Variation in documented inhalation injury rates following burn injury in Australia and New Zealand.

INTRODUCTION: The negative impact of inhalation injuries on in-hospital outcomes for burn patients is well known, but the burns community is yet to form a consensus on diagnostic criteria and clinical definitions. The diagnosis of inhalation injuries is consequently highly subjective. This study aimed to assess the variation in the rate of documented inhalation injury for adult patients in Australian and New Zealand burn units. METHODS: Data for sequential admissions collected from eight adult burn centres across Australia and New Zealand between July 2009 and June 2016 were extracted from the Burns Registry of Australia and New Zealand (BRANZ). Inhalation injury was classified in two ways: (i) a field in the BRANZ data dictionary, and (ii) through a series of International Classification of Disease 10th Revision Australian Modification (ICD-10-AM) codes. Variation in inhalation injury prevalence was assessed using descriptive statistics, funnel plots, logistic regression, and predicted probabilities. RESULTS: There were 11,206 admissions to BRANZ sites over the study period. Inhalation injury prevalence was the highest at Site D (13.1% for the BRANZ field and 11.8% for the ICD-10-AM codes), but there was significant variation between the contributing sites and the inhalation injury classification methods. CONCLUSION: There is significant variation in the prevalence of documented inhalation injury among Australian and New Zealand burns units. The variation in the prevalence of documented inhalation injury across Australian and New Zealand sites reinforces the need for a consensus definition in the diagnosis of these injuries. Further work is required to improve data quality and reconcile the differences between clinical and ICD-10-AM coding prevalence before changes in clinical practice can be recommended from these data.

Epidemiology of burn-related fatalities in Australia and New Zealand, 2009-2015.

BACKGROUND: Knowledge of the epidemiology of burn-related fatalities is limited, with most previous studies based on hospital and burn centre data only. AIMS: To describe the epidemiological characteristics of all burn-related fatalities in Australia and New Zealand, and to identify any trends in burn-related fatality incidence over the study period. METHODS: Data from the National Coronial Information System, including data for pre-hospital and in-hospital burn-related fatality cases, was used to examine the characteristics of burn-related fatalities occurring in Australia and New Zealand from 2009 to 2015. Burn-related fatality rates per 100,000 population were estimated, and incidence trends assessed using Poisson regression analysis. RESULTS: Of the 310 burn-related fatalities that occurred in Australia and New Zealand, 2009-2015, 41% occurred in a pre-hospital setting. Overall, most burn-related fatality cases were fire related, occurred at home, and were of people aged 41-80 years. One quarter of all burn-related fatalities were a result of intentional self-harm. The population incidence of all burn-related fatalities combined, and for NSW, decreased over the study period. CONCLUSIONS: This study has identified the importance of examining all burn-related fatalities. If this is not done, vulnerable population subgroups will be missed and prevention efforts poorly targeted.

Epidemiology of work-related burn injuries presenting to burn centres in Australia and New Zealand.

BACKGROUND: Burn injuries to workers can have a devastating impact, however knowledge of the epidemiology of work-related burn injuries in Australia and New Zealand is limited. PURPOSE: To describe epidemiological characteristics of work-related burn injuries in Australia and New Zealand, and to compare these with non-work-related burns. METHODS: Adult burn injury data, 2009-2016, were extracted from the Burns Registry of Australia and New Zealand. Descriptive statistics were used to describe demographic, injury, management and outcome characteristics. Differences between work-related and non-work-related injuries were assessed using Chi-square and Wilcoxon rank-sum tests. RESULTS: Of 10,574 adult patients treated in burn centres in Australia and New Zealand, 2009-2016, 17% had work-related burns. Most work-related cases were male (85%), less than 35 years old (53%), and had sustained flame (33%), scald (30%) or chemicals (17%) burns. Proportions of chemical, scald and electrical burns were greater for work-related than for non-work-related burns, with this being most marked for chemical and electrical burns (17% vs. 3% and 7% vs. 1%, respectively). CONCLUSIONS: Almost one in five cases of working-aged people admitted to Australian and New Zealand burns centres was work-related. Through identification of vulnerable groups, this study informs policy and strategies to minimise occupational burn risk.

