Nicola Christie

Measuring the Population Burden of Injuries—Implications for Global and National Estimates: A Multi-centre Prospective UK Longitudinal Study

Ronan Lyons and colleagues compared the population burden of injuries using different approaches from the UK Burden of Injury and Global Burden of Disease studies and find that the absolute UK burden of injury is higher than previously estimated.

How exposure information can enhance our understanding of child traffic “death leagues”

Objectives: To explore whether population-based fatality rates and measures of traffic exposure can be combined to provide a more comprehensive measure of safety. To illustrate how this could be achieved using surveys from a range of Organisation for Economic Cooperation and Development (OECD) countries. To discuss why exposure is important. Design and setting: Fatality data were obtained from the International Road Traffic and Accident Database and travel data from surveys among government transport administrations in each country. Methods: Comparable exposure data were obtained for children aged 10–14 years from the UK, the USA, Germany, The Netherlands, Norway, Sweden, Switzerland and New Zealand. Fatality rates for children travelling as pedestrians, cyclists and car occupants were calculated based on (1) per head of population and (2) a combination of rate per head population and per kilometre travelled. Results: In this study, exposure-based fatality rates suggest a more polarized distribution rather than a graduated league. The USA and the UK were at the lower end of the table for child pedestrian safety; Germany for car-occupant safety, Sweden and New Zealand performed less well. For cycling, the inclusion of exposure data considerably changes positions within the table. Countries with higher cycling levels like The Netherlands perform better than those with low levels like the UK and New Zealand. Conclusions: Exposure-based fatality rates can help us to understand whether policies reduce exposure or whether they increase safety, given a similar level of exposure. Data need to be harmonized across OECD countries for a better understanding of the risks and links between health and sustainable travel.

The UK Burden of Injury Study – a protocol. [National Research Register number: M0044160889]

BackgroundGlobally and nationally large numbers of people are injured each year, yet there is little information on the impact of these injuries on peoples lives, on society and on health and social care services. Measurement of the burden of injuries is needed at a global, national and regional level to be able to inform injured people of the likely duration of impairment; to guide policy makers in investing in preventative measures; to facilitate the evaluation and cost effectiveness of interventions and to contribute to international efforts to more accurately assess the global burden of injuries.Methods/DesignA prospective, longitudinal multi-centre study of 1333 injured individuals, atttending Emergency Departments or admitted to hospital in four UK areas: Swansea, Surrey, Bristol and Nottingham. Specified quotas of patients with defined injuries covering the whole spectrum will be recruited. Participants (or a proxy) will complete a baseline questionnaire regarding their injury and pre-injury quality of life. Follow up occurs at 1, 4, and 12 months post injury or until return to normal function within 12 months, with measures of health service utilisation, impairment, disability, and health related quality of life. National estimates of the burden of injuries will be calculated by extrapolation from the sample population to national and regional computerised hospital in-patient, emergency department and mortality data.DiscussionThis study will provide more detailed data on the national burden of injuries than has previously been available in any country and will contribute to international collaborative efforts to more accurately assess the global burden of injuries. The results will be used to advise policy makers on prioritisation of preventive measures, support the evaluation of interventions, and provide guidance on the likely impact and degree of impairment and disability following specific injuries.

Getting back to work after injury: the UK Burden of Injury multicentre longitudinal study

