Liraz Fridman

Annual Trends in Follow-Up Visits for Pediatric Concussion in Emergency Departments and Physicians' Offices

Objective To assess whether children and youth with concussion receive follow‐up visits in accordance with the recommended guidelines. Study design We conducted a retrospective, population‐based study using linked health administrative data from all concussion‐related visits to emergency department and physician offices by children aged 5 through 18 years (range, 5.00‐18.99) in Ontario between 2003 and 2013. We analyzed the percentage of children and youth seen for follow‐up. The Mann‐Kendall test for trends was used to assess a monotonic increasing trend over time in concussion follow‐up visits. Results A total of 126 654 children and youth were evaluated for an index concussion visit. The number of children and youth assessed for concussion follow‐up (N = 45 155) has increased significantly over time (P < .001). In 2003, 781 of 7126 patients (11.0%; 95% CI, 10.3‐11.7) with an index visit for concussion had a follow‐up assessment. By 2013, 6526 of 21 681 (30.1%; 95% CI, 29.5‐30.7) patients received follow‐up care. Conclusions The proportion of children and youth receiving follow‐up after an acute concussion has significantly increased between 2003 and 2013. Nevertheless, more than two‐thirds of all patients do not seek medical follow‐up or clearance as recommended by current concussion guidelines, suggesting that ongoing efforts to improve and monitor compliance with recommended guidelines by patients and physicians are important.

PW 1782 An environmental scan of road safety policies in toronto, canada

Background Toronto introduced a Vision Zero Road Safety Plan (RSP) in 2017 with a goal of eliminating road traffic fatalities and serious injuries by 2021. A series of policies were published alongside the RSP with a focus on pedestrians, school children, and cyclists. While these documents provide insight into plans for future interventions targeted at vulnerable road users, little is known about the types of interventions that are most frequently recommended by policymakers and whether they are effective at reducing injuries. Objective The purpose of this study was to identify and categorize the types of interventions outlined in city plans and/or policies directly related to traffic safety in Toronto, Canada. Methods We performed an environmental scan of policies/plans that outline interventions such as regulatory changes and awareness campaigns with a focus on road traffic safety. Results Our search yielded 26 policies with a purpose/objective statement on topics including the built environment, urban design, and active school transportation. Almost half (46%) were identified as being directly related to road traffic safety and were further summarized by intervention type, target population, cost, and whether the intervention was outlined in Toronto’s Vision Zero RSP. A total of 107 interventions were identified in policy documents in Toronto. Forty three percent of interventions recommended modifications to the built environment (e.g. traffic calming measures). Interventions requiring a reduced speed limit from 50 km/h to 40 or 30 km/h were mentioned in 58% of policy documents in Toronto. Conclusions Most interventions outlined in road safety policy documents in Toronto align with Vision Zero. Having identified the policies/plans that are recommended most often for implementation, these results will be used to prioritize naturalistic (quasi-experimental) research studies that demonstrate the effectiveness of specific interventions (e.g. speed limit reductions). Future studies will examine inter-municipal policy comparisons between Canadian provinces.

PW 2912 The effects of cycle tracks implementation on cyclist-motor vehicle collisions in toronto, canada

Background There has been an increase in cycling over recent years in Toronto, Canada and the risk of injuries associated with various cycling infrastructures have yet to be fully understood. More specifically, cycle tracks (painted bike lanes with a physical separation from traffic) have become more prevalent in Toronto’s cycling network and may offer additional protection for cyclists. However, there has been little research examining the effects of these new cycle tracks in Toronto. Objective To examine the impact of the implementation of cycle tracks on the rate of cycle-motor vehicle collisions (CMVC) on tracks in Toronto, Canada. Methods Using a naturalistic experimental design, CMVC rates per month were calculated for 2 years pre and post-installation of six cycle tracks. Collisions reported to the Toronto Police Service between 2000 and 2016 were mapped using ArcGIS. A repeated measures Poisson model was used to evaluate the effect of cycle track implementation on rates of CMVC adjusted for season and cycle tracks upgraded from painted bike lanes. Results A total of 20,632 CMVC were reported in Toronto between 2000 and 2016, of which 190 collisions occurred on the six cycle tracks (3 upgraded from lanes) included in the analysis. The crude CMVC incidence rate before and after cycle track implementation was 0.42 collisions/month and 0.90 collisions/month respectively. The rate of CMVC significantly increased more than 2-fold following the implementation of cycle tracks (IRR=2.18, 95% CI: 1.42 to 3.33, p=0.003).The implementation of cycle tracks may result in an increased number of cyclists which may lead to greater risks for collisions. Conclusions Further investigation is required to examine the change in cycling volume on these tracks. In addition, the area-wide effects of cycle tracks should be explored to determine whether CMVC rates change on surrounding roadways without any cycling infrastructure.

