Fun ride or risky transport: Golf cart-related injuries treated in U.S. emergency departments from 2007 through 2017

Introduction: Golf cart-related injuries constitute a substantial source of morbidity, most notably in pediatric populations. Despite the high rate of injuries, there have been no meaningful changes in golf cart design or legislation to reduce the overall burden of these injuries. This study sought to characterize the epidemiology of golf cart-related injuries treated in United States hospital emergency departments. Method: A retrospective analysis was conducted by using data from the National Electronic Injury Surveillance System for patients of all ages who were treated in emergency departments (EDs) (2007–2017) for a golf cart-related injury. Results: From 2007 through 2017, an estimated 156,040 (95% CI = 102,402–209,679) patients were treated in U.S. EDs for golf cart-related injuries. The average rate of traumatic brain injuries (TBIs) in children (1.62 per 100,000 children) was more than three times that of TBIs in adults (0.52 per 100,000 adults; rate ratio = 2.38; 95% CI = 2.36–2.41) and nearly twice that of TBIs in seniors (1.11 per 100,000 seniors; rate ratio = 1.21; 95% CI = 1.19–1.22). The rate of injuries in seniors increased significantly by 67.6% from 4.81 per 100,000 seniors in 2007 to 8.06 per 100,000 seniors in 2017 (slope = 0.096; p = 0.041). Conclusions: Golf cart use remains an important source of injury for people of all ages, especially in children. As use continues to increase, it is unlikely that golf cart-related injuries will decrease without substantial changes to product design, regulation, and/or legislation. Practical Applications: Use of golf carts pose a considerable risk of injury and morbidity; safety recommendations should be followed.     

Traumatic brain injury-related hospitalizations and deaths among American Indians and Alaska natives — United States, 2008–2014

IntroductionDespite progress, injury remains the leading cause of preventable death for American Indian and Alaska Natives (AI/AN), aged 1 to 44. There are few publications on injuries among the AI/AN population, especially those on traumatic brain injury (TBI). A TBI can cause short- or long-term changes in cognition, communication, and/or emotion. Methods: To describe changes over time in TBI incidence by mechanism of injury, injury intent, and age group among AI/ANs, the CDC analyzed hospitalization and death data from the 2008–2014 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) and the National Vital Statistics System (NVSS), respectively. Results: From 2008-2014, the incidence of TBI-related hospitalizations increased by 32% (1,477 in 2008 to 1,945 in 2014) and resulted in a 21% increase in age-adjusted rates of people hospitalized with TBI. TBI-related deaths increased in number (569 in 2008 to 644 in 2014) and age-adjusted rate (22.7 in 2008 to 25.4 in 2014) by approximately 13% and 12%, respectively. Motor-vehicle crashes were the leading cause of TBI-related deaths among AI/ANs aged 0–54 years. Practical application: Prevention efforts should focus on increasing motor-vehicle safety and advancing prevention strategies for other leading causes of TBI, including: falls, intentional self-harm, and assaults.     

Bystander injury evaluation of children from midwestern agricultural operations

Background

With more than a million youth living on agricultural operations, it is important for parents to understand the consequences of bystander injuries that children experience in these environments. We identified the childhood injuries for bystander status and compared the severity of these injuries to the working children in the Regional Rural Injury Study-II (RRIS-II).

Methods

RRIS-II followed 16,546 children (∼ 85% of eligible) from rural communities in the Midwest for two six-month recall periods in 1999 and 2001. Demographic, injury, and exposure data were collected through comprehensive computer-assisted telephone interviews. Child injuries were cataloged using narrative scenarios into four categories: (a) directly work-related; (b) indirectly work-related; (c) non-working accomplice; and (d) non-working attendant; the latter three all being bystander categories. Poisson regression modeling was used to calculate rates of bystander injuries. Frequencies were used for comparison of severity measures.

