Erin Patricia Cassell

Epidemiology of medically treated sport and active recreation injuries in the Latrobe Valley, Victoria, Australia

Objective: To quantify and describe medically treated sport and active recreation injuries in a defined region of the Latrobe Valley from 7 November 1994 to 6 November 1995. Method: A geographic target area was defined, restricted to the six postcodes that fell wholly within the catchment area of the Latrobe Regional Hospital. Data describing medically treated sport and active recreation injuries to Latrobe Valley residents aged over 4 years (about 70 000) were selected by postcode from three sources: the Victorian Admitted Episodes Dataset (hospital admissions), the Victorian Injury Surveillance System (presentations to hospital emergency departments), and the Extended Latrobe Valley Injury Surveillance (ELVIS) project (presentations to general practitioners). Results: At least 2300 cases of medically treated sport and active recreation injury were recorded. This corresponds to a hospital admission rate of 16/10 000 population, emergency department presentation rate of 169/10 000 population, and a general practitioner presentation rate of 187/10 000 population. There were more male patients than female, and younger age groups were also overrepresented, but these data may reflect the greater participation of these groups in sport and active recreation. Australian football was associated with the highest number of injuries (accounting for 24.0% and 22.0% of presentations to emergency departments and general practitioners respectively) followed by cycling (15.7% and 12.6%) and basketball (17.5% and 13.5%). Conclusions: This study shows that routine health sector data collections in defined populations can provide useful information on the size, distribution, and characteristics of the problem of sport and active recreation injuries at the community level. However, all current health sector systems for injury data collection and surveillance require attention to improve case capture and identification and data quality.

Evaluation of the Latrobe Valley Better Health Injury Prevention Program

Objective—To evaluate the Latrobe Valley Better Health Injury Prevention Program, a regional community based intervention in south east Victoria, Australia. Method—The evaluation design was quasiexperimental including pre-intervention and post-intervention observations in a predominately town dwelling population of approximately 76 000. There was no comparison community. Process measures included key informant interviews. Impact evaluation utilised self reported changes in injury risk and protective factors, gathered by a random household telephone survey. Outcome evaluation was based on five years of emergency department injury surveillance data for the Latrobe Valley. Results—The program built strategic partnerships, increasing the emphasis on local safety. Activities were implemented in the targeted areas of home, sport, and playground injuries. Some 47 000 educational contacts were made with the community and at least 6000 resource items distributed. There were significant increases in home safety knowledge. Some changes in the areas of playground and sport safety were achieved after partnership development with relevant agencies. Poisson regression models showed significant decreases in the presentation rate for all home injury and for the more severe home injuries. Conclusion—This study clearly demonstrates the difficulty of conducting robust evaluation in the absence of readily available and reliable data and adequate budgets. The Latrobe Valley Better Health Program activities contributed to structural, environmental, and organisational changes that have the potential to reduce injury. The extent of this contribution beyond that made by the statewide injury prevention strategy is not able to be determined.

Preventing in-line skating injuries: how effective are the countermeasures?

AbstractThere was a six-fold growth in participation in in-line skating in the US from 1989 to 1996 and a concomitant increase in injuries. Similar trends have been reported in Canada, the UK, Denmark and Australia.Falls, mostly from loss of balance, are a common cause of injury. Falling skaters typically put one or both hands out to break their fall and land on a hard surface with the upper limb sustaining the injury. Approximately one-quarter of all in-line skating injuries are wrist fractures.Hospital emergency department data shows that skaters aged 10 to 14 years are most at risk for injury. First-time skaters, inexperienced skaters and experienced skaters trying new tricks are also at risk for injury. In-line skating injuries can be severe, with several deaths reported.Measures to prevent in-line skating injury include: wearing personal protective equipment (wrist guards, helmets, knee and elbow pads); improving environmental conditions for skaters; providing lessons, particularly for novice skaters; certification for skating instructors; encouraging physical preparation; educating skaters about safety; improving equipment design and standards; and refining government policy and regulation in consultation with skating groups.Few of these measures have been formally proven to reduce injury. Controlled evaluations of the currently advocated methods are needed to establish their efficacy. More biomechanical and epidemiological research is needed, particularly in the area of wrist/forearm injury prevention. Given the rapid increase in popularity of in-line skating and the potential for a related epidemic of moderate to serious injuries, research into in-line skating injury prevention should be a priority.

