.00% (866/86,998) in 2001/02 to 0.72% (1115/154,009) in 2020/21. ICISS was a good predictor of in-hospital death with an area-under-the-curve of 0.91. In-hospital death was associated with financial year (Odds Ratio 0.950 [95%CI 0.947, 0.952]), in logistic regression modelling adjusted for ICISS, age and sex. In stratified modelling, decreasing injury death trends were observed in each of the top 10 injury diagnoses (together constituting > 50% of cases). Admission type and length of stay were added to the model: these did not alter the effect of year on in-hospital death. In conclusion, a 28% reduction in rates of in-hospital deaths in Victoria was observed over the 20-year study period, in spite of aging of the injured population. This amounts to 1222 additional lives saved in 2020/21 alone. Survival Risk Ratios therefore change markedly over time. A better understanding of the drivers of positive change will help to further reduce the injury burden in Victoria.

Intentional self-harm in culturally and linguistically diverse communities: A study of hospital admissions in Victoria, Australia.

PURPOSE: To examine the rates and profiles of intentional self-harm hospital admissions among people from culturally and linguistically diverse and non-culturally and linguistically diverse backgrounds. METHODS: A retrospective analysis of 29,213 hospital admissions for self-harm among people aged 15 years or older in Victoria, Australia, was conducted using data from the Victorian Admitted Episodes Dataset between 2014/2015 and 2018/2019. The Victorian Admitted Episodes Dataset records all hospital admissions in public and private hospitals in Victoria (population 6.5 million). Population-based incidence of self-harm, logistic regression and percentages (95% confidence intervals) were calculated to compare between culturally and linguistically diverse groups by birthplaces and the non-culturally and linguistically diverse groups of self-harm admissions. RESULTS: When grouped together culturally and linguistically diverse individuals had lower rates of (hospital-treated) self-harm compared with the non-culturally and linguistically diverse individuals. However, some culturally and linguistically diverse groups such as those originating from Sudan and Iran had higher rates than non-culturally and linguistically diverse groups. Among self-harm hospitalised patients, those in the culturally and linguistically diverse group (vs non-culturally and linguistically diverse group) were more likely to be older, Metropolitan Victorian residents, from the lowest socioeconomic status, and being ever or currently married. Self-harm admissions by persons born in Southern and Eastern Europe were the oldest of all groups; in all other groups number of admissions tended to decrease as age increased whereas in this group the number of admissions increased as age increased. CONCLUSION: There was considerable heterogeneity in rates of hospital-treated self-harm in culturally and linguistically diverse communities, with some countries of origin (e.g. Sudan, Iran) having significantly higher rates. Some of this variation may be due to factors relating to the mode of entry into Australia (refugee vs planned migration), and future research needs to examine this possibility and others, to better plan for support needs in the culturally and linguistically diverse communities most affected by self-harm. Combining all culturally and linguistically diverse people into one group may obscure important differences in self-harm. Different self-harm prevention strategies are likely to be needed for different culturally and linguistically diverse populations.

How representative is the Victorian Emergency Minimum Dataset (VEMD) for population-based injury surveillance in Victoria? A retrospective observational study of administrative healthcare data.

OBJECTIVE: The Victorian Emergency Minimum Dataset (VEMD) is a key data resource for injury surveillance. The VEMD collects emergency department data from 39 public hospitals across Victoria; however, rural emergency care services are not well captured. The aim of this study is to determine the representativeness of the VEMD for injury surveillance. DESIGN: A retrospective observational study of administrative healthcare data. SETTING AND PARTICIPANTS: Injury admissions in 2014/2015-2018/2019 were extracted from the Victorian Admitted Episodes Dataset (VAED) which captures all Victorian hospital admissions; only cases that arrived through a hospital's emergency department (ED) were included. Each admission was categorised as taking place in a VEMD-contributing versus a non-VEMD hospital. RESULTS: There were 535 477 incident injury admissions in the study period, of which 517 207 (96.6%) were admitted to a VEMD contributing hospital. Male gender (OR 1.13 (95% CI 1.10 to 1.17)) and young age (age 0-14 vs 45-54 years, OR 4.68 (95% CI 3.52 to 6.21)) were associated with VEMD participating (vs non-VEMD-participating) hospitals. Residing in regional/rural areas was negatively associated with VEMD participating (vs non-VEMD participating) hospitals (OR=0.11 (95% CI 0.10 to 0.11)). Intentional injury (assault and self-harm) was also associated with VEMD participation. CONCLUSIONS: VEMD representativeness is largely consistent across the whole of Victoria, but varies vastly by region, with substantial under-representation of some areas of Victoria. By comparison, for injury surveillance, regional rates are more reliable when based on the VAED. For local ED-presentation rates, the bias analysis results can be used to create weights, as a temporary solution until rural emergency services injury data is systematically collected and included in state-wide injury surveillance databases.

