Search

Abstract Introduction Mortality due to injuries disproportionately impact low income countries. Knowledge of who is at risk of poor outcomes is critical to guide resource allocation and prioritization of severely injured. Kampala Trauma Score (KTS), developed in 1996 and last modified in 2002 as KTS II, is still widely being used to predict injury outcomes in resource-limited settings with no further revisions in the past two decades, despite ongoing criticism of some of its parameters. The New Trauma Score (NTS), a recent development in 2017, has shown potential in mortality prediction, but a dearth of evidence exist regarding its performance in the African population. Objectives To compare NTS to the modified Kampala Trauma Score (KTS II) in the prediction of 30-day mortality, and injury severity amongst patients sustaining road traffic crashes in Ugandan low-resource settings. Methods Multi-center prospective cohort study of patients aged 15 years and above. Of the 194 participants, 85.1% were males with a mean age of 31.7 years. NTS and KTS II were determined for each participant within 30-minutes of admission and followed-up for 30 days to determine their injury outcomes. The sensitivity, specificity, and area under receiver operating characteristics curve (AUC) for predicting mortality were compared between the two trauma scores using SPSS version 22. Ethical clearance: Research and Ethics Committee of Kampala International University Western Campus (Ref No: KIU-2022-125). Results The injury severity classifications based on NTS vs. KTS II were mild (55.7% vs. 25.8%), moderate (29.9% vs. 30.4%), and severe (14.4% vs. 43.8%). The mortality rates for each injury severity category based on NTS vs. KTS II were mild (0.9% v 0%), moderate (20.7% vs. 5.1%), and severe (50% vs. 28.2%). The AUC was 0.87 for NTS (95% CI 0.808–0.931) vs. 0.86 (95% CI 0.794–0.919) for KTS II respectively. The sensitivity of NTS vs. KTS II in predicting mortality was 92.6% (95% CI: 88.9–96.3) vs. 70.4% (95% CI: 63.0-77.8) while the specificity was 70.7% (95% CI: 64.2–77.2) vs. 78.4% (95% CI: 72.1–84.7) at cut off points of 17 for NTS and 6 for KTS II respectively. Conclusions NTS was more sensitive but its specificity for purposes of 30-day mortality prediction was lower compared to KTS II. Thus, in low-resourced trauma environment where time constraints and pulse oximeters are of concern, KTS II remains superior to NTS.

Introduction: Mortality due to injuries disproportionately impact low income countries. Knowledge of who is at risk of poor outcomes is critical to guide resource allocation and prioritization of severely injured. Kampala Trauma Score (KTS), developed in 1996 and last modified in 2002 as KTS II, is still widely being used to predict injury outcomes in resource-limited settings with no further revisions in the past two decades, despite ongoing criticism of some of its parameters. The New Trauma Score (NTS), a recent development in 2017, has shown potential in mortality prediction, but a dearth of evidence exist regarding its performance in the African population. Objectives: To compare NTS to the modified Kampala Trauma Score (KTS II) in the prediction of 30-day mortality, and injury severity amongst patients sustaining road traffic crashes in Ugandan low-resource settings. Methods: Multi-center prospective cohort study of patients aged 15 years and above. Of the 194 participants, 85.1% were males with a mean age of 31.7 years. NTS and KTS II were determined for each participant within 30-minutes of admission and followed-up for 30 days to determine their injury outcomes. The sensitivity, specificity, and area under receiver operating characteristics curve (AUC) for predicting mortality were compared between the two trauma scores using SPSS version 22. Ethical clearance: Research and Ethics Committee of Kampala International University Western Campus (Ref No: KIU-2022-125). Results: The injury severity classifications based on NTS vs. KTS II were mild (55.7% vs. 25.8%), moderate (29.9% vs. 30.4%), and severe (14.4% vs. 43.8%). The mortality rates for each injury severity category based on NTS vs. KTS II were mild (0.9% v 0%), moderate (20.7% vs. 5.1%), and severe (50% vs. 28.2%). The AUC was 0.87 for NTS (95% CI 0.808–0.931) vs. 0.86 (95% CI 0.794–0.919) for KTS II respectively. The sensitivity of NTS vs. KTS II in predicting mortality was 92.6% (95% CI: 88.9–96.3) vs. 70.4% (95% CI: 63.0-77.8) while the specificity was 70.7% (95% CI: 64.2–77.2) vs. 78.4% (95% CI: 72.1–84.7) at cut off points of 17 for NTS and 6 for KTS II respectively. Conclusions: NTS was more sensitive but its specificity for purposes of 30-day mortality prediction was lower compared to KTS II. Thus, in low-resourced trauma environment where time constraints and pulse oximeters are of concern, KTS II remains superior to NTS. [ABSTRACT FROM AUTHOR]

Background: In 2009, Gary and colleagues reviewed prior research examining racial and ethnic differences in outcomes after traumatic brain injury (TBI). Over the past 15 years, advances in research and changes in the demographic composition of the United States warrant a comprehensive understanding of racial and ethnic disparities after TBI. Objective: A systematic review will be conducted to examine racial and ethnic differences in TBI outcomes from 2009 to 2023. Methods: Preliminary searches and study screening processes will identify relevant English-language articles published from January 2009 to December 2023 using the CINAHL, Gale OneFile, PsycINFO (Ovid), and PubMed electronic databases. Relevant articles will include quantitative or mixed method approaches, involve individuals with TBI or their caregivers, and compare 2 or more groups by race or ethnicity on post-TBI outcomes. Quality will be assessed using the Newcastle-Ottawa Scale. This systematic review protocol was developed following PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. Results will be summarized, and a subgroup analysis may be conducted based on demographics (eg, age, gender, or sex). Results: We have already identified abstracts using the search strategy for all 4 of the included electronic databases. We recently updated the search and will begin abstract screening of the additional abstracts identified from the last search completed in January 2024. This systematic review is anticipated to be completed by fall 2024, and its findings will be disseminated to the scientific community, persons with TBI, caregivers, and the lay audience. Conclusions: This systematic review will advance our understanding regarding outcome disparities among minoritized individuals with TBI, examine progress over the past 15 years in minimizing barriers encountered by these racial and ethnic groups, and provide professionals with a roadmap illustrating existing gaps in rehabilitation care, making way for further development and implementation of evidence-based interventions to improve health equity in TBI outcomes. Trial Registration: PROSPERO CRD42023394529; https://tinyurl.com/53mtcz9b International Registered Report Identifier (IRRID): PRR1-10.2196/58763 [ABSTRACT FROM AUTHOR]

