Risk factors for severe injury in cyclists involved in traffic crashes in Victoria,Australia

This study examines the impact of cyclist, road and crash characteristics on the injury severity of cyclists involved in traffic crashes reported to the police in Victoria, Australia between 2004 and 2008. Logistic regression analysis was carried out to identify predictors of severe injury (serious injury and fatality) in cyclist crashes reported to the police. There were 6432 cyclist crashes reported to the police in Victoria between 2004 and 2008 with 2181 (33.9%) resulting in severe injury of the cyclist involved. The multivariate analysis found that factors that increase the risk of severe injury in cyclists involved in traffic crashes were age (50 years and older), not wearing a helmet, riding in the dark on unlit roads, riding on roads zoned 70 km/h or above, on curved sections of the road, in rural locations and being involved in head-on collisions as well as off path crashes, which include losing control of vehicle, and on path crashes which include striking the door of a parked vehicle. While this study did not test effectiveness of preventative measures, policy makers should consider implementation of programs that address these risk factors including helmet programs and environmental modifications such as speed reduction on roads that are frequented by cyclists.     

Evaluation of vehicle side airbag effectiveness in Victoria,Australia

Side airbag systems were first introduced into vehicles around 1995 to help protect occupants from injury in side impact crashes. International studies have shown that side airbags are effective in reducing the risk of death and injury, however, serious injuries can still occur even when side airbags deploy. The objective of this study was to use detailed injury information from insurance injury compensation claims data linked to Police reported crash data to determine the effectiveness of side airbags in reducing the risk of death or injury for occupants involved in side impact crashes in Victoria, Australia based on the specific body regions that side airbag systems are designed to protect. It was found that head and torso-protecting dual airbag systems designed to protect the head, neck, face, chest and abdomen are highly effective in reducing driver death or injury due to near side crashes. They were associated with a statistically significant reduction of 41.1% (25.9%, 53.2%) in the odds of death or injury across all body regions; and a 48.0% (28.0%, 62.4%) reduction in the odds of death or injury to the head, neck, face, chest and abdomen. The study did not find any evidence that torso-protecting airbags alone are effective in reducing death or injury. Analysis results indicate that head and torso-protecting side airbag systems in vehicles are a highly effective technology for reducing the risk of death or injury to vehicle occupants in near side crashes. The magnitude of the injury reduction benefits estimated indicate that fitment of this technology to all vehicles should be a high priority and will yield significant savings in overall road trauma.     

Paediatric slow-speed non-traffic fatalities: Victoria, Australia, 1985–1995

An important group of fatal incidents are slow-speed pedestrian non-traffic incidents to children, which account for 14% of accidental deaths from all causes in Victorian children under 5 years of age between 1985 and 1995, and 12% of pedestrian deaths of all ages. In Victoria, Australia, the database of the state Consultative Council on Obstetric and Paediatric Morbidity and Mortality was utilised to identify paediatric slow-speed pedestrian non-traffic-accident deaths in the local population. Additional data relating to the car and its driver, the child, and the circumstances of the incident were abstracted from records kept by the State Coroner and the Victorian compulsory third party traffic injury insurance organisation. Twenty eight Victorian children were identified who had died in one of three types of incident (driverless cars, child interacting with the vehicle and driver, and drivers who were unaware of the child's proximity). These incidents were more common in rural areas compared with urban, usually occurring at the child's home. The child was with or near an adult on all occasions. The vehicle was usually being driven by a relative, and was reversing in a higher proportion of ‘unaware’ incidents compared with the ‘interactive’ type. The association of ‘off-road’ family vehicles and trucks with these incidents appears to be increasing, especially in recent years. These findings suggest some countermeasures, including the separation of vehicle driveways from children's play areas, and object vicinity ultrasonic warning devices for vehicles.     

Farm work related fatalities among adults in Victoria, Australia: the human cost of agriculture

The purpose of this study was to review the patterns of, and trends in, farm work related fatalities among adults in one Australian state for the period 1985-1996. Fatality data was provided by the Victorian Workcover Authority Health and Safety Division. Trends were determined using regression techniques assuming a Poisson error structure for annual fatality rates. Results showed an annual average of eight deaths. Males, and those 60 years and over, were over-represented, compared to persons employed. Tractor incidents were the most common type of fatality (72%), with tractor roll overs accounting for 61% of all tractor incidents. Non tractor fatalities included being hit by a falling object and transport incidents. Statistical trend analyses revealed a non significant decrease in the tractor roll over fatality rate, and significant increases in the all farm (P = 0.004) and non tractor fatality rates (P = 0.036). The 3 year moving average rate for non tractor farm fatalities has increased to the point where it exceeds that for tractor roll over fatalities, and is approaching that for all tractor fatalities. Changes within the agricultural industry, coupled with the ageing of the farm workforce, appear to placing Victorian farmers at increased risk of farm work related death.     

