New Methodology for an Expert-Designed Map From International Classification of Diseases (ICD) to Abbreviated Injury Scale (AIS) 3+ Severity Injury

Objective: There has been a longstanding desire for a map to convert International Classification of Diseases (ICD) injury codes to Abbreviated Injury Scale (AIS) codes to reflect the severity of those diagnoses. The Association for the Advancement of Automotive Medicine (AAAM) was tasked by European Union representatives to create a categorical map classifying diagnoses codes as serious injury (Abbreviated Injury Scale [AIS] 3+), minor/moderate injury (AIS 1/2), or indeterminate. This study's objective was to map injury-related ICD-9-CM (clinical modification) and ICD-10-CM codes to these severity categories.

Methods: Approximately 19,000 ICD codes were mapped, including injuries from the following categories: amputations, blood vessel injury, burns, crushing injury, dislocations/sprains/strains, foreign body, fractures, internal organ, nerve/spinal cord injury, intracranial, laceration, open wounds, and superficial injury/contusion. Two parallel activities were completed to create the maps: (1) An in-person expert panel and (2) an electronic survey. The panel consisted of expert users of AIS and ICD from North America, the United Kingdom, and Australia. The panel met in person for 5 days, with follow-up virtual meetings to create and revise the maps. Additional qualitative data were documented to resolve potential discrepancies in mapping. The electronic survey was completed by 95 injury coding professionals from North America, Spain, Australia, and New Zealand over 12 weeks. ICD-to-AIS maps were created for: ICD-9-CM and ICD-10-CM. Both maps indicated whether the corresponding AIS 2005/Update 2008 severity score for each ICD code was AIS 3+, 1/2, or indeterminable. Though some ICD codes could be mapped to multiple AIS codes, the maximum severity of all potentially mapped injuries determined the final severity categorization.

Results: The in-person panel consisted of 13 experts, with 11 Certified AIS specialists (CAISS) with a median of 8 years and an average of 15 years of coding experience. Consensus was reached for AIS severity categorization for all injury-related ICD codes. There were 95 survey respondents, with a median of 8 years of injury coding experience. Approximately 15 survey responses were collected per ICD code. Results from the 2 activities were compared, and any discrepancies were resolved using additional qualitative and quantitative data from the in-person panel and survey results, respectively.

Conclusions: Robust maps of ICD-9-CM and ICD-10-CM injury codes to AIS severity categories (3+ versus <3) were successfully created from an in-person panel discussion and electronic survey. These maps provide a link between the common ICD diagnostic lexicons and the AIS severity coding system and are of value to injury researchers, public health scientists, and epidemiologists using large databases without available AIS coding.     

Utilization of state-wide hospital separations data and the injury impairment scale to assess the incidence of spinal cord injury arising from motor vehicle traffic crashes

The objectives of this study were to determine whether routine state-wide hospitalization data can be used for population level surveillance of the incidence of spinal cord injury (SCI) from motor vehicle traffic crashes (MVTCs) and to verify the coverage of the Australian Spinal Cord Injury Register. A method was developed to identify new injury incidents from routine South Australian hospitalization data. Mapping software was then used to derive the Abbreviated Injury Scale (AIS) and Injury Impairment Scale (IIS) codes for each incident case of spinal injury using the principal diagnosis code on the hospital data file. IIS code values in the range from 3 to 6 were considered to be comparable with the SCI coding criteria utilized by the Australian Spinal Cord Injury Register (ASCIR) which were based on the criteria of the American Spinal Injury Association. The number of estimated new incident cases of SCI based on the IIS coding of hospitalization data was compared with the actual number reported from the ASCIR. The case numbers were highly comparable overall and also by time and age group suggesting that the coverage of the ASCIR was very high. The results of the study support use of the IIS for estimating incident case numbers of MVTC-related SCI from routine state-wide hospitalization data. If routine hospital separations data elsewhere were suitable for the purpose and the IIS also proves to be applicable to non-MVTC-related SCI, the incidence of SCI could be monitored in state and national populations using the IIS and this could provide an alternative data source where registers of SCI do not exist. In addition, the IIS provides a means to assess coverage where registers do exist.     