BackgroundAthletes in the Women's National Basketball Association (WNBA) and National Basketball Association (NBA) are subject to high injury rates given the physical demands of the sport. Comprehensive data regarding injury patterns and rates in these athletes are limited.PurposeTo summarize available data on orthopaedic and sports medicine-related injuries through 2020 in professional female and male basketball players.Study designSystematic review; Level of evidence, 4.MethodsA search was conducted using PubMed and Embase through April 5, 2020, to identify injury studies regarding WNBA and NBA players. Studies were included if the injury or surgery was considered a direct consequence of game play including musculoskeletal/orthopaedic, concussion, ophthalmologic, and craniomaxillofacial injuries. Systematic reviews, screening studies, or studies without sufficient WNBA or NBA player subgroup analysis were excluded.ResultsA total of 49 studies met inclusion criteria, 43 (87.8%) of which detailed musculoskeletal injuries. The lower extremity represented 63.3% of studies. A majority (59.2%) of studies were level 4 evidence. The source of data was primarily comprehensive online search (n = 33; 67.3%), followed by official databases (n = 11; 22.4%). Only 3 studies concerned WNBA athletes compared with 47 that concerned NBA athletes. The lowest return-to-play rates were cited for Achilles tendon repairs (61.0%-79.5%). Variability in return-to-play rates existed among studies even with similar seasons studied.ConclusionThe majority of literature available on orthopaedic and sports medicine-related injuries of NBA and WNBA athletes is on the lower extremity. The injuries that had the greatest effect on return to play and performance were Achilles tendon ruptures and knee cartilage injuries treated using microfracture. The reported outcomes are limited by heterogeneity and overlapping injury studies. There are limited available data on WNBA injuries specifically.

Abstract Background Injuries can have detrimental impacts on mental health, even after physical recovery. In our Prospective Outcomes of Injury Study (POIS), 25% of participants experienced psychological distress (assessed using the Kessler 6) three months after a sentinel injury event (SIE), declining to 16% at 24 months post-SIE. Internationally, studies of hospitalised patients found distress persisted beyond 24 months post-injury and remained higher than the general population. However, most studies only assessed distress at one timepoint, relied on long-term recall, or were limited to small samples or specific injury types. Therefore, we aim to describe the prevalence of psychological distress 12 years post-SIE and to investigate pre-injury, injury-related and early post-injury characteristics associated with long-term distress. Methods POIS is a longitudinal cohort study of 2856 New Zealanders injured between 2007 and 2009, who were on the national injury insurer, Accident Compensation Corporation entitlement claims’ register. Of these, 2068 POIS participants completed an interview at 24 months and agreed to further contact. They were invited to a follow-up interview 12 years post-SIE which included the Kessler-6 (K6), the psychological distress outcome of interest. Data about a range of pre-injury, injury-related and early (3 months) post-injury characteristics were collected via earlier interviews or administrative data sources (e.g. hospital discharge data). Results Twelve years post-SIE, 1543 (75%) people were re-interviewed and 1526 completed the K6; n = 177 (12%) reported psychological distress. Multivariable modified Poisson regression models found pre-injury characteristics were associated with an increased risk of clinically relevant distress at 12 years, i.e. having inadequate income, identifying as Māori, Pacific or Asian and having one mental health condition. Early post-injury psychological distress and dissatisfaction with social relationships also increased risk. However, being older was associated with a reduced risk of distress. Conclusion Clinically relevant distress persists long-term post-injury among adults with varying injury severity, types and causes, and at higher prevalence than in the general population. Early identification of injured people at risk of long-term psychological distress provides opportunities for timely interventions to reduce psychological distress.

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Injury is a leading cause of disability. Twenty years ago, we knew financial costs of injury were high but little was known about the short, medium and long-term outcomes after injury. In 2006, a Pilot Study and engagement with Māori across the country was undertaken to discuss the planned main study to understand how best to design a study that was meaningful and beneficial to Māori and policy-makers. Between 2007–2009, 2,856 injured New Zealanders (including 20% Māori) with an Accident Compensation Corporation (ACC) entitlement claim were recruited to the Prospective Outcomes of Injury Study (POIS). Participants shared detailed information (at 3, 12 and 24 months, and 12-years post-injury) about a broad range of topics including: the injury, socio-demographics, health, health services access, employment and wellbeing. Administrative data about injury-related hospitalisations, the sentinel injury and subsequent injuries were also collected, as well as in-depth qualitative interviews. This paper focuses on the why, how and impacts of POIS, especially in relation to Māori design and approaches, capability and capacity building, and leadership. Focusing on these aspects for Māori within POIS over time has ensured delivery of findings capable of informing and improving outcomes and policy. In particular, POIS has had considerable impact, influencing ACC's research strategy and outcomes' focus, and has provided disability, health, and wellbeing outcomes knowledge previously unavailable, especially for Māori.

Background: Injuries can have detrimental impacts on mental health, even after physical recovery. In our Prospective Outcomes of Injury Study (POIS), 25% of participants experienced psychological distress (assessed using the Kessler 6) three months after a sentinel injury event (SIE), declining to 16% at 24 months post-SIE. Internationally, studies of hospitalised patients found distress persisted beyond 24 months post-injury and remained higher than the general population. However, most studies only assessed distress at one timepoint, relied on long-term recall, or were limited to small samples or specific injury types. Therefore, we aim to describe the prevalence of psychological distress 12 years post-SIE and to investigate pre-injury, injury-related and early post-injury characteristics associated with long-term distress. Methods: POIS is a longitudinal cohort study of 2856 New Zealanders injured between 2007 and 2009, who were on the national injury insurer, Accident Compensation Corporation entitlement claims' register. Of these, 2068 POIS participants completed an interview at 24 months and agreed to further contact. They were invited to a follow-up interview 12 years post-SIE which included the Kessler-6 (K6), the psychological distress outcome of interest. Data about a range of pre-injury, injury-related and early (3 months) post-injury characteristics were collected via earlier interviews or administrative data sources (e.g. hospital discharge data). Results: Twelve years post-SIE, 1543 (75%) people were re-interviewed and 1526 completed the K6; n = 177 (12%) reported psychological distress. Multivariable modified Poisson regression models found pre-injury characteristics were associated with an increased risk of clinically relevant distress at 12 years, i.e. having inadequate income, identifying as Māori, Pacific or Asian and having one mental health condition. Early post-injury psychological distress and dissatisfaction with social relationships also increased risk. However, being older was associated with a reduced risk of distress. Conclusion: Clinically relevant distress persists long-term post-injury among adults with varying injury severity, types and causes, and at higher prevalence than in the general population. Early identification of injured people at risk of long-term psychological distress provides opportunities for timely interventions to reduce psychological distress. [ABSTRACT FROM AUTHOR]

