The influence of extrinsic and intrinsic risk factors on the probability of sustaining an injury

Noncontact Knee Ligament Injury Prevention Screening in Netball: A Clinical Commentary with Clinical Practice Suggestions for Community-Level Players

Netball is a predominantly female team court-sport which is played worldwide. Netball is becoming more popular in the United States following its countrywide introduction to schools and community centers. A unique characteristic of netball is the footwork rule which restricts players to a one-step landing after catching the ball. Most netball landings are single-leg landings resulting in high vertical ground reaction forces and high skeletal tissue forces. Thus, high-risk landing events that have the biomechanical potential for injury occur frequently. Noncontact knee ligament injuries are common following a knee abduction collapse when landing. Because the consequences of noncontact knee ligament injury are profound, strategies are needed to mitigate the burden of such injury for players, teams, and society. The purpose of this clinical commentary is to demonstrate how theoretical principles, different types of research, and different levels of evidence underpin a rational clinical reasoning process for developing noncontact knee ligament injury prevention screening procedures in netball. The theoretical principles that are discussed in this commentary include injury control, the sequence of prevention, principles of screening in injury prevention, the multifactorial model of injury etiology, complex systems theory, and systems science. The different types of research that are reviewed include descriptive and analytic-observational studies. The different levels of evidence that are discussed include prospective studies, cross-sectional studies, and clinicians' own kinesiological modelling. Subsequently, an integrated approach to the evidence-informed development of noncontact knee ligament injury prevention screening procedures is presented. Clinical practice suggestions include a selection of evidence-informed screening tests that are quickly and easily implemented with netball players in local communities. The need for repeated screening at strategic timepoints across a season/year is explained. Sports physical therapists will find this commentary useful as an example for how to undertake clinical reasoning processes that justify the content of screening procedures contributing to noncontact knee ligament injury prevention in community-level netball.

LEVEL OF EVIDENCE

5.

Demographics, Health, and Risk Behaviors of Young Adults Who Drink Energy Drinks and Coffee Beverages

Objective: The present study investigates risk behaviors, sleep habits, and mental health factors associated with caffeinated beverage use in young adults. Materials and Methods: Students from a midsize private university (n = 159) completed a 15-minute anonymous questionnaire, including questions on risk behaviors, sleep habits, alcohol, and caffeine consumption. We compared behaviors between the top ∼15% ("high end") of energy drink users (≥3/month) and coffee users (≥16/month) to those with less frequent or no caffeine consumption. Results: Caffeine consumption was frequent among young adults. In the last month, 36% of students had an energy drink, 69% had coffee or espresso, and 86% reported having any caffeine; however, the majority of students were unaware of the caffeine content in these beverages. High-end energy drink consumers reported more risk-taking behaviors (increased drug and alcohol use and less frequent seat belt use), sleep disturbances (later bedtimes, harder time falling asleep, and more all-nighters), and higher frequency of mental illness diagnoses than those who consumed fewer energy drinks. In contrast, the frequency of most risk behaviors, sleep disturbances, and mental illness diagnoses was not significantly different between the high-end and general population of coffee drinkers. Conclusion: Students with delayed sleep patterns, mental illness, and higher frequency of substance use and risk behaviors were more likely to be regular energy drink users but not regular coffee drinkers. It is unclear whether the psychoactive content in energy drinks results in different behavioral effects than just caffeine in coffee, and/or different personality/health populations are drawn to the two types of beverages.

Alcohol level and injury severity: is the floppy patient myth true?

BACKGROUND

The impact of inebriation on severity of injury is unclear. The few studies to date on this topic are limited to a particular mechanism of injury (MOI), injury pattern, or blood alcohol level (BAL). Therefore, we sought to determine the impact of BAL on injury pattern and severity across all MOI. We hypothesize that there is no relationship between BAL and injury severity when controlling for MOI.