BackgroundInjuries to working age adults are common and place a considerable burden on health services accounting for more than 10% of GP sick notes and 14% of those claiming benefits because they are unable to work in the UK. General practitioners (GPs) currently assess fitness to work and provide care and referral to other services to facilitate return to work (RTW). Recent UK recommendations suggest replacing GP sickness certification with independent assessments of fitness to work after four weeks sick leave. The impact of a wide range of injuries on RTW and subsequent need for independent fitness to work assessments has not been well studied in the UK. The aim of this study was to quantify RTW and factors predicting RTW following a wide range of injuries.MethodsWe used a multicentre longitudinal study, set in four acute NHS Trusts in the UK which recruited emergency department (ED) attenders and hospital admissions for injury and included those aged 16–65years that were employed or self-employed before the injury. Participants were followed up by postal questionnaire at 1, 4 and 12 months post injury to measure health status (EQ-5D), recovery, use of health and social services, time off work in the preceding month and work problems amongst those who had RTW. Multivariable Poisson regression with a robust variance estimator was used to estimate relative risks for factors associated with RTW.ResultsOne month after injury 35% of ED attenders had fully RTW. The self employed were more likely (RR 1.70, 95% CI 1.17 to 2.47 compared with employed) and the moderate/severely injured less likely to RTW (RR 0.48, 95% CI 0.32 to 0.72 compared with minor injuries). At four months, 83% of ED attenders had RTW and self employment and injury severity remained significant predictors of RTW (self employment RR 1.15, 95% CI 1.03 to 1.30; moderate/severe injury RR 0.79, 95% CI 0.68 to 0.92). At four months 57% of hospital admissions had RTW. Men were more likely than women to RTW (RR 1.94, 95% CI 1.34 to 2.82), whilst those injured at work (RR 0.49, 95% CI 0.27 to 0.87 compared with at home) and those living in deprived areas (most deprived tertile RR 0.59, 95% CI 0.40 to 0.85 and middle tertile RR 0.61, 95% CI 0.40 to 0.93) were less likely to RTW. Health status was significantly poorer at one and four months after injury than before the injury and was significantly poorer amongst those that had not RTW compared to those that had. Problems with pain control, undertaking usual activities, mobility and anxiety and depression were common and persisted in a considerable proportion of participants up to four months post injury.ConclusionsInjuries have a large impact on time off work, including amongst those whose injuries did not warrant hospital admission. The majority of injured people would require an in-depth fitness for work assessment if recent UK recommendations are implemented. Many people will have on-going pain, mobility problems, anxiety and depression at the point of assessment and it is important that patients are encouraged to use primary care services to address these problems. A range of factors may be useful for identifying those at risk of a slower recovery and a delayed RTW so that appropriate interventions can be provided to this group.

Recovery from injury: the UK Burden of Injury Multicentre Longitudinal Study

Objectives To estimate the likelihood of recovery at 1, 4 and 12 months post injury and investigate predictors of recovery in injured people attending an emergency department (ED) or admitted to hospital in the UK. Methods Participants completed questionnaires at recruitment and 1, 4 and 12 months post injury or until recovered. Data were collected on injury details, sociodemographic characteristics, general health prior to injury and recovery. We compared three age groups: 5–17, 18–64 and 65 years and above. Modified Poisson regression estimated the relative risk of recovery. Multivariable models were built using backward stepwise regression. Sensitivity analyses assessed the effect of missing data. Results We recruited 1517 participants, 55% (n=836) ED attenders and 44% (n=661) hospital admissions. By 1 month after injury, 28% (285/968) had fully recovered, 54% (440/820) at 4 months and 71% (523/738) at 12 months. Recovery was independently associated with gender, admission status, injury severity, body region injured and place of injury for 5–17 year olds and 18–64 year olds and with gender, admission status, injury severity and long-term illness for those aged 65+. Injury severity and hospital admission were associated with recovery across all age groups, but not at every time point in each age group. Other factors varied between age groups or time points. Results were generally robust to imputing missing data. Conclusions A range of factors was found to predict recovery among injured people. These could be used to identify those at risk of delayed recovery and to inform the design of interventions to maximise recovery.

Recruiting participants for injury studies in emergency departments

Emergency departments have the potential to maximize recruitment efficiency and minimize recruiting costs For many studies, especially those requiring incident injury cases, emergency departments are the most suitable location for recruiting participants.1 Although the total number of injury attendances is greater in outpatient or primary care settings than in emergency departments,2 geographical spread and the mixture of incident and prevalent cases make recruiting participants from these sites less feasible, more time consuming and more costly. Emergency departments, on the other hand, will see the largest number and spectrum of injury cases, usually presenting very shortly after injury in a single healthcare setting. This has the potential to maximize recruitment efficiency and minimize recruiting costs. Recruiting in emergency departments also provides opportunities to study the aetiology and epidemiology of injuries before recall of events diminishes with time and to enroll participants for studying short- and long-term consequences of injury. They are the only setting in which complete ascertainment of incident cases of specific injuries may be possible—for example, virtually all patients with long bone fractures will attend an emergency department, fewer will attend primary care and a proportion will be admitted to hospital, but this will vary between hospitals depending on a range of factors including clinician preference for management options, bed availability, social circumstances.3,4 Recruiting cases from emergency departments therefore, has the potential to minimize the selection bias inherent in recruiting such cases from other sites. Inspite of the potential for recruiting injured patients to studies within emergency departments, there are characteristics of the clinical setting and of injured patients which may make recruitment difficult. Emergency departments are often busy and crowded places, and the demand for emergency care continues to increase.5 Many emergency departments experience shortfalls in medical staffing and difficulties in recruiting and …