Results

Among the 463 child injuries (aged < 20 yrs), 102 were bystander injuries. Of the bystander-related injuries, 14 were identified as indirectly work-related (working bystanders), 27 as non-working accomplice (passengers/tag-alongs), and 60 as non-working attendant (playing on the operation). The overall rate of bystander injuries was 6.4 per 1,000 people, 95% CI (5.0, 8.1). Males, compared with females, had more than twice the injury rate (8.7; 95% CI 6.4-11.8, and 3.9; 95% CI 2.7-5.7, per 1,000 people, respectively). Bystanders in this population had more severe injuries with 4% having life-threatening circumstances; of these, 4% of the accomplices and 2% of the attendants subsequently died.

Conclusions

Children who live or work on agricultural operations are vulnerable to many hazards. Therefore, this study examined child injuries and found a clear difference in the consequences of these injuries between working-related and bystanding-related injuries.

Impact on Industry

Unlike occupations such as construction and mining, where laws and organizations have been created for the protection of bystanders, agricultural bystanders have remained unprotected and have had to face the consequent injury and death outcomes. As public health professionals considering these risks, it is necessary that we work to develop more intervention studies and continue to propose suggestive guidelines for child safety in these environments so as to challenge family traditions and possibly spark public policies that will give further protection to this population.     

Sport participation and injury rates in high school students: A Canadian survey of 2029 adolescents

Introduction: The objective of this study is to examine sport and recreational (S&R) activity participation and injury rates (IR) in high school students (ages 14–19). Methods: High school students (N = 24 schools, n = 2,029; 958 male, 1,048 female, 23 identified ‘other’ or missing; ages 14–19) in Alberta completed a web-based survey during class (October 2018–March 2019). Students identified their top three sports for participation in the past year. Primary outcome measures included IR for (a) any S&R-related injury, (b) most serious S&R-related injury resulting in medical attention, and (c) most serious injury resulting in restriction from S&R for at least one day. Results: In total, 1763/2029 (86.89%) respondents [861/958 (89.87%) male, 886/1048 (84.54%) female, 16/23 (69.57%) identifying as ‘other’ or missing] participated in an S&R activity in the past year. Top sports for male participation were basketball (33.08%; 95% CI 27.67–39.00), ice hockey (20.46%; 95% CI 14.87–27.47), and soccer (19.42%; 95% CI 15.67–23.80). Top sports for female participation were dance (22.52%; 95% CI 17.98–27.82), basketball (18.32%; 95% CI 14.32–23.14), and badminton (17.84%; 95% CI 13.35–23.43). Of the 1,971 students completing the S&R injury question, 889 reported at least one injury during the past year [(IR = 45.10 injuries/100 students/year (95% CI 39.72–50.61)]. The medical attention IR was 29.09 injuries/100 students/year (95% CI 24.49–34.17) and time loss IR was 36.00 injuries/100 students/year (95% CI 30.47–41.93). Conclusions: High school student S&R IRs are high with 29% of adolescents reporting at least one medical attention injury within the past year. Injury prevention strategies targeting youth are necessary. Practical Application: Participation in S&R activities has multiple physical, psychological, and health benefits for adolescents, but some S&R activities also have greater risks of injury. This study informs the next sports to target for implementation of optimal prospective surveillance and injury prevention strategies among high school aged students.     

Injuries associated with the use of riding mowers in the United States, 2002-2007

Context: To examine injuries among patients treated in an emergency department (ED) related to the use of a riding lawn mower.Design and Setting: Data were obtained from the National Electronic Injury Surveillance System for the years 2002-2007. National estimates of ED visits for injuries associated with the use of a riding lawn mower were analyzed. Narrative text entries were categorized to provide a detailed record of the circumstances precipitating the injury. Average annual rates were calculated and logistic regression analyses were employed to determine risk estimates for patient disposition and demographic characteristics related to ED visits for injuries associated with riding mowers.Results: From 2002 through 2007, there were an estimated 66,341 ED visits for injuries related to the use of riding lawnmowers in the U.S., with an average annual rate of 6.0 ED visits per 100,000 males, and 1.6 ED visits per 100,000 females. Older adults had higher rates of ED visits for injuries (7.2/100,000) than younger age groups. The most common injuries involved contusions (24%); sprains/strains (22%) and fractures (17%). The majority of patients (90%) were treated and released the same day. Results of logistic regression analyses revealed that older adults were more likely to be hospitalized when compared to younger age groups; and incidents involving rollovers [OR = 5.45 (95% CI = 3.22-9.23)] and being run over [6.01 (95% CI 3.23-11.17)] were more likely to result in hospitalization when compared to all other circumstances of injury.Conclusions: Riding mowers present injury patterns and circumstances that are different than those reported for push mowers. Circumstances related to injuries and age groups affected were varied, making prevention of riding mower injuries challenging. Application/Impact: Findings support the need to increase awareness and/or change the design of riding mowers with respect to risk of rollover injuries.     