Lower limb injuries often occur in the offset frontal impact. Besides the knee airbags, increasing the distance between the knee and the knee bolster is also worth being considered to reduce the injury risk of lower limb. An innovative knee bolster assembly was proposed in this study, which can increase the active survival space and reduce the injury risk of the lower extremity in the impact. This study establishes a numerical analysis model with a restrained human body and a car. Furthermore, the muscle function is activated in the lower extremity of the human model to simulate the emergency braking condition. Moreover, five sets of simulations are conducted under 40% offset frontal impact. Results showed that the new developed knee bolster can help to reduce the injury outcomes of the driver though the elastic stiffness of joint in the knee bolster is not play an important role. In detail, the impact force of the human femur could be reduced by more than 28% with the usage of innovative knee bolster assembly and the bending moment is reduced by over 10% compared with the drivers protected by classical knee bolster. Meanwhile, the tibia injury risk is reduced by around 29% through the comparison of tibia index. In terms of ligament performance, it is found that the use of innovative knee bolster assembly could significantly reduce the stretching and elongation change of posterior cruciate ligament. This study could provide a reference for reducing the risk of lower limb injuries for drivers. [ABSTRACT FROM AUTHOR]

Abstract Background Research examining psychological distress in people who have experienced an injury has focused on those with serious injuries or specific injury types, and has not involved long-term follow up. The aims of this investigation were to describe the prevalence of, and factors contributing to, psychological distress in a cohort of people with a broad range of injuries. Methods The Prospective Outcomes of Injury Study (POIS) is a longitudinal cohort study of 2856 injured New Zealanders recruited from a national insurance entitlement claims register between 2007 and 2009. Participants were interviewed approximately 3, 12, and 24 months after their injury. The Kessler Psychological Distress Scale (K6) was used to measure psychological distress at each interview. Results 25% of participants reported clinically relevant distress (K6 ≥ 8) 3 months post-injury, 15% reported distress at 12 months, and 16% reported distress at 24 months. Being 45 years or older, Māori or Pacific ethnicity, experiencing pre-injury mental health conditions, having inadequate pre-injury income, reporting poor pre-injury health or trouble accessing healthcare, having a severe injury or an injury resulting from assault, and reporting clinically relevant distress 3 months post-injury were independently associated with an increased risk of distress 12 months post-injury. The majority of these associations were also evident with respect to distress 24 months post-injury. Conclusions Distress is common after injury among people with a broad range of injury types and severities. Screening for distress early after injury is important to identify individuals in need of targeted support.

Motorcycles are a common mode of transport, especially in low-middle-income countries like Pakistan. The pattern and severity of injuries in motorcycle trauma depends on the mechanism of accident, which may be classified as collision accidents (CAs) or loss-of-control accidents (LOCAs). In this study, we aimed to investigate patterns of trauma due to motorcycle CAs and LOCAs, with a focus on injuries, management, complications, and outcomes. A retrospective cohort study was conducted at the Aga Khan University Hospital (AKUH), Pakistan (a level 1 trauma facility), enrolling all patients presenting with motorcycle trauma between January 2018 and March 2019. The most common sites of major injury were the lower limb (40.9%), head and neck (38.1%), and upper limb (27.5%). A significantly higher percentage of CA victims had head and neck injuries (43.4% vs. 30.5%), abdominal injuries (5.5% vs. 1.1%), pelvic fracture (5.9% vs. 0%), and polytrauma (22.8% vs. 11.1%). Compared to LOCA victims, CA victims had a significantly higher incidence of acute kidney injury (AKI; 25.7% vs. 15.8%; P <.011), longer hospital lengths of stay (LOSs; 3 [2–6] days vs. 2.5 [2–4] days; P =.019), and long-term disability (P =.002). When adjusted for age and gender on multivariable logistic regression with mechanism of accident as the dependent variable, CA was significantly associated with male gender (odds ratio [OR] = 2.045, 95% confidence interval [CI] [1.038–4.026]), abdominal injury (OR = 5.748, 95% CI [1.285–25.702]), head and neck injury (OR = 1.492, 95% CI [1.007–2.211]), polytrauma (OR = 2.368, 95% CI [1.383–4.055]), AKI (OR = 1.937, 95% CI [1.183–3.171]), and LOS (OR = 1.041, 95% CI [1.004–1.079]). Though both motorcycle CAs and LOCAs stress trauma systems in developing countries, the dynamics of CAs mean that they result in worse injuries and outcomes. Specific measures to reduce CAs and LOCAs are urgently indicated in developing countries to reduce the burden of morbidity and mortality of motorcycle accidents. [ABSTRACT FROM AUTHOR]

Abstract Background Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes. Methods Children (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression. Results The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97). Conclusions Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

Lower extremity injuries in AIS2+ were the most costly injuries through the statistical analysis of traffic accidents. This study aimed to investigate the response characteristics of the lower limb with different contact stiffness, in which knee cushion and foot cushion were applied. First, a model with a human body and a car was established, and the muscle function was activated in lower extremity of human model. Second, the deceleration pulse with a peak of 186 m/s² was applied to the car to simulate the frontal crash. Then, four sets of simulations with different contact stiffness are conducted to obtain the lower limb responses. Results indicate that the maximum loading of the left and right legs during the impact was 1.29 and 1.22 kN, respectively. Meanwhile, the maximum moment were 28.82 and 52.17 Nm, respectively. The maximum stress of lower extremity was 87.35 MPa, and the maximum tibia index was 0.230. It was demonstrated that the injury risk of the femur in the groups with equipment of knee cushion and foot cushion was low, but the injury risk of the tibia increased at the same time. This study could provide a reference to the study of lower limb injury in a frontal impact. [ABSTRACT FROM AUTHOR]

This study thematically analyses free text responses from telephone interviews with 141 participants from the Prospective Outcomes of Injury Study (POIS-10/POIS-10 Māori) to explore their “lived experiences” of the COVID-19 Alert Level 4 lockdown in Aotearoa/New Zealand (NZ). Interviews occurred in March-April 2020, at which time, NZ underwent some of the most stringent COVID-19 public health measures internationally. This study provides “real time” insights into participants’ experiences and views during this time in NZ.Many participants experienced losses, limitations, and restrictions due to the COVID-19 Alert Level 4 lockdown. Nevertheless, positive outcomes and reflections were reported alongside, and sometimes in conjunction with, the negative. Although the lockdown was limiting for many participants, some highlighted that this unique environment facilitated certain affordances including positive experiences with work, supporting others, and being supported, family dynamics changing for the better, more free time and positive reflections such as enhanced feelings of unity, closeness to others and a sense of gratefulness.The identification of affordances facilitated by the lockdown environment has implications for future pandemic response management, as these may be leveraged by policymakers, health care practitioners and individuals, potentially resulting in more favorable outcomes in future lockdowns.