The Advocacy in Action Study a cluster randomized controlled trial to reduce pedestrian injuries in deprived communities

Background Road trafficrelated injury is a major global public health problem. In most countries, pedestrian injuries occur predominantly to the poorest in society. A number of evaluated interventions are effective in reducing these injuries. Very little research has been carried out into the distribution and determinants of the uptake of these interventions. Previous research has shown an association between local political influence and the distribution of traffic calming after adjustment for historical crash patterns. This led to the hypothesis that advocacy could be used to increase local politicians knowledge of pedestrian injury risk and effective interventions, ultimately resulting in improved pedestrian safety. Objective To design an intervention to improve the uptake of pedestrian safety measures in deprived communities. Setting Electoral wards in deprived areas of England and Wales with a poor record of pedestrian safety for children and older adults. Methods Design mixedmethods study, incorporating a cluster randomized controlled trial. Data mixture of Geographical Information Systems data collision locations, road safety interventions, telephone interviews, and questionnaires. Randomization 239 electoral wards clustered within 57 local authorities. Participants 615 politicians representing intervention and control wards. Intervention a package of tailored information including maps of pedestrian injuries was designed for intervention politicians, and a general information pack for controls. Outcome measures Primary outcome number of road safety interventions 25months after randomization. Secondary outcomes politicians interest and involvement in injury prevention cost of interventions. Process evaluation use of advocacy pack, facilitators and barriers to involvement, and success.

Making a successful return to work: the UK burden of injury multicentre longitudinal study

BACKGROUND Injuries are common and make a significant contribution to sickness absence, but little is known about problems experienced by injured people on return to work (RTW). AIM To quantify work problems on RTW and explore predictors of such problems. DESIGN & SETTING Multicentre longitudinal study in four UK hospitals. METHOD Prospective study of injured participants aged 16-65 years who were employed or self-employed prior to the injury and had RTW at 1 or 4 months post injury. RESULTS At 1 month, most (59%) had only made a partial RTW. By 4 months, 80% had fully RTW. Those who had partially RTW had problems related to physical tasks (work limited for median of 25% of time at 1 month, 18% at 4 months), time management (10% at 1 month, 20% at 4 months) and output demands (10% at 1 month, 15% at 4 months). Productivity losses were significantly greater among those with partial than full RTW at 1 month (median 3.3% versus 0.9%, P<0.001) and 4 months (median 4.6% versus 1.1% P = 0.03). Moderate/severe injuries (relative risk [RR] 1.93, 95% confidence interval [CI] = 1.35 to 2.77) and sports injuries (RR 1.73, 95% CI = 1.12 to 2.67) were associated with significantly greater productivity losses at 1 month while pre-existing long-term illnesses (RR 2.12, 95% CI = 1.38 to 3.27) and upper limb injuries (RR 1.64, 95% CI = 1.06 to 2.53) were at 4 months. CONCLUSION Injuries impact on successful RTW for at least 4 months. Those who have only partially RTW experience the most problems and GPs should pay particular attention to identifying work problems in this group and ways of minimising such problems.

Ethnicity, deprivation and road traffic injury risk: a survey of risk and road safety and implications for injury prevention

Abstract Objective: To gain an insight into the relationship between ethnicity and road safety among adults living in low socioeconomic areas. Design: Questionnaire based face-to-face interview survey among residents from low socioeconomic areas. Setting: The survey was conducted in five districts which represent the poorest 15% of districts in England and Wales which also have high road traffic collision rates. Subjects: Community residents aged 16 or over living in low socioeconomic areas Results: Black, Asian and Minority Ethnic (BAME) participants in low socioeconomic areas are significantly more likely to report being injured in a collision as a car occupant, have access to a car in their household and less likely to report that they “always” wear a seat belt in the back of a car compared to the majority population. The data suggest that particular groups, notably Asian British, report relatively high casualty rates, are more likely to have access to a car in there household and are least likely to report “always” wearing a seat belt. Conclusions: More needs to be done to understand the reasons that underpin these observed differences between ethnic groups. The data suggests that the dichotomy between majority and BAME groups obscures important differences in risk between BAME groups. A segmented approach is required to targeting interventions at those most at risk. In order to do this we need to understand more about the types of car occupant collisions involving BAME groups and more about the factors that influence their safety behaviour.