The sources of the Kuznets relationship between the road deaths to road injuries ratio and economic growth

Introduction: Past empirical studies indicated that there is a Kuznets or reverse U-shaped relationship between road deaths and per capita income, such that the number of road death increases at a low level of per capita reverse U-shaped relationship was observed between road injuries and per capita income. While these studies explored the impact of per capita income on road deaths and road injuries, no studies have examined the relationship between per capita income and road death to road injury ratio (DPI). Method: Using a fixed effects panel regression analysis from 67 countries spanning over a period of five decades (1960–2013), the present study sought to explore the impact of per capita gross domestic product (per capita GDP) on the DPI ratio and the underlying factors responsible for the relationship. Results: Our result suggests that per capita GDP followed a reverse U-shaped relationship with DPI. Moreover, the relative improvements in higher mobility roads as compared to improvements in higher accessibility roads, motorcycle ownership to passenger car ownership ratio, percentage of population living in an urban area, infant mortality rate, and the percentage of population below 15 years of age and above 64 years of age contributed to this relationship. Practical Applications: This implies that, at lower level of economic growth where road deaths exceed road injuries, countries should implement low-cost measures to combat road deaths cases. Such measures include mandating wearing of quality helmets and daytime running headlights for motorcycles. On the other hand, at higher level of economic growth where road injuries surpass road deaths, countries are encouraged to devote more resources to improving medical technology and services to treat road injury victims, mandating seatbelt use, as well as enhancing and promoting public transportation service.     

Severity of e-scooter rider injuries associated with trip characteristics

Introduction: E-scooter rider injuries have been growing, but little is known about how trip and incident characteristics contribute to their severity. Method: We enrolled 105 adults injured while riding e-scooters who presented to an emergency department in Washington, DC, during 2019. Enrolled participants completed an interview during the emergency department visit, and their charts were abstracted to document their injuries and treatment. Logistic regression examined the association of incident location and circumstances with the likelihood of sustaining an injury on the Abbreviated Injury Scale (AIS) ≥ 2, while controlling for rider characteristics. Results: The most common locations of e-scooter injuries in our study sample occurred on the sidewalk (58%) or road (23%). Accounting for other trip and rider attributes, e-scooter riders injured on the road were about twice as likely as those injured elsewhere to sustain AIS ≥ 2 injuries (RR, 1.96; 95% CI, 1.23–2.36) and those who rode at least weekly more often sustained AIS ≥ 2 injuries compared with less frequent riders (RR, 1.86; 95% CI, 1.11–2.32). Conclusions: Greater injury severity for riders injured on the road may reflect higher travel speeds. Practical applications: Injury severity associated with riding in the road is one factor that jurisdictions can consider when setting policy on where e-scooters should be encouraged to ride, but the risk of any crash or fall associated with facilities should also be examined. Although injuries are of lower severity on sidewalks, sharing sidewalks with slower moving pedestrians could potentially lead to more conflicts.     

Pediatric electric bicycle injuries and comparison to other pediatric traffic injuries

Objective: The objective of this study was to conduct a comprehensive analysis of demographics, injury characteristics and hospital resource utilization of significant pediatric electric bicycle (e-bike) injuries leading to hospitalization following an emergency department visit in comparison to pediatric injuries caused by other traffic related mechanisms.

Methods: A retrospective review of all pediatric traffic injury hospitalizations following an emergency department visit to a level I trauma center between October 2014 and September 2016 was conducted. Data regarding age, sex, number of computed tomography (CT) scans obtained, number of major procedures, length of hospital stay (LOS), Injury Severity Score (ISS), and number of injuries per patient were collected and compared between e-bike injuries and other traffic injuries.