PW 0821 The effect of lowering residential speed limits to 30 km/h on child pedestrian injuries in toronto, canada

Background Road traffic injury is the leading cause of death for children in Canada. Lower speed roads are correlated with lower pedestrian injury severity. Pedestrians are 8 times more likely to die after being struck by a motor vehicle going 50 km/h compared with 30 km/h. Few studies have examined the effect of speed limit reductions on vulnerable road users such as bicyclists or pedestrians. Given the recent increase in the number of pedestrian motor vehicle collisions (PMVC) in Toronto, it is important to describe the effectiveness of interventions such as speed limit reductions. Objective To examine the effect of lowering residential speed limits to 30 km/h on police reported child PMVCs in Toronto, Canada between 2014 and 2018. Methods We will investigate the influence of implementing 30 km/h speed limits on 387 km of residential streets that occurred in January 2015. We will calculate the number of police reported child PMVC per km per month along these streets for two years before and two years after the speed limit change. We will use comparator streets with a constant 40 or 50 km/h limit to isolate the effect of the intervention from that of secular trends, controlling for other built environment characteristics (e.g., speed humps, pedestrian crossovers). Expected findings We hypothesize that the rate of PMVC will decrease after the implementation of 30 km/h speed limits. pedestrian safety, including speed limit reductions. It is important to evaluate and quantify the effect of these changes on child pedestrian injury rates. Policy implications Results may provide evidence to support the implementation of speed reductions to make our roads safer.

204 The Canadian Injury Prevention Curriculum: using an integrated knowledge-translation approach

Background Intentional and unintentional injuries are a significant and preventable health concern in Canada with 4.27 million Canadians ages 12 or older suffering an activity limiting injury. Knowledge translation and education among researchers, practitioners and policy makers as well as the continual development of trainees in the area of injury prevention, is paramount for the future health of Canadians. Methods The Canadian Injury Prevention Curriculum (CIPC) was designed to provide practitioners the understanding of the theory and practice of injury prevention along with the tools needed to develop and implement effective injury prevention programs. The CIPC is targeted toward adult learners (researchers, practitioners and/or policy makers) who develop, implement and/or evaluate programs aimed at reducing the frequency and severity of both intentional and unintentional injury. The last update of this curriculum was in 2010. This project aimed to update the CIPC, using an integrated knowledge translation approach to reflect an evidence-informed approach to injury prevention. Results The revision occurred over a series of phases: PHASE 1 – Update to the current curriculum to reflect an evidence-informed approach to injury prevention (what is injury prevention and defining the problem, risk and protective factors and key determinants of injury, designing/selecting an intervention, implementation and evaluation) in consultation with an adult learning expert; PHASE 2 – Modules were developed for practitioners to further knowledge and application of core knowledge; PHASE 3 – The updated curriculum was made available across Canada to researchers, practitioners and policy makers interested in preventing injury in Canada. Conclusions The CIPC was updated using an integrated knowledge translation approach. The result was an education tool using an evidence-informed approach to the prevention of injury, applicable for researchers, practitioners, policy makers, and junior trainees.

1046 The canadian injury prevention trainee network: building capacity for the future of injury prevention research

Background Injuries are a serious but preventable health concern in Canada and a growing field of research, attracting a large number of graduate students and other trainees across Canada to identify injury prevention as their field of study. In 2009, the Canadian Institute for Health Research funded a team in Child and Youth (C&Y) Injury Prevention. With this support, the team was able to develop a model of practice involving researchers, stakeholders, knowledge users, and trainees as part of a multidisciplinary approach to reducing the burden of injury in youth. The C&Y team was successful at supporting and highlighting the work of over 40 team trainees. The efforts of this trainee team have resulted in the formation of the Canadian Injury Prevention Trainee Network (CIPTN). Objective The CIPTN aims to build a network of trainees interested in the science and practice of injury prevention (IP) from a multi-disciplinary perspective. Specifically, the goals include increasing opportunities for collaboration, professional development, mentorship and networking. Results The CIPTN has worked to develop a list of learning and research oriented catalyst activities for trainee members. The CIPTN has successfully collaborated with IP experts and organisations from across Canada in the development of a comprehensive IP resource, as well as updating the Canadian Injury Prevention Curriculum, a course for IP practitioners across Canada. Further, an executive board and governance structure has facilitated the identification of future collaborative activities (e.g., bi-monthly seminars, grant writing, and evaluating an injury methods workshop). Conclusions The CIPTN increases opportunities for junior researchers and trainees to work within a network of colleagues to share research, build collaborative projects, expand capacity, and provide training opportunities. This in turn, will develop the quantity and quality of IP science and practice across Canada for future generations.