Cervical injuries in Sweden,a national survey of patient data from 1987 to 1999

Neck injuries are one of the most important injuries as they have the potential to influence the spinal cord. Data from most parts of the world are not sufficient to define a comprehensive view of mortality, morbidity, disability and handicap due to neck injuries. In Sweden, there are no data on the incidence of neck injuries. The aim of this study is to define the national incidence and causes of neck injuries in Sweden. An incidence study 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 over a period of three years, from 1997 to 1999. Data between 1987 and 1996 were reported in ICD 9, while data from 1997 to 1999 were reported in ICD 10. During the study period, 14,310 non-fatal and 782 fatal cervical injuries occurred. A decreasing incidence for cervical fractures can be seen for the Swedish population, except for the elderly that have a slight increase in incidence. The incidence for cervical soft tissue injuries is almost constant. Cervical fractures demand longer periods of hospitalization than the soft tissue injuries. Transportation-related cervical fractures have dropped since 1991, while soft tissue injuries increased slowly between 1997 and 1999. Fall accidents are now the largest external cause of cervical fractures, and the population above 65 years accounts for almost 50% of the fall accidents. The male population has a higher incidence of cervical fractures, disregarding age. It is concluded that safety programs for transportation-related injuries in Sweden have been successful, while fall accidents are still substantial. Much more can be done to prevent neck injuries; especially to reduce the number of transportation-related cervical soft tissue injuries and fall injuries in the elderly population.     

The epidemiology of head injuries in Sweden from 1987 to 2000

The purpose of the present study was to evaluate the variability in the annual head injury incidence rate in Sweden from 1987 to 2000. It was hypothesized that the annual incidence rate would decrease over time due to a variety of primary preventive strategies that have been introduced in Swedish society. We used the Hospital Discharge Register at the National Board for Health and Welfare and head injury codes 800-804, and 850-854 from ICD9 system and S2.0-S2.9, and S6.0-S6.9 codes from ICD-10 system. We evaluated the patterns of age, gender, external cause of injury (E-code), type of injury, length of hospital stay, and trends over time. Head injuries due to transportation collision were reduced over the 14-year period analysis. Falls persisted as the dominant cause of head injury. Overall, men had 2.1 times the incidence of head injury compared to women. There was a decline in younger ages experiencing a head injury over this interval, while the number of head injuries among elderly people increased over time. Concussion was about three times more frequent than fractures. Hematoma and diffuse or focal contusions had a much lower incidence rate than concussion. Concussions and fractures decreased over time. Diffuse or focal injuries showed a steady rate of occurrence over the study interval while hematoma increased. Although length of hospital stay varied widely from zero to more than 50 days, 73.6% of hospital days were confined to two days or less. The incidence rate is stable over this time frame. While head injuries attributable to transportation accidents decreased, falls made up an increasing proportion of head injuries. Since we observed an increase in head injuries among elderly, primary prevention strategies may need to be targeted at this age group, and at preventing falls.     

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.     

Impact of the Safe Community program in Harstad on the incidence of injuries

Objectives Since 1987, the Harstad community in Norway has run an injury prevention program according to the Safe Community approach. The effectiveness of this approach in reducing injury rates is poorly documented. The aim of this study was to evaluate the impact of the Harstad program on the incidence of injuries. Methods We used data from the National Injury register of Norway and compared age-adjusted incidence rates and standardized rate ratios of injuries in Harstad and three control communities for the period 1992-1997. Results Harstad had the second highest rates for both all injuries and fractures. No reduction in the incidence of injuries in Harstad was observed from 1992-1997. The injury rates in 1992-1997 were similar to the rates recorded in 1985/86. Conclusions The injury prevention program in Harstad has not reduced overall injury rates. The Safe Community concept is an organizational strategy, but implementation of proven and targeted risk reduction measures will be needed if community-based programs are to result in risk reductions.     

Socio-economic differentials in injury risk

The aim was to highlight the role of childcare products as causes for mild brain injury (concussion) in small children (0-4 years of age) and to determine the most dangerous products. By childcare products this report means the following items: child and baby furniture, nursing tables, baby walkers, toys, baby carriages, sport equipment for children, playground equipment and security equipment for children. The data were derived from the EHLASS (European Home and Leisure Accident Surveillance System) for 1998 and 1999 and covered a restricted population of Sweden (approximately 5 per cent). According to this register 182 mild brain injuries (concussions) were recorded following a fall, an accident or a blow to the head among children (0-4 years of age) during 1998 and 158 for 1999. Of those injuries, childcare products were the cause of the accident in 84 (46 per cent) and 76 (48 per cent) cases respectively for 1998 and 1999. The number of children admitted for hospital care was 68 (57/84) and 74 (56/76) per cent respectively. The home was the most common place of the accident and play and leisure activity were the most common activities. More than 50 per cent of these accidents took place during daytime. The product type that caused most accidents was nursery furniture and, in this category, the baby walker was the most dangerous. The product type that caused the second most frequent accidents was playground equipment.     