Background: Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes. Methods: Children (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression. Results: The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97). Conclusions: Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration. [ABSTRACT FROM AUTHOR]

Injury burden is greater in children from vulnerable and disenfranchised populations. This systematic review aimed to describe injury related Health Related Quality of Life (HRQoL) and function outcomes in children through a health equity lens. A systematic review was conducted focussed on HRQoL and functional outcomes in children (≤16 years) following injury. We applied PRISMA-E 2012 guidelines, the RTI (Research Triangle Institute) item bank for risk of bias and measured equity using PROGRESS-PLUS with a narrative synthesis. Of 3013 articles, 24 were eligible for inclusion. Most assessed outcomes following traumatic brain injury or burns over a 12-month period. Reduced functional and HRQoL levels pre-injury or baseline, longer hospitalisation, and lower socioeconomic status were linked to poorer long-term outcomes. Measures of equity in methodology, reporting and discussion were limited. Equity variables, such as prior disability, were points for participant exclusion. Ethnicity was often reported only in dominant cultural terms. The equity impact of injury in children remains largely unexplored. Worse injury outcomes were reported in low socioeconomic families, but the relationship to other equity variables was not routinely reported. This could significantly inhibit development of targeted preventative programs and health care for those most in need. Injury research agendas need reform, we provide guidance for research teams to assist in including equity in their research and outcomes. [ABSTRACT FROM AUTHOR]

Abstract Objective: To investigate post‐injury disability prevalence and identify pre‐injury and injury‐related predictors 24 months post‐injury among Māori Prospective Outcomes of Injury Study participants. Methods: Participants were recruited from New Zealand's no‐fault injury insurer. Pre‐injury and injury‐related characteristic information was obtained from participants at three and 24 months post‐injury. The World Health Organization Disability Assessment Schedule was used to measure disability. Multivariable models were developed to estimate relative risks of post‐injury disability. Results: Of 2,856 participants, 566 were Māori. Analyses were restricted to 374 Māori with pre‐injury and 24‐month post‐injury disability data available. Pre‐injury, 9% reported disability compared to 19% 24 months post‐injury. Strong predictors of increased risk of disability 24 months post‐injury were having ≥2 chronic conditions pre‐injury and having trouble accessing healthcare services after injury. Hospitalisation for injury and having inadequate pre‐injury household income were other predictors. Conclusions: Māori experience considerable disability 24 months post‐injury. Pre‐injury socio‐demographic, health and psychosocial, and injury‐related characteristics independently predict post‐injury disability and provide focus for future research and interventions to improve Māori post‐injury outcomes. Implications for public health: Despite having had access to services, injured Māori experienced considerable long‐term disability. Pre‐injury and injury‐related factors predict long‐term disability and should be the focus to reduce the post‐injury disability burden for Māori.

The objectives are to (1) describe disability outcomes at 24 months after injury and (2) identify factors contributing to disability outcomes at 24 months after injury, for Māori and non-Māori who have been hospitalised for injury. This is a prospective cohort study. Prospective Outcomes of Injury Study participants were injured New Zealanders aged 18–64 years and recruited from New Zealand's no-fault injury insurer, the Accident Compensation Corporation's entitlement claims register. Data about a number of pre-injury, injury-related and early post-injury characteristics were collected from interviews held at 3 and 24 months after injury. Disability was measured using the World Health Organization Disability Assessment Schedule (WHODAS). Modified Poisson regression modelling was used to estimate relative risks (RRs) of disability for Māori and non-Māori who were hospitalised for injury. Analyses were restricted to 375 Māori and 1824 non-Māori participants for whom complete data were available. Of these, 105 (28%) Māori and 446 (24%) non-Māori were hospitalised for their injury. Of these hospitalised groups, 26% of Māori and 10% of non-Māori were experiencing disability (WHODAS ≥10) at 24 months after injury. Māori who were hospitalised for injury and who were not working for pay before their injury (RR = 2.7; 95% confidence interval [CI] 1.4–4.9), who were experiencing disability before their injury (RR = 3.1; 95% CI 1.6–5.8) or who reported trouble accessing healthcare services for their injury (RR = 2.6; 95% CI 1.3–5.2) were independently at increased risk of disability 24 months after injury. Non-Māori who were hospitalised for injury and who had inadequate household income before injury (RR = 2.4; 95% CI 1.4–4.1), less than the secondary school qualifications (RR = 2.0; 95% CI 1.1–3.8), were not working for pay before injury (RR = 2.8; 95% CI 1.5–5.1), were experiencing disability before their injury (RR = 3.0; 95% CI 1.7–5.2), had ≥2 chronic conditions (RR = 3.5; 95% CI 2.0–6.4) or had body mass index ≥30 kg/m2/undisclosed (RR = 2.4; 95% CI 1.3–4.4) were at increased risk of disability 24 months after injury. Variables predicting disability 24 months after injury for Māori, also predict disability 24 months after injury for non-Māori, with one notable exception—trouble accessing healthcare services. Our findings show that having access to healthcare services for injury plays an important role after injury and must be focussed on to ensure that the burden of poor injury-related outcomes and injury-related inequities are reduced and ultimately eliminated. • Disability outcomes after injury inequities exist for injured Māori. • Disability, hospitalisation, mortality and health loss are worse for Māori after injury. • Māori have trouble accessing healthcare after injury. • Access to health care is an important factor for Māori to improve injury outcomes. [ABSTRACT FROM AUTHOR]

Identifying those patient groups, who have unwanted outcomes, in the early stages is crucial to providing the most appropriate level of care. In this study, we intend to find distinctive patterns in health service use (HSU) of transport accident injured patients within the first week post-injury. Aiming those patterns that are associated with the outcome of interest. To recognize these patterns, we propose a multi-objective optimization model that minimizes the k-medians cost function and regression error simultaneously. Thus, we use a semi-supervised clustering approach to identify patient groups based on HSU patterns and their association with total cost. To solve the optimization problem, we introduce an evolutionary algorithm using stochastic gradient descent and Pareto optimal solutions. As a result, we find the best optimal clusters by minimizing both objective functions. The results show that the proposed semi-supervised approach identifies distinct groups of HSUs and contributes to predict total cost. Also, the experiments prove the performance of the multi-objective approach in comparison with singleobjective approaches. [ABSTRACT FROM AUTHOR]

