Samantha Turner

Risk factors associated with unintentional house fire incidents, injuries and deaths in high-income countries: a systematic review

Objective To identify the distinguishing risk factors associated with unintentional house fire incidents, injuries and deaths. Study design Systematic review. Methods A range of bibliographical databases and grey literature were searched from their earliest records to January 2016. To ensure the magnitude of risk could be quantified, only those study types which contained a control group, and undertook appropriate statistical analyses were included. A best evidence synthesis was conducted instead of a meta-analysis due to study heterogeneity. Results Eleven studies investigating a variety of risk factors and outcomes were identified. Studies ranged from medium to low quality with no high quality studies identified. Characteristics commonly associated with increased risk of house fire incidents, injuries and fatalities included: higher numbers of residents, male, children under the age of 5 years, non-working households, smoking, low income, non-privately owned properties, apartments and buildings in poor condition. Several risk factors were only associated with one outcome (eg, living alone was only associated with increased risk of injurious fires), and households with older residents were at increased risk of injurious fires, but significantly less likely to experience a house fire in the first place. Conclusions This best evidence synthesis indicates that several resident and property characteristics are associated with risk of experiencing house fire incidents, injuries or death. These findings should be considered by the Fire and Rescue Services and others with a role in fire prevention. Future research should adopt robust, standardised study designs to permit meta-analyses and enable stronger conclusions to be drawn.

The Advocacy for Pedestrian Safety Study: Cluster Randomised Trial Evaluating a Political Advocacy Approach to Reduce Pedestrian Injuries in Deprived Communities

Objective To determine whether advocacy targeted at local politicians leads to action to reduce the risk of pedestrian injury in deprived areas. Design Cluster randomised controlled trial. Setting 239 electoral wards in 57 local authorities in England and Wales. Participants 617 elected local politicians. Interventions Intervention group politicians were provided with tailored information packs, including maps of casualty sites, numbers injured and a synopsis of effective interventions. Main outcome measures 25–30 months post intervention, primary outcomes included: electoral ward level: percentage of road traffic calmed; proportion with new interventions; school level: percentage with 20 mph zones, Safe Routes to School, pedestrian training or road safety education; politician level: percentage lobbying for safety measures. Secondary outcomes included politicians’ interest and involvement in injury prevention, and facilitators and barriers to implementation. Results Primary outcomes did not significantly differ: % difference in traffic calming (0.07, 95%CI: −0.07 to 0.20); proportion of schools with 20 mph zones (RR 1.47, 95%CI: 0.93 to 2.32), Safe Routes to School (RR 1.34, 95%CI: 0.83 to 2.17), pedestrian training (RR 1.23, 95%CI: 0.95 to 1.61) or other safety education (RR 1.16, 95%CI: 0.97 to 1.39). Intervention group politicians reported greater interest in child injury prevention (RR 1.09, 95%CI 1.03 to 1.16), belief in potential to help prevent injuries (RR 1.36, 95%CI 1.16 to 1.61), particularly pedestrian safety (RR 1.55, 95%CI 1.19 to 2.03). 63% of intervention politicians reported supporting new pedestrian safety schemes. The majority found the advocacy information surprising, interesting, effectively presented, and could identify suitable local interventions. Conclusions This study demonstrates the feasibility of an innovative approach to translational public health by targeting local politicians in a randomised controlled trial. The intervention package was positively viewed and raised interest but changes in interventions were not statistically significance. Longer term supported advocacy may be needed. Trial Registration Current Controlled Trials ISRCTN91381117

All Wales Injury Surveillance System revised: development of a population-based system to evaluate single-level and multilevel interventions

Background Injury surveillance has been established since the 1990s, but is still largely based upon single-source data from sentinel sites. The growth of electronic health records and developments in privacy protecting linkage technologies provide an opportunity for more sophisticated surveillance systems. Objective To describe the evolution of an injury surveillance system to support the evaluation of interventions, both simple and complex in terms of organisation. Methods The paper describes the evolution of the system from one that relied upon data only from emergency departments to one that include multisource data and are now embedded in a total population privacy protecting data linkage system. Injury incidence estimates are compared by source and data linkage used to aid understanding of data quality issues. Examples of applications, challenges and solutions are described. Results The age profile and estimated incidence of injuries recorded in general practice, emergency departments and hospital admissions differ considerably. Data linkage has enabled the evaluation of complex interventions and measurement of longer-term impact of a wide range of exposures. Conclusions Embedding injury surveillance within privacy protecting data linkage environment can transform the utility of a traditional single-source surveillance system to a multisource system. It also facilitates greater involvement in the evaluation of simple and complex healthcare and non-healthcare interventions and contributes to the growing evidence basis underlying the science of injury prevention and control.