Bayesian decision support for coding occupational injury data

IntroductionStudies on autocoding injury data have found that machine learning algorithms perform well for categories that occur frequently but often struggle with rare categories. Therefore, manual coding, although resource-intensive, cannot be eliminated. We propose a Bayesian decision support system to autocode a large portion of the data, filter cases for manual review, and assist human coders by presenting them top k prediction choices and a confusion matrix of predictions from Bayesian models.MethodWe studied the prediction performance of Single-Word (SW) and Two-Word-Sequence (TW) Naïve Bayes models on a sample of data from the 2011 Survey of Occupational Injury and Illness (SOII). We used the agreement in prediction results of SW and TW models, and various prediction strength thresholds for autocoding and filtering cases for manual review. We also studied the sensitivity of the top k predictions of the SW model, TW model, and SW–TW combination, and then compared the accuracy of the manually assigned codes to SOII data with that of the proposed system.ResultsThe accuracy of the proposed system, assuming well-trained coders reviewing a subset of only 26% of cases flagged for review, was estimated to be comparable (86.5%) to the accuracy of the original coding of the data set (range: 73%–86.8%). Overall, the TW model had higher sensitivity than the SW model, and the accuracy of the prediction results increased when the two models agreed, and for higher prediction strength thresholds. The sensitivity of the top five predictions was 93%.ConclusionsThe proposed system seems promising for coding injury data as it offers comparable accuracy and less manual coding.Practical ApplicationsAccurate and timely coded occupational injury data is useful for surveillance as well as prevention activities that aim to make workplaces safer.     

First aid training in secondary schools: A comparative study and implementation considerations

Introduction: School-based first aid training has benefits for adolescents with an opportunity to increase health and safety knowledge relating to injury and cardiac arrest. Method: Using a quasi-experimental design we evaluated differences among students (M_age = 13.46 years, 55% female) taught first aid through the Skills for Preventing Injury in Youth (SPIY) program (n = 1942), treatment-as-usual school-based first aid training (n = 675), and students who did not receive first aid training (n = 489). Results: Results showed significant differences in self-reported knowledge scores at twelve-month follow-up (controlling for baseline knowledge). Students in the SPIY group and the treatment-as-usual first aid group had higher total scores than the control group. Teachers and students reported positive perceptions to first aid study, in particular the interactive delivery and scenarios for contextualizing information. Practical Applications: The study provides support for the retention of first aid knowledge up to 12-months and thus the inclusion and feasibility of first aid training in secondary school curriculum.     

Workers’ compensation claim counts and rates by injury event/exposure among state-insured private employers in Ohio, 2007–2017

Introduction: This study analyzed workers’ compensation (WC) claims among private employers insured by the Ohio state-based WC carrier to identify high-risk industries by detailed cause of injury. Methods: A machine learning algorithm was used to code each claim by U.S. Bureau of Labor Statistics (BLS) event/exposure. The codes assigned to lost-time (LT) claims with lower algorithm probabilities of accurate classification or those LT claims with high costs were manually reviewed. WC data were linked with the state’s unemployment insurance (UI) data to identify the employer’s industry and number of employees. BLS data on hours worked per employee were used to estimate full-time equivalents (FTE) and calculate rates of WC claims per 100 FTE. Results: 140,780 LT claims and 633,373 medical-only claims were analyzed. Although counts and rates of LT WC claims declined from 2007 to 2017, the shares of leading LT injury event/exposures remained largely unchanged. LT claims due to Overexertion and Bodily Reaction (33.0%) were most common, followed by Falls, Slips, and Trips (31.4%), Contact with Objects and Equipment (22.5%), Transportation Incidents (7.0%), Exposure to Harmful Substances or Environments (2.8%), Violence and Other Injuries by Persons or Animals (2.5%), and Fires and Explosions (0.4%). These findings are consistent with other reported data. The proportions of injury event/exposures varied by industry, and high-risk industries were identified. Conclusions: Injuries have been reduced, but prevention challenges remain in certain industries. Available evidence on intervention effectiveness was summarized and mapped to the analysis results to demonstrate how the results can guide prevention efforts. Practical Applications: Employers, safety/health practitioners, researchers, WC insurers, and bureaus can use these data and machine learning methods to understand industry differences in the level and mix of risks, as well as industry trends, and to tailor safety, health, and disability prevention services and research.     