Hospitalized fall-related injury trends in Sweden between 2001 and 2010

Previous studies have indicated increasing trends of hospitalized fall-related injuries amongst elderly. Whether this is true also in Sweden is unknown though it is important to study considering the potential societal impact. Data were obtained regarding hospitalized injuries with falls as external cause among those aged 65 years and above with information on injury type, gender and age, on a yearly basis, from 2001 to 2010. Age- and sex-specific incidence rates were calculated (per 100,000 population) for all fall-related injuries, and for each injury type and trend lines were drawn. Linear regression analyses and percentage change were calculated for the types of fall-related injuries. A decreasing incidence was observed in the younger age groups (65–79 years) with greater decreases amongst women (women: ?14.6%, men 65–79 years: ?10.5%). However, increasing rates were observed in the older age group (80 years and above), with greater increases amongst men (women: 4.3%, men: 11.4%). Superficial injuries showed greater increases than fractures amongst those aged 80 years and above. This study indicates that older elderly in Sweden are increasingly being hospitalized for less serious injuries. This changing injury panorama is important to include in the future planning of both health care and fall-related prevention.     

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.     

Determinants of severe injury and mortality from road traffic accidents among motorcycle and car users in Southern Thailand

Abstract

This study aimed to identify factors associated with severe injury and mortality from road traffic accidents (RTA) among motorcycle and car users in southern Thailand. The data were obtained from the Office of Disease Prevention and Control, Thailand, for years 2008–2013. Chi-squared tests were used to assess associations between determinants and outcomes and these associations were then estimated after adjusting for possible confounding with other factors using logistic regression. Severe injury and mortality contributed 11.6% and 5% to RTA of motorcycle users, and 14.3% and 7.5% for car users. Among motorcycle users, male gender, older age, and not wearing a helmet increased severe injury and mortality rates, whereas drivers had more severe injuries than passengers. Older car users had higher severe injury and mortality rates, whereas not fastening seat belts had higher mortality. Safety device use should be made mandatory for both drivers and passengers. Male motorcycle users and the elderly should be focused on.     

Injuries sustained during snow removal from roofs resulting in hospital care

Clearing snow from roofs causes serious injuries annually. The aim of this study was to describe injury mechanisms, injury panorama, and injury incidence in connection to this activity. A specific aim was to study the association between snow depth and injury incidence. A total of 95 people were injured during four study periods. The risk of injury is strongly associated with snow depth, and the incidence varied up to 10-fold between the studied winter seasons. The majority of injuries (91; 96%) occurred during leisure time and only four people were injured in the occupational setting. The most common injury mechanism was falling off roofs or ladders of residential homes. Nearly 60% sustained moderate or serious injuries (Maximum Abbreviated Injury Scale [MAIS] 2–3), and fractures accounted for almost half of all injuries. Because roofs of single-family homes in Sweden usually do not require snow removal for heavy snow loads, these injuries may have been both unnecessary and avoidable. Further education is required to advise the public on the risks associated with snow removal from roofs.     

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.     

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.     

Trends in road traffic crashes and associated injury and fatality in the People’s Republic of China, 1951–1999

The burden of road traffic injuries in the People’s Republic of China is increasing as evidenced by trends since 1951. Data from the National Statistical Office, Ministry of Communications and the Traffic Administration Bureau were analyzed. Absolute numbers of crashes, fatalities, and injuries, as well as fatalities per 100,000 population and motorization (number of vehicles per 1000 population) were used as indices to measure trends. Regional variations in trends and the characteristics of people injured or killed were also analyzed. Road traffic crashes increased 68- fold, from around 6000 in 1951 to 413,000 in 1999. Excessive speed was the main reported cause of the crashes. The injuries increased 56-fold – from around 5000 to 286,000 – and fatalities 97-fold – from 852 to around 84,000 – over the same period. The crash, fatality and injury rates also increased after 1985, due to increased motorization spurred by rapid economic growth. The number of four-wheel motor vehicles increased from 60,000 in 1951 to just under a million four-wheel motor vehicles in 1975 and to 10 million in 1987. The number of four-wheel motor vehicles then rose to 50 million in 1999, with an additional 30 million motorcycles. The increase in motorization and fatalities affected all the provinces. Road traffic injuries are the leading cause of death for populations up to the age of 45 years and the leading cause of working-life years lost in China.     

