Unintentional injury prevention in American Indian and Alaska Native communities: a scoping review of the Indian Health Service Primary Care Provider newsletter.

BACKGROUND: Unintentional injuries disproportionately impact American Indian and Alaska Native (AI/AN) populations. Developing effective and culturally tailored data collection and intervention programs requires an understanding of past prevention efforts in AI/AN communities, but limited peer-reviewed literature on the topic is available. This scoping review aims to summarize efforts that have been published in the Primary Care Provider newsletter, a source of gray literature available through the Indian Health Service. METHODS: The research team obtained all injury related articles in the Provider newsletter and excluded those that did not describe an unintentional injury prevention effort. Included articles were organized chronologically and by topic, and outcomes were described in a data abstraction form. RESULTS: A total of 247 articles from the Provider newsletter were screened, and 68 were included in this review. The most number of articles were published in 2007 (n = 15). Many focused not specifically on one tribal community but on the AI/AN community as a whole (n = 27), while others reported that certain tribes were the focus of study but did not identify tribes by name (n = 24). The following is a list of 14 tribal communities explicitly mentioned: Omaha, Cherokee, Ute, Yakama, Chippewa, Apache, Ho-Chunk, The Crow Tribe, Tohono O'odham Nation, Fort Mojave Tribe, Chemehuevi Tribe, The Rosebud Tribe, Navajo, and The Pueblo of Jemez. Published unintentional injury prevention efforts have covered the following 7 topics in AI/AN communities: falls, motor vehicle crashes, poisonings, improving data, burns, children, and other. CONCLUSION: This scoping review makes available and searchable information on injury prevention work conducted in and for AI/AN communities that is not currently found in the peer-reviewed literature.

Defective Assistive Device Involvement in Older Adult Emergency Department Visits.

Background and Objectives: Many older adults adopt equipment to address physical limitations and reduce dependence on others to complete basic activities of daily living. Although a few prior studies have considered injuries associated with assistive devices for older adults, those studies focused on older adults' health and functional risks for injury. There is limited analysis of older adult injuries involving defective or malfunctioning assistive devices. Research Design and Methods: Data from this study are from the National Electronic Surveillance System All Injury Program which collected data on consumer product-related injuries from a probability sample of 66 hospital Emergency Departments across the United States. Data from 30 776 older adult Emergency Department (ED) injury narratives from 2016 to 2020 were coded according to the assistive device involved and whether malfunctioning led to the injury. The study team manually examined all narratives in which the assistive device was coded to have malfunctioned. Results: A total of 10 974 older adult ED cases were treated for 12 488 injuries involving a defective device. Injuries included 4 212 head and neck injuries (eg, concussion), 4 317 trunk injuries (eg, hip fractures), and 3 959 arm or leg injuries (eg, leg fracture). Of these patients, 4 586 were admitted to a hospital ward for further evaluation and treatment. Seventy percent of these patients were injured while using a walker; in contrast, wheelchairs were implicated in only 4% of the above cases. Design flaws were identified in 8 158 cases and part breakage/decoupling incidents in 2 816 cases. Discussion and Implications: Our findings provide evidence that assistive devices are actively involved in older adult injuries. Further research is needed to reduce injuries associated with assistive devices by educating patients and their careproviders about device use and assembly and developing effective methods for informing manufacturers about malfunctioning devices.

Surveillance methods and interventions implemented in American Indian and Alaska Native communities to increase child restraint device and seat belt use in motor vehicles: a systematic review.