Association between high ambient temperature and acute work-related injury: a case-crossover analysis using workers' compensation claims data.

Objectives The aim of this study was to investigate the association between high ambient temperature and acute work-related injury, expanding on previous research in this area. Specifically we examined the relationship between both daytime and overnight temperatures and injury risk and disentangled physically demanding occupational exposures from exposure to outdoor working conditions. Methods A time-stratified case-crossover study design was used to examine the association between ambient temperatures and acute work-related injuries in Melbourne, Australia, 2002-2012, using workers' compensation claims to identify work-related injuries. The relationship was assessed for both daily maximum and daily minimum temperatures using conditional logistic regression. Results Significant positive associations between temperature and acute work-related injury were seen for younger workers (<25 years), with the odds of injury increasing by 1% for each 1 °C increase in daily minimum temperature, and by 0.8% for each 1 °C increase in daily maximum temperature. Statistically significant associations were also observed between daily maximum temperature and risk of injury for workers employed in the highest strength occupations and for male workers, and between daily minimum temperature and injury for all cases combined, female workers, workers aged 25-35 and ≥55 years, "light" and "limited" physical demand groups, and "in vehicle or cab" and "regulated indoor climate" workplace exposure groups. Conclusions Young workers, male workers and workers engaged in heavy physical work are at increased risk of injury on hot days, and a wider range of worker subgroups are vulnerable to injury following a warm night. In light of climate change projections, this information is important for informing injury prevention strategies.

Comparison of data sets for surveillance of work-related injury in Victoria, Australia.

OBJECTIVE: To investigate differences and similarities between three sources of work-related injury information: workers compensation claims, emergency department (ED) presentation data and hospital admissions data. METHODS: This population-based, retrospective descriptive analysis of non-fatal, work-related injuries of workforce participants in Victoria, Australia, has compared data from workers compensation claims and ED presentation and hospital admission data sets for the period 2004-2011. Work-related injury case frequency and rate were compared across study years according to gender, age, geographical location and injury type. Injury rates were expressed as cases per million hours worked. RESULTS: Rates of hospital admissions for treatment of work-related injury increased over the study period, compared with decreasing rates of injury in compensation claims and ED data. The highest rate of injuries to younger workers was captured in ED data. There was greater capture of musculoskeletal injuries by workers' compensation data, and of open wound and burn injury by the ED data. Broad similarities were noted for temporal trends according to gender, for the distribution of cases across older age groups and for rates of fracture injuries. CONCLUSIONS: These study findings inform use of workers' compensation, ED presentation and hospital admission data sets as sources of information for surveillance of work-related injuries in countries where these types of data are routinely collected. Choice of data source for investigation of work-related injury should take into consideration the population and injury types of interest.

Preparation of residential aged care services for extreme hot weather in Victoria, Australia.

OBJECTIVES: The purpose of this study was to describe preparations for extreme hot weather at Victorian public sector residential aged care services for the 2010-11 summer, and to examine the role of the Residential Aged Care Services Heatwave Ready Resource in this process. METHOD: Qualitative data was collected through semi-structured interviews of senior staff of Victorian public sector residential aged care services. Interviews were conducted at monthly intervals from November 2010 to March 2011, and data were analysed thematically. RESULTS: All interviewees described pre-summer preparations for hot weather undertaken at the health services they represented. Staff awareness and experience, and having a heatwave plan, were reported to have facilitated heat preparedness, whereas challenges to preparations mainly concerned air conditioning. The Residential Aged Care Services Heatwave Ready Resource was used to inform heatwave plans, for staff and family education, and as an audit tool. CONCLUSIONS: An extensive and well-considered approach to minimisation of harm from extreme heat by a sample of residential aged care services is described, and the Residential Aged Care Services Heatwave Ready Resource is reported to have supported the heatwave preparedness process.

Characteristics of an educational publication sourced from deaths investigated by the coroner that is reported to have promoted practice change.