What Would You Like? Identifying the Required Characteristics of an Industry-Wide Incident Reporting and Learning System for the Led Outdoor Activity Sector.

The aim of this study was to identify the characteristics that led outdoor activity providers agree are necessary for the development of a new industry-wide incident reporting and learning system (UPLOADS). The study involved: 1) a literature review to identify a set of characteristics that are considered to be hallmarks of successful reporting and learning systems in other safety-critical domains; and (2) the presentation of these characteristics to 25 Australian led outdoor activity providers using a two round modified-Delphi technique to obtain consensus views on their relative importance in this domain. Thirteen out of 30 characteristics were endorsed as “essential” for developing an incident reporting and learning system for the led outdoor activity sector, and a further 13 were endorsed as “required”. “Essential” characteristics primarily related to operational or practical characteristics of the system, while “required” characteristics primarily related to system infrastructure, data quality and the basis for developing of countermeasures to address identified injury risks. The findings indicate that although led outdoor activity providers are primarily concerned that the demands of reporting do not adversely impact on their day to day operations, they also recognise that data collection methods and countermeasure development need to be of high quality. The paper concludes by highlighting some potential strategies for implementing the characteristics considered “essential” and “required”.

Traumatic orodental injuries and the development of an orodental injury surveillance system: a pilot study in Victoria, Australia

Traumatic orodental injuries are common dental public health problems that have complex aetiology and significant impact on those affected. It is important to understand the frequency, pattern and causes of traumatic orodental injuries so that appropriate and effective treatment services are made available and injury prevention interventions are designed and implemented. The aims of this study were to measure the frequency, causes and patterns of traumatic orodental injuries in patients of all ages treated at the Royal Dental Hospital of Melbourne in Victoria, Australia, over a 12-month period and to investigate the feasibility of establishing an orodental injury surveillance system. For which, a retrospective audit of 304 patient records was undertaken and injury surveillance data were extracted and analysed. Males represented 67% of cases. Three-quarters of all cases were aged less than 24 years. The most frequent cause of orodental injury was falls from less than 1 m or being struck by or colliding with a person or object. Injuries occurred most commonly around the home, on the road, street or footpath, the sports ground and places for recreation and were most often associated with leisure and sports activities. Orodental injuries sustained in one traumatic incident were often multiple and serious. Many severe orodental trauma injury cases present at this public dental hospital are expensive to treat, require long-term management and may be preventable. The findings from this study have led to the development and planned implementation of an enhanced electronic orodental injury structured history form that incorporates the collection of key injury surveillance data. These prospective data are to be combined with injury surveillance data that are routinely collected by all Victorian public hospital emergency departments in order to improve understanding of the nature of orodental injuries impacting Victorian communities and assist with appropriate service planning and the design of orodental injury prevention interventions.

Effectiveness of the 2005 compulsory personal flotation device (PFD) wearing regulations in reducing drowning deaths among recreational boaters in Victoria, Australia