Advancing injury and violence prevention through data science

Introduction: The volume of new data that is created each year relevant to injury and violence prevention continues to grow. Furthermore, the variety and complexity of the types of useful data has also progressed beyond traditional, structured data. In order to more effectively advance injury research and prevention efforts, the adoption of data science tools, methods, and techniques, such as natural language processing and machine learning, by the field of injury and violence prevention is imperative. Method: The Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control has conducted numerous data science pilot projects and recently developed a Data Science Strategy. This strategy includes goals on expanding the availability of more timely data systems, improving rapid identification of health threats and responses, increasing access to accurate health information and preventing misinformation, improving data linkages, expanding data visualization efforts, and increasing efficiency of analytic and scientific processes for injury and violence, among others. Results: To achieve these goals, CDC is expanding its data science capacity in the areas of internal workforce, partnerships, and information technology infrastructure. Practical Application: These efforts will expand the use of data science approaches to improve how CDC and the field address ongoing injury and violence priorities and challenges.     

The use of state workers' compensation administrative data to identify injury scenarios and quantify costs of work-related traumatic brain injuries

PROBLEM: Traumatic brain injury (TBI) is a public health problem but little is known about the nature of that problem in the working population. METHOD: The author used a national definition to identify cases in Washington State from workers' compensation (WC) hospital billing data, quantified the cost of WC insurance benefits using actuarial cost estimates, and identified high risk industries using ANSI Z16.2 typology. RESULTS: There were 928 cases of TBI with a lifetime claim cost of $159 million from the Washington State Fund (1994-2001). Sixty percent of injuries resulted in death or disability. The highest risks of TBI are concentrated in 16 industrial insurance risk classes and the highest costs in 19 North American Industry Classification codes. Injury scenarios were identified for nine industrial insurance risk classes. CONCLUSIONS: TBI is a disabling and costly workplace injury in the state of Washington, affecting even teenagers and seniors who are not generally considered to be part of the workforce. Injury typology codes provide useful information for improving workplace safety. IMPACT ON INDUSTRY: This research provides industry with quantitative information regarding the cost of work-related traumatic brain injury and the usefulness of using workers' compensation claims data to reduce the burden of workplace injury.     

Coverage of motor vehicle crashes with injuries in U.S. newspapers, 1999-2002

Problem

The aims of the study were to evaluate information on motor-vehicle crashes with injuries provided in newspaper reports and to assess the frequency of thematic and episodic reporting of motor-vehicle crashes.

Method

The study used Fatal Analysis Reporting System (FARS) derived variables to code a nationally representative sample of U.S. newspaper reports of motor-vehicle crashes from 1999-2002. A total of 473 newspaper reports of motor-vehicle crashes with injuries were included. Information on the crash event, people involved, and vehicles was extracted. The reports were coded for episodic and thematic news framing.

Results

A majority of newspaper reports used episodic framing. The majority of reports included information on the type of crash, but characteristics about people and vehicles were rarely reported.

Discussion

Lack of information in newspapers makes them an incomplete source from which to influence public perceptions and attitudes.

Impact on industry

This provides an opportunity for news print media to improve public health content.

