Is population flow an unintended consequence of alcohol management plans?

AIMS AND OBJECTIVES: The aim of this study was to gauge whether, and to what extent, population flow occurred as a result of the implementation of alcohol management plans in Indigenous communities. BACKGROUND: Alcohol management plans involving carriage limits and dry places were introduced into 15 Queensland Indigenous communities between 2002-2004. Controls on alcohol availability were further tightened between 2008-2010, seeing the closure of eight mainly remote community taverns/canteens. DESIGN: A retrospective observational study was undertaken using data from the Queensland Injury Surveillance Unit. METHODS: Population flow was measured by changing patterns of alcohol-related injuries in a mining region near dry Indigenous communities following the introduction of alcohol management plans and a control mining region distant from Indigenous communities with alcohol management plans. Data were analysed using descriptive and inferential statistics. Logistic regression was used for the comparison of the characteristics between the emergency department presentations. The rates of alcohol-related injury presentations per 1000/population were calculated and age-standardised to the Australian population. RESULTS: Between the five-year periods 2003-2007 and 2008-2012, alcohol-related injury presentations to the Mount Isa emergency department trebled from an age-adjusted average annual rate of 9·5/1000 in the region's population to 27·1/1000 population. In the control region, alcohol-related emergency department injury presentations did not increase to the same degree with age-adjusted average annual rates of 1·42/1000 and 2·21/1000, respectively. CONCLUSIONS: The 10-year pattern of emergency department presentations for alcohol-related injuries increased significantly in the Mount Isa region compared with the control region. Further research should investigate the impacts of population flow related to Indigenous community alcohol management plans. RELEVANCE TO CLINICAL PRACTICE: Although initiatives such as alcohol management plans have been implemented to reduce alcohol use and related consequences in Indigenous communities, there needs to be a greater consideration of the impact of these policies in nearby towns in the future.

Bandaids are not the fix: Examining the patterns of injury-related emergency department presentations in Australian children.

OBJECTIVE: To provide an epidemiological understanding of the types of injuries treated in ED in Australian children, describe the impact of these injuries in volume and severity, and assess the patterns by demographic and temporal factors. METHODS: ED data from six major paediatric hospitals in four Australian states over the period 2011-2017 were analysed to identify childhood injury patterns by nature of injury and body region, as well as sex, age group and temporal factors. RESULTS: A total of 486 762 ED presentations for injury in children aged 0-14 years were analysed. The most common injuries for all age groups were fractures of the upper extremities. Leading injury diagnosis groups varied by age groups and sex. Overall, children aged 1-2 years had the highest number of ED presentations for injury, and from birth more males than females presented to ED with injuries with the highest absolute sex difference observed for 10- to 14-year-olds. Seventeen percent of children who presented to ED were admitted to hospital with the leading type of hospitalised injury being fractures. Little monthly variation in ED presentations was observed, except for higher presentations for drowning in summer months, and for most injury types, ED presentations were higher during weekends and daytime. CONCLUSIONS: This is the first large-scale quantification of paediatric injury-related ED presentation patterns in Australia since the conclusion of the National Injury Surveillance and Prevention Program about 30 years ago. It provides valuable information to inform paediatric ED resourcing decisions as well as important evidence for injury prevention practitioners.

A Public Health Review into Two Decades of Domestic Trampoline Injuries in Children within Queensland, Australia.

Trampolining as an activity brings enjoyment and many health benefits, but at the same time it carries an injury risk. Most domestic trampoline users are children who are developing in skill, cognition, risk perception, physical strength and resilience to injury. Several common patterns of child trampoline injuries have been identified and countermeasures outlined in standards have been taken to reduce higher risk injury mechanisms, such as entrapment and falls from the trampoline through design, product and point of sale labelling. In Australia, the first national trampoline standard was published in 2003 which introduced improvements in trampoline design and requirements for labelling and padding. This work investigated the potential impact of these and subsequent changes based on almost two decades of emergency department trampoline injury data collected in Queensland, Australia. These data describe the changing representative proportion and pattern of trampoline injuries in Queensland over time by age, mechanism, gender, severity and nature of injury of injured persons up to the age of 14 years. The interrelationships between different injury characteristics were also analysed to propose the main factors influencing injury occurrence and severity. These findings seem to indicate that safety evolution in the form of enclosure nets, frame impact attenuation and entrapment protection have likely improved domestic trampoline safety. Other factors, such as adult supervision, minimum age and avoidance of multiple users, could further reduce injury but are harder to influence in the domestic setting.