Suicide among those who use mental health services: Suicide risk factors as evidenced from contact-based characteristics in Victoria.

Objective: The majority of suicide decedents have had contact with health services in the months before their death. Contacts for mental health services present potential suicide prevention opportunities. This study aims to compare contact-based characteristics among suicide decedents and living controls in the year subsequent to clinical mental health contact with the public health system in Victoria, Australia. Methods: A population-based nested case-control study of those who had mental health-related hospital and community contacts with the public health system was conducted. Cases (suicide decedents) were age and gender-matched to living controls (suicide non-decedents). These records were linked to records of suicides that occurred in the 12 months following the health service contact, between January 1, 2011, and December 31, 2016. Victorian residents aged 10 years and above were selected at the time of contact (483,933 clients). In the study population, conditional logistic regression models were used to assess the relationship between contact-based characteristics and suicide. Socio-demographics and mental health-related hospital and community contact data was retrieved from the Victorian Admitted Episodes Dataset, the Victorian Emergency Minimum Dataset and the Public Clinical Mental Health database and suicide data from the Victorian Suicide Register. Results: During a six-year period, 1,091 suicide decedents had at least one mental health contact with the public health system in the 12 months preceding the suicide. Overall, controls used more mental health services than cases; however, cases used more mental health services near the event. The relationship between the type of service and suicide differed by service type: hospital admissions and emergency department presentations had a significant positive association with suicide with an OR of 2.09 (95% CI 1.82-2.40) and OR of 1.13 (95% CI 1.05-1.22), and the effect size increased as the event approached, whereas community contacts had a significant negative association with an OR of 0.93 (95% CI 0.92-0.94), this negative association diminished in magnitude as the event approached (OR∼1). Conclusion: Suicide decedents had less contact with mental health services than non-decedents; however, evidence suggests suicide decedents reach out to mental health services proximal to suicide. An increase in mental health service contact by an individual could be an indication of suicide risk and therefore an opportunity for intervention. Further, community level contact should be further explored as a possible prevention mechanism considering the majority of suicide decedents do not access the public clinical mental health services.

Quantifying the Foregone Benefits of Intelligent Speed Assist Due to the Limited Availability of Speed Signs across Three Australian States.

By being able to communicate the speed limit to drivers using speed sign recognition cameras, Intelligent Speed Assist (ISA) is expected to bring significant road safety gains through increased speed compliance. In the absence of complete digital speed maps and due to limited cellular connectivity throughout Australia, this study estimated the forgone savings of ISA in the event that speed signs are solely relied upon for optimal advisory ISA function. First, speed-related fatalities and serious injuries (FSI) in the Australian states of Victoria, South Australia, and Queensland (2013-2018) were identified, and published effectiveness estimates of ISA were applied to determine the potential benefits of ISA. Subsequently, taking into account speed sign presence across the three states, the forgone savings of ISA were estimated as FSI that would not be prevented due to absent speed signage. Annually, 27-35% of speed-related FSI in each state are unlikely to be prevented by ISA because speed sign infrastructure is absent, equating to economic losses of between AUD 62 and 153 million. Despite a number of assumptions being made regarding ISA fitment and driver acceptance of the technology, conservative estimates suggest that the benefits of speed signs placed consistently across road classes and remoteness levels would far outweigh the costs expected from the absence of speed signs. The development and utilisation of a methodology for estimating the foregone benefits of ISA due to suboptimal road infrastructure constitutes a novel contribution to research. This work provides a means of identifying where infrastructure investments should be targeted to capitalise on benefits offered by advanced driver assist technologies.

Pre-injury health status of truck drivers with a workers' compensation claim.

