All-terrain vehicle crashes and associated injuries in North Queensland : findings from the Rural and Remote Road Safety Study

Objective: To define characteristics of all-terrain vehicle (ATV) crashes occurring in north Queensland from March 2004 till June 2007 with the exploration of associated risk factors. Design: Descriptive analysis of ATV crash data collected by the Rural and Remote Road Safety Study. Setting: Rural and remote north Queensland. Participants: Forty-two ATV drivers and passengers aged 16 years or over hospitalised at Atherton, Cairns, Mount Isa or Townsville for at least 24 hours as a result of a vehicle crash. Main outcome measures: Demographics of participants, reason for travel, nature of crash, injuries sustained and risk factors associated with ATV crash. Results: The majority of casualties were men aged 16–64. Forty-one per cent of accidents occurred while performing agricultural tasks. Furthermore, 39% of casualties had less than one year’s experience riding ATVs. Over half the casualties were not wearing a helmet at the time of the crash. Common injuries were head and neck and upper limb injuries. Rollovers tended to occur while performing agricultural tasks and most commonly resulted in multiple injuries. Conclusions: Considerable trauma results from ATV crashes in rural and remote north Queensland. These crashes are not included in most general vehicle crash data sets, as they are usually limited to events occurring on public roads. Minimal legislation and regulation currently applies to ATV use in agricultural, recreational and commercial settings. Legislation on safer design of ATVs and mandatory courses for riders is an essential part of addressing the burden of ATV crashes on rural and remote communities.

Tip-over injuries in children under 5 years of age in Queensland 1999-2008

Furniture and appliance related injuries in children under 5 years of age accounts for an estimated 180 emergency presentations annually in Queensland. Injuries occur when children push or pull items over, climb and fall off furniture, or climb and tip the item over. Children under 2 years of age tend to injure themselves by pulling items over onto themselves Children over 2 years of age are more likely to be injured after climbing the item and either falling off or tipping the item over onto themselves. Tip over injuries (where the item falls over and injures the child) in children under 5 years of age account for an estimated 115 emergency presentations annually in Queensland. The item most commonly associated with a tip over injury is a television (with or without the cabinet) Prevention requires better design and selection of furniture with inherent stability coupled with mechanisms to install or fix less stable items

Identifying work related injuries : comparison of methods for interrogating text fields

Background: Work-related injuries in Australia are estimated to cost around $57.5 billion annually, however there are currently insufficient surveillance data available to support an evidence-based public health response. Emergency departments (ED) in Australia are a potential source of information on work-related injuries though most ED’s do not have an ‘Activity Code’ to identify work-related cases with information about the presenting problem recorded in a short free text field. This study compared methods for interrogating text fields for identifying work-related injuries presenting at emergency departments to inform approaches to surveillance of work-related injury.---------- Methods: Three approaches were used to interrogate an injury description text field to classify cases as work-related: keyword search, index search, and content analytic text mining. Sensitivity and specificity were examined by comparing cases flagged by each approach to cases coded with an Activity code during triage. Methods to improve the sensitivity and/or specificity of each approach were explored by adjusting the classification techniques within each broad approach.---------- Results: The basic keyword search detected 58% of cases (Specificity 0.99), an index search detected 62% of cases (Specificity 0.87), and the content analytic text mining (using adjusted probabilities) approach detected 77% of cases (Specificity 0.95).---------- Conclusions The findings of this study provide strong support for continued development of text searching methods to obtain information from routine emergency department data, to improve the capacity for comprehensive injury surveillance.

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.

What factors are associated with cyclists getting injured? Correlates of cyclist injuries in Queensland

Pedal cyclists are over-represented in traffic crash injuries in Australia. This study examined correlates of cycling injuries in a sample of Queensland cyclists. Members of Bicycle Queensland (n=1976) were asked about cycling injuries as part of an online survey. They also reported demographic characteristics, reasons for cycling, years of cycling as an adult, and cycling frequency. Multivariate logistic regression modelling was used to examine the association between these variables and experiencing cycling injuries last year (yes/no). Thirty-one percent of respondents (n=617) reported at least one cycling injury. Respondents had greater likelihood of injury if they cycled more frequently, had cycled <5 years, or cycled for recreation or competition. These findings suggest that injuries are mostly likely to occur among less experienced cyclists, those cycling the most, and those cycling for sport and recreation. Injury prevention interventions should include cycle skills training along with fostering safer cycling environments.

Creating an effective prevention curriculum to reduce transport risks and injuries

Adolescent injury is a significant health concern and can be a result of the adolescents engagement in transport-related behaviours. There is however significant planning and formative research needed to inform prevention programme design. This presentation reports on the development and evaluation of a curriculum programme that was shown to be effective in reducing transport-related risks and injuries. Early adolescents report injuries resulting from a number of transport-related behaviours including those associated with riding a bicycle, a motorcycle, and as a passenger (survey of 209 Year 9 students). In focus groups, students (n=30) were able to describe the context of transport risks and injuries. Such information provided evidence of the need for an intervention and ecologically valid data on which to base programme design including insights into the language, culture and development of adolescents and their experiences with transport risks. Additional information about teaching practices and implementation issues were explored in interviews with 13 teachers. A psychological theory was selected to operationalise the design of the programmes that drew on such preparatory data. The programme, Skills for Preventing Injury in Youth was evaluated with 197 participating and 137 control students (13–14 year olds). Results showed a significant difference between the intervention and control groups from baseline to 6-month follow-up in a number of transport-related risk behaviours and transport-related injuries. The programme thus demonstrated potential in reduce early adolescents transport risk behaviours and associated harm. Discussion will involve the implications of the development research process in designing road safety interventions.

