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May 14, 2001
General Injury Issues:
National Estimates of Nonfatal Injuries Treated in Hospital Emergency Departments --- United States, 2000.
Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC. MMWR 2001; 50(17):340-346.
You may view the full text and all tables of this report online HERE.
On July 1, 2000, the Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System (NEISS) was expanded to collect data on all types and external causes of nonfatal injuries and poisonings treated in U.S. hospital emergency departments (EDs). This augmented system, called NEISS All Injury Program (NEISS-AIP), is a collaborative effort between CDC's National Center for Injury Prevention and Control and CPSC. This report presents annualized national estimates using NEISS-AIP data obtained during July 1--September 30, 2000, which indicate that approximately 31,000,000 persons were treated for nonfatal injuries in EDs in 2000. Although most of the injuries were unintentional, an estimated 1,973,000 were violence-related. Data from NEISS-AIP can be used for monitoring temporal trends in nonfatal injuries by mechanism and intent of injury.
During 2000, persons with nonfatal injuries were treated in EDs at an estimated rate of 11,188 per 100,000 population. The nonfatal injury rate was approximately 40% higher for males than for females. Males aged 15--19 years had the highest nonfatal injury rate (20,528 per 100,000 population). Of the estimated 31,000,000 nonfatal injuries, 93.6% were unintentional and the remaining 6.4% were violence-related, including assaults (5.5%), intentional self harm (0.7%), and legal interventions (0.2%). Falls were the leading cause of unintentional nonfatal injuries, accounting for an estimated 7,021,000 (24.4%) of unintentional injury-related ED visits. An estimated 3,299,000 persons were injured as an occupant in a motor vehicle, of which 95.2% were traffic-related. Injuries to motor-vehicle occupants were the leading cause of unintentional nonfatal injury-related ED visits for females aged 15--24 years. The non-fatal injury rate for pedal cyclists was 2.9 times higher for males than for females. An estimated 389,000 persons were treated in EDs for dog bites.
Of an estimated 1,973,000 violence-related nonfatal injuries, 66% were physical assaults that included being hit with an object or by another person. Sexual assault was the fourth leading cause of violence-related, nonfatal injury-related ED visits; the nonfatal rate of sexual assault for females was 4.8 times higher than that for males. Approximately 150,000 persons were treated in EDs for poisoning-related suicide attempts and the rate of intentionally self-inflicted, nonfatal poisonings for females was 1.6 times that for males. Messages in alcohol advertising targeted to youth
Jones SC, Donovan RJ. Aust N Z J Public Health 2001; 25: 126-31.
Correspondence: Sandra C. Jones, Centre for Behavioural Research in Cancer Control, Curtin University, GPO Box U 1987, Perth 6845, Western Australia, Sandra.Jones@curtin.edu.au
OBJECTIVE: To assess young people’s perceived messages in three ads for a vodka-based, pre-mixed alcohol beverage, and to assess the extent to which the ads appeared to be consistent with the industry’s voluntary code. METHOD: Members of two convenience samples of young people (15-16 and 19-21 years) were each exposed to one of three advertisements. Respondents completed a post exposure questionnaire based on standard advertising copy testing procedures. RESULTS: The most frequently nominated open-ended responses to "the main message(s) of the ad" related to the product delivering mood effects: both removal of negative emotions (e.g. "stress reduction"), as well as inducing positive states such as feeling "carefree" and gaining "increased enjoyment". Consumption of the product was perceived to offer "self-confidence", "sexual/relationship success" and "social success". Fewer respondents nominated tangible product characteristics, the main one being "easy to drink". One in four of the 15-16 year olds saw the ads as aimed at "people my age", while almost half of the 19-21 year olds saw the ads as aimed at "people younger or much younger than me". DISCUSSION: These results appear to contravene the Alcoholic Beverages Advertising Code (ABAC) by suggesting that the consumption of alcohol beverages: (i) contributes to social and sexual success; and (ii) contributes to a significant change in mood (stress reduction/relaxation). IMPLICATIONS: Incidental observation of alcohol ads suggests that contravention of the code is more widespread than the number of alcohol advertising complaints would indicate. All 11 such complaints lodged with the Advertising Standards Board between May 1998 and April 1999 were dismissed. Evidence such as that gathered in this study might improve the chances of complaints being upheld.
Personal protective equipment use by in-line skaters in Victoria
Sherker S, Cassell E. Aust N Z J Public Health 2001; 25: 179-184.