External causes of emergency department presentations: A missing piece to understanding unintentional childhood injury in Australia.

OBJECTIVE: To identify external causes of unintentional childhood injury presenting to Australian EDs. METHODS: Six major paediatric hospitals in four Australian states supplied de-identified ED data for 2011-2017 on age, sex, attendance time/date, presenting problem, injury diagnosis, triage category and mode of separation. Three hospitals supplied data on external cause and intent of injury. A machine classifier tool was used to supplement the missing external cause coding in the remaining hospitals to enable the compilation of a standardised dataset for childhood injury causes analysis. RESULTS: A total of 486 762 ED presentations for unintentional injury in children aged 0-14 years were analysed. The leading specified cause of ED presentations was low fall (35.0%) followed by struck/collision with an object (13.8%) with little sex difference observed. Males aged 10-14 years had higher rates of motorcycle, pedal cycle and fire/flame-related injury and lower rates of horse-related injury and drug/medicinal substance poisoning compared with females. The leading specified external cause resulting in hospitalisation was low fall (32.2%) followed by struck/collision with an object (11.1%). The injuries with the highest proportion of children being hospitalised were drownings (64.4%), pedestrian (53.4%), motorcycle (52.7%) and horse-related injuries (50.0%). CONCLUSIONS: This is the first large-scale study since the 1980s to explore external causes of unintentional childhood injury presenting to Australian paediatric EDs. It demonstrates a hybrid human-machine learning approach to create a standardised database to overcome data deficiencies. The results supplement existing knowledge of hospitalised paediatric injury to better understand the causes of childhood injury by age and sex, which require health service utilisation.

Navigating child product safety: Perspectives from experts on international challenges and priorities in regulation and research.

OBJECTIVE: To elicit and summarise collective expert opinion on contemporary child product safety risks, challenges and priorities. METHODS: An online survey targeted international experts from a cross-section of product safety fields. RESULTS: Fifty-five experts participated, representing 1,137 years of product safety experience, from a broad range of fields including industry risk management, product assessment and testing, policy and regulation, research, paediatric medicine, advocacy and product liability. Participants identified the leading product safety hazards across all age brackets as falls, drowning and chemical hazards, with variance in specific age brackets, particularly the threat to breathing hazards for infants. The leading products of concern to experts were electrical connection/distribution products, primarily button batteries and lithium-ion batteries, infant furnishing products and household furniture. Product safety priorities and challenges were identified under five themes: regulatory, surveillance, industry, consumer and product-specific. CONCLUSIONS: The gains in knowledge, insight and understanding from experts on contemporary child product safety risks and issues should inform policy and future research. IMPLICATIONS FOR PUBLIC HEALTH: There are significant consequences of unsafe consumer products on population health, and the results are timely as we face new product safety issues emerging from e-commerce, the digital transition and innovative product technologies.

Application of a Machine Learning-Based Decision Support Tool to Improve an Injury Surveillance System Workflow.