Results: Three hundred thirty-seven admissions were analyzed: 46 (14%) were due to e-bike injuries (29% of patients >12 years). Age, proportion of brain injuries, and use of CT were significantly increased compared to mechanical bicycle injuries (13.1?±?3.4 vs. 10.6?±?3.6, 13% vs. 3%, 1 [0–3] vs. 1 [0–1], P < .01, P = .03, P = .05). Age, LOS, and use of CT were significantly increased compared to injuries caused to automobile passengers (13.1?±?3.4 vs. 7.4?±?5.3, 1 [1–3] vs. 1 [1–2], 1 [0–3] vs. 0 [0–1], P < .01, P = .03, P = .01), as well as ISS and number of injuries per patient (P = .04, P < .01). Injuries caused by e-bikes were similar to injuries caused to pedestrians, except for age (13.1?±?3.4 vs. 8.5?±?3.7, P < .01). Multivariable analysis revealed a significant association between mechanism of injury and ISS, with increased ISS among e-bike injuries compared to mecahnical bike injuries (OR 2.56, CI 1.1–5.88, P = 0.03) and automobile injuries (OR 4.16, CI 1.49–12.5, (P < .01).

Conclusion: E-bikes are a significant cause of severe injury in children compared to most other traffic injuries, particularly in older children.     

Child passenger fatality: Child restraint system usage and contributing factors among the youngest passengers from 2011 to 2015

Objective: Motor-vehicle crashes (MVC) remain a leading cause of preventable injury and death for children aged 0–3 in the United States. Despite advancement in legislation and public awareness there is continued evidence of inappropriate child restraint system (CRS) use among the youngest passengers. The current study focuses on appropriate CRS use from 2011 to 2015 using data from the Fatality Analysis Reporting System (FARS) for children aged 0–3. Methods: Child-, driver-, vehicle-, and trip-related characteristics were investigated within a sample of 648 children from 625 crashes over 5-years in which a child aged 0–3 was fatally injured while unrestrained or wearing an identified CRS type. Multivariable log-binomial regression was used to obtain relative risk. Results: Only 48% of the fatally injured children were appropriately restrained in a CRS. Premature transition to a booster seat and seat belt was evident. The largest proportion of rear-facing restraint use was reported in < 1 year olds (40%), with less reported in 1 (11%) and 2 year olds (2%) and no usage in 3 year olds. Younger children were more likely to be in an appropriate CRS, while Black children, driver not restrained in a lap-shoulder belt configuration, and riding in a pickup truck were less likely to be restrained appropriately. Conclusions: Evidence of inappropriate CRS use supports the use of more stringent legislation and parental interventions to communicate best practice recommendations and educate caregivers regarding appropriate child restraint methods. Practical applications: Public health campaigns focused on increasing appropriate restraint use in children are of great importance as optimally restrained children are less likely to sustain injuries, or require crash-related hospitalization compared to unrestrained children. Researchers and practitioners may find these surveillance findings essential when developing education and interventions targeting child–parent dyads at the greatest risk for a MVC-related fatality.     

Bicycle helmet use among persons 5 years and older in the United States, 2012

IntroductionIn 2013, injuries to bicyclists accounted for 925 fatalities and 493,884 nonfatal, emergency department-treated injuries in the United States. Bicyclist deaths increased by 19% from 2010 to 2013. The greatest risk of death and disability to bicyclists is head injuries. The objective of this study was to provide estimates of prevalence and associated factors of bicycle riding and helmet use among children and adults in the United States.MethodCDC analyzed self-reported data from the 2012 Summer ConsumerStyles survey. Adult respondents (18 + years) were asked about bicycle riding and helmet use in the last 30 days for themselves and their children (5 to 17 years). For bicycle riders, CDC estimated the prevalence of helmet use and conducted multivariable regression analyses to identify factors associated with helmet use.ResultsAmong adults, 21% rode bicycles within the past 30 days and 29% always wore helmets. Respondents reported that, of the 61% of children who rode bicycles within the past 30 days, 42% always wore helmets. Children were more likely to always wear helmets (90%) when their adult respondents always wore helmets than when their adult respondents did not always wear helmets (38%). Children who lived in states with a child bicycle helmet law were more likely to always wear helmets (47%) than those in states without a law (39%).ConclusionsDespite the fact that bicycle helmets are highly effective at reducing the risk for head injuries, including severe brain injuries and death, less than half of children and adults always wore bicycle helmets while riding.Practical applicationStates and communities should consider interventions that improve the safety of riding such as policies to promote helmet use, modeling of helmet wearing by adults, and focusing on high risk groups, including Hispanic cyclists, occasional riders, adults, and children ages 10 to 14.     