Correspondence: Shauna Sherker or Erin Cassell, Monash University Accident Research Centre, PO Box 70A, Monash University, Victoria, 3800, Australia, Erin.Cassell@general.monash.edu.au
OBJECTIVES: To describe use of personal protective equipment (PPE) by in-line skaters at four different skate settings (rink, park, trail and street) in Melbourne and rural Victoria, and to compare local PPE with reported international use. METHODS: Unobtrusive observations of in-line skaters at four types of skate settings (rinks, parks, trails, street) in Melbourne and rural Victoria. RESULTS: Two-thirds of 490 observed in-line skaters (66.7%) wore none of the recommended PPE (wrist guards, elbow and knee pads and helmets). Only 2.2% wore all four pieces of PPE. Wrist guards were worn by 25.9% of skaters, knee pads by 23.5%, elbow pads by 6.9% and helmets by 5.5%. Younger skaters were least likely to wear any PPE. Trail skaters were more likely to wear PPE than skaters on rinks, parks and streets. Almost one-third of skaters did not have a heel brake on their skates. Use of PPE was influenced by group norms. CONCLUSION: Personal protective equipment use is low among in-line skaters in Victoria, and varies according to skate location. The use of PPE in Victoria is much lower than that reported overseas. IMPLICATIONS: Evidence of the effectiveness and the low use of PPE by skaters highlights the need to better promote the use of wrist guards, elbow and knee pads and helmets to skaters of all ages and abilities. There is opportunity for public health professionals to work in partnership with in-line skating bodies, organisers and sponsors of skating events, skate venue owners and managers, skating equipment manufacturers and hirers to promote PPE use. Scooter Injuries in Children
Levine DA, Platt SL, Foltin GL. Pediatrics 2001; 107(5):e64.
Correspondence: Deborah A. Levine, MD, FAAP, Department of Pediatrics, Pediatric Emergency Service, Bellevue Hospital Center, 27th St and First Ave, Room 1 S 6, New York, NY 10016. mlevine336@aol.com
The authors report a series of emergency department-treated injuries to children and adolescents who were operating non-motorized scooters. Charts were reviewed for patient data including age, place of injury, use of protective gear, adult supervision, injury sustained, medical management, and disposition. There were 15 children treated in the PES for scooter-related injuries. The mean age was 7.8 years, 73% were male. Approximately 90% of injuries occurred as a result of falling off a scooter. Irregular pavement caused 3 falls and tandem riding caused 2 falls. Inability to use the foot brake caused 1 collision, and 1 child was hit by a motor vehicle while crossing the street. Injuries occurred in a park (33%), on a sidewalk (47%), in a home (13%), and on the street (7%). Adult supervision was present in half of the cases. Only 2 children were wearing helmets at the time of injury; none wore protective padding. Five children (33%) suffered head trauma; 1 lost consciousness, and 2 suffered amnesia. Seven children (47%) sustained facial injuries, and 4 of these children required laceration repair. Seven children (47%) sustained extremity trauma, including 1 laceration and 6 fractures. Although not life-threatening, these injuries are serious and require significant intervention. Most scooter-related injuries are preventable if proper protective gear is used. The use of helmets and of wrist, elbow, and knee padding should be encouraged. Compliance with recommended age limits and close supervision of younger-aged children while riding scooters may help to protect young children from harm.
Validation of an injury surveillance epidemiological data system used with emergency departments.
Stokes M, Ozanne-Smith J, Harrison J, Steenkamp K. Injury Control and Safety Promotion 2000; 7(4):219-232.
Abstract: OBJECTIVES: To establish ascertainment rates, validity, and the presence of bias within the Victorian Emergency Minimum Data set (VEMD). METHODS: Experienced researchers conducted interviews using a paper-based instrument to collect injury details. These data were obtained in parallel with the routine electronic collection of injury data within four of the 25 VEMD hospitals. Data were matched using the unique data and time of presentation, as well as the birth date. Interviews were conducted with 481 injured persons. RESULTS: Electronic and paper records were successfully matched in 382 cases. A high mean capture rate (82.5%) across hospitals was found when the interview data and VEMD data were compared. Data were mostly coded with some inaccuracy, 82% of the cases had at least one error, yet when compared with interview descriptions, the coded injury and incident data were usually valid (83.9%). However, narrative data provided information beyond coded data for only 14.1% of the cases. CONCLUSIONS: These results suggest that the VEMD is a reliable and valid computerized data set, but that the case narratives require attention.