Truck drivers are a vulnerable population due to the high number of workplace injuries and fatalities predominant in their occupation. In Australia, the road freight transportation industry has been identified as a national priority area in terms of creating preventative measures to improve the health and safety of its workers. With an environment conducive to poor nutritional food choices and unhealthy lifestyle behaviours, many barriers exist to creating a safe and healthy workforce. Thus, the current study aimed to describe the pre-injury hospital-recorded health conditions and health service use of truck drivers with a worker's injury compensation claim/s when compared to workers in other industries. Data was obtained from a compensation claims database and linked with hospital admissions data recorded five years prior to the injury claim. Health and lifestyle behaviour data for the occupational code of truck drivers was compared to other occupational drivers, as well as to all other occupations. Analysis was conducted via logistic regression. The results found that when compared to other occupational drivers, truck drivers were significantly more likely to have a hospital-recorded diagnosis of diabetes and/or hypertension, as well as being significantly more likely to have a hospital record of tobacco use and/or alcohol misuse/abuse. The findings show that there is a need to review and revise existing health strategies to promote the health and wellbeing of truck drivers, especially given their challenging work environment.

Suicide following hospital admission for mental health conditions, physical illness, injury and intentional self-harm in Victoria, Australia.

OBJECTIVE: The majority of suicide decedents have had contact with health services close to their death. Some of these contacts include admissions to hospitals for physical and mental health conditions, injury and intentional self-harm. This study aims to establish and quantify the risks of suicide following hospital admission for a range of mental and physical illnesses. METHODS: A retrospective analysis was carried out on existing morbidity and mortality data in Victoria. Data was extracted from the Victorian Admitted Episodes Dataset and the Victorian Suicide Register. Unplanned hospital admissions among adult patients (> = 15 years of age), discharged between 01 January 2011 and 31 December 2016 (2,430,154 admissions), were selected. Standardised Mortality Ratios were calculated for conditions with at least five linked suicides within one year of discharge from hospital. RESULTS: Forty-three conditions defined at the three-digit level of the International Statistical Classification of Diseases and Related Health Problems 10th Revision, were associated with at least five subsequent suicides (within one year of hospital discharge); 14 physical illnesses, 5 symptoms, signs and abnormal clinical and laboratory findings, 12 mental health conditions, and 12 types of injury and poisonings. The highest Standardised Mortality Ratios were for poisonings (range; 27.8 to 140.0) and intentional self-harm (78.8), followed by mental health conditions (range; 15.5 to 72.9), symptoms, signs and abnormal clinical and laboratory findings (range; 1.4 to 43.2) and physical illnesses (range; 0.7 to 4.9). CONCLUSIONS: Hospital admissions related to mental health conditions and injury and poisonings including self-harm were associated with a greater risk of suicide than physical conditions. Mental health conditions such as depressive episodes, personality disorders and psychotic episodes, injuries caused by intentional-self-harm and poisonings by certain types of drugs, carbon monoxide and hormones such as insulin can be prioritised for targeting suicide prevention initiatives for persons discharged from hospitals.

Improving injury surveillance data quality: a study based on hospitals contributing to the Victorian Emergency Minimum Dataset.

OBJECTIVE: In this paper, we describe the design and baseline data of a study aimed at improving injury surveillance data quality of hospitals contributing to the Victorian Emergency Minimum Dataset (VEMD). METHODS: The sequential study phases include a baseline analysis of data quality, direct engagement and communication with each of the emergency department (ED) hospital sites, collection of survey and interview data and ongoing monitoring. RESULTS: In 2019/20, there were 371,683 injury-related ED presentations recorded in the VEMD. Percentage unspecified, the indicator of (poor) data quality, was lowest for 'body region' (2.7%) and 'injury type' (7.4%), and highest for 'activity when injured' (29.4%). In the latter, contributing hospitals ranged from 3.0-99.9% unspecified. The 'description of event' variable had a mean word count of 10; 16/38 hospitals had a narrative word count of <5. CONCLUSIONS: Baseline hospital injury surveillance data vary vastly in data quality, leaving much room for improvement and justifying intervention as described. IMPLICATIONS FOR PUBLIC HEALTH: Hospital engagement and feedback described in this study is expected to have a marked effect on data quality from 2021 onwards. This will ensure that Victorian injury surveillance data can fulfil their purpose to accurately inform injury prevention policy and practice.