Nationwide risk factors for hospital readmission for subsequent injury after motor vehicle crashes

Abstract

Objective: Some drivers involved in motor vehicle crashes across the United States may be identified as at risk of subsequent injury by a similar mechanism. The purpose of this study was to perform a national review of the risk factors for hospitalization for a new injury due to a subsequent motor vehicle crash. It was hypothesized that presenting to a different hospital after subsequent injury would result in worse patient outcomes when compared to presentation at the same hospital.

Methods: The Nationwide Readmissions Database for 2010–2014 was queried for all inpatient hospitalizations with injury related to motor vehicle traffic. The primary patient outcome of interest was subsequent motor vehicle crash–related injury within 1 year. The secondary patient outcomes were different hospital subsequent injury presentation, higher Injury Severity Score (ISS), longer length of stay (LOS), and in-hospital death after subsequent injury. The analysis of secondary patient outcomes was performed only on patients who were reinjured. Univariable analysis was performed for each outcome using all variables during the index admission. Multivariable logistic regression was performed using all significant (P < .05) variables on univariate analysis. Results were weighted for national estimates.

Results: During the study period, 1,008,991 patients were admitted for motor vehicle–related injury; 12,474 patients (1.2%) suffered a subsequent injury within 1 year. From the reinjured patients, 32.9% presented to a different hospital, 48.9% had a higher ISS, and 22.1% had a longer LOS. The in-hospital mortality rate after subsequent injury was 1.1%. Presentation to a different hospital for subsequent injury was associated with a longer LOS (odds ratio [OR]?=?1.32; 95% confidence interval [CI], 1.20–1.45; P < .01) and a higher ISS (OR?=?1.38; 95% CI, 1.27–1.49; P < .01). Motorcyclists were more likely to suffer subsequent injury (OR?=?1.39; 95% CI, 1.32–1.46; P < .01) and motorcycle passengers were more likely to present to a different hospital with a subsequent injury (OR?=?2.49; 95% CI, 1.73–3.59; P < .01). Alcohol abuse was associated with subsequent injury (OR?=?1.12; 95% CI, 1.07–1.18; P < .01).

Conclusions: Nearly a third of patients suffering subsequent motor vehicle crash–related injury after an initial motor vehicle crash in the United States present to a different hospital. These patients are more likely to suffer more severe injuries and longer hospitalizations due to their subsequent injury. Future efforts to prevent these injuries must consider the impact of this fragmentation of care and the implications for quality and cost improvements.     

Use of child safety seats and booster seats in the United States: A comparison of parent/caregiver-reported and observed use estimates

Background: Motor-vehicles crashes are a leading cause of death among children. Age- and size-appropriate restraint use can prevent crash injuries and deaths among children. Strategies to increase child restraint use should be informed by reliable estimates of restraint use practices. Objective: Compare parent/caregiver-reported and observed child restraint use estimates from the FallStyles and Estilos surveys with the National Survey of the Use of Booster Seats (NSUBS). Methods: Estimates of child restraint use from two online, cross-sectional surveys—FallStyles, a survey of U.S. adults, and Estilos, a survey of U.S. Hispanic adults—were compared with observed data collected in NSUBS. Parents/caregivers of children aged ≤ 12 years were asked about the child’s restraint use behaviors in FallStyles and Estilos, while restraint use was observed in NSUBS. Age-appropriate restraint use was defined as rear-facing child safety seat (CSS) use for children aged 0–4 years, forward-facing CSS use for children aged 2–7 years, booster seat use for children aged 5–12 years, and seat belt use for children aged 9–12 years. Age-appropriate restraint users are described by demographic characteristics and seat row, with weighted prevalence and corresponding 95% confidence intervals (CI) calculated. Results: Overall, child restraint use as reported by parents/caregivers was 90.8% (CI: 87.5–94.1) (FallStyles) and 89.4% (CI: 85.5–93.4) for observed use (NSUBS). Among Hispanic children, reported restraint use was 82.6% (CI: 73.9–91.3) (Estilos) and 84.4% (CI: 79.0–88.6) for observed use (NSUBS, Hispanic children only). For age-appropriate restraint use, estimates ranged from 74.3% (CI: 69.7–79.0) (FallStyles) to 59.7% (CI: 55.0–64.4) (NSUBS), and for Hispanic children, from 71.5% (CI: 62.1–81.0) (Estilos) to 57.2% (CI: 51.2–63.2) (NSUBS, Hispanic children only). Conclusion and Practical Application: Overall estimates of parent/caregiver-reported and observed child restraint use were similar. However, for age-appropriate restraint use, reported use was higher than observed use for most age groups.     

