Accident; analysis and prevention
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To summarise the extent to which narrative text fields in administrative health data are used to gather information about the event resulting in presentation to a health care provider for treatment of an injury, and to highlight best practise approaches to conducting narrative text interrogation for injury surveillance purposes. ⋯ Manual review and coding approaches, text search methods, and statistical tools have been utilised to extract data from narrative text and translate it into useable, detailed injury event information. These techniques can and have been applied to administrative datasets to identify specific injury types and add value to previously coded injury datasets. Only a few studies thoroughly described the methods which were used for text mining and less than half of the studies which were reviewed used/described quality assurance methods for ensuring the robustness of the approach. New techniques utilising semi-automated computerised approaches and Bayesian/clustering statistical methods offer the potential to further develop and standardise the analysis of narrative text for injury surveillance.
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To determine prevalence and correlates of handgun access among adolescents seeking care in an urban Emergency Department (ED) in order to inform future injury prevention strategies. ⋯ High rates of handgun access were evident among adolescents presenting in an inner city ED, including those seeking care for non-injury related reasons. Adolescents with access to handguns were more likely to report risk behaviors and past injury, providing clinicians with an opportunity for injury prevention initiatives.
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The Crash Injury Research Engineering Network (CIREN) database contains detailed medical and crash information on a large number of severely injured occupants in motor vehicle crashes. CIREN's major limitation for stand-alone analyses to explore injury risk factors is that control subjects without a given injury type must have another severe injury to be included in the database. This leads to bias toward the null in the estimation of risk associations. ⋯ These pseudo-weights not only allow for reduced bias in the estimation of risk associations, they allow direct prevalence estimates to be made using medical outcome data available only in CIREN. We illustrate the use of these methods with both simulation studies and application to estimation of prevalence and predictors of AIS 3+ injury risk to head, thorax, and lower extremity regions, as well as prevalence and predictors of acetabular pelvic fractures. Results of these analyses demonstrate combining NASS and CIREN data can yield improvements in mean square error and nominal confidence interval coverage over analyses that use either the NASS-CDS or the CIREN sample alone.
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The Committee on Trauma recommends that older motor vehicle crash (MVC) victims or victims of crashes with significant vehicle intrusion of more than 12 in. be transferred to a trauma center since those older than 55 have an increased risk of death after injury. Yet, the precise injury thresholds as they relate to age, gender and velocity remain ill-defined. To maintain a low rate of under triage, reliable methods to identify patients at moderate injury risk are needed. We therefore characterized the likelihood of moderate to severe injury in MVC victims to determine the influence of age, gender and velocity. ⋯ Our data indicate that age and gender must be considered in addition to crash velocity when making triage decisions. Furthermore, Federal Motor Vehicle Safety Standards may need to be modified to address the increased risk of injury among older adults at lower velocities given the increasing number of elderly drivers in the US.