BACKGROUND: American Indian/Alaska Native (AI/AN) children are disproportionately affected by injuries and deaths related to motor vehicle crashes. We aimed to synthesise published evidence on surveillance methods and interventions implemented in AI/AN communities and analyse characteristics that make them successful in increasing child restraint devices and seat belt use. METHODS: Studies were collected from the PubMed, Scopus, and TRID databases and the CDC Tribal Road Safety website, Community Guide, and Indian Health Service registers. Included studies collected primary data on AI/AN children (0-17) and reported morbidity/mortality outcomes related to child restraint devices or seat belt use. Studies with poor methodological quality, published before 2002, whose data were collected outside of the USA, or were non-English, were excluded. Checklists from the Joanna Briggs Institute were used to assess the risk of bias. In the synthesis of results, studies were grouped by whether a surveillance method or intervention was employed. RESULTS: The final review included 9 studies covering 72 381 participants. Studies conducted surveillance methods, interventions involving law enforcement only and multipronged interventions. Multipronged approaches were most effective by using the distribution of child restraint devices combined with at least some of the following components: educational programmes, media campaigns, enactment/enforcement of child passenger restraint laws, incentive programmes and surveillance. DISCUSSION: Although this review was limited by the number and quality of included studies, available resources suggest that we need multipronged, culturally tailored and sustainable interventions fostered by mutually beneficial and trusting partnerships. Continued investment in AI/AN road safety initiatives is necessary.

Medication Safety Counseling Practices of Pediatric Primary Care Clinicians.

Medication exposures and poisonings are a major cause of pediatric morbidity and mortality. Unsafe patient practices are well documented despite the American Academy of Pediatrics recommending that pediatric primary care clinicians discuss medication safety with patients. Current clinician counseling practices for pediatric patients are unknown. Studies of adult patients suggest that physician counseling practices often focus on administration but not storage or disposal. To address this gap, we administered a web-based survey to clinically active pediatric primary care clinicians in two mid-Atlantic health care systems. Survey content focused on characteristics of medication safety counseling practices by age group, including safe medication storage, administration, and disposal. Of 151 clinicians emailed, 40 (26.5%) responded. The majority were physicians (93.5%), female (87.1%), and completed residency/clinical training in pediatrics >15 years ago (58.1%). Most (82.5%) reported having >1 pediatric patient (aged < 19 years) in their practice who experienced an unintentional or intentional medication exposure or poisoning event. Reported practices for medication safety counseling often varied by patient age but safe disposal was rarely addressed for any age group. Respondents generally felt less knowledgeable and less comfortable with providing counseling on safe disposal in comparison to safe storage and safe administration. Nearly all respondents (97%) would like to provide more counseling about medication safety, and the majority (81.3%) wanted additional educational resources. In this survey, we identified several modifiable deficits in pediatric medical counseling practices and a need for additional clinician training and resources, most notably in the content area of safe disposal.

CHASE (Children's Housing Assessment for a Safe Environment): a protocol for the inspection and modification of injury risks in children's homes.

BACKGROUND: Decades of research and practice experience have led to an extensive body of evidence about effective home safety modifications. However, the benefits of safety modifications have not reached all segments of society. Poor quality housing in low-income neighborhoods, along with limited access to safety products and injury prevention information, can be significant barriers to child safety. METHODS: This is a longitudinal study of 300 low-income families in Baltimore City and Baltimore County with children under 7 years of age who are referred from existing Green & Healthy Homes Initiative (GHHI) home visiting programs. Three home visits will be completed to assess home injury hazards using a previously developed tool, the Children's Housing Assessment for a Safe Environment (CHASE), and provide a Scope of Work that includes home modifications specific to the identified home injury hazards. An Assessor will also provide do-it-yourself education materials and injury prevention supplies to assist residents in completing the modifications. If the parent or caregiver is unable to complete the home modifications, a professional Housing Intervention Services team will complete the home modifications necessary to prevent injury in the home. This study will involve both quantitative and qualitative data analysis methods. Paired and regression analyses will be conducted to examine the maintenance of modifications and the variables associated with positive outcomes. A thematic analysis of staff and participant interviews will be used to identify perceived barriers and facilitators of successful program implementation. DISCUSSION: Better data on residential injuries of children and an improvement in the overall surveillance of home injuries are necessitated. This study will set a strong foundation for a larger future study of health and cost effectiveness outcomes and will advance our understanding of the feasibility, costs, and potential benefits of addressing and preventing home injuries to children.

Using the NEISS database to understand pressure cooker related injuries in the USA.

