Pattern of road traffic injuries: one year hospital-based study in Western Nepal

Road traffic injuries and deaths caused by motor vehicles is a growing public health problem all over the world. Inter-country or regional differences in the pattern of injury by road users have significant implications in determining prevention policies. The present study was conducted to evaluate the pattern of injuries in 217 hospitalized trauma patients admitted during 1 year, 2003. The majority of the injuries (54%) involved motorcycles. The highest incidence amongst the male population was in the age group of 16 – 30 years. Head and face injuries and injuries to the lower limbs comprised 58.1% and 50.7% of all injuries respectively. The bones of the lower limbs were most commonly fractured. To conclude, the traffic casualties of motorcyclists and pedestrians are considered a major problem and the preventive measures to reduce these transport-related injuries are discussed in this study.     

Incidence,patterns and risk factors for injuries among Ugandan children

There is limited epidemiological data on childhood injuries in developing countries. This study assessed the incidence, patterns and risk factors for injuries among children aged 0–5 years in Wakiso District, Uganda. To determine differences, chi-square and Wilcoxon rank sum tests were used. Risk factors were assessed using Poisson regression. Overall, information from 359 children of mean age 32 months (SD: 18.4) was collected. Annual incidence of injuries was 69.8 per 1000 children/year (95% CI 58.8–80.8). One fatal injury due to burns was reported. Incidence of injuries was less associated with being female (IRR: 0.56, 95% CI 0.34–0.90) and increasing age of the caretaker (IRR: 0.96, 95% CI 0.92–0.99). The high incidence of childhood injuries necessitates the need for interventions to reduce injuries among children.     

Patterns of injuries and motor-vehicle traffic accidents in Athens

The extremely high cost of motor-vehicle accidents in public health leads to the necessity of a better injury data collection in the Accident and Emergency Hospital Departments. The ‘Asclepeion’ of Voula Hospital covers the southeastern suburban areas of the greater Athens area (1 000 000 population). The aim of this study is to present information on the pattern of injuries in Athens, in order to understand the magnitude of the problem and develop rational prevention programmes. Specially trained health visitors of the Emergency Department Injury Surveillance System (EDISS) interviewed in person every injured victim who was brought into the Emergency Service of the ‘Asclepeion’ of Voula Hospital. The study was performed during a 3-year period, from 1996 to 1998; 4564 persons were interviewed. Traffic accidents were more frequent on weekdays with a seasonal peak in July and among young Greeks (aged 25 – 34 years). The usual type of injuries seen in vehicle-accident victims were cerebral contusion and concussion, while in motorcycle-accident victims, head contusion and fractures. The most common reasons for the accident were excessive speed, poor condition of road, inattention, abstraction or drowsiness and drug effects. A total of 29.8% of motorcycle drivers and 5.7% of motorcycle passengers wore a helmet and 26.3% of car drivers and 14.1% of car passengers were using seatbelts. The identification of road traffic injury patterns can contribute to the development of injury prevention measures and guide rational preventive interventions that can reduce the incidence of these injuries. The EDISS system established at ‘Asclepeion’ of Voula Emergency Service can provide useful and accurate information about this serious and multidimensional problem of Greek Public Health.     

Bunk bed injuries in Australia: the case for a mandatory safety standard

Bunk beds have long been recognised as a potential source of injury to children. This study was undertaken to establish an evidence base for a proposed injury reduction program and to determine whether or not there is a case for a mandatory safety standard. Recent literature on bunk bed safety was reviewed to provide an overview of the injury issues involved. Major sources of relevant Australian and international data were identified and the available data summarised. An in-depth analysis of Victorian data was undertaken to identify the nature and severity of injuries sustained and any patterns or trends, including age profiles. It is estimated that, in Australia, in the under fifteen age-group, there are at least 2,100 bunk bed-related injuries treated annually by hospital emergency departments. This represents a rate of about 50 injuries per 100,000 age-specific population. The majority of these injuries (86%) occur in children under the age of 10 years with injuries peaking in the 5-9 year age-group. The main cause of non-fatal injury is falls from the top bunk resulting in a fracture (33%), mainly to the upper extremity (75%). There have been at least two deaths from asphyxia in Australia in the past 10 years, due to entrapment in the bunk structure. It is clear from the current evidence that bunk bed injuries are a significant problem in Australia and represent a life-threatening hazard to young children in particular. The existing voluntary Australian/New Zealand Standard adequately addresses the safety issues raised by the examination of the literature and the analysis of the injury data. It is also clear that, in Australia, voluntary standards and the market place have been ineffective in achieving compliance. It is therefore recommended that the Australian Standard be made mandatory in an effort to significantly improve the safety of bunk beds in Australia.     