Impact on industry

Newspapers represent an important source of public information; they are, however, an incomplete source [Voight, B., Lapidus, G., Zavoski, R., & Banco, L. (1998). Injury reporting in Connecticut newspapers. Injury Prevention, 4, 292-294.; Baullinger, J., Quan, L., Bennett, E., Cummings, P., & Williams, K. (2001). Use of Washington state newspaper for submersion injury surveillance. Injury Prevention, 7, 339-342]. To increase the accuracy of information provided to the public through media sources, there is a need for increased communication between public health professionals and reporters.The results of this study raise concerns about the contents of motor-vehicle crash information provided in newspapers and suggest that newspapers do not provide information to allow public perception to be in accord with the importance of motor-vehicle crash injuries and health promoting actions to reduce risk of injury. More balanced and detailed information in newspapers would provide an opportunity for news print media to improve public health programs and public perception about the impact of motor-vehicle crashes on safety for all.     

Continued progress in the prevention of nail gun injuries among apprentice carpenters: What will it take to see wider spread injury reductions?

Problem

Nail guns are a common source of acute, and potentially serious, injury in residential construction.

Method

Data on nail gun injuries, hours worked and hours of tool use were collected in 2008 from union apprentice carpenters (n = 464) through classroom surveys; this completed four years of serial cross-sectional data collection from apprentices. A predictive model of injury risk was constructed using Poisson regression.

Results

Injury rates declined 55% from baseline measures in 2005 with early training and increased use of tools with sequential actuation. Injury rates declined among users of tools with both actuation systems, but the rates of injury were consistently twice as high among those using tools with contact trip triggers.

Discussion and impact

Nail gun injuries can be reduced markedly through early training and use of tools with sequential actuation. These successful efforts need to be diffused broadly, including to the non-union sector.     

Beach and patio umbrella injuries treated at emergency departments

Introduction: Beach and patio umbrellas may cause injury. There is limited published information on injuries due to beach and patio umbrellas. This study sought to describe beach and patio umbrella injuries reported to United States emergency departments (EDs). Method: An analysis was performed of beach and patio umbrella injuries using data from the National Electronic Injury Surveillance System during 2000–2019. Results: An estimated 5,512 beach umbrella injuries and 7,379 patio umbrella injuries were identified. The patient was age 40 years or older in 62.1% of the beach umbrella and 65.1% of the patio umbrella injuries. The patient was female in 68.0% of the beach umbrella and 66.9% of the patio umbrella injuries. Wind was reported involved in 50.6% of the beach umbrella and 27.5% of the patio umbrella injuries. The most frequently reported injuries with beach and patio umbrella injuries, respectively, were laceration (44.0% vs 33.0%), contusions or abrasions (19.8% vs 19.0%), and internal organ injury (16.6% vs 17.0%) and most often affected the head/neck (60.2% vs 44.0%) and upper extremity (16.3% vs 30.1%). Conclusions: The majority of patients with beach and patio umbrella injuries treated at EDs were age 40 years or older and most patients were female. For both types of umbrella injury, the most frequently reported injury was laceration followed by contusions or abrasions and internal organ injury, and the body part with the highest proportion of injuries was the head/neck followed by the upper extremity. Practical Applications: Persons should use sturdier models of beach or patio umbrella, use a rocking motion to dig into the sand and secure the beach umbrella with a metal anchor and screws, add weight to the bottom of the umbrella, and tilt the umbrella into the wind. Policy-makers should educate the public about the potential dangers of beach and patio umbrellas.     

