Comparison of the number of pedestrian and cyclist injuries captured in police data compared with health service utilisation data in Toronto, Canada 2016-2021.

INTRODUCTION: Pedestrian and cyclist injuries represent a preventable burden to Canadians. Police-reported collision data include information on where such collisions occur but under-report the number of collisions. The primary objective of this study was to compare the number of police-reported collisions with emergency department (ED) visits and hospitalisations in Toronto, Canada. METHODS: Police-reported collisions were provided by Toronto Police Services (TPS). Data included the location of the collision, approximate victim age and whether the pedestrian or cyclist was killed or seriously injured. Health services data included ED visits in the National Ambulatory Care Reporting System and hospitalisations from the Discharge Abstract Database using ICD-10 codes for pedestrian and cycling injuries. Data were compared from 2016 to 2021. RESULTS: Injuries reported in the health service data were higher than those reported in the TPS for cyclists and pedestrians. The discrepancy was the largest for cyclists treated in the ED, with TPS capturing 7.9% of all cycling injuries. Cyclist injuries not involving a motor vehicle have increased since the start of the pandemic (from 3629 in 2019 to 5459 in 2020 for ED visits and from 251 in 2019 to 430 for hospital admissions). IMPLICATIONS: While police-reported data are important, it under-reports the burden. There have been increases in cyclist collisions not involving motor vehicles and decreases in pedestrian injuries since the start of the pandemic. The results suggest that using police data alone when planning for road safety is inadequate, and that linkage with other health service data is essential.

Is higher school neighbourhood Walk Score associated with greater child pedestrian safety near schools?

Walk Score is a common index used to estimate how suitable the built environment is for walking. Although Walk Score has been extensively validated as a measure of walkability and walking, there are limited studies examining whether commonly used constructs of walkability are associated with traffic safety in children. This study examined the association between Walk Score and child pedestrian injury controlling for observed walking exposure in school zones in Calgary, Toronto and Montreal, Canada. Results indicate that a higher Walk Score was associated with more child pedestrian injuries in all three cities, even after controlling for walking exposure. School travel planning should consider established individual pedestrian collision risk and individual factors rather than assuming a highly walkable environment is also a safe pedestrian environment.

Blame attribution analysis of police motor vehicle collision reports involving child bicyclists.

BACKGROUND: Injuries resulting from collisions between a bicyclist and driver are preventable and have high economic, personal and societal costs. Studying the language choices used by police officers to describe factors responsible for child bicyclist-motor vehicle collisions may help shift prevention efforts away from vulnerable road users to motorists and the environment. The overall aim was to investigate how police officers attribute blame in child (≤18 years) bicycle-motor vehicle collision scenarios. METHODS: A document analysis approach was used to analyse Alberta Transportation police collision reports from Calgary and Edmonton (2016-2017). Collision reports were categorised by the research team according to perceived blame (child, driver, both, neither, unsure). Content analysis was then used to examine police officer language choices. A narrative thematic analysis of the individual, behavioural, structural and environmental factors leading to collision blame was then conducted. RESULTS: Of 171 police collision reports included, child bicyclists were perceived to be at fault in 78 reports (45.6%) and adult drivers were perceived at fault in 85 reports (49.7%). Child bicyclists were portrayed through language choices as being irresponsible and irrational, leading to interactions with drivers and collisions. Risk perception issues were also mentioned frequently in relation to poor decisions made by child bicyclists. Most police officer reports discussed road user behaviours, and children were frequently blamed for collisions. CONCLUSIONS: This work provides an opportunity to re-examine perceptions of factors related to motor vehicle and child bicyclist collisions with a view to prevention.

Cortical and cerebellar structural correlates of cognitive-motor integration performance in females with and without persistent concussion symptoms.

