Sources of coding discrepancies in injury morbidity data: Implications for injury surveillance

Objective: To examine the sources of coding discrepancy for injury morbidity data and explore the implications of these sources for injury surveillance.-------- Method: An on-site medical record review and recoding study was conducted for 4373 injury-related hospital admissions across Australia. Codes from the original dataset were compared to the recoded data to explore the reliability of coded data aand sources of discrepancy.---------- Results: The most common reason for differences in coding overall was assigning the case to a different external cause category with 8.5% assigned to a different category. Differences in the specificity of codes assigned within a category accounted for 7.8% of coder difference. Differences in intent assignment accounted for 3.7% of the differences in code assignment.---------- Conclusions: In the situation where 8 percent of cases are misclassified by major category, the setting of injury targets on the basis of extent of burden is a somewhat blunt instrument Monitoring the effect of prevention programs aimed at reducing risk factors is not possible in datasets with this level of misclassification error in injury cause subcategories. Future research is needed to build the evidence base around the quality and utility of the ICD classification system and application of use of this for injury surveillance in the hospital environment.

Mining patterns and factors contributing to crash severity on road curves

Road curves are an important feature of road infrastructure and many serious crashes occur on road curves. In Queensland, the number of fatalities is twice as many on curves as that on straight roads. Therefore, there is a need to reduce drivers’ exposure to crash risk on road curves. Road crashes in Australia and in the Organisation for Economic Co-operation and Development(OECD) have plateaued in the last five years (2004 to 2008) and the road safety community is desperately seeking innovative interventions to reduce the number of crashes. However, designing an innovative and effective intervention may prove to be difficult as it relies on providing theoretical foundation, coherence, understanding, and structure to both the design and validation of the efficiency of the new intervention. Researchers from multiple disciplines have developed various models to determine the contributing factors for crashes on road curves with a view towards reducing the crash rate. However, most of the existing methods are based on statistical analysis of contributing factors described in government crash reports. In order to further explore the contributing factors related to crashes on road curves, this thesis designs a novel method to analyse and validate these contributing factors. The use of crash claim reports from an insurance company is proposed for analysis using data mining techniques. To the best of our knowledge, this is the first attempt to use data mining techniques to analyse crashes on road curves. Text mining technique is employed as the reports consist of thousands of textual descriptions and hence, text mining is able to identify the contributing factors. Besides identifying the contributing factors, limited studies to date have investigated the relationships between these factors, especially for crashes on road curves. Thus, this study proposed the use of the rough set analysis technique to determine these relationships. The results from this analysis are used to assess the effect of these contributing factors on crash severity. The findings obtained through the use of data mining techniques presented in this thesis, have been found to be consistent with existing identified contributing factors. Furthermore, this thesis has identified new contributing factors towards crashes and the relationships between them. A significant pattern related with crash severity is the time of the day where severe road crashes occur more frequently in the evening or night time. Tree collision is another common pattern where crashes that occur in the morning and involves hitting a tree are likely to have a higher crash severity. Another factor that influences crash severity is the age of the driver. Most age groups face a high crash severity except for drivers between 60 and 100 years old, who have the lowest crash severity. The significant relationship identified between contributing factors consists of the time of the crash, the manufactured year of the vehicle, the age of the driver and hitting a tree. Having identified new contributing factors and relationships, a validation process is carried out using a traffic simulator in order to determine their accuracy. The validation process indicates that the results are accurate. This demonstrates that data mining techniques are a powerful tool in road safety research, and can be usefully applied within the Intelligent Transport System (ITS) domain. The research presented in this thesis provides an insight into the complexity of crashes on road curves. The findings of this research have important implications for both practitioners and academics. For road safety practitioners, the results from this research illustrate practical benefits for the design of interventions for road curves that will potentially help in decreasing related injuries and fatalities. For academics, this research opens up a new research methodology to assess crash severity, related to road crashes on curves.