OBJECTIVE: The purpose of this study was to investigate the characteristics of the Residential Aged Care Coronial Communiqué that have promoted previously reported professional practice change, and to explore the circumstances of these changes. METHODS: This was an exploratory, qualitative study for which data was collected through semi-structured interview of 15 subscribers to the Residential Aged Care Coronial Communiqué. RESULTS: The Residential Aged Care Coronial Communiqué was reported to promote self-reported practice change though the inclusion of case studies, by being associated with the Coroner, and by providing evidence to justify change. The combination of existing concerns about risk and staff awareness, in conjunction with reading the Residential Aged Care Coronial Communiqué was also reported to promote practice change, as was having the support of senior staff and the authority to implement change. CONCLUSIONS: The combination of narrative case studies in the context of an educational publication associated with the Coroner's Office has been reported to provided evidence and incentive to promote professional practice change in an aged care setting. However the relative influence of the Residential Aged Care Coronial Communiqué, and other background circumstance and facilitating factors on practice change cannot be determined from this study.

Minimising harm from heatwaves: a survey of awareness, knowledge, and practices of health professionals and care providers in Victoria, Australia.

OBJECTIVES: Heatwaves cause illness and death, and are likely to become more severe and frequent in the future. This study has investigated the awareness, knowledge and practices of health professionals and care providers regarding heatwaves and health of older clients, in order to inform harm minimisation strategies for Victoria, Australia. METHODS: An electronic survey of personnel of six health profession and care provider groups that support the health of older people living in the community was conducted in Victoria, Australia, in 2008. Descriptive statistics were derived through quantitative analysis. RESULTS: Survey respondents showed a high level of awareness that heatwaves can be harmful for older people. Gaps in knowledge were identified regarding thermoregulation, risk factors, heat-related illness, and the use of fans. Few organisations had existing heatwave response plans, and responses to heatwaves were mostly reactive and opportunistic. CONCLUSIONS: Despite a broad level of understanding of the dangers of heatwaves, an opportunistic, reactive approach by health profession and carer personnel, in conjunction with gaps in knowledge, leaves older people in Victoria at risk of preventable harm from extreme hot weather.

Minimising harm to older Victorians from heatwaves: A qualitative study of the role of community-based health profession and carer organisations.

AIM: To investigate the role of community-based health profession and carer organisations in Victoria in minimising harm to older people from heatwaves. METHODS: A qualitative study based on semistructured interviews was conducted in Victoria, Australia. Twelve people were interviewed, representing four professional groups that support the health of older Victorians who reside at home. RESULTS: None of the health profession and carer organisations studied had formalised heatwave strategies; however, their staff conduct a range of activities before and during heatwaves that may reduce harm to older clients. Interviewees discussed roles their organisations could play in a heatwave response plan, including coordination, identification of high-risk individuals and education. All saw a need for extra resources and training if responses to heatwaves were required more frequently. CONCLUSION: It may be feasible to utilise the existing services and infrastructure of community-based health profession and carer organisations operating in Victoria within a State-wide Heatwave Response plan; however, this will require extra resources, training and coordination.

The effect of printed educational material from the coroner in Victoria, Australia, on changing aged care health professional practice: a subscriber survey.

There are substantial knowledge and research gaps about the effects of printed educational material on professional practice. This study has examined whether the Residential Aged Care Coronial (RACC) Communiqué, an electronic newsletter of narrative case reports about lessons learned from deaths in residential aged care settings reported to the coroner in Victoria, Australia, prompted subscribers to initiate change in professional practice to improve care. An anonymous electronic survey was distributed to all registered subscribers of the RACC Communiqué to collect information about self-reported changes in professional practice, respondent characteristics, reading behavior, and an assessment of effect and content of the publication. Researchers from the Victoria Institute of Forensic Medicine, Victoria, Australia, conducted the study in 2008. Of 778 subscribers invited to participate in the study, 426 (54.8%) provided valid responses. The majority of respondents were aged 45 and older, female, and working at a residential aged care facility in a management role. Half of the survey respondents reported making a change to their professional practice as a result of reading the RACC Communiqué, with one-fifth of these respondents agreeing that they would not have made the self-reported change if they had not read this publication. These findings are greater than the previously reported small effects of education through printed education material and make an important contribution to understanding the use of printed education material for initiating professional practice change.