INTRODUCTION: Fifteen percent of individuals who sustain a concussion develop persistent concussion symptoms (PCS). Recent literature has demonstrated atrophy of the frontal, parietal, and cerebellar regions following acute concussive injury. The frontoparietal-cerebellar network is essential for the performance of visuomotor transformation tasks requiring cognitive-motor integration (CMI), important for daily function. PURPOSE: We investigated cortical and subcortical structural differences and how these differences are associated with CMI performance in those with PCS versus healthy controls. METHODS: Twenty-six age-matched  female participants (13 PCS, 13 healthy) completed four visuomotor tasks.  Additionally, MR-images were analyzed for cortical thickness and volume, and cerebellar lobule volume. RESULTS: No statistically significant group differences were found in CMI performance. However, those with PCS demonstrated a significantly thicker and larger precuneus, and significantly smaller cerebellar lobules (VIIIa, VIIIb, X) compared to controls. When groups were combined, volumes of both the cerebellar lobules and cortical regions were associated with CMI task performance. CONCLUSION: The lack of behavioral differences combined with the structural differences may reflect a compensatory mechanism for those with PCS. In addition, this study highlights the effectiveness of CMI tasks in estimating the structural integrity of the frontoparietal-cerebellar network and is among the first to demonstrate structural correlates of PCS.

The Impact of Sex, Body Mass Index, Age, Exercise Type and Exercise Duration on Interstitial Glucose Levels during Exercise.

The impact of age, sex and body mass index on interstitial glucose levels as measured via continuous glucose monitoring (CGM) during exercise in the healthy population is largely unexplored. We conducted a multivariable generalized estimating equation (GEE) analysis on CGM data (Dexcom G6, 10 days) collected from 119 healthy exercising individuals using CGM with the following specified covariates: age; sex; BMI; exercise type and duration. Females had lower postexercise glycemia as compared with males (92 ± 18 vs. 100 ± 20 mg/dL, p = 0.04) and a greater change in glycemia during exercise from pre- to postexercise (p = 0.001) or from pre-exercise to glucose nadir during exercise (p = 0.009). Younger individuals (i.e., <20 yrs) had higher glucose during exercise as compared with all other age groups (all p < 0.05) and less CGM data in the hypoglycemic range (<70 mg/dL) as compared with those aged 20-39 yrs (p < 0.05). Those who were underweight, based on body mass index (BMI: <18.5 kg/m2), had higher pre-exercise glycemia than the healthy BMI group (104 ± 20 vs. 97 ± 17 mg/dL, p = 0.02) but similar glucose levels after exercise. Resistance exercise was associated with less of a drop in glycemia as compared with aerobic or mixed forms of exercise (p = 0.008) and resulted in a lower percent of time in the hypoglycemic (p = 0.04) or hyperglycemic (glucose > 140 mg/dL) (p = 0.03) ranges. In summary, various factors such as age, sex and exercise type appear to have subtle but potentially important influence on CGM measurements during exercise in healthy individuals.

Pilot study to evaluate school safety zone built environment interventions.

BACKGROUND: School safety zones were created in 2017 under the City of Toronto's Vision Zero Road Safety Plan. This pilot study examined the effect of built environment interventions on driver speeds, active school transportation (AST) and dangerous driving. METHODS: Interventions were implemented at 34 schools and 45 matched controls (2017-2019). Drivers travelling over the speed limit of >30 km/hour and 85th percentile speeds were measured using pneumatic speed tubes at school frontages. Observers examined AST and dangerous driving at school arrival times. Repeated measures beta and multiple regression analyses were used to study the intervention effects. RESULTS: Most schools had posted speed limits of 40 km/hour (58%) or ≥50 km/hour (23%). A decrease in drivers travelling over the speed limit was observed at intervention schools post-intervention (from 44% to 40%; OR 0.79, 95% CI 0.66 to 0.96). Seventy-one per cent of drivers travelled >30 km/hour and the 85th percentile speed was 47 km/hour at intervention schools, with no change in either postintervention. There were no changes in speed metrics in the controls. AST increased by 5% (OR 1.22, 95% CI 0.97 to 1.54) at intervention schools. Reductions in dangerous driving were observed at all schools. CONCLUSIONS: Posted speed limits were >30 km/hour at most schools and high proportions of drivers were travelling above the speed limits. There were reductions in drivers exceeding the speed limit and in dangerous driving, and modest increased AST post intervention. Bolder interventions to slow traffic are required to effectively reduce speeding around schools, which may increase safe AST.