Adiabatic compression testing - part II : background and approach to estimating severity of test methodology

Adiabatic compression testing of components in gaseous oxygen is a test method that is utilized worldwide and is commonly required to qualify a component for ignition tolerance under its intended service. This testing is required by many industry standards organizations and government agencies; however, a thorough evaluation of the test parameters and test system influences on the thermal energy produced during the test has not yet been performed. This paper presents a background for adiabatic compression testing and discusses an approach to estimating potential differences in the thermal profiles produced by different test laboratories. A “Thermal Profile Test Fixture” (TPTF) is described that is capable of measuring and characterizing the thermal energy for a typical pressure shock by any test system. The test systems at Wendell Hull & Associates, Inc. (WHA) in the USA and at the BAM Federal Institute for Materials Research and Testing in Germany are compared in this manner and some of the data obtained is presented. The paper also introduces a new way of comparing the test method to idealized processes to perform system-by-system comparisons. Thus, the paper introduces an “Idealized Severity Index” (ISI) of the thermal energy to characterize a rapid pressure surge. From the TPTF data a “Test Severity Index” (TSI) can also be calculated so that the thermal energies developed by different test systems can be compared to each other and to the ISI for the equivalent isentropic process. Finally, a “Service Severity Index” (SSI) is introduced to characterizing the thermal energy of actual service conditions. This paper is the second in a series of publications planned on the subject of adiabatic compression testing.

Knowledge, attitudes and beliefs towards injury prevention : a population based telephone survey

Public knowledge and beliefs about injury prevention are currently poorly understood. A total of 1030 residents in the State of Queensland, Australia responded to questions about injury prevention in or around the home, on the roads, in or on the water, at work, deliberate injury, and responsibility for preventing deliberate injury allowing comparison with published injury prevalence data. Overall the youngest members of society were identified as being the most vulnerable to deliberate injury with young adults accounting for 59% of responses aligning with published data. However, younger adults failed to indicate an awareness of their own vulnerability to deliberate injury in alcohol environments even though 61% of older respondents were aware of this trend. Older respondents were the least inclined to agree that they could make a difference to their own safety in or around the home but were more inclined to agree that they could make a difference to their own safety at work. The results are discussed with a view to using improved awareness of public beliefs about injury to identify barriers to the uptake of injury prevention strategies (e.g. low perceived injury risk) as well as areas where injury prevention strategies may receive public support.

Assessing the safety of a velocity sourced series elastic actuator using the head injury criterion

The Velocity Sourced Series Elastic Actuator has been proposed as a method for providing safe force or torque based actuation for robots without compromising the actuator performance. In this paper we assess the safety of Velocity Sourced Series Elastic Actuators by measuring the Head Injury Criterion scores for collisions with a model head. The study makes a comparative analysis against stiff, high impedance actuation using the same motor without the series elastic component, showing that the series elastic component brings about a massive reduction in the chance of head injury. The benefits of a collision detection and safe reaction system are shown to be limited to collisions at low speeds, providing greater interaction comfort but not necessarily contributing to safety from injury.

The properties of the international classification of the external cause of injury when used as an instrument for injury prevention research

Objective: To demonstrate properties of the International Classification of the External Cause of Injury (ICECI) as a tool for use in injury prevention research. Methods: The Childhood Injury Prevention Study (CHIPS) is a prospective longitudinal follow up study of a cohort of 871 children 5–12 years of age, with a nested case crossover component. The ICECI is the latest tool in the International Classification of Diseases (ICD) family and has been designed to improve the precision of coding injury events. The details of all injury events recorded in the study, as well as all measured injury related exposures, were coded using the ICECI. This paper reports a substudy on the utility and practicability of using the ICECI in the CHIPS to record exposures. Interrater reliability was quantified for a sample of injured participants using the Kappa statistic to measure concordance between codes independently coded by two research staff. Results: There were 767 diaries collected at baseline and event details from 563 injuries and exposure details from injury crossover periods. There were no event, location, or activity details which could not be coded using the ICECI. Kappa statistics for concordance between raters within each of the dimensions ranged from 0.31 to 0.93 for the injury events and 0.94 and 0.97 for activity and location in the control periods. Discussion: This study represents the first detailed account of the properties of the ICECI revealed by its use in a primary analytic epidemiological study of injury prevention. The results of this study provide considerable support for the ICECI and its further use.