Feasibility of routine collection of injured worker occupational information in hospital emergency departments

The aim of this study was to examine injury events and risk-factors among Swedish adult eventing athletes. A cross-sectional study design with retrospective recording of 1-year sports-specific exposure and injury data was used. The invited study population consisted of all members of the Swedish Equestrian Federation with eventing as their primary discipline (n = 513). The participation rate was 70.0%. The total 1-year injury prevalence was 26.6%; the specific 1-year prevalence of traumatic injury was 19.3% and of overuse injury 10.9%. The incidence of traumatic injury events was 0.54 injury events/1000 eventing hours (95% confidence interval (CI), 0.35–0.73 injury events/1000 eventing hours) for novices and 0.35 injury events/1000 eventing hours for qualified riders (95% CI, 0.21–0.49 injury events/1000 eventing hours). A total of 27.9% of the traumatic injury events led to severe injuries (causing more than 3 weeks absence from riding). Attitude to risk-taking was the only factor predicting an athlete becoming injured (p = 0.023), and qualification level was the only risk factor for additional injuries among injured riders (p = 0.003). Our results suggest that injury prevention programs in eventing should also give attention to overuse injuries and that care should be taken when eventing athletes are licensed into higher qualification groups.     

Product-related injuries at home

Abstract

The current study was undertaken in order to highlight the most typical circumstances and products related to home injuries and to establish the extent to which any patterns found in domestic injuries were age or gender related.

Injury data were taken from a community-based injury surveillance register built up over a one-year period in a Swedish county. Injury incidence by gender and age was calculated, and typical injury patterns were identified through the multivariate analysis of nine characteristics of the injuries.

Home-injury incidence was found to be higher for males than females in all younger age categories except 7-15 years, and for females than males in the oldest age category (65+). Seven typical injury patterns were identified, and their associations with age group and gender established.

The patterns emerging from the study demonstrate that injuries in home settings are simultaneously product, age and gender related, which points to a combination of risk groups and safety planning problems. The results suggest that home injuries are incurred in many specific locations and under a wide variety of circumstances. Accordingly, the question of safety promotion at home needs to be addressed in a global and environmental manner. It is necessary to reflect on the ways in which domestic building structures, items of equipment and products can be designed so as to be conducive to domestic safety.     

Incidence and characteristics of unintentional injuries among children in a resource limited setting in Kampala,Uganda

ABSTRACT

Given that little is known about the epidemiology of unintentional injuries in children in low-income countries, this study sought to determine the incidence and characteristics of unintentional injuries among children aged ≤18 years in a slum community in Uganda. From a household survey, the incidence and odds ratios for factors associated with unintentional injury characteristics were calculated. Of 1583 children, 706 had suffered 787 unintentional injuries yielding an annual incidence rate of 497 injuries per 1000 children. Commonest injuries were cuts, bites or open wounds (30.6%) and bruises or superficial injuries (28.6%) with majority (75.5%) occurring at home. Boys were more likely to be injured at school (AOR 4.34; 95% CI 1.22–15.54) and to be injured from falls (AOR 1.41; 95% CI 1.01–1.96). Older children (12–18 years) were more likely to suffer from fractures (AOR 2.37; 95% CI 1.26–4.43), concussions and organ system injuries (AOR 3.58; 95% CI 1.03–12.39) and cuts, bites or open wounds (AOR 2.05; 95% CI 1.21–3.48). Older children were less likely to suffer burns or scalds as compared to the young children (AOR: 0.23; 95% CI 0.11–0.50). Unintentional injury incidence rate was high among children with most occurring in the homes.     