Child pedestrian and cyclist injuries, and the built and social environment across Canadian cities: the Child Active Transportation Safety and the Environment Study (CHASE).

INTRODUCTION: Traffic injury is a leading and preventable cause of child death and disability, with child pedestrians and cyclists particularly vulnerable. Examining built environment correlates of child pedestrian and cyclist motor vehicle collisions (PCMVC) in different settings is needed to promote an evidence-based approach to road safety. METHODS: We conducted a cross-sectional study across multiple urban/suburban environments in Canada (Calgary, Toronto, Montreal, Laval, Peel Region). All public elementary schools were included (n=1030). We examined the role of land use/social environments, road environments and traffic safety interventions on the rates of child PCMVC within 1000 m of schools. Multivariable negative binomial regression was conducted for all cities and by individual city. In a subset of schools (n=389), we examined associations when controlling for active school transportation (AST). RESULTS: Mean PCMVC rate per school ranged from 0.13 collisions/year in Peel to 0.35 in Montreal. Child PCMVC were correlated with land use, social and road environments and traffic safety interventions. In fully adjusted models, social and land use features remained the most important correlates. New immigrant population had the largest positive association with child PCMVC (incidence rate ratio (IRR): 1.26, 95% CI 1.06 to 1.50), while old housing (pre-1960) density was most protective (IRR: 0.83, 95% CI 0.77 to 0.90). AST was associated with PCMVC, but it had no effect on the relationships between PCMVC and other social/environmental correlates. CONCLUSION: The built environment and social factors influence rates of child PCMVC. Opportunities to reduce child PCMVC exist through modifications to city design and road environments and implementing traffic safety interventions.

A Comparison of On-Ice External Load Measures Between Subelite and Elite Female Ice Hockey Players.

ABSTRACT: Douglas, AS, Rotondi, MA, Baker, J, Jamnik, VK, and Macpherson, AK. A comparison of on-ice external load measures between subelite and elite female ice hockey players. J Strength Cond Res 36(7): 1978-1983, 2022-This study quantified and examined differences in measures of on-ice external load for subelite and elite female ice hockey players. External load variables were collected from subelite (N = 21) and elite (N = 24) athletes using Catapult S5 monitors during the preseason. A total of 574 data files were analyzed from training and competition during the training camp. Significant differences between groups were found across all variables. Differences in training between the 2 groups ranged from trivial (forwards PlayerLoad, p = 0.03, effect-size [ES] = 0.18) to large (forwards Explosive Efforts [EEs], p < 0.001, ES = 1.64; defense EEs, p < 0.001, ES = 1.40). Match comparisons yielded similar results, with differences ranging from small (defense Low Skating Load [SL], p = 0.05, ES = 0.49; Medium SL, p = 0.04, ES = 0.52) to very large (forwards PlayerLoad, p < 0.001. ES = 2.25; PlayerLoad·min-1, p < 0.001, ES = 2.66; EEs, p < 0.001, ES = 2.03; Medium SL, p < 0.001, ES = 2.31; SL·min-1, p < 0.001, ES = 2.67), respectively. The differences in external load measures of intensity demonstrate the need to alter training programs of subelite ice athletes to ensure they can meet the demands of elite ice hockey. As athletes advance along the development pathway, considerable focus of their off-ice training should be to improve qualities that enhance their ability to perform high-intensity on-ice movements.

State-of-the-art review: preventing child and youth pedestrian motor vehicle collisions: critical issues and future directions.