Objective To investigate whether the Victorian mandatory personal flotation device wearing regulations that came into effect on 1 December 2005 reduced drowning deaths among recreational boaters in Victoria, Australia. Design A retrospective population-based ‘before and after’ study using Victorian coronial data on drowning deaths of occupants of recreational vessels operating in Victorian waters. Methods The annual numbers of deaths in the 5 years after the transition year of the regulations (2005) was compared with the annual numbers of deaths in the 6 years prior to the transition year, using the Mann-Whitney U test. Results There were 59 recreational boating drowning deaths in the 6-year preintervention period (1 December 1998 to 30 November 2004) compared with 16 in the 5-year postintervention period (1 December 2005 to 30 November 2010). The analysis showed a significant decrease in drowning deaths among all recreational boaters (U=30.0, p=0.01) and among these strata: vessel occupants aged 0–29 years (U=28.0, p=0.02) and 30–59 years (U=27.5, p=0.02), vessel occupants engaged in pleasure cruising (U=29.0, p=0.01) and in ‘other’ boating activities (U=25.0, p=0.04), boaters on small powerboats ≤4.8 m in length (U=29.5; p=0.01), boaters on motorised (U=29.5; p=0.01) and sail-powered vessels (U=26.0; p=0.04), and occupants of vessels operating in inland waterways (U=30.0; p=0.01). Conclusions These findings provide further support for the adoption of a regulatory approach to personal flotation device wearing to reduce drowning among recreational boaters.

Injury prevention during physical activity in the Australian Defence Force

INTRODUCTION Injuries sustained by Australian Defence Force (ADF) personnel during non-combat military training and sports activity are associated with increasing costs due to work days lost, medical treatment, compensation, and early retirement. In 2001, the ADF commissioned a systematic review of the evidence-base for reducing injuries associated with physical activity, while at the same time improving physical activity participation rates to sustain a trained, fit and deployable workforce. METHOD Literature from on-line library databases, relevant unclassified military reports, and material from previously published sport-specific injury countermeasure reviews were systematically and critically analysed to address the study aims. RESULTS Modification of intensity, frequency and duration of basic military training activities and improved equipment is likely to reduce injury occurrence. Sports injury countermeasures used for the civilian population have merit for the ADF physical activity program. Injury countermeasures should be designed to minimise any possible deterrent effect on the motivation to participate in regular physical activity. Increasing the participation of ADF personnel in physical activity in the presence of evidence-based injury prevention strategies has the potential to increase health, fitness and deployability with minimal impact on injury frequency. CONCLUSION Recommendations arising from the review include injury intervention trials in basic military training and sports. These and other interventions should be supported by refinement to ADF injury surveillance systems. Research should focus on interventions with the greatest gain for fitness, deployability, and cost effectiveness.

Victorian Emergency Minimum Dataset: Factors that impact upon the data quality

Objective:  The Victorian Emergency Minimum Dataset (VEMD) records details of approximately 80% of Victorias ED presentations. Its usefulness for quality assurance and research relies on the data being both complete and accurate. We aimed to determine the factors that impact adversely on the collection of high‐quality VEMD data.

Do wrist guards have the potential to protect against wrist injuries in bicycling, micro scooter riding, and monkey bar play?

Objective: To test the potential of wrist guards to prevent wrist injury in recreational activities that require good grip strength and hand dexterity. Methods: Forty eight children aged 5–8 years from one Melbourne school volunteered for tests chosen or devised following a review of the literature on the effects of orthoses use and hand function. Results: Wrist guard wearing significantly degraded grip strength, bicycle steering, and performance on a monkey bar. Micro scooter steering was not significantly affected by their use. Conclusion: Wrist guards designed for skating are not recommended for bicycle riding and playing on climbing apparatus, and their suitability for scooter riding requires further investigation.

The decreasing trend in hip fractures: response to Stevens & Rudd

Dear editor, We analysed the trends in fall-related hip fracture incidence for men and women separately by 10-year age groups (65 to 74, 75 to 84 and 85 years and older) to compare our results for Victoria [1] to those reported for the USA by Stevens and Rudd in their letter [2]. Our results showed that, from 1998/9 to 2008/9, fallrelated hip fracture rates for men and women decreased significantly in all 10-year age groups (range −43.1 to −20.8 %). However, in contrast to the pattern found for the USA, the sharpest decline in hip fracture rates was in males aged 65– 74 years (−43.1 %, 95 % confidence interval −51.2 to −35.5), then in females in the same age group (−28.1 %, 95 % confidence interval −39.4 to −15.7).