Children’s fear in traffic and its association with pedestrian decisions

Introduction: Research on risk for child pedestrian injury risk focuses primarily on cognitive risk factors, but emotional states such as fear may also be relevant to injury risk. The current study examined children's perception of fear in various traffic situations and the relationship between fear perception and pedestrian decisions. Method: 150 children aged 6–12-years old made pedestrian decisions using a table-top road model. Their perceived fear in the pedestrian context was assessed. Results: Children reported greater emotional fear when they faced quicker traffic, shorter distances from approaching traffic, and red rather than green traffic signals. Children who were more fearful made safer pedestrian decisions in more challenging traffic situations. However, when the least risky traffic situation was presented, fear was associated with more errors in children’s pedestrian decisions: fearful children failed to cross the street when they could have done so safely. Perception of fear did not vary by child age, although safe pedestrian decisions were more common among the older children. Conclusions: Children’s emotional fear may predict risk-taking in traffic. When traffic situations are challenging to cross within, fear may appropriately create safer decisions. However, when the traffic situation is less risky, feelings of fear could lead to excessive caution and inefficiency. Practical applications: Child pedestrian safety interventions may benefit by incorporating activities that introduce realistic fear of traffic risks into broader safety lessons.     

Characteristics of bicycle crashes among children and the effect of bicycle helmets

Abstract

Objective: Focusing on children (0–17?years), this study aimed to investigate injury and accident characteristics for bicyclists and to evaluate the use and protective effect of bicycle helmets.

Method: This nationwide Swedish study included children who had visited an emergency care center due to injuries from a bicycle crash. In order to investigate the causes of bicycle crashes, data from 2014 to 2016 were analyzed thoroughly (n?=?7967). The causes of the crashes were analyzed and categorized, focusing on 3 subgroups: children 0–6, 7–12, and 13–17?years of age. To assess helmet effectiveness, the induced exposure approach was applied using data from 2006 to 2016 (n?=?24,623). In order to control for crash severity, only bicyclists who had sustained at least one Abbreviated Injury Scale (AIS) 2+ injury (moderate injury or more severe) in body regions other than the head were included.

Results: In 82% of the cases the children were injured in a single-bicycle crash, and the proportion decreased with age (0–6: 91%, 7–12: 84%, 13–17: 77%). Of AIS 2+ injuries, 8% were head injuries and 85% were injuries to the extremities (73% upper extremities and 13% lower extremities). Helmet use was relatively high up to the age of 10 (90%), after which it dropped. Helmets were much less frequently used by teenagers (14%), especially girls. Consistently, the share of head injuries increased as the children got older. Bicycle helmets were found to reduce all head injuries by 61% (95% confidence interval [CI], 10: +/? 10%) and AIS 2+ head injuries by 68% (95% CI, 12: +/? 12%). The effectiveness in reducing face injuries was lower (45% CI +/? 10% for all injuries and 54% CI +/? 32% for AIS2+ injuries).

Conclusions: This study indicated that bicycle helmets effectively reduce injuries to the head and face. The results thus point to the need for actions aimed at increasing helmet use, especially among teenagers. Protective measures are necessary to further reduce injuries, especially to the upper extremities.     