OBJECTIVE: To determine the incidence of pressure cooker related injuries in US hospital emergency departments. To quantify injury patterns associated with pressure cookers and inform prevention recommendation messaging. METHODS: The National Electronic Injury Surveillance System (NEISS) was queried to identify injuries associated with pressure cookers between 1 January 2003 and 31 December 2019. Case narratives were reviewed to identify precipitating or contributing factors of pressure cooker related injuries. Negative binomial regression was employed to test for trends over time. RESULTS: The NEISS query identified 759 actual pressure cooker injuries between 2003 and 2019, yielding a national estimate of 28 337 (95% CI 24 588 to 32,086) injuries treated in US emergency departments, 1667 cases annually. Analysis of case narratives resulted in the identification of four predominant precipitating or contributing factors to injury: burning agent, struck by product, injured while opening and other. CONCLUSION: NEISS is a valuable tool for determining injury incidence and understanding common injury patterns associated with specific products. Consumers and manufacturers of pressure cookers can develop safety strategies targeted at preventing the product's main injury risks.

Understanding the circumstances of paediatric fall injuries: a machine learning analysis of NEISS narratives.

OBJECTIVES: Falls are the leading cause of non-fatal injury among young children. The aim of this study was to identify and quantify the circumstances contributing to medically attended paediatric fall injuries among 0-4 years old. METHODS: Cross-sectional data for falls among kids under 5 years recorded between 2012 and 2016 in the National Electronic Injury Surveillance System was obtained. A sample of 4546 narratives was manually coded for: (1) where the child fell from; (2) what the child fell onto; (3) the activities preceding the fall and (4) how the fall occurred. A natural language processing model was developed and subsequently applied to the remaining uncoded data to yield a set of 91 325 cases coded for what the child fell from, fell onto, the activities preceding the fall, and how the fall occurred. Data were descriptively tabulated by age and disposition. RESULTS: Children most often fell from the bed accounting for one-third (33%) of fall injuries in infants, 13% in toddlers and 12% in preschoolers. Children were more likely to be hospitalised if they fell from another person (7.4% vs 2.6% for all other sources; p<0.01). After adjusting for age, the odds of a child being hospitalised following a fall from another person were 2.1 times higher than falling from other surfaces (95% CI 1.6 to 2.7). CONCLUSIONS: The prevalence of injuries due to falling off the bed, and the elevated risk of serious injury from falling from another person highlights the need for more robust and effective communication to caregivers on fall injury prevention.

The cost burden of hospital-treated tap water scald burns in the United States.

OBJECTIVE: We aimed to determine the cost burden and epidemiology of hospital-treated, tap water scald burns in the United States to inform consideration of policy proposals to require thermostatic mixing valves with all new water heaters. METHODS: A retrospective, cross-sectional study was performed using the 2016-2018 National Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS) from the Healthcare Cost and Utilisation Project (HCUP). We queried the samples to examine the prevalence, cost, and epidemiology of hospital-treated, tap water scald burns. RESULTS: The NIS and NEDS identified 52 088 (weighted) emergency department (ED) visits, 7270 (weighted) hospitalisations and 110 hospital-based deaths attributable to tap water scald burns in 2016-2018. The average cost for each encounter was $572 per ED visit and $28 431 per hospitalisation. In aggregate, the direct healthcare cost of these initial encounters was $206.69 million for inpatient (IP) visits and $29.79 million for ED visits. Medicare paid $109.54 million of these costs and Medicaid paid $18.3 million. Multiple body surfaces were involved in 35.4% of IP visits and 16.1% of ED visits. CONCLUSIONS: NIS and NEDS are valuable tools to examine the cost burden and epidemiology of hospital-treated, tap water scald burns. The high injuries, deaths, and overall cost of these scald burns suggest policy proposals are needed to require the use of thermostatic mixing valves.The additional detail provided by using the International Classification of Diseases (ICD)-10 External Cause of Morbidity Code allows for a better understanding of the size and scope of tap water scald injuries than was possible with ICD-9.

Safety Concerns in Mobility-Assistive Products for Older Adults: Content Analysis of Online Reviews.