Respondents’ recall of injury events: an investigation of recall bias in cross-sectional injury data from the Sudan Household Health Survey 2010

Recall bias is a well-documented limitation of population-based cross-sectional injury surveys. To fill some gaps in this area, we investigated the extent and nature of recall bias in Sudan Household Health Survey (SHHS 2010) injury data. The extent of incomplete recall was measured by comparing the total reported injuries over 12 months with the annualised number of injuries in the four weeks preceding the survey. Multivariable logistic regression was used to investigate the association of socio-demographic variables, injury attributes and interviewee characteristics with differential recall. Relevant interactions were tested. Overall, reported injuries were 33% of the expected. Injuries among children 1–4 years had lower odds of being reported to have occurred earlier than the four weeks preceding the survey than people aged 65 years and over (OR = 0.24, 95% CI 0.12–0.47). Injuries that received inpatient care in the first week were more likely to be recalled than those that did not receive care (OR = 2.07, 95% CI 1.14–3.75). Respondent's age was associated with differential recall. Differential injury recall should be considered when using SHHS 2010 to compare injury occurrence between children under five and older groups or at the level of health care received.     

Clothing-related motorcycle injuries in Pakistan: findings from a surveillance study

This study aims to assess the burden and patterns of clothing-related motorcycle injuries in Karachi, Pakistan. Data were extracted from an ongoing traffic injury surveillance system. In three years (2007–2009), out of 99155 road traffic injury cases there were 986 (0.9%) cases of clothing-related motorcycle injuries. Most cases were females (73.9%) and pillion riders (80.6%). The crashes involving clothing-related injuries were mostly single vehicle (98.5%), and largely resulted in injuries to the external body (60.3%), limbs (51.0%), head (41.5%) and face (35.9%). One-third of injuries were either moderate (26.7%) or severe (10.2%) while 10 (1.01%) deaths were reported. Female gender (11.4%), age ≥ 45 years (19.4%), pillion riding (11.3%) and crashes occurring at intersections (12.3%) were more likely to result in moderate or severe injury as compared to other users (P < 0.001). Injuries due to entanglement of loose fitting clothing in motorcycles are not uncommon in Karachi. Awareness campaigns for prevention of such injuries may involve promotion of appropriate dressing for motorcycle riding including close wrapping of clothes and encouraging installations of covers on the rear wheels and drive chains.     

Childhood and adolescent injuries in elementary schools in north-western Uganda: extent,risk and associated factors

Childhood injuries remain understudied in Uganda. The objective of this study was to determine the extent, nature and determinants of school-related childhood injury risk in north-western Uganda. A cohort of 1000 grade fives from 13 elementary schools was followed-up for one term. Survival and multi-level modelling techniques compared the risk rates across gender, schools and locations. Childhood injuries are common in north-western Uganda. Most of them occur during travel, breaks, practical classes and gardening, while walking, playing, learning and digging. Most injuries result from collisions with objects, sports and falls. Two-thirds of children receive first aid and hospital care. Times to injury were 72.1 and 192.9 person days (p = 0.0000). Gender differences in time to event were significant (p = 0.0091). Girls had better survival rates: cumulative prevalence of childhood injury was 36.1%; with significant gender differences (p = 0.007). Injury rate was 12.3/1000 person days, with a hazard ratio of 1.4. Compared to girls, boys had a 37% higher injury rate (p = 0.004). Rates varied among schools. Associated factors include sex and school. Rural–urban location and school differences do influence childhood injury risk. Childhood injuries are common: the risk is high, gender- and school-specific. Determinants include gender and school. Location and school contexts influence injury risk.     