Injury surveillance trends in career–technical education: New Jersey 1999–2018

Introduction: Adolescents engaging in school-sponsored work experiences may be at risk of injury due to factors such as inexperience. This article examines trends in 20 years of reported injuries among New Jersey (NJ) adolescents engaging in school-sponsored work experiences, and compares a transition from paper to online reporting format. Methods: New Jersey requires reporting of injuries occurring during school-sponsored work experiences to the NJ Department of Education. Injuries reported by NJ schools from 1999 to 2018 (n = 2,119) were examined; incidence rates for 2008 to 2018 (n = 743) were calculated using publicly available NJ Department of Education enrollment data for the denominator, including for specific groups of students: career and technical education; special healthcare needs. Results: A downward trend in reported injuries in NJ schools was observed. However, the year online reporting became required by code (2013), an increase of nearly 50% was seen from 2012 (59–89), followed by a decline in reported incidents 2014 to 2018 (mean = 65, range 76 down to 47). Injury rate trends over time paralleled those of reported incidents. Conclusions: This study suggested worker safety and public health benefits of improvements from State of NJ code required training programs and online injury surveillance report form. Practical Applications: One potential method to address the safety and health of adolescents engaging in work experiences is the use of online reporting forms, to aid in surveillance efforts, coupled with occupational safety and health training specifically geared toward teachers and administrators who both supervise young, relatively inexperienced and vulnerable workers and who make relatively frequent worksite visits. Incorporation of specific details of the instructions on the use of a reporting form into required trainings, in addition to providing a clear, accessible guidance manual online, could further help improve youth worker safety surveillance efforts.     

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.     

Estimated Injury Risk for Specific Injuries and Body Regions in Frontal Motor Vehicle Crashes

Objective: Injury risk curves estimate motor vehicle crash (MVC) occupant injury risk from vehicle, crash, and/or occupant factors. Many vehicles are equipped with event data recorders (EDRs) that collect data including the crash speed and restraint status during a MVC. This study's goal was to use regulation-required data elements for EDRs to compute occupant injury risk for (1) specific injuries and (2) specific body regions in frontal MVCs from weighted NASS-CDS data.

Methods: Logistic regression analysis of NASS-CDS single-impact frontal MVCs involving front seat occupants with frontal airbag deployment was used to produce 23 risk curves for specific injuries and 17 risk curves for Abbreviated Injury Scale (AIS) 2+ to 5+ body region injuries. Risk curves were produced for the following body regions: head and thorax (AIS 2+, 3+, 4+, 5+), face (AIS 2+), abdomen, spine, upper extremity, and lower extremity (AIS 2+, 3+). Injury risk with 95% confidence intervals was estimated for 15–105 km/h longitudinal delta-Vs and belt status was adjusted for as a covariate.

Results: Overall, belted occupants had lower estimated risks compared to unbelted occupants and the risk of injury increased as longitudinal delta-V increased. Belt status was a significant predictor for 13 specific injuries and all body region injuries with the exception of AIS 2+ and 3+ spine injuries. Specific injuries and body region injuries that occurred more frequently in NASS-CDS also tended to carry higher risks when evaluated at a 56 km/h longitudinal delta-V. In the belted population, injury risks that ranked in the top 33% included 4 upper extremity fractures (ulna, radius, clavicle, carpus/metacarpus), 2 lower extremity fractures (fibula, metatarsal/tarsal), and a knee sprain (2.4–4.6% risk). Unbelted injury risks ranked in the top 33% included 4 lower extremity fractures (femur, fibula, metatarsal/tarsal, patella), 2 head injuries with less than one hour or unspecified prior unconsciousness, and a lung contusion (4.6–9.9% risk). The 6 body region curves with the highest risks were for AIS 2+ lower extremity, upper extremity, thorax, and head injury and AIS 3+ lower extremity and thorax injury (15.9–43.8% risk).

Conclusions: These injury risk curves can be implemented into advanced automatic crash notification (AACN) algorithms that utilize vehicle EDR measurements to predict occupant injury immediately following a MVC. Through integration with AACN, these injury risk curves can provide emergency medical services (EMS) and other patient care providers with information on suspected occupant injuries to improve injury detection and patient triage.     