BACKGROUND: Older adults who have difficulty moving around are commonly advised to adopt mobility-assistive devices to prevent injuries. However, limited evidence exists on the safety of these devices. Existing data sources such as the National Electronic Injury Surveillance System tend to focus on injury description rather than the underlying context, thus providing little to no actionable information regarding the safety of these devices. Although online reviews are often used by consumers to assess the safety of products, prior studies have not explored consumer-reported injuries and safety concerns within online reviews of mobility-assistive devices. OBJECTIVE: This study aimed to investigate injury types and contexts stemming from the use of mobility-assistive devices, as reported by older adults or their caregivers in online reviews. It not only identified injury severities and mobility-assistive device failure pathways but also shed light on the development of safety information and protocols for these products. METHODS: Reviews concerning assistive devices were extracted from the "assistive aid" categories, which are typically intended for older adult use, on Amazon's US website. The extracted reviews were filtered so that only those pertaining to mobility-assistive devices (canes, gait or transfer belts, ramps, walkers or rollators, and wheelchairs or transport chairs) were retained. We conducted large-scale content analysis of these 48,886 retained reviews by coding them according to injury type (no injury, potential future injury, minor injury, and major injury) and injury pathway (device critical component breakage or decoupling; unintended movement; instability; poor, uneven surface handling; and trip hazards). Coding efforts were carried out across 2 separate phases in which the team manually verified all instances coded as minor injury, major injury, or potential future injury and established interrater reliability to validate coding efforts. RESULTS: The content analysis provided a better understanding of the contexts and conditions leading to user injury, as well as the severity of injuries associated with these mobility-assistive devices. Injury pathways-device critical component failures; unintended device movement; poor, uneven surface handling; instability; and trip hazards-were identified for 5 product types (canes, gait and transfer belts, ramps, walkers and rollators, and wheelchairs and transport chairs). Outcomes were normalized per 10,000 posting counts (online reviews) mentioning minor injury, major injury, or potential future injury by product category. Overall, per 10,000 reviews, 240 (2.4%) described mobility-assistive equipment-related user injuries, whereas 2318 (23.18%) revealed potential future injuries. CONCLUSIONS: This study highlights mobility-assistive device injury contexts and severities, suggesting that consumers who posted online reviews attribute most serious injuries to a defective item, rather than user misuse. It implies that many mobility-assistive device injuries may be preventable through patient and caregiver education on how to evaluate new and existing equipment for risk of potential future injury.

"Before I Could Get Him, He Fell": Experiences, Concerns, and Fall Prevention Strategies of Parents With Young Children.

Little is known about parents' perceptions and prevention strategies regarding childhood falls. In this qualitative study using semi-structured interviews, we sought to describe parental reports of child fall experiences, concerns, and prevention strategies in the home. Sixteen parents with at least one child younger than 18 months were asked about their awareness of fall risks, falls experienced by the child, fall concerns, prevention strategies, and where in the home the child spends time throughout the day. Seven themes emerged: (1) "falls are unexpected," (2) "role of the physical environment," (3) "children's temperament and developmental stage," (4) "physical barriers and baby products," (5) "addressing walking surfaces," (6) "modifying the height of a fall," and (7) "supervision." Parents are aware of in-home fall hazards and actively use strategies to lessen fall risk. Anticipatory guidance should promote evidence-based and evidence-informed prevention strategies and augment effective strategies some parents use to lower fall risk.

Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Seroprevalence in Decedents Undergoing Forensic Postmortem Examination: Feasibility for Real-Time Pandemic Surveillance.

Background: Population-based seroprevalence studies offer comprehensive characterization of coronavirus disease 2019 (COVID-19) spread, but barriers exist and marginalized populations may not be captured. We assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody seroprevalence among decedents in Maryland over 6 months in 2020. Methods: Data were collected on decedents undergoing forensic postmortem examination in Maryland from 24 May through 30 November 2020 from whom a blood specimen could be collected. Those with available blood specimens were tested with the CoronaCHEK lateral flow antibody assay. We assessed monthly seroprevalence compared to the statewide estimated number of cases and proportion of positive test results (testing positivity). We used Poisson regression with robust variance to estimate adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) for associations of demographic characteristics, homelessness, and manner of death with SARS-CoV-2 antibodies. Results: Among 1906 decedents, 305 (16%) were positive for SARS-CoV-2 antibodies. Monthly seroprevalence increased from 11% to 22% over time and was consistently higher than state-level estimates of testing positivity. Hispanic ethnicity was associated with 2- to 3.2-fold higher seropositivity (P < .05) irrespective of sex. Deaths due to motor vehicle crash were associated with 62% increased seropositivity (aPR, 1.62 [95% CI, 1.15-2.28]) vs natural manner of death. Though seroprevalence was lower in decedents of illicit drug overdose vs nonoverdose in early months, this shifted, and seroprevalence was comparable by November 2020. Conclusions: Decedents undergoing forensic postmortem examination, especially those dying due to motor vehicle trauma, may be a sentinel population for COVID-19 spread in the general population and merits exploration in other states/regions.