Vulnerability of motorcycle riders and co-riders to injuries in multi-occupant crashes

In developing countries, most motorcycles are ridden with more than one occupant. The objective of this study was to establish the relative vulnerability of riders and co-riders to injury and determine the injury risk factors in multi-occupant motorcycle crashes. Between January and December 2010, we collected crash and injury data from victims of multi-occupant motorcycle. It is a hospital-based study. The probability of sustaining injuries was similar for co-riders and riders, but co-riders were more likely to sustain severe injuries. Occupants of >2-occupant motorcycles were also more likely to be involved in risky behaviours like not wearing helmet and speeding than those on 2-occupant motorcycles. Occupants of motorcycles on which there were more than two occupants were at an increased risk of sustaining injuries compared with occupants of motorcycles with only two occupants (OR: 2.1, 95% CI: 1.1–4.3). Motorcycle co-riders were more vulnerable to severe injuries than riders. The significance of the study finding to prevention was discussed.     

Injury prevention priority setting based on the National Injury Surveillance data in Korea

For the reduction of injury burden, injury prevention efforts are essential. However, financial, material and human resources are far from sufficient, and this situation necessitates setting priorities for effective injury prevention. Hence, the aim of this study is to prioritise 13 injury mechanisms for prevention of injury using four injury burden criteria. National death certificate, hospital discharge data and emergency data during 2004 were used. According to the 13 most frequent injury mechanisms (ICD-10), mortality priority score, years of potential life lost (YPLL) priority score, morbidity priority score and hospital charge priority score were calculated. Injury mechanisms which were ranked fourth or higher on at least three of the four criteria scores were arranged in rank orders. Traffic crashes ranked highest on all four of the priority criteria for injury prevention followed by fall and poisoning in second and third positions, respectively. Categorised by age groups, in 0–19 year olds, traffic crashes, suffocation and drowning; in 20–59 years, traffic crashes, suffocation and poisoning; and in 60 and over, traffic crashes and fall were shown to be significant injury prevention priority in rank orders. Injury prevention priorities identified from this study could be useful in strategically allocating limited resources and implementing more focused prevention policies in Korea.     

Injury prevention priority setting based on the National Injury Surveillance data in Korea

For the reduction of injury burden, injury prevention efforts are essential. However, financial, material and human resources are far from sufficient, and this situation necessitates setting priorities for effective injury prevention. Hence, the aim of this study is to prioritise 13 injury mechanisms for prevention of injury using four injury burden criteria. National death certificate, hospital discharge data and emergency data during 2004 were used. According to the 13 most frequent injury mechanisms (ICD-10), mortality priority score, years of potential life lost (YPLL) priority score, morbidity priority score and hospital charge priority score were calculated. Injury mechanisms which were ranked fourth or higher on at least three of the four criteria scores were arranged in rank orders. Traffic crashes ranked highest on all four of the priority criteria for injury prevention followed by fall and poisoning in second and third positions, respectively. Categorised by age groups, in 0-19 year olds, traffic crashes, suffocation and drowning; in 20-59 years, traffic crashes, suffocation and poisoning; and in 60 and over, traffic crashes and fall were shown to be significant injury prevention priority in rank orders. Injury prevention priorities identified from this study could be useful in strategically allocating limited resources and implementing more focused prevention policies in Korea.     

Hospitalisation costs and duration of elderly motorcyclists’ non-fatality crashes in Taiwan

This paper investigates the relationship between medical treatment costs and the length of hospital stays resulting from motorcycle crashes involving the elderly. The World Health Organization defines ‘elderly’ as people more than 65 years old. The sample for this study consisted of data for the year 2007 collected by the Bureau of National Health Insurance, Taiwan. We develop models for predicting medical costs and the length of hospital stays based on diagnosis, hospital and user types. The seemingly unrelated regression equation (SURE) model was applied first to investigate the relationship between medical costs and the length of hospital stays. The SURE model shows that the type of injury (e.g. head injury) is statistically significant and has positive effects on medical costs for motorcycle crashes involving the elderly in Taiwan. Due to the statistical insignificance of the dependency between medical costs and length of hospital stays, two separate simple linear regression models were subsequently estimated. For motorcycle crashes, patients over 80 years old had the highest medical costs. The findings reinforce the need for transportation authorities to focus on preventing certain types of injuries that are particularly serious and costly for the elderly in Taiwan.     