BACKGROUND: Emergency department (ED)-based injury surveillance systems across many countries face resourcing challenges related to manual validation and coding of data. OBJECTIVE: This study describes the evaluation of a machine learning (ML)-based decision support tool (DST) to assist injury surveillance departments in the validation, coding, and use of their data, comparing outcomes in coding time, and accuracy pre- and postimplementations. METHODS: Manually coded injury surveillance data have been used to develop, train, and iteratively refine a ML-based classifier to enable semiautomated coding of injury narrative data. This paper describes a trial implementation of the ML-based DST in the Queensland Injury Surveillance Unit (QISU) workflow using a major pediatric hospital's ED data comparing outcomes in coding time and pre- and postimplementation accuracies. RESULTS: The study found a 10% reduction in manual coding time after the DST was introduced. The Kappa statistics analysis in both DST-assisted and -unassisted data shows increase in accuracy across three data fields, that is, injury intent (85.4% unassisted vs. 94.5% assisted), external cause (88.8% unassisted vs. 91.8% assisted), and injury factor (89.3% unassisted vs. 92.9% assisted). The classifier was also used to produce a timely report monitoring injury patterns during the novel coronavirus disease 2019 (COVID-19) pandemic. Hence, it has the potential for near real-time surveillance of emerging hazards to inform public health responses. CONCLUSION: The integration of the DST into the injury surveillance workflow shows benefits as it facilitates timely reporting and acts as a DST in the manual coding process.

Value of emergency department triage data to describe and understand patterns and mechanisms of cycling injuries.

OBJECTIVE: To characterise patients presenting to EDs for a bicycle-related injury, identify contributing factors to the injuries and describe the data gaps. METHODS: A retrospective study of bicycle-related injury presentations over the 5 year period 2010-2014 to two major metropolitan EDs. Data collected from the emergency presentation database consisted of patient demographics, presenting complaint, discharge diagnosis and details about the circumstances and mechanism of the accident. RESULTS: Bicycle injuries (n = 4144) increased from 20.0 to 25.2 per 1000 injury presentations over 5 years. Patients were 80% male across all age groups and 35% of presentations occurred at the weekend. Fractures accounted for one-third (34%) of all injuries, while injuries to the upper extremities and head resulted in 36% and 19% of cases, respectively. Admission rate was 17%. The number of falls exceeded collisions (1611 vs 937), and in the 13.3% of the fall cases where documentation was present for which how the fall occurred, over half were attributed to bike handling errors. Information related to type of bicycle, accident location, type of activity, protective clothing worn (including helmets) and visibility aids was not recorded for over 95% of the cases. CONCLUSION: Bicycle injuries carry a considerable burden to the ED and the incidence of presentations appears to be rising. The current triage data, designed to provide a rapid assessment for medical urgency, are limited to describing broad demographics, trends and causes.

Monitoring Injuries Associated with Mandated Children's Products in Australia: What Can the Data Tell Us?

Mandatory standard regulation is used within Australia to ensure the safety of consumer products, preventing product-related injury. Standard regulation is particularly important for products designed for use by children, who are highly vulnerable to sustaining product-related injuries due to their small size and inability to identify product hazards. This project aims to investigate how effectively information regarding product-related injuries is able to be captured within Australian health and coronial data. Further, it aims to investigate the extent to which child injury occurs for products for which mandatory safety standards exist through the review of available data. This study highlights significant limitations in injury surveillance data for identification and monitoring of child product-related injuries. This in turn limits the evidence base to assess the efficacy of existing regulations. Available data show baby walkers, cots, prams, nightwear, and bunk beds to be associated with a considerable number of child hospital presentations, admissions, and deaths. A significant scope for improvement in current product injury recording practices in the health sector exists.

The Extent of Consumer Product Involvement in Paediatric Injuries.

A challenge in utilising health sector injury data for Product Safety purposes is that clinically coded data have limited ability to inform regulators about product involvement in injury events, given data entry is bound by a predefined set of codes. Text narratives collected in emergency departments can potentially address this limitation by providing relevant product information with additional accompanying context. This study aims to identify and quantify consumer product involvement in paediatric injuries recorded in emergency department-based injury surveillance data. A total of 7743 paediatric injuries were randomly selected from Queensland Injury Surveillance Unit database and associated text narratives were manually reviewed to determine product involvement in the injury event. A Product Involvement Factor classification system was used to categorise these injury cases. Overall, 44% of all reviewed cases were associated with consumer products, with proximity factor (25%) being identified as the most common involvement of a product in an injury event. Only 6% were established as being directly due to the product. The study highlights the importance of utilising injury data to inform product safety initiatives where text narratives can be used to identify the type and involvement of products in injury cases.