Parents’ work injuries and children’s mental health: The moderating role of children’s work centrality

Introduction: The purpose of this study is to explore the relationship between parents’ work-related injuries and their children’s mental health, and whether children’s work centrality – the extent to which a child believes work will play an important part in their life – exacerbates or buffers this relationship. Method: We argue that high work centrality can exacerbate the relationship between parental work injuries and children’s mental health, with parental work injuries acting as identity-threatening stressors; in contrast, high work centrality may buffer this relationship, with parental work injuries acting as identity-confirming stressors. We test this relationship with a sample of Canadian children (N = 4,884, 46.2% female, M age = 13.67 years). Results:Children whose parents had experienced more frequent lost-time work-related injuries reported worse mental health with high work centrality buffering this negative relationship. Conclusions: Our study highlights the vicarious effects of work injuries on salient others, specifically parental work injuries on children’s mental health, as well as the role of work centrality in shaping children’s sense-making and expectations about the consequences of work.     

Physical,psychological and economic burden of two-wheel users after a road traffic injury: Evidence from intensive care units of three EU countries

Introduction: This study aimed to assess the physical, psychological, and economic burden shouldered by severely injured two-wheel users in three European countries as well as the cost resulting from their hospitalization. Methods: A total of seven public hospitals were involved in three countries: Greece, Italy, and Germany. Participants enrolled during a 12-month period starting in April 2013. Eligibility criteria included an injury sustained at Road Traffic Crashes (RTC) irrespective of the type of vehicle, hospitalization 1 day in the Intensive Care Unit (ICU) or sub-ICU, and age 18 years or over. Patients were interviewed at 1, 6, and 12 months upon admission. The study used widely recommended classifications for injury severity (Abbreviated Injury Severity [AIS]; Maximum Abbreviated Injury Severity [MAIS]) and standardized measures such as the Disability Assessment Schedule II (WHODAS 2.0), “Impact of Event Scale” (IES-R), Center for Epidemiological Studies Depression Scale (CES-D Scale). Health Care Expenditure was assessed through the Monash University Accident Research Centre (MUARC's) framework, which included measures of ‘Direct’ and ‘Indirect’ costs. Diagnosis-related groups (DRGs) were used to estimate hospitalization costs. Results: A total of 54 two-wheel users enrolled in the study in all the countries and 32 completed all follow-up questionnaires. Physical disability increased over 12 months following the injury. Post Traumatic Stress Disorder (PTSD) symptoms of avoidance remained at high levels over the study period. PTSD symptoms of intrusion improved significantly during the second half of the year under investigation. The total annual cost of injury for the two-wheel users who were hospitalized in the selected ICU of all the partner countries for severe injury in 2013/2014, was estimated at €714,491 made up of €123,457 direct and €591,034 indirect costs. Men, aged 50–64 years and those who sustained slight injuries primarily at the lower extremities presented higher indirect costs per person. A total of €1032.092 was spent on hospitalization payments. Women, aged 65 + and those who sustained severe injuries at the central body region presented higher direct costs per person. Women, aged 50–64 years, those with severe injuries and a major injury at the central body and the upper body region presented the highest hospitalization costs per person. Conclusions: There is a need for effective strategies to early detect and treat groups at risk of being confronted with prolonged psychosocial and economic consequences. Practical implications: A holistic understanding of the impact of injury on individuals is important in order to achieve effective treatment of psychological co-morbidities in a timely manner.     

