Kate Turcotte

Do Light Truck Vehicles (LTV) Impose Greater Risk of Pedestrian Injury Than Passenger Cars? A Meta-analysis and Systematic Review

Objective: Pedestrian crashes present a growing challenge for public health trauma and road safety researchers around the world. They are associated with substantial morbidity, mortality, and cost, yet there is an international lack of published work on the topic, especially when compared with vehicle occupant safety studies. Our review attempts to quantify the risk of fatal injury among vulnerable road users. The specific objective of this systematic review and meta-analysis is to quantify and compare the impact of light truck vehicles (LTVs) versus conventional cars on pedestrian fatal injury. Methods: A protocol was developed using methods of the Cochrane Collaboration. We conducted a search for the studies in bibliographic databases that included ATI (Australian Transport Index); Cochrane Injuries Group Specialized Register; EMBASE; ERIC; MEDLINE; National Research Register; PsycINFO; Road Res (ARRB); SIGLE; Science (and Social Science) Citation Index; TRANSPORT (NTIS, TRIS, TRANSDOC, IRRD). Web sites of traffic and road accident research bodies, government agencies, and injury prevention organizations were searched for grey literature. Reference lists from selected papers or topic reviews were scanned for potentially relevant papers. Results: Our initial search identified 878 potentially eligible studies. After thorough review by three of the researchers a total of 12 studies were included in the systematic review, 11 of which were included in the meta-analysis. The overall pooled odds ratio for the risk of fatal injury in pedestrian collisions with LTVs compared to conventional cars was odds ratio 1.54, 95 percent confidence interval 1.15–1.93, p = 0.001. Thus, the risk for pedestrians of sustaining fatal injury is 50 percent greater in collisions with LTVs than in collisions with conventional cars. Conclusions: Our systematic review and meta-analysis suggests that LTVs pose a greater risk of pedestrian injury death compared to conventional cars. These findings have important implications for the automotive industry and the safety of vulnerable road users.

Does Obesity Increase the Risk of Injury or Mortality in Motor Vehicle Crashes? A Systematic Review and Meta-Analysis

The objective of this review was to assess the risk of obesity in injuries and fatalities resulting from motor vehicle crash (MVC), as compared with individuals with a normal-range body mass index. A systematic review of the literature was conducted yielding 824 potential studies. Nine of these studies met our inclusion criteria. Meta-analyses examining obesity as a risk factor for various injury types and risk of fatality were conducted using data from these studies. Obesity was associated with higher fatality risk (odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.51-2.37, P = .0001; pooled estimate from 6 studies), and increased risk of lower extremity fractures (OR = 1.39, 95% CI = 1.18-1.65, P = .0001; pooled estimate from 2 studies). No significant differences were observed when considering abdominal injuries or pelvic fractures. Interestingly, for head injuries obesity was a protective factor (OR = 0.67, 95% CI = 0.46-0.97, P = .0001; pooled data from 3 studies). Evidence strongly supports the association of obesity with higher fatality and fractures of the lower extremities in MVCs. Contrary to our hypothesis, 3 studies showed that obesity was a protective factor in reducing head injuries. Furthermore, the review shows that obesity was not a risk factor of MVC-related pelvic fractures and abdominal injuries.

A Systematic Review of Community Interventions to Improve Aboriginal Child Passenger Safety

We evaluated evidence of community interventions to improve Aboriginal child passenger safety (CPS) in terms of its scientific merit and cultural relevance. We included studies if they reported interventions to improve CPS in Aboriginal communities, compared at least pre- and postintervention conditions, and evaluated rates and severity of child passenger injuries, child restraint use, or knowledge of CPS. We also appraised quality and cultural relevance of studies. Study quality was associated with community participation and cultural relevance. Strong evidence showed that multicomponent interventions tailored to each community improves CPS. Interventions in Aboriginal communities should incorporate Aboriginal views of health, involve the community, and be multicomponent and tailored to the communitys circumstances and culture.