AIM: To undertake a comprehensive review of the best available evidence related to risk factors for child pedestrian motor vehicle collision (PMVC), as well as identification of established and emerging prevention strategies. METHODS: Articles on risk factors were identified through a search of English language publications listed in Medline, Embase, Transport, SafetyLit, Web of Science, CINHAL, Scopus and PsycINFO within the last 30 years (~1989 onwards). RESULTS: This state-of-the-art review uses the road safety Safe System approach as a new lens to examine three risk factor domains affecting child pedestrian safety (built environment, drivers and vehicles) and four cross-cutting critical issues (reliable collision and exposure data, evaluation of interventions, evidence-based policy and intersectoral collaboration). CONCLUSIONS: Research conducted over the past 30 years has reported extensively on child PMVC risk factors. The challenge facing us now is how to move these findings into action and intervene to reduce the child PMVC injury and fatality rates worldwide.

Childhood unintentional injury: The impact of family income, education level, occupation status, and other measures of socioeconomic status. A systematic review.

INTRODUCTION: Unintentional injuries represent a substantial public health burden among children and adolescents, and previous evidence suggests that there are disparities in injury by socioeconomic status (SES). This paper reports on a systematic review of literature on injury rates among children and adolescents by measures of SES. METHODS: A systematic literature search was conducted using six electronic databases: MEDLINE, PsycINFO, CINAHL, HealthSTAR, EMBASE, and SportsDiscus. This review considered children ages 19 years and under and publications between 1997 and 2017-representing an update since the last systematic review examined this specific question. Fifty-four articles were summarized based on study and participant descriptions, outcome and exposure, statistical tests used, effect estimates, and overall significance. RESULTS: Most articles addressed risk factors across all injury mechanisms; however, some focused particularly on burns/scalds, road traffic injuries, falls/drowning cases, and playground/sports injuries. Other studies reported on specific injury types including traumatic dental injuries, traumatic brain injuries, and fractures. The studies were of moderate quality, with a median of 15.5 (95% confidence interval [CI]: 15.34 to 15.66) out of 19. Thirty-two studies found an inverse association between SES and childhood unintentional injury, three found a positive association while twenty were not significant or failed to report effect measures. CONCLUSION: Given the variability in definition of the exposure (SES) and outcome (injury), the results of this review were mixed; however, the majority of studies supported a relationship between low SES and increased injury risk. Public health practice must consider SES, and other measures of health equity, in childhood injury prevention programming, and policy.

Terrain park feature compliance with Québec ski area safety recommendations.

OBJECTIVES: The primary objective of this paper is to examine terrain park (TP) feature compliance with recommendations from a ski area industry guide (are TP features compliant with the guide?) and determine factors that could be associated with TP feature compliance in Québec ski areas (do factors influence TP feature compliance?), Canada. These recommendations on the design, construction and maintenance are provided by the Québec Ski Areas Association Guide. METHODS: A group of two to four trained research assistants visited seven ski areas. They used an evaluation tool to assess the compliance of 59 TP features. The evaluation tool, originally developed to assess the quality of TP features based on the guide, was validated in a previous study. Compliance was calculated by the percentage of compliant measures within a given feature. The potential influence of four factors on compliance (size of the TP, size of the feature, snow conditions and type of feature) were examined using a mixed-effects logistic regression model. RESULTS: The average TP feature compliance percentage was 93% (95% CI 88% to 99%) for boxes, 91% (95% CI 89% to 94%) for rails and 89% (95% CI 86% to 92%) for jumps. The logistic regression showed that none of the four factors examined were associated with TP feature compliance with the guide. CONCLUSION: Our results suggest that TP features are highly compliant with the guide in Québec ski areas.

Spatial distribution of roadway environment features related to child pedestrian safety by census tract income in Toronto, Canada.