MATERIALS AND METHODS

After institutional review board approval, a retrospective study was performed at an adult trauma center from January 1, 2012-December 31, 2012. All MOI were included. Injury severity was assessed using the injury severity score (ISS). Chi square and analysis of variance were used to examine the relationship between BAL, injury pattern, and ISS within each MOI. Multivariate regression analysis examined the BAL-ISS association adjusting for MOI, gender, and age.

RESULTS

Of 1397 patients, the mean age was 44 ± 19, ISS was 7.5 ± 6.8, BAL was 93 ± 130 mg/dL, and 70% were male. Rib fracture (P = 0.002) and hemothorax and/or pneumothorax (P = 0.0009) were negatively associated with BAL, whereas concussion and soft tissue injury had a positive association with BAL (P < 0.0001). An increasing BAL had a negative correlation with ISS after fall from standing (P < 0.001), whereas bicycle collisions had a positive association (P = 0.027). Across all MOI, there was no significant association between BAL and ISS.

CONCLUSIONS

BAL is associated with ISS, in specific MOI; however, across all MOI, there was no significant association between BAL and ISS. Inebriated patients should be triaged with the same clinical index of suspicion for injury as sober patients.

Risk of injury from drinking: the difference which study design makes

BACKGROUND

The magnitude of risk of injury from drinking, based on emergency department (ED) studies, has been found to vary considerably across studies, and the impact of study design on this variation is unknown.

METHODS

Patients were interviewed regarding drinking within 6 hours prior to the injury or illness event, drinking during the same time the previous week, and usual drinking during the last 30 days. Risk estimates were derived from case-control analysis and from both pair-matched and usual frequency case-crossover analysis.

RESULTS

The odds ratio (OR) based on case-control (2.7; 1.9 to 3.8) was larger than that based on pair-matched case-crossover analysis (1.6; 1.0 to 2.6). The control-crossover estimate suggested the case-crossover estimate was an underestimate of risk, and when this adjustment was applied to the case-crossover estimate, risk of injury increased (OR = 3.2; 1.7 to 6.0). Adjusted case-crossover estimates compared with unadjusted showed the largest proportional increase at 7 or more drinks prior to injury (OR = 7.1; 2.2 to 22.9). The case-crossover estimate based on usual frequency of drinking was substantially larger (OR = 10.7; 8.0 to 14.3) than that based on case-control or pair-matched case-crossover analysis, but less than either when adjusted based on control-crossover usual frequency analysis (OR = 2.2; 1.5 to 3.3).

CONCLUSIONS

The data suggest that while risk of injury based on case-control analysis may be biased, control data are important in providing adjustments derived from control-crossover analysis to case-crossover estimates, and are most important at higher levels of consumption prior to the event.

Proposal of a risk-factor-based analytical approach for integrating occupational health and safety into project risk evaluation

Excluding occupational health and safety (OHS) from project management is no longer acceptable. Numerous industrial accidents have exposed the ineffectiveness of conventional risk evaluation methods as well as negligence of risk factors having major impact on the health and safety of workers and nearby residents. Lack of reliable and complete evaluations from the beginning of a project generates bad decisions that could end up threatening the very existence of an organization. This article supports a systematic approach to the evaluation of OHS risks and proposes a new procedure based on the number of risk factors identified and their relative significance. A new concept called risk factor concentration along with weighting of risk factor categories as contributors to undesirable events are used in the analytical hierarchy process multi-criteria comparison model with Expert Choice(©) software. A case study is used to illustrate the various steps of the risk evaluation approach and the quick and simple integration of OHS at an early stage of a project. The approach allows continual reassessment of criteria over the course of the project or when new data are acquired. It was thus possible to differentiate the OHS risks from the risk of drop in quality in the case of the factory expansion project.

Planning Volunteer Responses to Low-Volume Mass Gatherings: Do Event Characteristics Predict Patient Workload?

Introduction:

Workforce planning for first aid and medical coverage of mass gatherings is hampered by limited research. In particular, the characteristics and likely presentation patterns of low-volume mass gatherings of between several hundred to several thousand people are poorly described in the existing literature.