SPORTS UTILITY VEHICLES AND VULNERABLE ROAD USERS

We read with interest the article by Robertson,1 and we certainly agree that the sports utility vehicles (SUVs) pose an increased risk to small car occupants as well as vulnerable road users, such as pedestrians, cyclists, older persons, and children.2 In many developing countries, pedestrians, cyclists, rickshaw operators, and moped users represent the majority of road users. These countries rarely have the resources to physically separate such road users from car traffic. Many developing countries have no sidewalks or bicycle paths and those that do exist are heavily obstructed by trees, trash, drainage ditches, and vendors selling goods. Pedestrian injuries are a leading cause of global death and injury burden, accounting for 65% of the 1.2 million annual road deaths.3 Collisions between pedestrians and vehicles present a major challenge for public health, trauma and emergency medicine, and traffic safety professionals. Yet, in spite of the size of the pedestrian injury problem, research has concentrated almost exclusively on increasing the survival rates for vehicle occupants.4 A man waits for his identification wristband to be scanned during a mock evacuation drill May 23, 2006 in New Orleans, Louisiana. The two-day drill is being held in New Orleans and Baton Rouge in order to help the area prepare for the upcoming hurricane season. Photograph by Mario Tama. Courtesy of Getty Images. Recent US and United Arab Emirates studies have reported that increased numbers of SUVs and pickup trucks were associated with pedestrian deaths and a higher pedestrian injury severity score,5,6 and SUVs were 4 times as likely to be associated with fatal injury for the 5- to 9-year-old age group.7 Method of transportation is an important determinant of public health, affecting physical activity levels, social and economic opportunities, and general well-being.8 Extensive literature on the various health benefits of physical activity has illustrated the need to understand the determinants, risks, and barriers of physical activity. Vehicle danger is a disincentive to active lifestyles in that reducing the risks of fatal traffic injury for pedestrians and cyclists is an important part of any strategy to encourage walking and cycling to combat childhood obesity. Walking and cycling are essential modes of travel for many people living in low- and middle-income countries. Safe walking and cycling should be promoted, because their environmental, economic, and health benefits are significant.9 Potential reduction in the costs of treating heart disease if adults walked regularly has been calculated in the United States, saving US

Applying the health action process approach to bicycle helmet use and evaluating a social marketing campaign

5.6 billion annually if 10% of adults began a regular walking program.10 Safety standards for vehicle front-end construction, which would make vehicles less hazardous to pedestrians and cyclists, may be as important as standards that affect vehicle occupants; however, political obstacles have made such standards difficult to implement.1,2,5,7

PW: 1806 Determinants of injury and death among canadian firefighters

Background Bicycle injuries are of concern in Canada. Since helmet use was mandated in 1996 in the province of British Columbia, Canada, use has increased and head injuries have decreased. Despite the law, many cyclists do not wear a helmet. Health action process approach (HAPA) model explains intention and behaviour with self-efficacy, risk perception, outcome expectancies and planning constructs. The present study examines the impact of a social marketing campaign on HAPA constructs in the context of bicycle helmet use. Method A questionnaire was administered to identify factors determining helmet use. Intention to obey the law, and perceived risk of being caught if not obeying the law were included as additional constructs. Path analysis was used to extract the strongest influences on intention and behaviour. The social marketing campaign was evaluated through t-test comparisons after propensity score matching and generalised linear modelling (GLM) were applied to adjust for the same covariates. Results 400 cyclists aged 25–54 years completed the questionnaire. Self-efficacy and Intention were most predictive of intention to wear a helmet, which, moderated by planning, strongly predicted behaviour. Perceived risk and outcome expectancies had no significant impact on intention. GLM showed that exposure to the campaign was significantly associated with higher values in self-efficacy, intention and bicycle helmet use. Conclusion Self-efficacy and planning are important points of action for promoting helmet use. Social marketing campaigns that remind people of appropriate preventive action have an impact on behaviour.

PW 1831 Addressing physician uncertainty and standardizing concussion recognition and management: the new online concussion awareness and training tool (CATT)

Professional firefighters are exposed to a variety of injury hazards over the course of their occupation, including: extreme temperatures, toxic substances, strenuous physical labour, unstable structures, falling objects, extreme heights, violence and traumatic events. The purpose of this study is to describe the determinants of injury, disease and death among Canadian firefighters by age, gender, region, and employment status. A descriptive analysis of the Association of Workers’ Compensation Boards of Canada and WorkSafeBC data was undertaken to define priority issues for targeted intervention. Outcome measures included time-loss and fatality claims accepted by compensation boards between 2006 and 2015, and submitted by professional and volunteer firefighters over the age of 14 years. An analysis of AWCBC data revealed five principal determinants of injury and death among Canadian firefighters: cancer, traumatic injury, cardiovascular disease, respiratory disease and mental health. Cancer represented over 86% of all fatality claims, while traumatic injuries represented 90% of all time-loss claims among firefighters. Firefighter time-loss claims due to traumatic injury occurred at a rate of 1,661.3 per 1 00 000 firefighter population per year. Mental health was the third leading cause of time-loss claims among Canadian firefighters, occurring at a rate of 23.95 per 1 00 000 firefighter population per year. Volunteer firefighters in British Columbia reported lower rates of time-loss claims per 1 00 000 firefighter population than professional firefighters for traumatic injury, cancer, mental health, cardiovascular disease and respiratory disease. Given inherent limitations of claims data to analyze injury and death within an occupation, a dedicated national firefighter injury surveillance model is needed to support timely and responsive prevention and intervention, as well as specific research. The results of this study suggest that cancer, injury and mental health should be priority issues for researchers, employers and policy-makers working to improve firefighter health and safety.