BACKGROUND: Investments in traffic calming infrastructure and other street design features can enhance pedestrian safety as well as contribute to the 'walkability' of neighbourhoods. Pedestrian-motor vehicle collisions (PMVCs) in urban areas, however, remain common and occur more frequently in lower income neighbourhoods. While risk and protective features of roadways related to PMVC have been identified, little research exists examining the distribution of roadway environment features. This study examined the relationship between roadway environment features related to child pedestrian safety and census tract income status in Toronto. METHODS: Spatial cluster detection based on 2006 census tract data identified low-income and high-income census tract clusters in Toronto. Police-reported PMVC data involving children between the ages of 5 and 14 years were mapped using geographical information system. Also mapped were roadway environment features (densities of speed humps, crossing guards, local roads, one-way streets and missing sidewalks). Multivariate logistic regression was used to examine the relationship between roadway environment features (independent variables) and cluster income status (dependent variable), controlling for child census tract population. RESULTS: There were significantly fewer speed humps and local roads in low-income versus high-income clusters. Child PMVC rates were 5.4 times higher in low-income versus high-income clusters. CONCLUSION: Socioeconomic inequities in the distribution of roadway environment features related to child pedestrian safety have policy and process implications related to the safety of child pedestrians in urban neighbourhoods.

Canadian Child Safety Report Card: a comparison of injury prevention practices across provinces.

BACKGROUND: Injury prevention report cards that raise awareness about the preventability of childhood injuries have been published by the European Child Safety Alliance and the WHO. These report cards highlight the variance in injury prevention practices around the world. Policymakers and stakeholders have identified research evidence as an important enabler to the enactment of injury legislation. In Canada, there is currently no childhood injury report card that ranks provinces on injury rates or evidence-based prevention policies. METHODS: Three key measures, with five metrics, were used to compare provinces on childhood injury prevention rates and strategies, including morbidity, mortality and policy indicators over time (2006-2012). Nine provinces were ranked on five metrics: (1) population-based hospitalisation rate/100 000; (2) per cent change in hospitalisation rate/100 000; (3) population-based mortality rate/100 000; (4) per cent change in mortality rate/100 000; (5) evidence-based policy assessment. RESULTS: Of the nine provinces analysed, British Columbia ranked highest in Canada and Saskatchewan lowest. British Columbia had a morbidity and mortality rate that was close to the Canadian average and decreased over the study period. British Columbia also had a number of injury prevention policies and legislation in place that followed best practice guidelines. Saskatchewan had a higher rate of injury hospitalisation and death; however, Saskatchewan's rate decreased over time. Saskatchewan had a number of prevention policies in place but had not enacted bicycle helmet legislation. CONCLUSIONS: Future preventative efforts should focus on harmonising policies across all provinces in Canada that reflect evidence-based best practices.

Spatial distribution of pedestrian-motor vehicle collisions before and after pedestrian countdown signal installation in Toronto, Canada.

BACKGROUND: Pedestrian countdown signals (PCS) have been installed in many cities over the last 15 years. Few studies have evaluated the effectiveness of PCS on pedestrian motor vehicle collisions (PMVC). This exploratory study compared the spatial patterns of collisions pre and post PCS installation at PCS intersections and intersections or roadways without PCS in Toronto, and examined differences by age. METHODS: PCS were installed at the majority of Toronto intersections from 2007 to 2009. Spatial patterns were compared between 4 years of police-reported PMVC prior to PCS installation to 4 years post installation at 1864 intersections. The spatial distribution of PMVC was estimated using kernel density estimates and simple point patterns examined changes in spatial patterns overall and stratified by age. Areas of higher or lower point density pre to post installation were identified. RESULTS: There were 14 911 PMVC included in the analysis. There was an overall reduction in PMVC post PCS installation at both PCS locations and non-PCS locations, with a greater reduction at non-PCS locations (22% vs 1%). There was an increase in PMVC involving adults (5%) and older adults (9%) at PCS locations after installation, with increased adult PMVC concentrated downtown, and older adult increases occurring throughout the city following no spatial pattern. There was a reduction in children's PMVC at both PCS and non-PCS locations, with greater reductions at non-PCS locations (35% vs 48%). CONCLUSIONS: Results suggest that the effects of PCS on PMVC may vary by age and location, illustrating the usefulness of exploratory spatial data analysis approaches in road safety. The age and location effects need to be understood in order to consistently improve pedestrian mobility and safety using PCS.

Recent trends in child and youth emergency department visits because of pedestrian motor vehicle collisions by socioeconomic status in Ontario, Canada.