Validating the underlying assumption of quasi-induced exposure technique disaggregated by crash injury severity

Introduction: Quasi-induced exposure (QIE) technique has been popularly applied in the field of traffic safety research for decades. One of the basic assumptions of QIE theory is that the not-at-fault driving parties (D2s) involved in the crashes are the random selection of overall driving population at the event of crash occurrence. Very few literatures, however, can be identified to validate the assumption for crashes with specific injury severities that may not be satisfied in reality. Method: The study aims to check the validity of the assumption categorized by crash injury severity with the use of Michigan crash data. Latent class analysis is employed to generate several latent classes for the crashes with specific injury outcomes. Chi-square test is adopted to identify the significance of the similarity of D2 distributions among the latent classes. Results: The results indicate that: (a) for fatal crashes the statistical tests do not identify the significant discrepancies for D2 distributions of driver gender, age, and vehicle type between latent classes; (b) for injury crashes, both D2 driver gender and age have the similar distributions between/among various classes, while the D2 vehicle types show the inconsistent distributions; and (c) with respect to property damage only crashes, the distributions of three vehicle-driver characteristics are significantly different among the latent classes. It implies that the underlying assumption may not entirely hold true for all the injury severities and driver-vehicle characteristics. Practical Applications: The findings pinpoint the applicability of the QIE technique under specific scenarios and highlight the importance of validating the underlying assumption of QIE prior to its application.     

Occupational injury rates among Norwegian farmers: A sociotechnical perspective

Introduction: This study addressed relative injury risk among Norwegian farmers, who are mostly self-employed and run small farm enterprises. The aim was to explore the relative importance of individual, enterprise, and work environment risks for occupational injury and to discuss the latent conditions for injuries using sociotechnical system theory. Method: Injury report and risk factors were collected through a survey among Norwegian farm owners in November 2012. The response rate was 40% (n = 2,967). Annual work hours were used to calculate injury rates within groups. Poisson regression using the log of hours worked as the offset variable allowed for the modeling of adjusted rate ratios for variables predictive of injury risk. Finally, safety climate measures were introduced to assess potential moderating effects on risk. Results: Results showed that the most important risk factors for injuries were the design of the workplace, type of production, and off-farm work hours. The main results remained unchanged when adding safety climate measures, but the measures moderated the injury risk for categories of predominant production and increased the risk for farmers working with family members and/or employees. An overall finding is how the risk factors were interrelated. Conclusions: The study identified large structural diversities within and between groups of farmers. The study drew attention to operating conditions rather than individual characteristics. The farmer’s role (managerial responsibility) versus regulation and safety climate is important for discussions of injury risk. Practical Applications: We need to study sub-groups to understand how regulation and structural changes affect work conditions and management within different work systems, conditioned by production. It is important to encourage actors in the political-economic system to become involved in issues that were found to affect the safety of farmers.     

Attitude and behaviour of junior rugby union players towards tackling during training and match play

The tackle event in rugby, places both ball-carrier and tackler at a high risk of injury at all levels of play. To reduce this risk of injury, risk factors need to be identified. Attitude and behaviour have been identified as risk factors for injury in other sports, and probably also have a role in rugby. The purpose of this study was to assess the attitude and behaviour of players in training and match play with regards to safety and performance. A questionnaire was designed to assess attitude (importance) and behaviour (frequency and quantity) among junior (under 19) players on a 5-point Likert Scale. Questionnaires were handed out to 220 players (10 schools) at a tournament and 75% (9 schools, n = 164) were returned for analysis. During training and match play, players’ mean ratings were higher for improving performance than for injury prevention. However, a level of importance was evident for injury prevention. When executing a tackle the aim is to dominate the contact situation and prevent the ball-carrier from gaining territory and retaining the ball. Therefore, players, coaches and administrators need to find the most suitable balance between injury prevention and performance during training within their team setting. This process may be facilitated by modifying the current equipment and training drills used to train the tackle, and the time of season during which tackle technique training occurs. Equally important, players should learn proper tackle technique at a younger age, with the importance of safety emphasised from all information sources.     