Rear seat safer: seating position, restraint use and injuries in children in traffic crashes in Victoria, Australia

Car crashes are a major cause of death and serious injury to children but most analyses of risk are based on US data. The Australian context is different in at least three ways: (1) the proportion of passenger-side airbags, a potential risk to children in front seats, is much lower; (2) unlike in the US, Australian airbags are designed to work with restrained passengers; (3) restraint use for children 0-12 years is high (>90%). Official data drawn from Victorian crash records (n=30,631) were used to calculate relative risks of death or serious injury for children (0-3 years, 4-7 years; 8-12 years) traveling in passenger cars during 1993-1998 and 1999-2004. Over 90% were reportedly wearing a restraint, and 20% were traveling in the front seat. For children under 4 years traveling in the front seat, the relative risk of death was twice as great as when traveling in the rear, and that of serious injury was 60% greater. The relative risk of death whilst traveling in the front seat was almost four times greater for children aged under 1 year. We suggest that serious consideration should be given to mandating rear seating for children, particularly those aged 4 and under.     

San Francisco pedestrian injury surveillance: mapping, under-reporting, and injury severity in police and hospital records

GOALS: Police reports of severely injured pedestrians help identify hazardous traffic areas in San Francisco, but they under-report non-fatal collisions. We set out to: identify injured pedestrians who were missing from police collision reports, see what biases exist in injury reporting and assess the utility of broad categories of police severe injury (including fatal) for mapping and analysis. METHODS: We linked data on injured pedestrians from police collision reports listed in the Statewide Integrated Traffic Reporting System (SWITRS, n = 1991) with records of pedestrians treated at San Francisco General Hospital (SFGH, n = 1323) for 2000 and 2001. Data were analyzed using bivariate statistics, logistic regression and mapping. RESULTS: : We found that police collision reports underestimated the number of injured pedestrians by 21% (531/2442). Pedestrians treated at SFGH who were African-American were less likely then whites (odds ratio = 0.55, p-value < or= 0.01), and females were more likely than males (odds ratio = 1.5, p-value < or = 0.01) to have a police collision report. Over 70% of pedestrians deemed by the police to have a severe injury received treatment at SFGH, regardless of the collision's distance from SFGH. The sensitivity of a police-designated severe injury (including fatal) was 69% and the specificity was 89% when compared with a known SFGH assessment. But, sensitivity declined when we included pedestrians without a SFGH record. CONCLUSION: Though collision reports have demonstrated limitations, broad categories of police severity may be sensitive enough to map locations where numerous severe injuries occur, for timely countermeasure selection.     

Trends in tractor related fatalities among adults working on farms in Victoria,Australia, 1985–2010

Tractors are associated with more fatalities than any other piece of machinery in agriculture, with tractor rollovers being a frequent mechanism. This study examines tractor fatalities between 1985 and 2010 in Victoria, Australia, and examines the impact of the 1998 legislation mandating the retrofitting of rollover protection structures (ROPS). The data source was the Victorian WorkCover Authority to whom unintentional work placed deaths are reportable. During the study period, 121 tractor fatalities occurred, of which 55 were rollovers. Poisson regression modelling indicated a significant decline in rollover fatalities during this period of approximately 7% per annum (incidence rate ratio [IRR] = 0.93, 95% CI 0.90–0.97), however there was no simple relationship between the introduction of the legislation and the fatality decrease. It is proposed that the impact of previous voluntary retrofitting initiatives, coupled with the existing requirement for ROPS on new tractors, may have increased ROPS fitment to a critical point prior to the final requirement for retrofitting, diluting the effect over a number of years so that it could not be detected using the statistical techniques that have been applied. An increased trend in run over fatalities was also found (IRR = 1.04, 95% CI 1.00–1.09) suggesting the need for research into interventions for this type of fatality, such as safe tractor access platforms.     

Alcohol and fatal road accidents: estimates of risk in Australia 1983.