PW 1830 Evaluation of the efficacy and acceptability of the BC hockey mandate for team officials to complete the concussion awareness training tool

Context The Concussion Awareness Training Tool (CATT) is a series of online educational modules and resources with the goal of standardizing concussion recognition, diagnosis, treatment, and management. Based upon the established principles of the Consensus Statement on Concussion in Sport and other evidence-based resources, this tool includes a new self-paced learning module for medical professionals to address current gaps and variations in practice for the initial assessment and management of acute concussion patients in the office setting. CATT for medical professionals originally launched in 2013, focusing on the recognition and diagnosis of concussion. Evaluation found physicians demonstrated significant positive change in concussion practices (p=0.001), and significant change in knowledge by those treating more than 10 concussions per year (p=0.039). Objective To support physicians and other medical professionals in treating and managing concussion. Key messages The new e-learning course covers medical assessment for concussion, concussion management, addressing persistent symptoms, and providing medical clearance following recovery. The course is available in both English and French. Beyond medical professionals, CATT also caters to coaches, players/participants, parents and school professionals. Resources for workers and workplaces are currently being developed. To date, over 100 relationships have been developed with organizations and key stakeholders in British Columbia and beyond,>15 000 print resources have been distributed,>30 000 coaches and parents and >3000 school professionals have completed CATT, and >15 sporting organizations and schools have mandated CATT training. Discussion and conclusions Concussion is an under-recognized, -diagnosed and -treated medical condition, requiring both physical and mental rest. The CATT addresses this gap by increasing knowledge and awareness among appropriate specific audiences (www.cattonline.com). Good concussion management can reduce related health problems and the risk of long-term brain damage, potentially lowering total health care costs among those who are injured.

70 Preventing adverse concussion outcomes: the online concussion awareness training toolkit

Background The Concussion Awareness Training Tool (CATT) is a series of online educational modules and resources with the goal of standardizing concussion recognition, diagnosis, treatment, and management (www.cattonline.com). Based upon the established principles of the Consensus Statement on Concussion in Sport, CATT caters to coaches, players/participants, and parents, as well as medical and school professionals. CATT for parents, players and coaches launched in 2014 with an e-learning module and resources, including the Concussion Response Tool and Questions to Ask Your Doctor. Evaluation found parents/coaches demonstrated significant positive change in concussion knowledge (p=0.002) following the CATT training. In June 2016, BC Hockey mandated CATT training for all team officials, to be completed prior to the 2016–2017 hockey season. Aim To assess the efficacy and acceptability of the CATT training for the minor hockey community in British Columbia, Canada. Methods Self-reported retrospective information on the efficacy and acceptability of the CATT training was collected via online survey. Quantitative and qualitative analyses were performed, with selected cross-tabulations. Results The survey had a>10% response rate (n=1,593). CATT training led to a significant increase in self-reported concussion knowledge (p<0.001). Mandating CATT training for parents was supported by 68.4% of respondents, with females significantly more in favour than males (p<0.02). Discussion and conclusions Sport plays an important role in maintaining mental and physical wellbeing, however, concussion is an under-recognized, -diagnosed and -treated medical condition. CATT addresses this gap by increasing knowledge and awareness among appropriate specific audiences. The BC Hockey mandate for CATT training successfully increased the level of concussion-related knowledge among team officials. Mandating the CATT for parents of BC Hockey players should be strongly considered. This resource supports the implementation of a standardized protocol for the recognition, treatment, and management of sport-related concussions, both in the minor hockey leagues and other sports, in BC.

Vulnerable Child Pedestrians in Rapidly Motorizing Developing Countries

Statement of purpose Prevention, recognition and treatment of concussion, particularly in sport, is important nationally and internationally. The online Concussion Awareness Training Toolkit (CATT) was developed to standardise diagnosis, treatment and management. Methods/approach Based upon the Zurich Consensus Statement on Concussion in Sport, CATT is a resource designed for specific audiences. The first, for health practitioners (CATT HP) aims to standardise practice in a clinical setting. CATT HP includes a self-paced learning module; diagnostic tools; clinical resources, patient handouts, journal articles, websites, videos and individual case studies. The second tool is specific to parents, players and coaches (CATT PPC) and speaks to the identification and appropriate management of concussion, including smartphone accessible resources: ‘concussion response tool’ and ‘questions to ask your doctor’. The final tool is for educators (CATT E). It includes the return-to-learn protocol and resources for teachers, administrators, counsellors, aides. Results CATT HP was launched mid April, 2013. To date, it has received 28,000 hits worldwide and has been evaluated using a pre/post intervention self-report survey. Physicians demonstrated significant positive change in concussion practices (p = 0.001), and significant change in knowledge by those treating more than 10 concussions/yr (p = 0.039). Nurses had significant positive change in practices (p = 0.005) and attitudes (p = 0.035). CATT PPC was launched mid June, 2014 and evaluation data is currently being analysed. Results will be prepared by December, 2014. Conclusion Concussion is an under-recognised, -diagnosed and -treated medical condition, requiring both physical and mental rest. The CATT addresses this gap by increasing knowledge and awareness among appropriate specific audiences. Significance and contributions Good concussion management can reduce related health problems and the risk of long-term brain damage, potentially lowering total health care costs among those who are injured.