The intercoder agreement when using the Driving Reliability and Error Analysis Method in road traffic accident investigations

Many different classification schemes have been used in the analysis of road traffic accidents but the agreement between coders using the same classification scheme is rarely tested and/or reported. As a high intercoder agreement is a prerequisite for a study’s validity, this is a serious shortcoming. The aim of the present study was, therefore, to test the intercoder agreement of the Driving Reliability and Error Analysis Method (DREAM) version 3.0 by letting seven coders from different European countries analyse and classify the causes of the same four accident scenarios. The results showed that the intercoder agreement for genotypes (contributing factors) ranges from 74% to 94% with an average of 83%, while for phenotypes (observable effects) it ranges from 57% to 100% with an average of 78%. The results also showed that weaknesses in classification schemes, methods, training of coders as well as in presentation of accident information can be identified by testing the intercoder agreement.     

Fall-related traumatic brain injury in children ages 0–4 years

Introduction: Falls are the leading cause of traumatic brain injury (TBI) for children in the 0–4 year age group. There is limited literature pertaining to fall-related TBIs in children age 4 and under and the circumstances surrounding these TBIs. This study provides a national estimate and describes actions and products associated with fall-related TBI in this age group. Method: Data analyzed were from the 2001–2013 National Electronic Injury Surveillance System–All Injury Program (NEISS–AIP), a nationally representative sample of emergency departments (ED). Case narratives were coded for actions associated with the fall, and product codes were abstracted to determine fall location and product type. All estimates were weighted. Results: An estimated 139,001 children younger than 5 years were treated annually in EDs for nonfatal, unintentional fall-related TBI injuries (total = 1,807,019 during 2001–2013). Overall, child actions (e.g., running) accounted for the greatest proportion of injuries and actions by others (e.g., carrying) was highest for children younger than 1 year. The majority of falls occurred in the home, and involved surfaces, fixtures, furniture, and baby products. Conclusions: Fall-related TBI in young children represents a significant public health burden. The majority of children seen for TBI assessment in EDs were released to home. Prevention efforts that target parent supervision practices and the home environment are indicated. Practical applications: Professionals in contact with parents of young children can remind them to establish a safe home and be attentive to the environment when carrying young children to prevent falls.     

Injury outcomes and costs for cross-median and median barrier crashes

Introduction

The objective of this research was to quantify the injury outcomes and develop reliable and comprehensive injury costs for cross-median crashes (CMC) and median barrier crashes (MBC).

Method

A three-step methodology was developed to quantify the crash costs for each crash severity and type. All CMC and MBC between 2001 and 2007 in Wisconsin were identified and used in this analysis. The Wisconsin CODES database provided comprehensive injury costs based on the injury types and severities suffered by participants in study crashes.

Results

As expected, multi-vehicle CMC result in more total injuries and more severe injuries than single-vehicle CMC. Injury costs for the same injury level on KABCO scale are different for different crash types. Injury costs for concrete MBC are 33% to 50% less than those of multi-vehicle CMC, while the injury costs of concrete MBC for lower severities (B and C) are similar to those of single-vehicle CMC for the same severities; but for incapacitating injuries the costs are 30% less. As expected, concrete MBC result in lower severities than CMC. The costs, by crash severity, vary significantly between different crash types. Concrete median barrier injury crashes are roughly 20% of multi-vehicle CMC costs and 50% of single-vehicle CMC costs.

Conclusions

Results indicate that using one set of crash costs for all crash types biases any evaluation. Therefore, it is recommended that crash-type-specific costs be used in applications such as development of median barrier warrant where specific types of crashes are considered (CMC and MBC).

Impact on industry

Using crash specific costs can lead to a more realistic benefit-cost analysis and enable better decision-making.