State and city laws governing the use of child restraint systems in rideshare vehicles and taxicabs: requirements and responsibility.

OBJECTIVES: To identify, describe and critique state and local policies related to child passenger safety in for-hire motor vehicles including ridesharing and taxis. METHODS: We used standard legal research methods to collect policies governing the use of child restraint systems (CRS) in rideshare and taxi vehicles for all 50 states and the 50 largest cities in the USA. We abstracted the collected policies to determine whether the policy applies to specific vehicles, requires specific safety restraints in those vehicles, lists specific requirements for use of those safety restraints, seeks to enhance compliance and punishes noncompliance. RESULTS: All 50 states have policies that require the use of CRS for children under a certain age, weight or height. Seven states exempt rideshare vehicles and 28 states exempt taxis from their CRS requirements. Twelve cities have relevant policies with eight requiring CRS in rideshare vehicles, but not taxis, and two cities requiring CRS use in both rideshare vehicles and taxis. CONCLUSION: Most states require CRS use in rideshare vehicles, but not as many require CRS use in taxis. Though states describe penalties for drivers who fail to comply with CRS requirements, these penalties do not actually facilitate the use of CRS in rideshare or taxis. Furthermore, there is ambiguity in the laws about who is responsible for the provision and installation of the restraints. To prevent serious or fatal injuries in children, policy-makers should adopt policies that require, incentivise and facilitate the use of CRS in rideshare vehicles and taxis.

Working With Fire Departments to Adapt and Implement Evidence-Based Programs That Increase Uptake of Smoke Alarms: A Case-Series Report.

We describe a partnership between an academic injury center and three U.S. fire departments to adapt and implement strategies for promoting smoke alarm programs. Each fire department identified the aims and parameters for a new promotion campaign for their smoke alarm programs. Promotion was directed toward residents in each department's catchment area who were eligible for the smoke alarm program. All three departments independently elected to use an automated telephone message to promote their smoke alarm programs. Uptake of smoke alarm installation services ranged between 0.02% and 2% of the calls placed. In Rochester, automated calls were sent to all residential landlines via the city's nonemergency call center; requests for smoke alarms increased by a factor of 7.5 in the month following the campaign. In Grand Rapids, automated calls were sent to 6% of the households served due to the telecommunications infrastructure; because of the limited reach, the overall number of requests remained unchanged, and the number of callers citing the automated calls was less than the number of requests callers reported were motivated by Grand Rapids' existing promotion strategies. In Cloquet, the automated calls were broadcast on a rolling basis to geographic clusters of households; although the number of requests remained unchanged, fire district officials were pleased to reduce driving time between appointments which allowed volunteers to offer more home visit appointments. Automated telephone calls can be a valuable tool for promoting smoke alarm programs, but fire departments should carefully identify how dissemination strategies can best complement existing program efforts.

It Is Not the Batteries! Smoke Alarm Presence and Functionality 5 to 7 Years Postinstallation of Sealed Lithium Battery Alarms.

Smoke alarms with lithium batteries have been marketed as long life or "10-Year Alarms." Previous work has drawn into question the actual term of functionality for lithium battery alarms. This article reports on observed smoke alarm presence and functionality in a sample of 158 homes that had participated in a fire department smoke alarm installation program 5 to 7 years prior to the observations. A total of 391 alarms were originally installed in the 158 homes that completed the revisit. At the time of the revisit, 217 of those alarms were working (54%), 28 were nonworking (7%), and 146 were missing (39%). Of the 158 homes that completed the revisit, n = 62 (39%) had all their originally installed project alarms up and working at the revisit. Respondents who reported owning their homes or who reported living in their home for 6 or more years were significantly more likely to maintain all of their project alarms than renters or those living in their homes for 5 or fewer years. Smoke alarm installation programs should consider revisiting homes within 5 to 7 years postinstallation to inspect and replace any missing or nonfunctioning alarms. We recommend programs conducting community risk reduction programs track and plan installations and revisits to improve smoke alarm coverage.