BACKGROUND: Children in lower-income households have higher injury rates. Trends in emergency department (ED) visits by children 0-19 years because of pedestrian motor vehicle collisions (PMVCs) in Ontario, Canada (2008-2015) by socioeconomic status were examined. METHODS: PMVC ED data were obtained from the Institute for Clinical Evaluative Sciences for children age 0-19 years over the period 2008-2015. Age-adjusted rates were calculated using Ontario census data. Household income quintiles were determined from the Registered Persons Database. Poisson regression was used to model ED visit rates by year, age and income quintile. RESULTS: The frequency of child PMVC ED visits in Ontario decreased from 1562 in 2008 to 1281 in 2015. Age-adjusted rates were unchanged over time (IRR 1.00, 95% CI 0.99 to 1.00); however, rate disparities by income status persisted with an IRR of 0.52 (0.50 to 0.55) comparing the highest with the lowest income level. CONCLUSIONS: Exposure to traffic may play a role in rate disparities by income status in child PMVC; however, less safe traffic environments in lower income areas may also be strong contributors. These findings highlight the potential impact of roadway safety modifications in lower income areas to mitigate disparities in injury rates by socioeconomic status.

The decline in active school transportation (AST): A systematic review of the factors related to AST and changes in school transport over time in North America.

Active travel to school has declined during the last 50years in North America. During the last decade, the children's active school transportation (AST) literature has grown. This systematic review provides an updated examination of AST correlates, and discusses why school travel mode (STM) share may have changed over time. AST trends are described and a systematic literature review of AST correlates in North America for the period 1990-2016 was conducted. Strength of association between correlates and AST, and relationship direction are assessed and reported. Graphical presentation of correlates included in ≥5 studies were included. Sixty-three studies were identified and reviewed. Distance to school was most strongly associated with AST. Individual, parental and societal correlates had moderate positive associations with AST including: child age, lower parental education, income and other income related factors, race and positive perceptions of AST. Longitudinal studies were few in number, as were studies about exceptional populations, policy, and interventions. AST intervention should focus on key AST correlates. Social and environmental diversity calls for local solutions to school travel challenges. Changes in AST correlates over time should be considered for evaluating existing policy approaches, and to support development of new policy, regulation, design, and program interventions.

Age-Related Patterns in Cancer Pain and Its Psychosocial Impact: Investigating the Role of Variability in Physical and Mental Health Quality of Life.

Objective: Age-related patterns in cancer pain remain equivocal. Most studies ignore heterogeneity across multiple domains of well-being, and the potential role of physical (PH) and mental health (MH) quality of life (QOL) in these age-related patterns is unknown. We investigated the relationships between age and cancer pain intensity, qualities, and interference, and physical and psychosocial adaptation and the interaction between age and PH and MH QOL on pain and adaptation to cancer pain. Design: In this cross-sectional study, 244 patients with advanced cancer and pain completed measures of pain, QOL, physical function, and psychosocial well-being. Pearson's correlations and ANOVAs assessed relationships between age and demographic and clinical factors, pain, and physical and psychosocial measures. Regression models tested the role of age and its interaction with PH and MH QOL on pain and physical and psychosocial adaptation. Results: Older age was associated with a lower likelihood of receiving an opioid prescription, greater likelihood of having comorbidities, and worse functional status. When we did not account for these factors, age was not associated with pain and most adaptation indices. When we did account for these factors and PH QOL, older age was associated with lower non-neuropathic and neuropathic pain and several indices of psychosocial adaptation. Most interestingly, older age was associated with lower non-neuropathic pain among those with high, but not low, MH QOL. Conclusions: This study addresses knowledge gaps about factors underlying age-related patterns in cancer pain. Impaired MH QOL may be a proxy for age-related patterns in cancer pain. Summary: This study investigated age-related patterns in the experience of cancer pain and the role of quality of life in resilience and vulnerability to pain and adaptation to pain. Older age is associated with lower non-neuropathic pain among those with high, but not low, mental health quality of life, suggesting that impaired mental health quality of life is an important indicator of vulnerability to multidimensional pain outcomes.