• Assessment of the roles of human factors in motorcycle KSI crashes. • The findings help better understand how motorcycle KSI crashes occur. • The findings highlight the top priority of monitoring factors. • The finding provide a new direction for research about motorcyclists' behavior. Although the importance of human factors to crash occurrence has been demonstrated previously, the roles played by human factors in motorcycle killed and severely injured (KSI) crashes have remained unclear. One aim of our study is therefore to empirically determine the relative contribution of illegal behavior to motorcycle KSI crashes, conditional on real-world collisions between motorcycles and motor vehicles. Given that a crash is typically the synthetical result of human, vehicle, roadway, and environmental factors, another aim is to identify high-risk scenarios where inappropriate behavior is more likely to result in severe injuries for motorcyclists through interactions with other related factors. Based on a comprehensive dataset of 4587 police-reported crashes involving motorcycles during 2015–2017 in Hunan province, China, a data mining technique namely classification and regression tree was elaborately employed. Our results demonstrated the illegal behavior of the striking motor-vehicle drivers as one of the most dominant factors contributory to motorcycle KSI crashes, with a normalized importance value of 36.9%. We also confirmed collision object (i.e., collision with heavy or light vehicles) and helmet use of motorcyclists as determinants influencing motorcycle rider injury severities. Two types of extreme high-risk traffic scenarios were identified accordingly. A motorcycle rider was hit at weekends by a heavy motor-vehicle driver who was driving without license, driving a substantial vehicle, speeding, changing lanes illegally or driving in the wrong direction, and a motorcyclist was hit on weekdays by a heavy motor-vehicle driver aged 18–34 or 45–54, who was driving without license, driving a substantial vehicle, speeding, changing lanes illegally or driving in the wrong direction. Our findings are expected to shed more light on a deeper understanding of the illegal driving behavior as causation of motorcycle KSI crashes. [ABSTRACT FROM AUTHOR]

Injury is a leading cause of disability and is costly. This prospective cohort study extension aims to improve disability, health, and wellbeing outcomes for injured New Zealanders, including for Māori. We will identify predictors and modifiable risk factors of long-term outcomes (positive and negative), and develop an Injury Early Care Tool (INJECT) to inform the implementation of effective interventions to improve outcomes. In the Prospective Outcomes of Injury Study (POIS), 2856 people participated following an injury (occurring between 2007 and 2009) registered with New Zealand’s no-fault accident compensation scheme (ACC). POIS-10 will invite 2121 people (including 358 Māori) who completed a 24-month POIS interview and agreed to follow-up, anticipating 75% participation (n = 1591). Interviews will collect sociodemographic characteristics, life events, comorbidities, and new injuries since participants’ 24-month interview, as well as key disability, health, and wellbeing outcomes 12 years post-injury. Injury-related data will be collected from ACC and hospitalisation records 12 years post-injury. Regression models for the main outcomes will examine the direct effects of predictor variables after adjustment for a wide range of confounders. POIS-10 is enhanced by our partnership with ACC, and expert advisors and will benefit injured people, including Māori, through increased understanding of mechanisms and interventions to improve long-term post-injury outcomes.

Injury-related disability burden extends well beyond two years post-injury, especially for Māori (Indigenous) New Zealanders. Māori also experience greater difficulty accessing health services. This prospective cohort study extension uses mixed-methods and aims to understand and identify factors contributing to long-term experiences and outcomes (positive and negative) at 12 years post-injury for injured Māori and their whānau (families), and explore the barriers and facilitators to whānau flourishing, and access to health and rehabilitation services. Five hundred and sixty-six Māori, who were injured between 2007–2009, participated in the Prospective Outcomes of Injury Study (POIS). Of these, 544 consented to long-term follow up, and will be invited to participate in a POIS-10 Māori interview at 12 years post-injury. We anticipate a 65% follow-up rate (~n = 350). Aligned with the Meihana Model, interviews will collect information about multiple inter-related dimensions. Administrative injury and hospitalisation data up to 12 years post-injury will also be collected. Regression models will be developed to examine predictors of long-term health and disability outcomes, after adjusting for a range of confounders. POIS-10 Māori will identify key points in the injury and rehabilitation pathway to inform future interventions to improve post-injury outcomes for Māori and whānau, and will highlight the support required for Māori flourishing post-injury.

Objective: The Florida Adult Trauma Triage Criteria (FATTC) define specific parameters concerning injury mechanism and physiologic data that prompt paramedics to initiate a trauma alert and necessitate transport to a trauma center. In the state of Florida, paramedics are also given discretion to bring patients to the trauma center who do not meet those criteria. Our aim was to compare the injury characteristics and outcomes of adult patients who were evaluated in our trauma center after activation due to FATTC criteria vs. paramedic discretion (PD) and to identify predictors of PD. Methods: This retrospective study included all patients 18 years and older evaluated in our trauma center from January 1, 2007, to December 31, 2014. Descriptive statistics were computed for all variables. Bivariate and multivariate analyses were performed to compare demographic, injury severity, and outcome differences between groups. Results: A total of 13,963 patients met FATTC during the study period, and 1,811 were brought in by PD. PD patients had lower injury severity and crude mortality. Regression modeling of demographic and injury variables found that only the combination of older age and higher heart rate predicted PD when both were lower than FATTC alone. Conclusions: While PD patients were less seriously injured and had lower mortality, they experienced similar lengths of stay and resource utilization after presentation. Paramedics may be able to identify patients at risk for poor outcomes who would otherwise not be captured by FATTC. [ABSTRACT FROM AUTHOR]

Objective: To determine return to work (RTW) after severe traumatic brain injury (TBI) and to compare long-term labor market attachment (LMA) with the general population. Participants: All persons aged 18 to 64 years who received highly specialized neurorehabilitation after severe TBI between 2004 and 2012 (n = 637) were matched to general population controls on age, sex, preinjury employment status, educational level, and residence (n = 2497). Design: Nationwide follow-up study using weekly records on public assistance benefits. Main Measures: Both RTW and LMA were defined as having no public assistance benefits except education grants/leave. Stable LMA was defined as weeks with LMA of 75% or more. LMA among persons with severe TBI and controls was compared using multivariable conditional logistic regression. Results: RTW mainly occurred within first 2 years after severe TBI, with 30% of the people attempting RTW and 16% achieving stable LMA within 2 years. The prevalence of people with LMA decreased to 11% from 2V2 years to 5 years postinjury. Adjusted odds ratios were 0.01 for LMA up to 2 years postinjury and 0.05 for stable LMA for persons with severe TBI compared with the general population. Conclusion: Both RTW and long-term LMA after severe TBI were low in Denmark when compared with the general population and other countries. [ABSTRACT FROM AUTHOR]

Abstract Objectives: To: describe pre‐injury characteristics of Pacific (n=239) and non‐Pacific (n=2,611) participants and compare their outcomes three months after injury. Methods: Participants were New Zealand residents aged 18–64 years referred to the Accident Compensation Corporation's injury entitlement claims register. Univariate and multivariable analyses compared pre‐injury and injury‐related characteristics of Pacific and non‐Pacific people and assessed the unadjusted and adjusted relative risks for selected outcomes. Results: Of the 2,856 participants, 239 identified at least one Pacific ethnicity. Adjusted relative risks (aRR; 95% confidence intervals) for Pacific peoples, with the non‐Pacific group as the reference, indicate Pacific peoples were: less likely to have no/lesser problems with disability (aRR=0.82; 0.70,0.95); less likely to have no problems with EQ‐5D self‐care (aRR=0.88; 0.80,0.98); less likely not to report EQ‐5D anxiety/depression (aRR=0.84; 0.76,0.93); and less satisfied with social relationships three months after injury (aRR=0.89; 0.83,0.95). Conclusions: Evidence does not suggest Pacific peoples’ likelihood of paid employment differs from non‐Pacific people three months after injury. However, Pacific peoples appear to have an increased likelihood of problems with disability, self‐care, anxiety/depression and social relationships. Implications: This study provides information about a range of previously unknown outcomes following injury for Pacific peoples in New Zealand, and suggests areas of possible focus for health and rehabilitation service providers and policy‐makers interested in improving outcomes for injured Pacific peoples.