This paper concerns the statistical relationship between the risk of a fatality and the age and sobriety of drivers in New South Wales, Australia. The estimation of this relationship is based on fatal accident data from New South Wales and non-accident or control data from South Australia collected between the hours of 5.00 AM and 3.00 PM. The results are presented in new ways. In particular, tables of "accidents attributable to alcohol" and age specific intensity functions of "risk attributable to alcohol" may be an aid to policy making.     

Gender and injury in Finnish comprehensive schools

The aim of this study is to analyze the gender differences in injuries at Finnish comprehensive schools. Nine schools reported a total of 1135 injuries to the injury register over two school years. Boys (56%) were injured more often than girls, their injuries happened more often during breaks at school yard, whereas girls hurt themselves during sport lectures in the gymnastic halls. The proportion of boys' injuries also increased with age. More often, boys' injuries were caused by intentional actions by other pupils. Girls injured their lower extremities more often, whereas boys injured their faces and head. Boys also suffered concussion more often than girls, and were also referred for further care to health care centres or hospitals more often than girls. The higher injury frequency among boys at school corresponds to the higher injury rate of males in general, which is true for work, traffic, and leisure-time injuries. Increased adult supervisor control especially during breaks can prevent most of school injuries.     

Estimation of the social costs of home injury: a comparison with estimates for road injury

Home injury is thought to constitute a major health burden in most developed countries. However, efforts to address this burden have been hampered by reluctance from outside agencies to interfere with the home environment of individuals, even if it benefits the occupant's safety. This paper outlines cost–benefit evaluation methods established in the transport safety domain applied to home safety to estimate the social cost of unintentional home injury in New Zealand. Estimates of costs imposed on society by home injury can provide an important motivator for initiating research and programmes to reduce home injury risk. Data sources used included mortality data, hospitalisation data and data on minor injuries that required medical treatment, but not hospital admission. We estimated that unintentional home injuries in New Zealand impose an annual social cost of about $NZ 13 billion (about $US 9 billion), which is about 3.5 times the annual social cost of road injury. These estimates provide a rational evidence base for decisions on housing-focused safety regulation or interventions that always carry some cost, and therefore need to be weighed against the benefits of injuries potentially prevented.     

Injury incidence rates in a paint company on rotating production shifts

Reports of work accidents and increased absence due to sickness among shift workers have suggested that their work performance and health are adversely affected by interference with the body's normal circadian or biological rhythm. Since the rotating shift is the most disruptive of the work regimens, an investigation was undertaken of the reportable occupational injuries of 1700 paint production and associated employees of one company working only on rotating shift. Their annual accident incidence rates averaged over 10 years were compared to the average annual rate reported by the Department of Labor for the entire United States paint manufacturing industry representing predominately day and non-rotating shift workers. The significance of the hour of the accident incidence rates was tested by chi-square statistics using loglinear models appropriate for null hypotheses that assume no effect due to shift work. The incidence rates of the company studied were lower than those of the U.S. paint industry, suggesting work safety practices uniquely related to the company studied may have predominated. Within the company, however, some time-of-day and circadian effects were indicated by an increased rate of accidents on the night shift, particularly during the last 3 h of the shift.     

Incidence and patterns of spinal cord injury in Australia

The objective of this paper is to report on the epidemiology of spinal cord injury (SCI) based on the Australian SCI register and to discuss the implications for prevention. All adult cases of SCI are reported to the registry. The case reports for 1998/1999 were aggregated and described. The age adjusted rate of persisting SCI was 14.5 per million of population. Rates were highest in young adults and in males. The vast majority of cases (93%) were due to unintentional injury. Forty-three percent were due to motor vehicle crashes, principally from motor vehicle rollover. Cases of SCI from falls, aquatic activities, and working for income are also described. Incomplete cervical cord injuries were most common (38%), particularly as a result of motor vehicle crashes and low falls. The study indicates that the surveillance of SCI needs to be improved internationally so that comparative studies can be undertaken. It is recommended that the Centers for Disease Control case definition be adopted. Australia is one of the few countries that have a register based on that case definition, and the only one that has a register covering a full national adult population. The results presented on the basis of this data source provide some hitherto unavailable information on the incidence rates and patterns of SCI. National population based surveillance is fundamental to an understanding of the epidemiology, and hence the prevention, of this severe and costly health and welfare problem.     

