Editorial. Bicycle injuries and injury prevention.

In 1989, long before this journal added injuries to its title, it published two papers on childhood injuries and I was asked to write an editorial for this occasion. I chose the title "Challenges for Injury Prevention: Two Neglected Aspects" because I thought the papers neglected to mention the inadequacy of injury statistics (at the time there were no emergency department data) and also failed to emphasize the public health importance of childhood injuries. It is instructive, therefore, to compare this issue's offerings with how matters stood nearly 25 years ago and see what progress we've made. Papers in this and the previous issue of this journal discuss bicycle safety in general and helmet use in particular. Although this is a somewhat narrow focus, it serves as one indicator of how the field has evolved and what remains to be done to improve both the science and policy in this domain.

TITRE: Éditorial -- Traumatismes subis par les cyclistes et prévention des traumatismes. INTRODUCTION: En 1989, cette revue, bien avant que le terme « blessures ¼ ne soit ajouté à son titre, publiait deux articles sur les traumatismes chez les enfants, et on m'avait demandé à cette occasion de rédiger un éditorial. J'avais alors choisi le titre « Deux aspects négligés de la prévention des traumatismes ¼, car j'avais l'impression qu'on omettait de souligner que les statistiques sur les traumatismes étaient insuffisantes (il n'y avait pas de données des services des urgences à l'époque) et qu'on ne mettait pas assez l'accent sur l'importance pour la santé publique des traumatismes chez les enfants. Par conséquent, il est intéressant de comparer les statistiques d'aujourd'hui avec celles d'il y a 25 ans et de constater les progrès accomplis. Certains articles de ce numéro et du numéro précédent portent sur la sécurité des cyclistes en général et sur le port du casque en particulier. Bien qu'il s'agisse d'un objet quelque peu restreint, il peut servir d'indicateur sur la manière dont ce champ a évolué et sur ce qui reste à faire pour améliorer la recherche et la politique en la matière.

Impact of a celebrity death on children's injury-related emergency room visits.

OBJECTIVES: To determine whether a sharp increase in Emergency Room (ER) visits at the Montreal Children's Hospital (MCH) during the week following the death of Natasha Richardson from a skiing-related head injury was a) statistically significant and b) related to media coverage of the event. We postulated that there would be less coverage in the French media and in centres west of Quebec. METHODS: We compared the number of visits to the MCH ER for 10 weeks beginning March 5 and recorded the number for head-related injuries. These data were also compared with averages for the MCH for the same weeks in the previous 16 years; with visit figures from Hôpital Ste-Justine (HSJ); and with those from 3 other pediatric hospitals in provinces west of Quebec for the same period. RESULTS: We found a 60% increase in injury visits to the MCH ER compared to the baseline week (p < 0.001) and a 66% difference when compared with the 16-year average. HSJ also recorded a sharp increase during the study week but the rise did not persist. Smaller increases were recorded in the more western children's hospitals. At the MCH nearly half of the visits were for head injuries, but there was no change in the number judged to be severe. CONCLUSIONS: These data suggest that the media coverage of this celebrity death may have generated anxiety among parents, prompting those who might not otherwise have sought medical care to bring their children to the ER.

Research Consortium on Children with Chronic Conditions (RCCCC): a vehicle for interdisciplinary collaborative research.

To describe the evolution, accomplishments, and limitations of a research consortium after 25 years of existence. A narrative historical account supplemented by data documenting citations to all group papers. In 1980 the Research Consortium on Children with Chronic Conditions was established. Since then, we have met 2-3 times a year to discuss issues related to research and policies for children with special health care needs. We describe the origin of the Consortium, its operation, and some of its accomplishments, as well as the difficulties it encountered. Our interactions helped promote and sustain research on an emerging topic and did so in an interdisciplinary manner. We include a citation analysis suggesting that group papers published by Consortium members are reasonably well cited by others. We believe our work has been of value in developing influencing research, clinical practice, and policy. This paper is intended to serve as a guide for others who believe that this type of interaction can do much to promote an emerging field. However, it also highlights some of the difficulties in forging and maintaining a productive, research-focused relationship over an extended period of time. The most important lesson learned is that a small group of committed individuals able to meet on a regular basis can accelerate movement in a new field. However, unless stable funding can be secured, maintaining a consortium is truly challenging.

Long term effects of a home visit to prevent childhood injury: three year follow up of a randomized trial.

OBJECTIVE: To assess the long term effect of a home safety visit on the rate of home injury. DESIGN: Telephone survey conducted 36 months after participation in a randomized controlled trial of a home safety intervention. A structured interview assessed participant knowledge, beliefs, or practices around injury prevention and the number of injuries requiring medical attention. SETTING: Five pediatric teaching hospitals in four Canadian urban centres. PARTICIPANTS: Children less than 8 years of age presenting to an emergency department with a targeted home injury (fall, scald, burn, poisoning or ingestion, choking, or head injury while riding a bicycle), a non-targeted injury, or a medical illness. RESULTS: We contacted 774 (66%) of the 1172 original participants. A higher proportion of participants in the intervention group (63%) reported that home visits changed their knowledge, beliefs, or practices around the prevention of home injuries compared with those in the non-intervention group (43%; p<0.001). Over the 36 month follow up period the rate of injury visits to the doctor was significantly less for the intervention group (rate ratio = 0.74; 95% CI 0.63 to 0.87), consistent with the original (12 month) study results (rate ratio = 0.69; 95% CI 0.54 to 0.88). However, the effectiveness of the intervention appears to be diminishing with time (rate ratio for the 12-36 month study interval = 0.80; 95% CI 0.64 to 1.00). CONCLUSIONS: A home safety visit was able to demonstrate sustained, but modest, effectiveness of an intervention aimed at improving home safety and reducing injury. This study reinforces the need of home safety programs to focus on passive intervention and a simple well defined message.

Quality of information on risk factors reported by ski patrols.

OBJECTIVE: To determine the reliability of reporting of information on risk factors from a standard accident report form used by ski patrols and a follow up mail questionnaire or telephone interview among injured skiers and snowboarders. SETTING: 19 ski areas in the Canadian province of Quebec between November 2001 and April 2002. PARTICIPANTS: 4377 injured skiers and snowboarders seen by the ski patrol, who completed a follow up mail questionnaire or telephone interview. MAIN OUTCOME MEASURES: Kappa and weighted kappa statistics were used to measure the chance corrected agreement for self reported ability, age, skiing time on day of injury, lessons, type of practice, use of helmet at time of injury, and hill difficulty. RESULTS: The kappa value for helmet use at the time of injury was 0.88 (95% confidence interval 0.87 to 0.90) and for other risk factors ranged from 0.45 (skiing time on day of injury) to 0.98 (age). Few differences were seen in reporting by body region of injury. Reporting consistency was lower for respondents who completed telephone interviews compared with those who completed mail questionnaires and those who responded more than four months after the injury. CONCLUSIONS: Moderate to almost perfect agreement, depending on the risk factor, exists between ski patrols' accident report forms and follow up information. Ski patrol reports can be a reliable and readily available source of information on risk factors for skiing and snowboarding.