Epidemiology and 6- and 12-Month Outcomes of Intimate Partner Violence and Other Violence-Related Traumatic Brain Injury in Major Trauma: A Population-Based Trauma Registry Study.

OBJECTIVE: To compare the epidemiology, in-hospital outcomes, and 6-month and 12-month patient-reported, outcomes of major trauma patients with intimate partner violence (IPV)-related traumatic brain injury (TBI) with other interpersonal violence (OV)-related TBI. SETTING: Victoria, Australia. PARTICIPANTS: Adult (≥18 years) major trauma cases with TBI (concussion, skull fracture, or intracranial injury), injured through IPV or OV, between July 2010 and June 2020, and included on the population-based Victorian State Trauma Registry. There were 133 adult major trauma cases due to IPV and 1796 due to OV. The prevalence of TBI was 39% (n = 52) in the IPV group and 56% (n = 1010) in the OV group. DESIGN: Registry-based cohort study. MAIN MEASURES: Trauma care indicators and 6- and 12-month patient-reported outcomes (self-reported disability, Glasgow Outcome Scale-Extended, EQ-5D-3L, and return to work). RESULTS: The annual incidence (95% CI) of major trauma involving TBI was 0.11 (0.08-0.14) per 100 000 population for IPV and 2.11 (1.98-2.24) per 100 000 for OV. A higher proportion of IPV-related cases were women (73% vs 5%), had sustained a severe TBI (Glasgow Coma Scale score 3-8; 27% vs 15%), were admitted to intensive care (56% vs 37%), and died in hospital (14% vs 5%). The median (interquartile range) time to definitive care (4.7 hours vs 3.3 hours) and head computed tomographic scan (5.0 hours vs 3.1 hours) was longer in the IPV group. Follow-up rates at 6 and 12 months were 71% and 69%, respectively. The 6- and 12-month outcomes were generally poorer in the IPV-related group. CONCLUSION: The incidence of IPV-related major trauma with TBI was low. However, the prevalence of severe TBI, the time to key aspects of clinical care, in-hospital mortality, and longer-term work-related disability were higher. However, power to detect differences was low due to the small number of IPV-related cases compared with the OV group.

International classification of disease based injury severity score (ICISS): A data linkage study of hospital and death data in Victoria, Australia.

BACKGROUND: Surveillance of severe injury incidence and prevalence using ICD-based injury severity scores (ICISS) requires valid, locally applicable diagnosis-specific survival probabilities (DSPs). This study aims to derive and validate ICISS in Victoria, Australia, and compare various ICISS methodologies in terms of accuracy and calculated severe injury prevalence. METHODS: This study used injury admissions (ICD-10-AM coded) from the Victorian Admitted Episodes Database (VAED) linked with death data (Cause of Death - Unit Record Files: CODURF). Using design data (July 2008 - June 2014; n = 720,759), various ICISS scales were derived, based on (i) in-hospital and (ii) three-month mortality. These scales were applied to testing data (July 2014 - December 2016; n = 334,363). Logistic regression modelling was used to determine model discrimination and calibration. RESULTS: In the design data, there were 6,337(0.9%) hospital deaths and 17,514(2.4%) three-months deaths; in the testing data, there were 2,700(0.8%) hospital deaths and 8,425(2.5%) three-month deaths. Newly developed ICISS scales had acceptable to outstanding discrimination, with Area Under the Curve ranging from 0.758 to 0.910. Age-specific ICISS scales were superior to general ICISS scales in model discrimination but inferior in model calibration. Calculated severe injury (ICISS ≤0.941) prevalence in the testing data ranged from 2% to 24%, depending on which mortality outcomes were used to calculate DRGs. CONCLUSIONS: This study provides local, validated ICISS scores that can be used in Victoria. It is recommended that age group stratified ICISS based on the worst-injury method is used. From the comparison of various ICISS scores, reflecting the range of ICISS permutations that are currently in use, care should be taken to compare ICISS methodology before comparing severe injury prevalence per population, injury cause, and time trends.

Pharmaceutical opioid poisonings in Victoria, Australia: Rates and characteristics of a decade of emergency department presentations among nine pharmaceutical opioids.