In the last decade, injury statistics have not exhibited appreciable improvement within the construction industry, with current management strategies deployed reactively in response to typically safety lagging indicators (e.g., injury rates, lost workdays, and post-incident inspections). This situation suggests that proactive safety management approaches that rely on leading indicators for key decision-making need to be developed. To propel the third wave of construction safety management research, the current study aims at developing site risk models that generate predictions for safety risk leading indicators across different work zones and over the entire project lifecycles. Such leading indicators can be used to proactively anticipate worksite risks such that preventative measures are implemented in advance and/or adjusted in real-time as projects progress to dynamically monitor and enhance safety performance. The developed risk models are driven by ensemble machine learning algorithms trained using previous injury precursors and outcomes. The ensemble algorithms consider five base algorithms subsequently tuned and validated: naïve Bayes, decision trees, random forests, support vector machines, and artificial neural networks. A demonstration application is also presented herein, where the ensemble algorithms are employed to develop a risk model that forecasts leading indicators of site-specific risk levels, including financial implications of potential injuries and the most likely affected body parts. The results demonstrate that, unlike currently available approaches, machine learning-based site risk models may be able to proactively and dynamically assess and subsequently boost the safety performance of construction projects. Such site risk models are expected to provide project managers with key information to proactively prevent worksite accidents, prioritize their resources, enhance project safety culture, and minimize injury-related costs. • Develop project site risk models predicting safety risk leading indicators • Train ensemble machine learning algorithms on injury precursors and outcomes • Develop models to assess site safety risk levels proactively over time and space • Empower managers to prioritize resources for boosting project safety performance • Tools to predict and proactively intervene to mitigate workplace safety incidents [ABSTRACT FROM AUTHOR]

Background: Injury represents one of the greatest public health challenges of our time with over 5 million deaths and 100 million people temporarily or permanently disabled every year worldwide. The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, the organisation of trauma care varies significantly across trauma systems and we know little about which components of trauma systems contribute to their effectiveness. The objective of the study described in this protocol is to systematically review evidence of the impact of trauma system components on clinically significant outcomes including mortality, function and disability, quality of life, and resource utilization. Methods: We will perform a systematic review of studies evaluating the association between at least one trauma system component (e.g. accreditation by a central agency, interfacility transfer agreements) and at least one injury outcome (e.g. mortality, disability, resource use). We will search MEDLINE, EMBASE, COCHRANE central, and BIOSIS/Web of Knowledge databases, thesis holdings, key injury organisation websites and conference proceedings for eligible studies. Pairs of independent reviewers will evaluate studies for eligibility and extract data from included articles. Methodological quality will be evaluated using elements of the ROBINS-I tool and the Cochrane risk of bias tool for non-randomized and randomized studies, respectively. Strength of evidence will be evaluated using the GRADE tool. Discussion: We expect to advance knowledge on the components of trauma systems that contribute to their effectiveness. This may lead to recommendations on trauma systemstructure thatwill help policy-makersmake informed decisions as to where resources should be focused. The review may also lead to specific recommendations for future research efforts. [ABSTRACT FROM AUTHOR]

Background: Social support can be an important coping resource for persons recovering from injury. In this study, we examined the effects of family structure and sources of social support on physical health, persistent pain and return to work (RTW) outcomes following musculoskeletal injury (MSI) sustained in a transport accident. Methods: Secondary analysis of Transport Accident Commission (TAC) cross-sectional surveys held in 2010 and 2011 was conducted. In total 1649 persons with MSI were identified and included. Family structure was determined by marital status and number of children. Sources of social support were measured as perceived help from family, friends, neighbours and employers. Physical health was measured with the Physical Component Summary (PCS) score of the Short-Form-12 Health Survey Version 2. Persistent pain was defined as self-reported persistent pain experienced in the last 3 months, and RTW was defined as being back at work for =3 months at time of interview. Multiple linear and logistic regressions were used for the analyses. Results: Family and friends' support was associated with better physical health among persons with >1 day hospital stay. Being married or in a de facto relationship was associated with greater PCS score among non-hospitalised persons. Being widowed/separated/divorced was associated with more self-reported persistent pain (odds ratio 1.62 [95 % confidence intervals 1.11-2.37]). Support from family (0.40 [0.24-0.68]), friends (0.29 [0.17-0.47]) and neighbours (0.59 [0.41-0.84]) was associated with less persistent pain. Among women, support from family (0.09 [0.01-0.78]) was negatively associated with RTW, whereas support from friends (3.03 [1.15-8.02]) was positively associated with RTW. These associations were not observed among men. For both men (5.62 [2.77-11.38]) and women (7.22 [2.58-20.20]), support from employers was positively associated with RTW. Conclusion: Family structure and sources of social support had a positive impact on physical health, persistent pain and RTW following MSI. This study highlights the importance of identifying people who have limited access to a social support network. Those with limited access to social support after a transport accident could potentially benefit from the provision of formal sources of practical and psychological support. [ABSTRACT FROM AUTHOR]