Risk factors for injury in community-level football: a cohort study

We investigated the independent effect of commonly postulated risk factors on injury incidence in amateur football (soccer), using a prospective cohort design with follow-up over two seasons. A total of 1702 male and female players aged 13 years or older contributed information on 21,797 player-matches. Confirmed, were the effect of male vs. female sex (injury rate ratios (IRR) = 0.81, 95% confidence interval (CI): 0.67–0.97), older age (increasing IRR gradient), New Zealand European ethnicity (IRR = 0.87, 95% CI: 0.74–1.01), being taller (180–189 cm: IRR = 1.32, 95% CI: 1.06–1.63), previous injury (IRR = 1.32, 95% CI: 1.12–1.57), playing against medical advice (IRR = 1.24, 95% CI: 1.03–1.49), playing while recovering from injury (IRR = 1.40, 95% CI: 1.20–1.49), history of cigarette smoking (IRR = 1.27, 95% CI: 1.00–1.61) and time of season (IRR = 0.97, 95% CI: 0.96–0.98). Female, adult, non-European and taller players could be paid particular attention in injury prevention programmes. The need for effective injury management is reinforced. Adding physical conditioning to pre-season training may be required.     

Road traffic crash injuries and fatalities in the city of Kerman,Iran

The objective of this study was to investigate road traffic crash injuries and fatalities. Cases of 3902 road traffic injuries (1709 drivers, 891 passengers, 376 pedestrians and 926 motorcyclists) and 1564 road traffic fatalities (RTFs; 1222 males and 342 females) were collected from 2005 to 2008 using the database of the police forces and Department of Forensic Medicine in Kerman, respectively. Results showed that 66% of the injuries were related to car occupants (drivers and passengers) and men/women ratio was 5:1. The highest men/women ratio was (12.2:1) for drivers, while the lowest ratio (1.8:1) was for pedestrians. Most of the injuries had taken place at 16:01–20:00 h followed by 08:01–12:00 h. Highest numbers of injuries were found in male with the age groups of 18–24 years. The highest fatality rate of 79 per 100,000 population occurred in 2007–2008. Fatality ratio indicated higher male ratio, four times higher than females. The victims were 39% male between 30 and 55 years of age. Head injuries were present in 69% of the cases. In our series of forensic autopsy cases, head injuries were more frequent in motor vehicle occupants, pedestrians and motorcyclists. On average, two people died per day in RTFs in Kerman.     

How socioeconomic status influences road traffic injuries and home injuries in Rome

Road traffic injuries (RTI) and home injuries (HI) are a relevant public health problem, especially among people living in deprived areas. The objective of this study was to explore the relationship between morbidity, hospitalisation, mortality from RTI and HI, and socioeconomic status (SES) of the area of residence. RTI and HI surveillance based on the Emergency Information System, the Hospital Information System and the Mortality Registry of Lazio region are the three sources of this study to create a unique surveillance system. For each subject, the SES index (5 levels) of its census tract of residence was obtained. The study population included emergency department admissions (year 2005) of residents in Rome, Italy. Incidence Rate Ratios (IRRs) have been estimated using Poisson Regression. The rates of RTI and HI emergency department visits were higher among the most deprived level of SES (IRR = 1.27, 95% CI: 1.24–1.30; IRR = 1.33, 95% CI: 1.29–1.37, respectively) compared to the most privileged ones; a similar result was found for hospitalisation (IRR = 1.19, 95% CI: 1.08–1.32; IRR = 1.11, 95% CI: 1.01–1.22). A strong relation was found between RTI mortality rates and poor level of SES. The study concluded that RTI and HI incidence were associated to sociodemographic factors.     