The Validity of the Brief Michigan Alcohol Screening Test (bMAST) as a Problem Drinking Severity Measure

Objective: The Brief Michigan Alcoholism Screening Test (bMAST) is a 10-item test derived from the 25-item Michigan Alcoholism Screening Test (MAST). It is widely used in the assessment of alcohol dependence. In the absence of previous validation studies, the principal aim of this study was to assess the validity and reliability of the bMAST as a measure of the severity of problem drinking. Method: There were 6,594 patients (4,854 men, 1,740 women) who had been referred for alcohol-use disorders to a hospital alcohol and drug service who voluntarily participated in this study. Results: An exploratory factor analysis defined a two-factor solution, consisting of Perception of Current Drinking and Drinking Consequences factors. Structural equation modeling confirmed that the fit of a nine-item, two-factor model was superior to the original one-factor model. Concurrent validity was assessed through simultaneous administration of the Alcohol Use Disorders Identification Test (AUDIT) and associations with alcohol consumption and clinically assessed features of alcohol dependence. The two-factor bMAST model showed moderate correlations with the AUDIT. The two-factor bMAST and AUDIT were similarly associated with quantity of alcohol consumption and clinically assessed dependence severity features. No differences were observed between the existing weighted scoring system and the proposed simple scoring system. Conclusions: In this study, both the existing bMAST total score and the two-factor model identified were as effective as the AUDIT in assessing problem drinking severity. There are additional advantages of employing the two-factor bMAST in the assessment and treatment planning of patients seeking treatment for alcohol-use disorders. (J. Stud. Alcohol Drugs 68: 771-779,2007)

Teachers’ understanding of school connectedness : implications for the development and implementation of school based injury prevention strategies

Aim: Worldwide, injury is the leading cause of death and disability for young people. Injuries among young people are commonly associated with risk taking behaviour, including violence and transport risks, which often occur in the context of alcohol use. The school environment has been identified as having a significant role in shaping adolescent behaviour. In particular, school connectedness, the degree to which adolescents feel that they belong and are accepted at school, has been shown to be an important protective factor. Strategies for increasing school connectedness may therefore be effective in reducing risk taking and associated injury. Prior to developing connectedness strategies, it is important to understand the perspectives of those in the school regarding the construct and how it is realised in the school context. The aim of this research was to understand teachers’ perspectives of school connectedness, the strategies they employ to connect with students, and their perceptions of school connectedness as a strategy for risk taking and injury prevention. Method: In depth interviews of approximately 45 minutes duration were conducted with 13 Health and PE teachers and support staff from 2 high schools in Southeast Queensland, Australia. Additionally, 6 focus group workshop discussions were held with 35 Education department employees (5-6 per group), including teachers from 15 Southeast Queensland high schools. Results: Participants were found to place strong importance on the development of connectedness among students, including those at risk for problem behaviour. Strategies used to promote connectedness included building trust, taking an interest in each student and being available to talk to, and finding something positive for students to succeed at. Teachers identified strategies as being related to decreased risk taking behavior. Teacher training on school connectedness was perceived as an important and useful inclusion in a school based injury prevention program. Conclusions: The established link between increased school connectedness and decreased problem behaviour has implications for school based strategies designed to decrease adolescent risk taking behaviour and associated injury. Targeting school connectedness as a point of intervention, in conjunction with individual attitude and behaviour change programs, may be an effective injury prevention strategy.

Do clients with acquired brain injury use the splints prescribed by occupational therapists? A descriptive study

Clients with acquired brain injury often demonstrate hypertonicity and decreased function in their upper limbs, requiring appropriate intervention. Splinting is one of the intervention methods that is widely used to address these issues. Literature shows that some clients are not using splints following fabrication. However, there is a paucity of research about the factors that influence clients to use or not use splints. This study aims to investigate these influential factors for clients with upper limb hypertonicity. Two survey tools including therapist and client questionnaires were developed and completed by both therapists and clients. Six therapists and 14 clients participated in this study and completed the relevant questionnaires. The results illustrate that most clients (13 out of 14) were continuing to use their splints four weeks following discharge from hospital. The main goals of choosing splints for both therapists and clients were prevention of contracture and deformity. The most indicated client reasons for adhering to the splint wearing program were therapist-related factors including clients’ trust and reliance on their therapists. Further reasons for clients implementing the recommended splint-wearing program and clinical implications are discussed.