Installation of home safety devices reduces incidence of preventable injury in young children

EDITOR’S NOTE: Journals reviewed for this issue: Archives of Disease in Childhood, Archives of Pediatrics and Adolescent Medicine, British Medical Journal, Journal of the American Medical Association, The Journal of Pediatrics, The Lancet, New England Journal of Medicine, Pediatric Infectious Diseases Journal, and Pediatrics. Heidi Marleau, MLS, Ebling Library for the Health Sciences, University of Wisconsin, contributed to the review and selection of this month’s abstracts. —John G. Frohna, MD, MPH

843 Risk factors for unintentional house fire incidents, injuries and deaths: a systematic review

Background Unintentional house fires appear to be reducing but remain a serious public health concern, disproportionately affecting certain groups in population. To ensure preventative measures reach those at greatest risk, it is vital that risk factors for unintentional fires are identified; particularly in light of recent funding cuts in many Fire Services across high-income countries. However, the last review to be conducted in this area was undertaken over 15 years ago. Methods To synthesise the evidence on risk factors for unintentional house fires, a range of bibliographic databases and grey literature were searched until October 2015. Key journals and reference lists were also hand-searched. To ensure the magnitude of risk could be quantified for each factor, only those studies that contained a comparison group, and undertook appropriate statistical analyses were included. A best evidence synthesis was undertaken instead of a meta-analysis due to study heterogeneity. Results This review identified 12 studies that investigated a variety of potential risk factors and outcomes that fulfilled the inclusion criteria. None of the identified studies were deemed high quality, but the available evidence suggests the following factors may be associated with fire risk: age, gender, socio-economic status, race/ethnicity, disability, household ownership, household composition, property characteristics, smoking, alcohol/drug use, fire safety practices and marital status. It also appears that whilst older and disabled residents are more likely to suffer an injury or fatality in the event of a fire; they are less likely to ignite a fire in the first instance. Conclusions There is a surprising paucity of high quality studies examining risk factors for house fire incidents, injuries and deaths. Further high quality studies, adopting standardised methods are required to permit synthesis, and to develop a firmer understanding of unintentional house fire risk factors.

68 Implementation of the ‘School Travel Safety Survey’ for Data Linkage Research

Background The School Travel and Child Safety Survey (STCSS) was developed as part of the European TACTICS project (Tools to Address Childhood Trauma, Injury and Children’s Safety) to address the lack of standardised data on children’s safety and exposure to risk across Europe. Description of the Problem Current methods used to collect data on child safety and exposures to risk are not collected in a coordinated way, making research and policy evaluation in these areas difficult. The STCSS was developed with European partners, as a standardised tool which could be adopted by member states, to collect child safety data and enable comparisons between different regions/countries for policy development and evaluation. Travel behaviour data (e.g. mode of transport and distance travelled) is also limited; but vitally important for monitoring active travel and road safety interventions. Results The STCSS was developed for children aged 10–13 years to be undertaken in school, and was successfully piloted in 5 countries across Europe (n = 636, participation rate = 88.37%). A sample of children were retested to establish the survey reliability, and per cent agreements were ≥96%. The STCSS has been further developed in Wales, to enable the results to be anonymised and incorporated into the Secure Anonymised Information Linkage (SAIL) databank at Swansea University. Data linkage methods within SAIL allow the STCSS results to be linked to other individual and household level datasets; for example, socioeconomic, demographic, health and education data. Conclusions The ability to link the results from this survey to other routinely collected data in the SAIL database, will provide much needed evidence on the medium and long-term effectiveness of child safety interventions and policies; as well as provide regional, national and international policy makers with data to support the planning and evaluation of interventions.