Characteristics of Ophthalmic Trauma in Fall-Related Hospitalizations in the United States from 2000 to 2017.

PURPOSE: Falls is a leading cause of injuries nationally and can lead to serious ophthalmic injuries. The purpose of this study is to examine the incidence and characteristics of ophthalmic trauma in patients with fall-related hospitalizations in the United States. METHODS: Retrospective, cross-sectional study. National Inpatient Sample (NIS) was queried to identify all ophthalmic trauma associated with fall-related hospitalizations from 2000 to 2017. Patients were identified using relevant International Classification of Diseases (ICD) codes. National estimates, annual incidences and characteristics were produced from trend weights provided by the NIS sampling frame and population data from the US Census Bureau. RESULTS: There were 21,415,120 fall-related hospitalizations of which 425,725 (2.0%) had ophthalmic trauma. Ophthalmic injury incidence increased from 4.26 to 14.31 per 100,000 population (P < .01) from 2000 to 2017. Mean (±SEM) age was 69.2 ± 20.1 years and 56.9% were females. Of the patients with specified fall mechanism, the most common mechanisms were tripping or stumbling (48.0%), falls related to furniture (18.3%), and falls related to stairs (16.3%). The most common ophthalmic injuries were contusions of the eye and adnexa including hyphema and commotio retinae (50.1%), orbital fractures (20.7%), and eyelid lacerations (14.9%). CONCLUSIONS: Incidence of ophthalmic trauma in patients with fall-related hospitalizations has increased and our study provides valuable information for targeting preventive measures particularly for the elderly and falls due to tripping, stairs, and furniture related accidents. The most common associated ophthalmic injuries are contusions, orbital fractures and eyelid lacerations.

Efficacy of a mobile technology-based intervention for increasing parents' safety knowledge and actions: a randomized controlled trial.

BACKGROUND: Leading causes of unintentional child injury such as poisoning and falls are preventable, and the majority occur in the home. Numerous home safety interventions have been developed and tested to increase safety behaviors; however, no smart phone-based applications (apps) have been developed and evaluated for this purpose. The objective of this study was to evaluate whether a mobile technology-based health behavior change intervention, the Make Safe Happen® app, was an effective tool to increase safety knowledge and safety actions/behaviors for the prevention of child unintentional injuries in and around the home. METHODS: Data were collected in pretest and posttest online surveys from an existing nationwide population-based survey panel. Intervention subjects were randomized to organically (participant-driven) use the Make Safe Happen® app for 1 week, which provided home safety information and the ability to purchase safety products, while control participants were assigned to download and use an app about a topic other than home safety. The primary outcomes of safety knowledge and home safety actions were assessed by using linear mixed model regressions with intention-to-treat analyses. RESULTS: A total of 5032 participants were randomized to either the intervention (n = 4182) or control (n = 850) group, with 2055 intervention participants downloading and entering their participant IDs into the Make Safe Happen® app. The online posttest survey was completed by 770 intervention and 283 control subjects. Mean knowledge parent safety score increased at a greater rate for intervention than control subjects (p < 0.0001), and at posttest was significantly higher for intervention than control subjects (p < 0.0001). The percentage of intervention subjects who reported doing all one-time and repeated safety actions significantly increased from pretest to posttest (p < 0.0001 and p = 0.0001, respectively), but there was no change among the control subjects (p = 0.1041 and p = 0.9755, respectively). At posttest, this percentage was larger for intervention than control subjects only for repeated safety actions (p = 0.0340). CONCLUSIONS: The mobile application significantly improved safety knowledge and safety actions for participants using the Make Safe Happen® app, although loss to follow-up was a limitation. The results of this study indicate the usefulness of widespread distribution and use of the Make Safe Happen® app. Trial registration number NCT02751203 ; Registered April 26, 2016.