Trends and characteristics of injuries in the State of Qatar: hospital-based study

Injuries account for a large burden of mortality and morbidity in the State of Qatar. No comprehensive study has been conducted on all types of injuries in the State of Qatar. The objective of this study was to determine the trend in the number, incidence and pattern of injuries in the State of Qatar. This hospital-based study is a retrospective analysis of 53,366 patients treated at the accident and emergency and trauma centres for injuries during the period from 2006 to 2010. Injuries were determined according to the ICD 10 criteria. The details of the entire trauma patients who were involved in occupational/domestic injuries were extracted from the database of the Emergency Medical Services (EMS), Hamad Medical Corporation. Our results demonstrated that the rates of injury remained relatively stable in the State of Qatar over the five–year period. Those most at risk of injury were non-Qatari males who were below 30 years. Road traffic accidents (RTA) (36.7%) followed by falls causing back injuries (11.0%) were the most common types of injuries during the period. Most of the injuries occurred at the head for both males (17.7%) and females (13.5%); this was consistently the case across all of the age groups. The greatest proportion of RTA (21.2%), industrial machinery injuries (16.4%), construction injuries (15.5%), recreational sporting injuries (20.5%) and beach/sea/ocean injuries (15.0%) resulted in head injuries. Intervention efforts need to be aimed at reducing occupational injuries, RTA injuries and work–related hazards in the State of Qatar.     

The pattern and predictors of intentionally inflicted injuries on Greek adults; data from an Emergency Injury Surveillance System (EDISS)

Background Intentional injuries due to violence are both a social and a public health problem in most societies. This study assesses the patterns and some of the sociodemographic determinants of violence-related injuries among Greek adults. Methods Data recorded by the Emergency Department Injury Surveillance System (EDISS) during the two-year period 1996-1997 were used. This database relies on all age injury data collected in the emergency departments of three sentinel hospitals, covering both urban and rural population areas. Results Among 52026 recorded injuries, 1322 (3%) were violence related, excluding self-inflicted injuries, while the majority of injuries (28269) were attributed to home and leisure accidents. Weapons of any type were used only in 5% of violence-related injuries. In comparison to home and leisure injuries, the intentionally inflicted injuries occurred more frequently among men, among those 25-54 years old, and were particularly common among migrants and during late night and early morning hours. Violence-related injuries frequently occur in pubs, restaurants, cafeterias and other places of entertainment. However, 52% of violence-related injuries among women occurred at home. Intentional injuries were generally more severe than unintentional ones. Conclusions We conclude that violence is not a negligible public health problem in the Greek population, but is considerably less serious than in most other developed countries. In particular, firearms-related injuries represent a very small fraction of the generally low incidence of violence-related injuries in this Mediterranean country.     

Pattern of traffic injuries in Shanghai: implications for control

In China, traffic-related injuries are often treated as transportation issues, called 'accidents'. The objectives of the research are to analyse traffic injury patterns, estimate costs of traffic injuries and provide evidence to develop effective prevention strategies. There were over 1 500 deaths due to traffic-related injuries annually in Shanghai from 1987 to 2003, and it is rising year by year with the rate of growth in motorization. The rates of annual increase are 3.59% in fatalities (from 7.78 to 14.18 per 100000 population) and 10.46% in non-fatalities (from 53.93 to 264.98 per 100000 population) respectively during the period. The analysis of the geographic information system showed that the geographic distribution of traffic injuries in the countryside regions of Shanghai had the highest rates. Labour force groups represented the majority of fatalities (70.97%) and serious traffic injuries (90.51%). The mortality rates were 18.40 per 100000 population and 10.02 per 100000 population in 45-65 year age group and 15-44 year age group respectively; the morbidity rates of serious traffic injuries were 121.60 per 100000 population and 70.46 per 100000 population in the same groups respectively. And females generally showed a lower incidence than males. In general, fatalities and injuries were higher for drivers, bicyclists and pedestrians. Among road traffic injury-related fatalities, 66.8% were attributed to head injuries. Of those with fatal head injuries, bicyclists accounted for 29.8% of the total; pedestrians accounted for 28.3%; motorcyclists accounted for 25.5%. Total traffic injury cost was estimated at least US $645989580 in Shanghai in 2003. Good injury intervention programmes need to be done as soon as possible to effectively reduce traffic injury burden in Shanghai, China.