417 Incidence and epidemiology of burns treated in the welsh centre for burns

Background It is important to understand the epidemiology of burns in order to support the development and refinement of preventative measures. We used population based data from the Welsh Centre for Burns and Plastic Surgery (catchment area 2.3 million people) to study trends in the epidemiology of burns. Methods Anonymised data from the Welsh Burns Centre have been included in the Secure Anonymised Information Linkage (SAIL) databank and linked to a population register. To describe the epidemiology of burns treated at the centre, data were restricted to acute injury assessments/admissions between 01/01/2003 and 31/12/2012 for patients who lived in Wales. Results During the 10 years, there were 7160 acute injury admissions/assessments. There is an increasing trend in the rates over the decade, increasing from 26.6 per 100,000 population in 2003 to 31.9 in 2012. Rates of burns in the home have increased from 13.2 per 100 K in 2003 to 20.8 in 2012 and more specifically, rates of burns in the kitchen have increased. During 2012, rates of treated burns were highest in males aged 0–4. The 0–4 age group suffer mainly from scalds followed by contact burns; contact burn rates have doubled over the ten years for this group of patients. Over the decade, rates were highest in the most deprived quintiles; however the rates are increasing in the least deprived and a substantial narrowing of the inequality can be seen over time. The distance travelled to Morriston hospital does not appear to be increasing over time and the severity of the burns have not changed over the decade; therefore the increase in the rate of treated burns does not appear to be due to an increasing rate of transfers of more serious burns from other hospitals in Wales. Conclusions Given increasing incidence and narrowing of inequalities more effective preventive interventions are needed.

226 Using Long bone fractures as an injury incidence indicator in Europe

Background It is important to select robust injury indicators for international comparisons and evaluation of preventive interventions. Emergency department data provide the best opportunity for robust indicators with the greatest utility. Previous analyses have suggested that long bone fracture (LBF) incidence should be a robust population indicator for use by emergency department surveillance systems (Lyons et al. 2006 & Polinder et al. 2008). The purpose of this study was to compare between country variation in incidence using all incidence (AI) and LBF indicators in the development of robust indicators. Methods This study was carried out using data supplied to the European Injury Data Base (IDB) from 2009–2013 as part of the Joint Action on Monitoring Injuries in Europe (JAMIE) project and now part of the BRIDGE-Health (BRidging Information and Data Generation for Evidence-based Health Policy and Research) development. Data were supplied by 26 countries. More detailed analyses were possible using data from 16 countries. European age-standardised incidence rates were calculated using estimated catchment populations. Results The proportion of LBFs varied from 31% to 2%. There was greater (15x) variability in the LBF indicator than in the AI indicator (3x). The impact of a number of health service system effects was obvious. Conclusions The results indicated variation in incidence that is largely due to differences in health service provision, sample data collection and estimates of catchment areas. Further work is ongoing to correct for these issues in deriving more robust indicators, e.g. using variation between observed and expected hip fracture rates as a potential correction factor.

223 Are register-based data better than surveys in estimating burden of injuries among adults? results from Luxembourg

Background Injury is a major cause of mortality and morbidity. The emergency department (ED) registry based data, provides a cost-effective way to estimate the burden of injuries. Previous studies in general population have suggested that survey based data collection is not efficient and suffers from recall or selection bias. The aim of this study was to compare the yearly incidence of home, leisure, traffic and work injuries estimated by survey-based and registry based methods among adults in Luxembourg. Methods Survey based data on 1529 residents aged 25–64, were collected during 2013/2014 in the frame of the European Health Examination Survey (EHES). Luxembourgish ED registry based data supplied to the European Injury Data Base (IDB) for the period 2013–2014 were used for the comparison. Both IDB and EHES are now part of the BRIDGE-Health (BRidging Information and Data Generation for Evidence-based Health Policy and Research) development. Results The estimated incidence rate of all the selected injuries from registry-based data was 8.4% in 2013 and 8.3% in 2014. From survey based data the incidence of; injuries treated in hospital (CI: 95%) was 8.8% (7.7%; 10.4%), treated outside the hospital was 3.6% (2.8%: 4.7%) and not medically treated was 2.7% (2.0%: 3.7%). Conclusions Both survey and registry based data are concordant in estimating ED treated injury incidence among 25–64 years old in Luxembourg.

224 Hospital registrations and health survey data – do they agree?

Background In many countries health interview survey data are used for indicators for injury incidence. However, the validity of self-reported injury incidence may be questioned due to e.g. recall bias and low response rate in groups at high injury risk. In the first European Health Interview Survey the incidence of home and leisure injuries varied as much as from 1.3% to 8.2%. The purpose of the present study is to compare survey response and hospital registration at the individual level with focus on reporting bias. Methods This study was carried out using the Danish health interview survey data with information on injury the past year and the treatment. These data were linked at the individual level to the hospital registration of both in- and outpatient data for the period up to two year before the interview, for all hospitals in Denmark. Results In total 368 reported injuries being hospital treated as outpatient, of these 234 were actually hospital treated within the last 12 months (64%). Ninety-six reported being admitted to hospital, of these 51 were actually admitted the past year (53%) and 59 the past two years (61%). Conversely, only about half of the hospital treated injuries were reported in the survey. Conclusions There is considerable disagreement at the individual level between self-reported hospital treated injuries and actual hospital treatment. Hospital admissions in particular seem to be over reported.