An Exploration of Emergency Department Visits for Home Unintentional Injuries Among Children With Autism Spectrum Disorder for Evidence to Modify Injury Prevention Guidelines.

OBJECTIVES: Current childhood injury prevention guidance is anchored by a child's age. For example, children are considered at high risk for falls at ages 4 years and less, and guidance for prevention focuses on these ages. However, these guidelines may not be adequate for children with autism spectrum disorders (ASD). METHODS: This retrospective chart review examined injury characteristics for children with ASD receiving treatment in a pediatric emergency department between 2014 and 2016. Bivariate statistics determined injury demographic correlates. Chart narratives were also coded using traditional content analysis to determine the mechanism that caused the home injury. RESULTS: The sample (27 cases) was mostly male (89%), Black (48%), with a mean age of 7.8 (SD, 4.9) years. The most common mechanism was a fall (44%), followed by self-injurious behavior (33%), and then burns (22%). All cases identified at least 1 mechanism contributing to the injury, in 2 cases, 2 items were mentioned. Of the 29 items identified, most involved a house feature that was not stairs (24%); some included stairs, furniture, or a combination of foreign object and grill (21%); and few identified food/beverage/liquid (11%). CONCLUSIONS: Analyses suggest that unintentional home injury prevention for children with ASD may require prevention guidance extended through older ages.

Evaluating a smartphone application to increase the quantity and improve the quality of supervised practice driving.

BACKGROUND: The learner stage of graduated driver licensing (GDL), when teenagers are supervised by an adult driver, represents an opportunity to develop skills that could confer a safety benefit during their years of independent driving. This paper describes the design of a teenage driving study, which aims to evaluate the impact of a smartphone application, the 'DrivingApp,' to increase the quantity and improve the quality of supervised practice driving. METHODS: This longitudinal intervention study of teenage drivers and a parent/guardian spans the final 6 months of the learner licence and the first year of independent driving. Participants will be assigned to experimental or control groups using block allocation. Parent-teenage dyads assigned to the intervention arm will receive information about their practice driving via a smartphone application, including miles driven and total drive time. Baseline and monthly surveys will be administered to both experimental and control participants to measure the outcome measures during the learner stage: (1) practice driving amount, (2) consistency and (3) variety. Outcomes during independent driving are (1) self-reported number of attempts at the driving test and (2) number of crashes during the first year of independent driving. DISCUSSION: Improving the quality of teenagers' supervised practice driving is an unmet research need. This study will contribute to the evidence about what can be done during the learner period of GDL to maximise teenage drivers' safety during the first years of independent driving, when crash risk is highest.

Short-term outcomes in children following emergency department visits for minor injuries sustained at home.

BACKGROUND: Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes. METHODS: Children (n = 102) aged 0-7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression. RESULTS: The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97). CONCLUSIONS: Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

Drug presence in driving deaths in Maryland: Comparing trends and prevalence in medical examiner and FARS data.

Accurate and reliable information on drug use by road users is essential to inform safety policy development but the reliability of national data has been questioned. There are two primary repositories of drug test information from fatal motor vehicle crashes in Maryland: (1) the Fatality Analysis Reporting System (FARS), which is a national crash database managed by the US Department of Transportation, and (2) the Maryland Medical Examiner (ME). In this study, we compared drug test information for people killed in crashes in Maryland between the FARS system and ME from 2006 - 2018. As ME records are the primary source for the FARS data from Maryland, these two data sets should be closely correlated. We used probabilistic linkage to match FARS and ME cases and compared matched cases by individual drug group. Matching was achieved on 83 % of cases (N = 4803 matched pairs). ME data consistently indicated higher overall incidence and trends in the presence of depressants, narcotics, and stimulants in crash deaths. Sensitivity analysis using both strict and relaxed matching criteria did not change this result. Road safety policy and prevention efforts for crashes involving drugs and alcohol require an accurate understanding of both long-term trends and year-to-year changes in drug prevalence. These findings demonstrate the potential value of using ME data as source of drug test information for crash deaths in the United States.