The impact of school connectedness on violent behavior, transport risk taking behavior and associated injuries in adolescence

Adolescents engage in many risk-taking behaviors that have the potential to lead to injury. The school environment has a significant role in shaping adolescent behavior, and this study aimed to provide additional information about the benefits associated with connectedness to school. Early adolescents aged 13 to 15 years (N = 509, 49% boys) were surveyed about school connectedness, engagement in transport and violence risk-taking, and injury experiences. Significant relations were found between school connectedness and reduced engagement in both transport and violence risk-taking, as well as fewer associated injuries. This study has implications for the area of risk-taking and injury prevention, as it suggests the potential for reducing adolescents' injury through school based interventions targeting school connectedness.

Injuries across adolescence : an investigation using the Extended Adolescent Injury Checklist (E-AIC)

Injury is the leading cause of death among adolescents, and in many countries, accounts for more deaths than all other causes combined. Rates of death due to injury also increase dramatically across adolescence. The Australian Institute of Health and Welfare reported that, in 2005, there were 954 deaths of young Australians due to injury, which is a rate of 26 deaths per 100,000 young people. Of these deaths, 4% were adolescents aged 12-14, 17% were aged 15-17, and 80% were aged 18-24 years. Issues addressed: Injuries are the leading cause of death among adolescents. The current research examined a measure of adolescent injury in terms of whether it encompasses the diverse injury experiences of Australian adolescents, including high-risk and normative adolescents, and thus determine its utility as a tool for health promotion research. Grade 9 students from two Brisbane high schools (n=202, aged 13-14 years) and adolescents recruited from the Emergency Department waiting rooms of four Brisbane hospitals (n=98, aged 16-18 years) completed the Extended Adolescent Injury Checklist (E-AIC). The most common cause of injury among adolescents was a sports activity, followed by fights for all participants except schoolbased males, who experienced more bicycle injuries. Alcohol use was most frequently reported in association with interpersonal violence injuries. A broad variety of injuries, occurring in context of multiple risk as well as normative behaviours, were reported by adolescents in both school and ED settings, and were captured by the E-AIC. Findings suggest that the E-AIC is a useful measure that captures the injury experiences of adolescents in different contexts. The high occurrence of injuries that do not result in formal medical treatment also indicates scope for interventions to be based around lessons in first aid, while also incorporating injury prevention components.

Incidence, severity and correlates of bicycling injuries in a sample of cyclists in Queensland, Australia

Bicycle injuries, particularly those resulting from single bicycle crashes, are underreported in both police and hospital records. Data on cyclist characteristics and crash circumstances are also often lacking. As a result, the ability to develop comprehensive injury prevention policies is hampered. The aim of this study was to examine the incidence, severity, cyclist characteristics, and crash circumstances associated with cycling injuries in a sample of cyclists in Queensland, Australia. A cross-sectional study of Queensland cyclists was conducted in 2009. Respondents (n=2056) completed an online survey about their cycling experiences, including cycling injuries. Logistic regression modelling was used to examine the associations between demographic and cycling behaviour variables with experiencing cycling injuries in the past year, and, separately, with serious cycling injuries requiring a trip to a hospital. Twenty-seven percent of respondents (n=545) reported injuries, and 6% (n=114) reported serious injuries. In multivariable modelling, reporting an injury was more likely for respondents who had cycled <5 years, compared to ≥10 years (p<0.005); cycled for competition (p=0.01); or experienced harassment from motor vehicle occupants (p<0.001). There were no gender differences in injury incidence, and respondents who cycled for transport did not have an increased risk of injury. Reporting a serious injury was more likely for those whose injury involved other road users (p<0.03). Along with environmental and behavioural approaches for reducing collisions and near-collisions with motor vehicles, interventions that improve the design and maintenance of cycling infrastructure, increase cyclists’ skills, and encourage safe cycling behaviours and bicycle maintenance will also be important for reducing the overall incidence of cycling injuries.

Risk of falls, injurious falls, and other injuries resulting from visual impairment among older adults with age-related macular degeneration

Purpose: Age-related macular degeneration (AMD) is the leading cause of irreversible visual impairment among older adults. This study explored the relationship between AMD, falls risk and other injuries and identified visual risk factors for these adverse events. Methods: Participants included 76 community-dwelling individuals with a range of severity of AMD (mean age, 77.0±6.9 years). Baseline assessment included binocular visual acuity, contrast sensitivity and merged visual fields. Participants completed monthly falls and injury diaries for one year following the baseline assessment. Results: Overall, 74% of participants reported having either a fall, injurious fall or other injury. Fifty-four percent of participants reported a fall and 30% reported more than one fall; of the 102 falls reported, 63% resulted in an injury. Most occurred outdoors (52%), between late morning and late afternoon (61%) and when navigating on level ground (62%). The most common non-fall injuries were lacerations (36%) and collisions with an object (35%). Reduced contrast sensitivity and visual acuity were associated with increased fall rate, after controlling for age, gender, cognitive function, cataract severity and self-reported physical function. Reduced contrast sensitivity was the only significant predictor of falls and other injuries. Conclusion: Among older adults with AMD, increased visual impairment was significantly associated with an increased incidence of falls and other injuries. Reduced contrast sensitivity was significantly associated with increased rates of falls, injurious falls and injuries, while reduced visual acuity was only associated with increased falls risk. These findings have important implications for the assessment of visually impaired older adults.