Objectives: Mental ill health after road traffic injury is common, as is the use of antidepressant medication after injury. Little is known about antidepressant use by injured people prior to their injury. The aim of this study is to describe the nature and extent of antidepressant use before and after road traffic injury. Methods: Victorian residents who claimed Transport Accident Commission (TAC) compensation for a non-catastrophic injury that occurred between 2010 and 2012 and provided consent for Pharmaceutical Benefits Scheme (PBS) linkage were included (n = 734). PBS records dating from 12 months prior through to 12 months post injury were provided by the Department of Human Services (Canberra). PBS and TAC claims data were linked. Results: Among participants, 12% used antidepressants before injury (84.4 Defined Daily Doses/ 1000 person-days) and 17% used antidepressants after injury (114.1 DDD/1000 p-d). Only 7.7% of the injured cohort commenced antidepressant treatment post injury. Thus, of all post-injury antidepressant use, 45% could potentially be related to the incident injury, with the remaining 55% most probably a continuation of pre-injury use. Pre-injury use was more common among women (109.4 vs. 54.6 DDD/ 1000 p-d, p < 0.0001), and those with whiplash injury (119.3 vs. 73.1, p = 0.03). Cyclists and motorcyclists were less likely to use antidepressants pre-injury than car drivers (18.3 vs. 16.9 vs. 109.3, respectively; p < 0.001). Conclusions: Less than half of post-injury antidepressant use could potentially be attributable to the incident injury. These results highlight the importance of obtaining information on pre-injury health status before interpreting post-injury health service use to be an outcome of the injury in question. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of unemployment and part-time employment in the United States for working-age individuals completing rehabilitation for a primary diagnosis of traumatic brain injury (TBI) between 2001 and 2010. Design: Secondary data analysis. Setting: Acute inpatient rehabilitation facilities. Participants: Patients aged 16 to 60 years at injury who completed inpatient rehabilitation for TBI between 2001 and 2010. Main Outcome Measures: Unemployment; Part-time employment. Results: The prevalence of unemployment for persons in the selected cohort was 60.4% at 2-year postinjury. Prevalence of unemployment at 2-year postinjury was significantly associated with the majority of categories of age group, race, gender, marital status, primary inpatient rehabilitation payment source, education, preinjury vocational status, length of stay, and Disability Rating Scale. The direction of association for the majority of these variables complement previous research in this area, with only Hispanic ethnicity and the FIM Cognitive subscale demonstrating disparate findings. For those employed at 2-year postinjury, the prevalence of part-time employment was 35.0%. The model of prevalence for part-time employment at 2-year postinjury was less robust, with significant relationships with some categorical components of age group, gender, marital status, primary payment source, preinjury vocational status, and Disability Rating Scale. Conclusions: The prevalence of unemployment for patients completing inpatient rehabilitation for TBI was substantial (60.4%). The majority of factors found to associate with 2 years' unemployment were complementary of previously published research; however, these were often smaller in magnitude than previous reports. The prevalence of part-time employment was also an issue for this cohort and included 35.0% of all employed individuals. In regard to the determination of factors associated with part-time employment, additional analyses that include more finegrained factors associated with employment, including physical and psychosocial functioning, are recommended. [ABSTRACT FROM AUTHOR]

Background: Social support can be an important coping resource for persons recovering from injury. In this study, we examined the effects of family structure and sources of social support on physical health, persistent pain and return to work (RTW) outcomes following musculoskeletal injury (MSI) sustained in a transport accident. Methods: Secondary analysis of Transport Accident Commission (TAC) cross-sectional surveys held in 2010 and 2011 was conducted. In total 1649 persons with MSI were identified and included. Family structure was determined by marital status and number of children. Sources of social support were measured as perceived help from family, friends, neighbours and employers. Physical health was measured with the Physical Component Summary (PCS) score of the Short-Form-12 Health Survey Version 2. Persistent pain was defined as self-reported persistent pain experienced in the last 3 months, and RTW was defined as being back at work for ≥3 months at time of interview. Multiple linear and logistic regressions were used for the analyses. Results: Family and friends’ support was associated with better physical health among persons with >1 day hospital stay. Being married or in a de facto relationship was associated with greater PCS score among non-hospitalised persons. Being widowed/separated/divorced was associated with more self-reported persistent pain (odds ratio 1.62 [95 % confidence intervals 1.11–2.37]). Support from family (0.40 [0.24–0.68]), friends (0.29 [0.17–0.47]) and neighbours (0.59 [0.41–0.84]) was associated with less persistent pain. Among women, support from family (0.09 [0.01–0.78]) was negatively associated with RTW, whereas support from friends (3.03 [1.15–8.02]) was positively associated with RTW. These associations were not observed among men. For both men (5.62 [2.77–11.38]) and women (7.22 [2.58–20.20]), support from employers was positively associated with RTW. Conclusion: Family structure and sources of social support had a positive impact on physical health, persistent pain and RTW following MSI. This study highlights the importance of identifying people who have limited access to a social support network. Those with limited access to social support after a transport accident could potentially benefit from the provision of formal sources of practical and psychological support. [ABSTRACT FROM AUTHOR]

Objectives: Injury is a major public health problem. While the impacts of injury on the injured person are well documented, there is relatively little knowledge about the impacts of injury on those individuals and groups in the community connected to the injured person. This study seeks to describe this breadth of research using a meta-review methodology. Study design: Systematic meta-review. Methods: To gain a better understanding of the known impacts of injury on family, community and society, a systematic meta-review of injury outcomes research literature was conducted. Seventy-eight peer-reviewed published literature reviews were included in the meta-review. Results: Of these, 70 reported outcomes at the level of the injured person including mortality, body functions, activity and participation limitations. Nine reviews reported impacts at the level of the community including impacts on family members, work colleagues and carers. Six studies reported impacts at the societal level including economic, health system and injury compensation system impacts. Conclusions: In summary, the meta-review identified a substantial body of knowledge at the individual level outcomes of injury, and a relative lack of information regarding the community and societal impacts of injury. An injury outcome framework is proposed on the basis of the findings of the meta-review to guide future research activity, particularly with regard to injury outcome domains where there is currently limited evidence. A comprehensive framework that takes account of all levels of impact is necessary for effective policies, systems and strategies to support recovery following injury. [ABSTRACT FROM AUTHOR]

Highlights: [•] There is some evidence of management characteristics that may prevent injuries. [•] There is little statistical evidence of the effectiveness of safety management systems. [•] Safety training, management commitment, worker participation, incentives, and pay affect safety. [•] Risk analysis, prior safety violations, crashes or incidents, vehicle financial performance predict transport safety. [•] Work scheduling, vehicle technologies, recruitment and worker characteristics/attitudes affect transport safety. [ABSTRACT FROM AUTHOR]

Over recent years, there has been increasing recognition that the burden of injuries and violence includes more than just the direct and indirect monetary costs associated with their medical outcomes. However, quantification of the total burden has been seriously hampered by lack of a framework for considering the range of outcomes which comprise the burden, poor identification of the outcomes and their imprecise measurement. This article proposes a new conceptual framework, the List of All Deficits (or LOAD) Framework, that has been developed from extensive expert discussion and consensus meetings to facilitate the measurement of the full burden of injuries and violence. The LOAD Framework recognises the multidimensional nature of injury burden across individual, family and societal domains. This classification of potential consequences of injury was built on the International Classification of Functioning concept of disability. Examples of empirical support for each consequence were obtained from the scientific literature. Determining the multidimensional injury burden requires the assessment and combination of 20 domains of potential consequences. The resulting LOAD Framework classification and concept diagram describes 12 groups of injury consequences for individuals, three for family and close friends and five for wider society. Understanding the extent of the negative implications (or deficits) of injury, through application of the LOAD Framework, is needed to put existing burden of injury studies into context and to highlight the inter-relationship between the direct and indirect burden of injury relative to other conditions. [ABSTRACT FROM AUTHOR]