How do prolonged wakefulness and alcohol compare in the decrements they produce on a simulated driving task?
Arnedt JT, Wilde GJS, Munt PW, McLean AW. Accid Anal Prev 2001; 33(3):337-344.
Correspondence: J. Todd Arnedt, Slep research Laboratory, E.P. Bradley Hospital, 1011 Veterans Memorial Parkway, Providence, RI 02915, USA j_todd_arnedt@brown.edu
The authors compared the effects of prolonged wakefulness (assessed in an earlier published study) with those of alcohol ingestion on a simulated driving task. Driving performance was assessed using a York Driving Simulator. This device allows the measurement of tracking (deviation from the center of the traffic lane), speed compared to posted limit, speed variation, and run-off-the-road incidents. Clear decreases in driver performance were evident in driver performance at the 0.05% BAC compared to 0.0% BAC. For mean tracking, tracking variability, and speed variability 18.5 and 21 h of wakefulness produced changes of the same magnitude as 0.05 and 0.08% blood alcohol concentration, respectively. Alcohol consumption produced changes in speed deviation and drive-off-the-road occurrences of greater magnitude than the corresponding levels of prolonged wakefulness. However, the increase in drive-off-the-road occurrence with sleep loss was high when compared to low-fatigue subjects. While limited to situations in which there is no other traffic present, the findings suggest that impairments in simulated driving are evident even at relatively modest blood alcohol levels, and that wakefulness prolonged by as little as 3 h can produce decrements in the ability to maintain speed and road position as serious as those found at the legal limits of alcohol consumption. The authors recommend further research on the combined effects of prolonged wakefulness and alcohol consumption and the fact that these may co-occur at a time when otherwise unimpaired driver performance is low because of circadian variation. Developing measures of fatigue using an alcohol comparison to validate the effects of fatigue on performance.
Williamson AM, Feyer A, Mattick RP, Friswell R, Finlay-Brown S. Accid Anal Prev 2001; 33(3):313-326.
Correspondence: Ann M. Williamson, NSW Injury Risk Management Research Centre, University of New South Wales School of Psychology, Sydney, NSW 2025, Australia, a.williamson@unsw.edu.au
The authors conducted a laboratory study to compare the effects of 28 hours of sleep deprivation with that of levels of blood alcohol concentration (BAC) in the same subjects. Thirty-nine subjects (20 of whom were long-haul truckers) were examined. Several different tests of reaction-time, coordination, alertness, and logical reasoning capacity were conducted. All tests showed a linear decrease in performance capacity with increasing doses of alcohol. Sleep deprivation affected performance on most tests, but had little no effect on performance on the logical reasoning tests. The study demonstrated that sleep loss produces significant effects on driver capacity to perform functions important to safe driving: reaction speed and accuracy, vigilance, and hand-eye co-ordination. Area-wide urban traffic calming schemes: a meta-analysis of safety effects.
Evik R. Accid Anal Prev 2001; 33(3):327-336.
Correspondence: Rune Elvik, Institute of Transport Economics, P.O. Box 6110, Etterstad, N-0602 Oslo, Norway, ryne.elvik@toi.no
The author reports the results of a meta-analysis of 33 studies that examined the relationship between area-wide traffic calming schemes and road safety. The meta-analysis demonstrated an average overall reduction in injury crashes of 15 percent, with a 25 percent reduction on residential streets. There was a similar reduction in property damage only crashes. Drivers compliance with stop and yield signs in Jordan
Tarawneh TM, Tarawneh MS, Al-Balbissi AH. J Traffic Med 2000, 28(3-4): 17-22.