Unintentional injury deaths in children and youth, 2010–2019

Background: Unintentional injuries are the leading cause of death for children and youth aged 1–19 in the United States. The purpose of this report is to describe how unintentional injury death rates among children and youth aged 0–19 years have changed during 2010–2019. Method: CDC analyzed 2010–2019 data from the National Vital Statistics System (NVSS) to determine two-year average annual number and rate of unintentional injury deaths for children and youth aged 0–19 years by sex, age group, race/ethnicity, mechanism, county urbanization level, and state. Results: From 2010–2011 to 2018–2019, unintentional injury death rates decreased 11% overall—representing over 1,100 fewer annual deaths. However, rates increased among some groups—including an increase in deaths due to suffocation among infants (20%) and increases in motor-vehicle traffic deaths among Black children (9%) and poisoning deaths among Black (37%) and Hispanic (50%) children. In 2018–2019, rates were higher for males than females (11.3 vs. 6.6 per 100,000 population), children aged < 1 and 15–19 years (31.9 and 16.8 per 100,000) than other age groups, among American Indian or Alaska Native (AIAN) and Blacks than Whites (19.4 and 12.4 vs. 9.0 per 100,000), motor-vehicle traffic (MVT) than other causes of injury (4.0 per 100,000), and rates increased as rurality increased (6.8 most urban [large central metro] vs. 17.8 most rural [non-core/non-metro] per 100,000). From 2010–2011 to 2018–2019, 49 states plus DC had stable or decreasing unintentional injury death rates; death rates increased only in California (8%)—driven by poisoning deaths. Conclusion and Practical Application: While the overall injury death rates improved, certain subgroups and their caregivers can benefit from focused prevention strategies, including infants and Black, Hispanic, and AIAN children. Focusing effective strategies to reduce suffocation, MVT, and poisoning deaths among those at disproportionate risk could further reduce unintentional injury deaths among children and youth in the next decade.     

Traumatic brain injury mortality among U.S. children and adolescents ages 0–19 years, 1999–2017

IntroductionTo examine recent traumatic brain injury (TBI) mortality changes among Americans aged 0–19 years by sex, age, urbanicity, state, and intent/causes of injury. Method: TBI mortality per 100,000 population and average annual percent changes (AAPCs), plus 95% confidence intervals (CIs) based on Joinpoint regression models. Results: Age-adjusted TBI mortality among Americans aged 0–19 years declined consistently, though at varying rates between 1999 and 2013 (AAPC = −4.8%, 95%CI: −6.3%, −3.2%), and then significantly increased from 4.42 per 100,000 population in 2013 to 5.17 per 100,000 population in 2017 (AAPC = 3.4%, 95% CI: 1.7%, 5.1%). During the study time period, boys, rural children, and youth aged 15–19 years had higher TBI mortality rates than girls, urban children, and younger children, respectively. TBI mortality from unintentional transport crashes decreased substantially in all age groups between 1999 and 2017, and especially from 1999 to 2010. TBI mortality from suicide increased significantly from 2008 to 2017 in the 10–14-year age group (AAPC = 14.6%, 95% CI: 12.6%, 16.6%) and from 2007 to 2017 in the 15–19-year age group (AAPC = 6.3%, 95% CI: 3.8%, 8.7%). Unintentional transport crashes were the leading cause of TBI-related mortality in 46 states in 1999, but by 2017, suicide became the first leading cause in 14 states. Conclusions: Pediatric TBI mortality declined consistently between 1999 and 2013 and increased significantly from 2013 to 2017, driven primarily by the mortality decrease from unintentional transport crashes and increase in suicide mortality. The spectrum of leading causes of pediatric TBI mortality changed across age groups and over time from 1999 to 2017. Practical Applications: TBI mortality increases in the United States since 2013 are driven primarily by increasing suicide rates, a trend that merits the attention of policy-makers and injury researchers. Action should be taken to curb growing TBI mortality rates among adolescents aged 10–19 years.     

Injuries and risk-taking behaviours in Portuguese adolescents: Highlights from the health behaviour in school-aged children survey

Aim

Injuries in adolescence are an important public health problem and a major cause of morbidity and mortality in this age group. This study aimed to determine the behaviour profile associated to risk of injury and the differences between genders, region and ethnic origin.

Methods

A cross-sectional study design of a nationally representative sample of 1581 adolescents of the Portuguese Health Behaviour in School-Aged Children study.

Results

An occurrence of one injury-related event in the previous year was reported by 21.4% of the respondents and 5.9% referred having more than one injury-related event. Boys reported higher frequency of those events when compared to girls, and non-Portuguese subjects referred higher frequency of events. Scoring higher in violence-related behaviour and psychosomatic complaints was associated to higher chances of referring more than one injury-related event.

Conclusion

Gender, social background and behaviour profile are factors that seem to influence the risk of injuries. This information should guide those involved in the planning of injuries prevention programs in youth.