Performing Aboriginality: Desiring Pre-contact Aboriginality in Victoria, 1886–1901

This paper re-investigates notions of performed Aboriginality in relation to photographs made at Lake Tyers Mission Station, Victoria, Australia, and argues that Nicholas Caire's photographs reveal complex Aboriginal subjectivities. The photographs, made originally in 1886 and distributed to tourists, were later reproduced and circulated in book format in 1897. The first presentation of the photographs, whilst focusing on historical Aboriginality, contains traces of cross-cultural hybridity. However, the later presentation of the work reinforces historical and traditional material culture over cross-cultural dialogue. This paper argues that the desire to find historical notions of Aboriginality on mission stations in Victoria was not just due to the establishment of hierarchical racial theories in the latter part of the nineteenth century (generating the idea that Aborigines could not change and adapt to notions of ‘civilisation’) and doubts about the success of mission stations, but also because there was an interest in Aborigines who had experienced little assimilation from more remote parts of the continent of Australia. This curiosity in pre-contact Aboriginality fuelled tourism in Victoria to accessible mission stations such as Lake Tyers.     

Effects of service delivery versus changes in incidence on trends in injury: a demonstration using hospitalised traumatic brain injury

Though injury incidence and hospitalisations are likely to be correlated, a range of factors other than incidence of injury in a population may influence trends in hospitalised injuries. These include technical changes in the hospital data's coverage, and real changes in the incidence of hospitalisations independent of the population incidence. This paper addresses the latter using the example of traumatic brain injury (TBI) hospitalisations in New Zealand.Data were New Zealand public hospitals inpatient discharges. Five measures of TBI severity were used.The relative rate of minor to serious TBI hospitalisations declined by approximately 2-6% per year from 1988 to 1998. This decline is observed across different mechanisms and the two severity measures used in the detailed analysis.The relative decline in minor to serious TBI is likely to be related to a change in the probability of admission rather than a change in the population TBI incidence. As most TBI hospitalisations are minor this suggests the trend in TBI hospitalisations was significantly influenced by factors other than changes in population incidence. Any analysis of routinely collected secondary injury data needs to consider case selection carefully, especially if trends are being examined. Applying a severity threshold should give more reliable trends.     

The use of narrative text for injury surveillance research: A systematic review

Objective

To summarise the extent to which narrative text fields in administrative health data are used to gather information about the event resulting in presentation to a health care provider for treatment of an injury, and to highlight best practise approaches to conducting narrative text interrogation for injury surveillance purposes.

Design

Systematic review.

Data sources

Electronic databases searched included CINAHL, Google Scholar, Medline, Proquest, PubMed and PubMed Central. Snowballing strategies were employed by searching the bibliographies of retrieved references to identify relevant associated articles.

Selection criteria

Papers were selected if the study used a health-related database and if the study objectives were to a) use text field to identify injury cases or use text fields to extract additional information on injury circumstances not available from coded data or b) use text fields to assess accuracy of coded data fields for injury-related cases or c) describe methods/approaches for extracting injury information from text fields.

Methods

The papers identified through the search were independently screened by two authors for inclusion, resulting in 41 papers selected for review. Due to heterogeneity between studies meta-analysis was not performed.

Results

The majority of papers reviewed focused on describing injury epidemiology trends using coded data and text fields to supplement coded data (28 papers), with these studies demonstrating the value of text data for providing more specific information beyond what had been coded to enable case selection or provide circumstantial information. Caveats were expressed in terms of the consistency and completeness of recording of text information resulting in underestimates when using these data. Four coding validation papers were reviewed with these studies showing the utility of text data for validating and checking the accuracy of coded data. Seven studies (9 papers) described methods for interrogating injury text fields for systematic extraction of information, with a combination of manual and semi-automated methods used to refine and develop algorithms for extraction and classification of coded data from text. Quality assurance approaches to assessing the robustness of the methods for extracting text data was only discussed in 8 of the epidemiology papers, and 1 of the coding validation papers. All of the text interrogation methodology papers described systematic approaches to ensuring the quality of the approach.

Conclusions

Manual review and coding approaches, text search methods, and statistical tools have been utilised to extract data from narrative text and translate it into useable, detailed injury event information. These techniques can and have been applied to administrative datasets to identify specific injury types and add value to previously coded injury datasets. Only a few studies thoroughly described the methods which were used for text mining and less than half of the studies which were reviewed used/described quality assurance methods for ensuring the robustness of the approach. New techniques utilising semi-automated computerised approaches and Bayesian/clustering statistical methods offer the potential to further develop and standardise the analysis of narrative text for injury surveillance.