Empirical validation of the New Zealand serious non-fatal injury outcome indicator for 'all injury'.

Our purpose was to empirically validate the official New Zealand (NZ) serious non-fatal 'all injury' indicator. To that end, we aimed to investigate the assumption that cases selected by the indicator have a high probability of admission. Using NZ hospital in-patient records, we identified serious injury diagnoses, captured by the indicator, if their diagnosis-specific survival probability was ≤0.941 based on at least 100 admissions. Corresponding diagnosis-specific admission probabilities from regions in Canada, Denmark and Greece were estimated. Aggregate admission probabilities across those injury diagnoses were calculated and inference made to New Zealand. The admission probabilities were 0.82, 0.89 and 0.90 for the regions of Canada, Denmark and Greece, respectively. This work provides evidence that the threshold set for the official New Zealand serious non-fatal injury indicator for 'all injury' captures injuries with high aggregate admission probability. If so, it is valid for monitoring the incidence of serious injuries.

Childhood road traffic injuries in Canada - a provincial comparison of transport injury rates over time.

BACKGROUND: In Canada, road traffic injuries are the leading cause of death among children and youth ≤19. Across the country, there is variability in road traffic injury prevention policies and legislation. Our objective was to compare pediatric road traffic related injury hospitalization and death rates across Canadian provinces. METHODS: Population-based hospitalization and death rates per 100,000 were analyzed using data from the Discharge Abstract Database and provincial coroner's reports. Road traffic related injuries sustained by children and youth ≤19 years were analyzed by province and cause between 2006 and 2012. RESULTS: The overall transport-related injury morbidity rate for children in Canada was 70.91 per 100,000 population between 2006 and 2012. The Canadian population-based injury hospitalization rates from all transport-related causes significantly decreased from 85.51 to 58.77 per 100,000 (- 4.42; p < 0.01; - 5.42; - 3.41) during the study period. Saskatchewan had the highest overall transport related morbidity rate (135.69 per 100,000), and Ontario had the lowest (47.12 per 100,000). Similar trends were observed for mortality rates in Canada. CONCLUSIONS: Transport-related injuries among children and youth have significantly decreased in Canada from 2006 to 2012; however the rates vary by province and cause.

Trends in concussions at Ontario schools prior to and subsequent to the introduction of a concussion policy - an analysis of the Canadian hospitals injury reporting and prevention program from 2009 to 2016.

BACKGROUND: Concussion is a preventable injury that can have long-term health consequences for children and youth. In Ontario, the Policy/Program Memorandum # 158 (PPM) was introduced by the Ministry of Education of Ontario in March 2014. The PPM's main purpose is to require each school board in the province to create and implement a concussion policy. The purpose of this paper is to examine trends in school-based concussions prior to and subsequent to the introduction of the PPM. METHODS: This report examined emergency department (ED) visits in 5 Ontario hospitals that are part of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), and compared trends over time in diagnosed concussions, and suspected concussions identified as "other head injury" in children and youth aged 4-18. RESULTS: From 2009 to 2016 study years, there were 21,094 suspected concussions, including 8934 diagnosed concussions in youth aged 4-18. The average number of diagnosed concussions in the 5 years before the PPM was 89 concussions/month, compared to approximately 117 concussions per month after; a 30% increase in the monthly rate of concussions presenting to the ED. The total number of concussion or head injury-related ED visits remained relatively unchanged but the proportion of diagnosed concussions rose from 31% in 2009 to 53% in 2016. The proportion of diagnosed concussions in females also increased from 38% in 2013 to 46% in 2016. The percent of all diagnosed concussions occurring at schools increased throughout the study reaching almost 50% in 2016 with most injuries taking place at the playground (24%), gymnasium (22%) or sports field (20%). CONCLUSIONS: The introduction of the PPM may have contributed to a general increase in concussion awareness and an improvement in concussion identification at the school level in children and youth aged 4-18.