Validity of the Waterlow screening tool and risks for pressure injury in acute care

Objectives: To assess the validity of the Waterlow screening tool in a cohort of internal medicine patients and to identify factors contributing to pressure injury. Design: Longitudinal cohort study Setting: A tertiary hospital in Brisbane, Australia Participants: 274 patients admitted through the Emergency Department or outpatient clinics and expected to remain in hospital for at least three days were included in the study. The mean age was 65.3 years. Interventions: Patients were screened on admission using the Waterlow screening tool. Every second day, their pressure ulcer status was monitored and recorded. Main outcome measures: Pressure ulcer incidence Results: Fifteen participants (5.5%) had an existing pressure ulcer and a further 12 (4.4%) developed a pressure ulcer during their hospital stay. Sensitivity of the Waterlow scale was 0.67, (95% CI: 0.35 to 0.88); specificity 0.79, (95% CI: 0.73 to 0.85); PPV 0.13, (95% CI: 0.07 to 0.24); NPV 0.98, (95% CI: 0.94 to 0.99). Conclusion: This study provides further evidence of the poor predictive validity of the Waterlow scale. A suitably powered randomised controlled trial is urgently needed to provide definitive evidence about the usefulness of the Waterlow scale compared with other screening tools and with clinical judgement.

Modelling of inflatable rescue boats (IRBs) in surf conditions to reduce injuries

The Inflatable Rescue Boat (IRB) is arguably the most effective rescue tool used by the Australian surf lifesavers. The exceptional features of high mobility and rapid response have enabled it to become an icon on Australia's popular beaches. However, the IRB's extensive use within an environment that is as rugged as it is spectacular, has led it to become a danger to those who risk their lives to save others. Epidemiological research revealed lower limb injuries to be predominant, particularly the right leg. The common types of injuries were fractures and dislocations, as well as muscle or ligament strains and tears. The concern expressed by Surf Life Saving Queensland (SLSQ) and Surf Life Saving Australia (SLSA) led to a biomechanical investigation into this unique and relatively unresearched field. The aim of the research was to identify the causes of injury and propose processes that may reduce the instances and severity of injury to surf lifesavers during IRB operation. Following a review of related research, a design analysis of the craft was undertaken as an introduction to the craft, its design and uses. The mechanical characteristics of the vessel were then evaluated and the accelerations applied to the crew in the IRB were established through field tests. The data were then combined and modelled in the 3-D mathematical modelling and simulation package, MADYMO. A tool was created to compare various scenarios of boat design and methods of operation to determine possible mechanisms to reduce injuries. The results of this study showed that under simulated wave loading the boats flex around a pivot point determined by the position of the hinge in the floorboard. It was also found that the accelerations experienced by the crew exhibited similar characteristics to road vehicle accidents. Staged simulations indicated the attributes of an optimum foam in terms of thickness and density. Likewise, modelling of the boat and crew produced simulations that predicted realistic crew response to tested variables. Unfortunately, the observed lack of adherence to the SLSA footstrap Standard has impeded successful epidemiological and modelling outcomes. If uniformity of boat setup can be assured then epidemiological studies will be able to highlight the influence of implementing changes to the boat design. In conclusion, the research provided a tool to successfully link the epidemiology and injury diagnosis to the mechanical engineering design through the use of biomechanics. This was a novel application of the mathematical modelling software MADYMO. Other craft can also be investigated in this manner to provide solutions to the problem identified and therefore reduce risk of injury for the operators.

Property damage crash equivalency factors to solve crash frequency-severity dilemma: Case study on South Korean rural roads

Safety interventions (e.g., median barriers, photo enforcement) and road features (e.g., median type and width) can influence crash severity, crash frequency, or both. Both dimensions—crash frequency and crash severity—are needed to obtain a full accounting of road safety. Extensive literature and common sense both dictate that crashes are not created equal, with fatalities costing society more than 1,000 times the cost of property damage crashes on average. Despite this glaring disparity, the profession has not unanimously embraced or successfully defended a nonarbitrary severity weighting approach for analyzing safety data and conducting safety analyses. It is argued here that the two dimensions (frequency and severity) are made available by intelligently and reliably weighting crash frequencies and converting all crashes to property-damage-only crash equivalents (PDOEs) by using comprehensive societal unit crash costs. This approach is analogous to calculating axle load equivalents in the prediction of pavement damage: for instance, a 40,000-lb truck causes 4,025 times more stress than does a 4,000-lb car and so simply counting axles is not sufficient. Calculating PDOEs using unit crash costs is the most defensible and nonarbitrary weighting scheme, allows for the simple incorporation of severity and frequency, and leads to crash models that are sensitive to factors that affect crash severity. Moreover, using PDOEs diminishes the errors introduced by underreporting of less severe crashes—an added benefit of the PDOE analysis approach. The method is illustrated with rural road segment data from South Korea (which in practice would develop PDOEs with Korean crash cost data).