Costs of unintentional injuries among children in an urban slum community in Kampala city,Uganda

Abstract

Unintentional injuries cause deaths, disabilities, productivity and financial losses and disproportionately affect children in low-income settings yet their cost remains under studied. This study determined the household out-of-pocket expenditure and missed school attendance due to unintentional childhood injuries in a Ugandan slum. We used a cross-sectional household survey design. Data were collected on occurrence and associated costs of unintentional injuries during a one-year period from July 2014 to June 2015. A total of 706 (44.7%) children who had suffered from injuries were reported in the one year period. More male children (N?=?415, 58.7%) suffered injuries than females (N?=?291, 41.2%). The average out-of-pocket expenditure on treating an injury was US $24.1 [standard deviation (SD)?=?±$62.8] and mean school days lost were 25 days (SD?=?±51.8). Road traffic injuries (RTIs) resulted in higher costs [mean difference was US $51.1 (95% CI: $11.4–$90.8)] compared to injuries that, for example, occurred at school. In a Ugandan slum community, unintentional childhood injuries resulted in high out-of-pocket expenditures and missed school attendance. The costs varied widely depending on external causes of the injury. These findings highlight the need to invest in population level injury prevention interventions to reduce injury costs by households.     

Neck injuries among the elderly in Sweden

Neck injuries are some of the most important injuries as they have the potential to influence the spinal cord. A previous national survey of neck injuries in Sweden revealed that injury incidence was increasing for the population over 65 years of age, although it was decreasing for the population as a whole. The aim of this study was therefore to further clarify the magnitude, severity, and external causes of neck injuries in the elderly people in Sweden. A national incidence study, with focus on the age group above 65 years, was undertaken with data from the injury surveillance program at the Swedish National Board of Health and Welfare. The investigation includes cervical vertebral fractures reported between 1987 and 1999, and cervical soft tissue injuries from 1997 to 1999. Data in the hospital discharge register were reported in ICD9 from 1987 to 1996, while data from 1997 to 1999 were reported in ICD10. During the study period 4168 cervical injuries occurred of which 341 were fatal. People above 65 years of age made up 17% of the population and sustained 30% of all cervical injuries and 43% of all fatal cervical injuries. Half of the cervical injuries were axis (C2) fractures. Lower vertebral fractures occurred in 16% of the cases and atlas (C1) fractures in 11%. The cervical soft tissue injuries amount to 19% of all injuries. Fall accidents account for the majority (71%) of the accidents. There is an increasing trend for fall accidents resulting in neck injuries. The male population has a higher incidence for neck fractures than females, disregarding the external cause of injury. The upper cervical injuries are the most common, have the longest hospital treatments, and seem to be caused mainly by low energy falls. Further research is needed to understand the mechanisms of these injuries and in this aspect engineering could contribute with valuable knowledge, through accident simulations with numerical models. The increasing incidence of fall injuries calls for further preventive actions. The public sector should implement preventive strategies to reduce the number of extrinsic accidents, while the health care sector should focus on preventing intrinsic accidents with individual actions for each patient.     

A review of national policies and programs to prevent unintentional injuries in the Americas

Injuries are a global public health problem, with injury mortality increasing in many regions. We describe a survey of injury policies and programs in 23 countries in the Americas. Most countries surveyed (87%) perceived unintentional injuries to be a significant public health problem. When asked about actual policy agendas, however, just one-fourth (26%) of the countries ranked unintentional injuries among policy makers’ top five concerns. Approximately half of the countries reported having a national injury prevention strategy, injury prevention coordinator, or consultative group. Virtually all countries with national strategies and consultative groups had established them in the 1990s, suggesting that concern about injuries is both recent and growing. Three-fourths (74%) reported that their country had a surveillance system to monitor injury-related mortality and, to a lesser extent, morbidity. The study’s results suggest that most policies and programs for the prevention and control of unintentional injuries have been developed in the past 10 years, and primarily address motor vehicle injuries. It is essential that current efforts be both broadened and strengthened so that the societal burden of unintentional injuries in the Americas can be reduced.     

Accidental injuries among the elderly within the Vienna community: Epidemiology,risk factors and preventive measures

Abstract

Unintentional injuries ('accidents’) among elderly people are a significant burden in public health because such accidents happen frequently and because the proportion of older age groups in the population will continue to rise during the coming decades. One aim of this study, which was done in Vienna, the capital of Austria, was to broaden the preventive concept, adding lifestyle and living conditions to already well-known risk factors following the health promotion approach. Furthermore, characteristics that predispose older residents to accidents should be identified in order to design preventive measures for reducing injuries in this age group.