BACKGROUND AND AIMS: Pharmaceutical opioids are a significant contributor to the global 'opioid crisis', yet few studies have comprehensively distinguished between opioid types. We measured whether a range of common pharmaceutical opioids varied in their contribution to the rates and characteristics of harm in a population-wide indicator of non-fatal overdose. DESIGN: Retrospective observational study of emergency department (ED) patient care records in the Victorian Emergency Minimum Data set (VEMD), July 2009 to June 2019. SETTING: Victoria, Australia. CASES: ED presentations for non-fatal overdose related to pharmaceutical opioid use (n = 5403), where the specific pharmaceutical opioid was documented. MEASUREMENTS: We compared harms across the nine individual pharmaceutical opioids most commonly sold, and considered where multiple opioids contributed to the overdose. We calculated supply-adjusted rates of ED presentations using Poisson regression and used multinomial logistic regression to compare demographic and clinical characteristics of presentations among nine distinct pharmaceutical opioids and a 10th category where multiple opioids were documented for the presentation. FINDINGS: There were wide differences, up to 27-fold, between supply-adjusted rates of overdose. When considering presentations with sole opioids, the highest supply-adjusted overdose rates [per 100 000 oral morphine equivalents (OME); 95% confidence interval (CI)] were for codeine (OME = 0.078, 95% CI = 0.073-0.08) and oxycodone (OME =0.029, 95% CI = 0.027-0.030) and the lowest were for tapentadol (OME = 0.004, 95% CI = 0.003-0.006) and fentanyl (OME = 0.003, 95% CI = 0.002-0.004). These rates appeared related to availability rather than opioid potency. Most (62%) poisonings involved females. Codeine, oxycodone and tramadol were associated with younger presentations (respectively, 59.5%, 41.7% and 49.8% of presentations were 12-34 years old), and intentional self-harm (respectively 65.2%, 50.6%, and 52.8% of presentations). Relative to morphine, fentanyl [ 0.32 relative risk ratio (RRR)] and methadone ( 0.58 RRR) presentations were less likely to be coded as self-harm. Relative to morphine-buprenorphine, codeine, oxycodone and tramadol presentations were significantly more likely to be associated with the less urgent triage categories (respectively 2.18, 1.80, 1.52, 1.65 RRR). CONCLUSIONS: In Victoria, Australia, rates and characteristics of emergency department presentations for pharmaceutical opioids show distinct variations by opioid type.

Sociodemographic characteristics associated with hospital contact in the year prior to suicide: A data linkage cohort study in Victoria, Australia.

AIMS: The aims of this study were to examine the prevalence of hospital contact in the year prior to suicide in Victoria, Australia, and to compare characteristics among those who did and did not have contact in the year prior to suicide. METHODS: The study was a data linkage cohort study of 4348 Victorians who died by suicide over the period 2011-2017. Data from the Victorian Suicide Register (VSR) was linked with hospital separations and Emergency Department (ED) presentations datasets by the Centre for Victorian Data Linkages (CVDL). The main outcomes were: (1) hospital contact for any reason, (2) hospital contact for mental-health-related reasons, and (3) hospital contact for intentional self-harm. Unadjusted and adjusted odds ratios were calculated as the measures of association. RESULTS: In the year prior to suicide, half of the decedents (50.0%) had hospital contact for any reason (n = 2172), 28.6% had mental-health-related hospital contact (n = 1244) and 9.9% had hospital contact for intentional self-harm (n = 432). In the year prior to suicide, when compared with males aged 25-49 years (the reference group):males aged 75+ years and females of all ages were significantly more likely to have hospital contact for any reasonfemales aged 10-24 years and 25-49 years were significantly more likely to have mental-health-related hospital contactfemales aged 10-24 years and 25-49 years had 3.5 times and 2.4 times the odds of having hospital contact for intentional self-harm. CONCLUSIONS: The comparatively high proportion of female decedents with mental-health related hospital contact in the year prior to suicide suggests improving the quality of care for those seeking help is an essential prevention initiative; this could be explored through programs such as the assertive outreach trials currently being implemented in Victoria and elsewhere in Australia. However, the sizeable proportion of males who do not have contact in the year prior to suicide was a consistent finding and represents a challenge for suicide prevention. Programs to identify males at risk in the community and engage them in the health care system are essential. In addition, promising universal and selective interventions to reduce suicide in the cohort who do not have hospital contact, include restricting access to lethal means and other public health interventions are also needed.