Objective To investigate whether valid indicators of injury-related impairment could be developed based on data from a New Zealand national no-fault accident insurance scheme. Design The feasibility of (1) developing impairment related indicators using insurance data directly, and (2) deriving diagnosis specific probability of impairment measures based on hospital discharge data were investigated. Setting The source data were lump sum payment data for permanent impairment arising from an injury event between 1 April 2002 and 31 October 2006, and hospital discharge data for injury events between 1 April 2002 and 31 December 2005. Main outcome measure A threat of impairment measure was developed that was based on a list of International Classification of Diseases codes (version 10) which, if assessed would attract a lump sum payment for permanent impairment, and would almost always be expected to be admitted to hospital. Results A group of approximately 80 diagnoses satisfying the above criteria were identified. The trend in age standardised injury rates for the threat of impairment indicator is consistent with the trend for the New Zealand threat to life indicator. Conclusions This work has provided a method for the development of hospital discharge-based serious threat of impairment injury indicators. This is an important first step in developing a comprehensive package of (threat of) disability indicators. [ABSTRACT FROM AUTHOR]

There is considerable evidence linking perpetrators' substance use with unfavorable outcomes among victims of intimate partner violence. Little is known, however, about the relationship between substance use by both the perpetrators and the victims and the victims' outcomes. Using interview data from 117 women who have experienced abuse by their partners, this study examines the association of both perpetrators' and victims' substance use with victim outcomes through a series of hierarchical multiple regressions. Substance use by both perpetrators and victims was not significantly related to increased risk of victims' physical injuries, but was significantly associated with poorer victim functionality after an intimate partner violence incident. [ABSTRACT FROM AUTHOR]

The article discusses the frequency and severity farm tractor operators' injuries due to overturn. Farm tractor accidents, particularly overturning, has caused death in an estimated range of 30 to 68 percent. A study of these accidents and its frequency was done considering a population-based estimate and the frequencies of six different classes of overturn injury outcomes with and without rollover protective structures (ROPS). The study methodology was a 40-item telephone survey with eight percent of Kentucky farms as the respondents. Results showed that 9.1 percent of the farm respondents reported overturns and 90.1 reported no overturns. There was a higher incidence of overturns with non-ROPS farms and most of the injured farmers preferred to have outpatient treatments.

There is an acknowledged need for valid and reliable injury scores, suitable for use at the population level, which can accurately predict the long-term outcome of injury. The objective was to quantify the extent to which the abbreviated injury severity score (AIS) and the functional capacity index score (FCI) predict use of health services in the 12 months following an injury event. A cohort of injured people (ICD-9-CM 800-995) aged 18 - 64 years was identified from Manitoba hospital discharge abstracts from January 1988 to December 1991. For each member of the cohort whose injuries could be mapped to an abbreviated injury scale unique identifier, a maximum AIS (maxAIS) and a maximum FCI (maxFCI) were obtained. The cohort was linked with hospital discharge abstracts, physicians' claims and deaths from the population registry for the 12 months following injury. Negative binomial regression was used to model the relationships between the severity scores and the three outcome measures, while controlling for potential confounding variables. In total, 20 677 (97%) eligible cases were identified, of which 16 834 (81%) could be assigned a maxAIS and 15 823 (77%) a maxFCI. MaxAIS and maxFCI were significantly associated with total days in hospital following injury, but explained little of the variation in any of the health service use outcome variables (maxAIS, partial pseudo r2 ranging from < 0.001 to 0.041; and maxFCI, partial pseudo r2 ranging from < 0.001 to 0.018). It was concluded that anatomical damage is only partly responsible for long-term injury outcome. Additional variables would need to be included in predictive models of health outcomes of injury before these models could be reliable. [ABSTRACT FROM AUTHOR]

Background: Noise sensitivity (NS) following mild traumatic brain injury (mTBI) is common impacts functioning and outcomes. Recent research suggests psychological factors may have a significant role in the development of NS after mTBI. Psychological interventions have been advocated for to reduce this experience. To be effective, these interventions must aim to target the psychological processes that contribute to this relationship. Fear avoidance holds promise in this regard. The current study aimed to explore the role of fear avoidance in NS and examine its role in mediating the relationship between psychological distress and NS.Method: Adults (n = 234) diagnosed with mTBI were recruited from outpatient mTBI clinics throughout New Zealand. Participants completed self-report measures of pre-injury mental health status, as well as current post-concussion symptoms, psychological distress (anxiety, stress, depression, fear avoidance and post-traumatic stress symptoms) and functional status upon entry to an mTBI outpatient clinic (M = 8.9, SD = 9.2, post injury).Results: A pre-injury mental health diagnosis was associated with NS after mTBI, as were symptoms of anxiety, stress, depression, and post-traumatic stress. Regression analyses revealed that fear avoidance (β = 0.45, p = .01), as well as stress (β = 0.07, p = .01) and PTSD symptoms (β = 0.02, p = .01), made a significant and unique contribution to NS. A series of mediation analyses found that fear avoidance had a significant indirect effect on the relationships between psychological distress and NS.Conclusions: Fear avoidance is related to NS following mTBI. Targeting fear avoidance behaviours and beliefs may represent a treatment target for reducing NS after mTBI. [ABSTRACT FROM AUTHOR]

As the field of injury outcomes measurement has moved beyond counting deaths and injuries, the need for instruments to measure long-term outcomes has increased. Early validation efforts indicated that the Functional Capacity Index (pFCI12) was a promising tool for predicting functional loss 12 months post trauma, but that the predictive validity for lower extremity fractures was low. The pFCI12 was recently revised in conjunction with the 2005 revision of the Abbreviated Injury Scale (AIS). This preliminary study was undertaken to assess the performance of the revised pFCI12 in predicting outcomes for patients with lower extremity trauma. This case review study used the Crash Injury Research and Engineering Research (CIREN) database which includes AIS codes, extensive clinical data and 3- and 12-month outcomes. Generally predicted functional loss at 12 months was greater with the pFCI12 (AIS 2005) than with the original FCI based on AIS 1990. All patients whose pFCI12 scores predicted functional loss experienced some morbidity at 1 year. The pFCI12 appears to provide improved predictions of functional outcome 12-months post-trauma for persons experiencing lower extremity trauma. [ABSTRACT FROM AUTHOR]