809 interviews with people 60 years of age and over were conducted, concerning accidents, outcomes of accidents, physical fitness, drug intake, type of house or dwelling, equipment in the household incorporating safety features, psychological well-being and social relations. The information collected was used to draw cross-sectional comparisons between participants who reported having experienced at least one accident in the previous 12 months and those who did not. Furthermore, the accident incidents were classified into 2 groups: incidents without injuries and injurious accidents. The latter served as a base for the epidemiology of injuries for people 60 years of age and over within the Vienna community.

20% of all senior citizens suffer at least one unintentional injury every year, in addition to which 8% experience critical incidents (mostly falls) without injury. Most accidents occur at home or involve pedestrians in public traffic areas. Over 90% of all accidents are falls, and 20% result in fractures. The most important risk factors for accidents in the elderly are gender, increasing age, poor physical fitness and low physical activity, the type of household and household equipment, poor psychological well-being, low income and loneliness.

The findings regarding falls suggest some possible opportunities for reducing the risk of falls by improving buildings and dwellings of the elderly. A promising attempt at practical implementation of these findings is being conducted by the Vienna-based Austrian Institute for Home and Leisure Safety in cooperation with the Vienna City Council. These two organizations are implementing a long-term program that aims at mobilizing institutions and organizations involved in working with the elderly.     

Adolescent injuries in relation to economic status: An international perspective

The primary objective of the study was to examine the relationship between patterns in car-to-car crashes involving young drivers and car and driver characteristics and the research design was a national register-based prospective cohort study. Individual records in a cohort born 1970 – 1972 are linked to road-traffic-crash data (1988 – 2000). Subjects' first police-registered two-car crash leading to severe or fatal injury (n = 4875) are identified. Typical crash patterns are highlighted and associations between pattern and both car and individual socio-demographic characteristics are tested. Four crash patterns are highlighted. Male drivers and those with lower educational attainment are over-represented in all patterns. Pattern-based risk levels vary considerably according to car safety level and driver's age at time of injury and socio-economic status. Crash patterns might be considered in young adult driver education systems, bearing in mind the consistent higher risks of male drivers and of drivers with lower educational attainment.     

Applying the capture-recapture method to estimate road traffic deaths and injuries in three non-contiguous cities in the Philippines

In establishing goals for the Philippine road safety plan, police data were used. Police reports are likely underreporting. We apply capture-recapture analysis to determine expansion factors and estimate the true incidence. Three cities were visited where data on deaths (2014) and injury (January–March 2014) from hospitals, police and civil registry were collected. Matching was done to generate a final list of injured and dead individuals. The Chapman method was used for estimating the true number of cases. Police data exhibited underreporting in all site. Expansion factors of the police data range from 5.4 to 29× for deaths and 3.2 to 47× for non-fatal injuries. Expansion factors are likely useful to estimate the true incidence of road traffic injuries in areas with weak injury surveillance systems such as the Philippines.     

Characteristics of non-fatal injuries in Leon,Nicaragua – 2004

This article describes the epidemiology of injuries collected in the Injury Surveillance System in Leon Hospital in Nicaragua. A total of 6659 persons were treated for injuries in 2004. It was discovered that 88% of all injuries were unintentional, 9% involved interpersonal violence, 2% were self-inflicted and 0.2% was undetermined. Men accounted for 64.7% of the cases, with the highest rate among 20 – 24 year olds (5625.8 per 100 000 inhabitants). Among women, the highest rate was in those aged 64 years and older (5324.2 per 100 000 inhabitants). The most common mechanisms were falls (33.9%), blunt force (26.8%), cut/pierce/stab (15.1%) and transportation-related (12.8%). These results indicate the need to identify prevention strategies for those injuries that were most commonly treated in emergency, such as unintentional falls among older women, self-inflicted poisoning among young women and blunt force and transportation-related injuries among young men.