Correspondence: Tarek M. Tarawneh, Civil Engineering Department, Jordan University, Amman, Jordan wardtrek@nol.com.jo
The authors studied driver knowledge and behavior related to unsignalized intersections with stop or yield signs. In an behavioral study, the drivers of 8108 vehicles were observed at 20 intersections. The researchers selected sites with low traffic volume to assure that when a motorist complied with the sign, his or her compliance was voluntary and not due to heavy traffic on the intersecting street. Driver age ( and sex were estimated. Compliance with a stop sign was defined as coming to a voluntary complete stop before entering the intersection. Compliance with a yield sign was defined as slowing or stopping before entering the intersection. Compliance with stop signs was very low: 8 percent for males and 11 percent for females. Overall, older (55+) and middle-aged (36-55) drivers were found to have a compliance of 10 percent compared with 5 percent for young (18-35) drivers. The authors also reported on a survey of driver knowledge of the expected behavior at signed intersections. Seventy-two percent and 66 percent of respondents knew the expected behavior when encountering stop and yield signs, respectively. A study of alcohol and drugs in impaired and fatally injured drivers in the West of Scotland
Seymour A, Oliver JS. J Traffic Med 2000, 28(3-4): 32-37.
Correspondence: Alison Seymour, Department of Forensic Medicine and Science, University of Glasgow, G12 8QQ, Scotland, UK a.seymour@formed.gla.ac.uk
The prevalence of licit and illicit drug (including alcohol) was toxicologically assessed in biological samples of 214 drivers (fatally injured or suspected of drug use). Blood and urine samples were assessed for the presence of alcohol, benzodiazepines, opiates, LSD, cannabinoids, amphetamines, buprenorphine, and methadone. Drugs were found in 77 percent of the blood samples. Eight percent of these also tested positive for alcohol. Alcohol alone was detected in 12.6 percent of the cases. The remaining 10.4 percent of the samples tested negative for both alcohol and drugs. Polydrug use was evident in 53 percent of the positive blood samples. The median blood alcohol concentration in the alcohol-only cases was 136mg/100ml. The validity of self-reported seatbelt use: Hispanic and non-Hispanic drivers in El Paso.
Parada MA, Cohn LD, Gonzalez E, Byrd T, Cortes M. Accid Anal Prev 2001; 33(1):139-143.
Correspondence: Lawrence D. Cohn, Department of Psychology, University of Texas, El Paso, TX 79968-0553, USA lcohn@miners.utep.edu
The validity of self-reported seatbelt use among low belt use populations has not been evaluated directly, despite the importance of such data for estimating the effectiveness of community-wide interventions and compliance with state laws. To address this gap in knowledge 612 drivers were recruited from convenience stores located in 12 randomly generated zip code areas located in El Paso, TX. Self-reported seatbelt use was compared with observed seatbelt use in a single sample of participants. Both data sets were collected almost contemporaneously and no participant was aware of having their seatbelt use observed. Hispanic (n=388) and white/non-Hispanic (n=126) drivers over reported seatbelt use by 27 and 21%, respectively. These findings suggest that response bias within low belt use populations may be greater than suggested by state and national data.
Long-term effects of an early childhood intervention on educational achievement and juvenile arrest: a 15-Year follow-up of low-income children in public schools.
Reynolds AJ, Temple JA, Robertson DL, Mann EA. JAMA. 2001; 285(18):2339-2346.
Correspondence: Arthur J. Reynolds, PhD, Waisman Center on Mental Retardation and Human Development, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI 53705, e-mail: ajreynol@facstaff.wisc.edu.
In order to determine the long-term effectiveness of the Chicago Child-Parent Center (CPC) Program, a preschool and school–based intervention program for urban low-income children, the authors conducted a 15-year follow-up study. The authors compared tangible measures of educational achievement (rates of high school completion and school dropout by age 20 years, and grade retention and special education placement by age 18 years) and social adjustment (juvenile arrests for violent and nonviolent offenses) of children in the CPC program and a control group.
The CPC (n = 989 children) provides comprehensive education, family, and health services and includes half-day preschool at ages 3 to 4 years, half- or full-day kindergarten, and school-age services in linked elementary schools at ages 6 to 9 years. The comparison group (n = 550) consisted of children who participated in alternative early childhood programs (full-day kindergarten): 374 in the preschool comparison group from 5 randomly selected schools plus 2 others that provided full-day kindergarten and additional instructional resources and 176 who attended full-day kindergartens in 6 CPCs without preschool participation. Children who participated in the preschool intervention for 1 or 2 years had a higher rate of high school completion (49.7 % vs 38.5%; P = .01); more years of completed education (10.6 vs 10.2; P = .03); and lower rates of juvenile arrest (16.9% vs 25.1%; P = .003), violent arrests (9.0% vs 15.3%; P = .002), and school dropout (46.7% vs 55.0%; P = .047).The authors conclude that these findings provide strong evidence that established programs administered through public schools can promote children's long-term success.
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