Objectives:

This study was conducted to:

1. Describe key patient and event characteristics of medical presentations at a series of mass gatherings, including events smaller than those previously described in the literature;

2. Determine whether event type and event size affect the mean number of patients presenting for treatment per event, and specifically, whether the 1:2,000 deployment rule used by St John Ambulance Australia is appropriate; and

3. Identify factors that are predictive of injury at mass gatherings.

Methods:

A retrospective, observational, case-series design was used to examine all cases treated by two Divisions of St John Ambulance (Queensland) in the greater metropolitan Brisbane region over a three-year period (01 January 2002–31 December 2004). Data were obtained from routinely collected patient treatment forms completed by St John officers at the time of treatment. Event-related data (e.g., weather, event size) were obtained from event forms designed for this study. Outcome measures include: total and average number of patient presentations for each event; event type; and event size category. Descriptive analyses were conducted using chi-square tests, and mean presentations per event and event type were investigated using Kruskal-Wallis tests. Logistic regression analyses were used to identify variables independently associated with injury presentation (compared with non-injury presentations).

Results:

Over the three-year study period, St John Ambulance officers treated 705 patients over 156 separate events. The mean number of patients who presented with any medical condition at small events (≤2,000 attendees) did not differ significantly from that of large (>2,000 attendees) events (4.44 vs. 4.67, F = 0.72, df = 1, 154, p = 0.79). Logistic regression analyses indicated that presentation with an injury compared with non-injury was independently associated with male gender, winter season, and sporting events, even after adjusting for relevant variables.

Conclusions:

In this study of low-volume mass gatherings, a similar number of patients sought medical treatment at small (<2,000 patrons) and large (>2,000 patrons) events. This demonstrates that for low-volume mass gatherings, planning based solely on anticipated event size may be flawed, and could lead to inappropriate levels of first-aid coverage. This study also highlights the importance of considering other factors, such as event type and patient characteristics, when determining appropriate first-aid resourcing for low-volume events. Additionally, identification of factors predictive of injury presentations at mass gatherings has the potential to significantly enhance the ability of event coordinators to plan effective prevention strategies and response capability for these events.

Drinking patterns and risk behaviors associated with combined alcohol and energy drink consumption in college drinkers

OBJECTIVE

In recent years the consumption of alcohol mixed with energy drinks (AmED) has become popular in young adults in North America. There have been few studies into the drinking patterns and risk behaviors that accompany this new form of alcoholic beverage consumption and more information is required to support harm reduction and prevention efforts. This paper goes beyond previous research by investigating risk behaviors associated with AmED use while (1) controlling for risk-taking propensity, (2) examining a range of outcomes (e.g., stimulant drug use), and (3) replicating previous findings in a Canadian sample.

METHOD

In winter 2009/10, a web-based survey was completed by 465 students (56% female) attending a university in Western Canada. Regression analyses were used to investigate whether consumption of AmED is associated with heavy drinking, stimulant drug use, and alcohol-related consequences.

RESULTS

A total of 105 students (23%) reported consuming AmED in the past 30days. These students were more likely to be heavier drinkers, than non-AmED users after controlling for risk-taking propensity. More frequent AmED drinkers had twice the odds of experiencing one or more negative consequences from AmED use (e.g. drinking and driving, being hurt or injured), compared to less frequent drinkers after controlling for risk-taking propensity and drinking behavior.

CONCLUSIONS

Students who consume AmED are at increased risk for harms. Therefore, consuming AmED should be considered "high-risk drinking" for university students and efforts should be made to discourage combined consumption.

The basis for Canada's new low-risk drinking guidelines: a relative risk approach to estimating hazardous levels and patterns of alcohol use

ISSUE

Low-risk drinking guidelines have been developed independently in a number of jurisdictions resulting in different sets of advice with different definitions of 'low risk'. This paper discusses some of the fundamental issues addressed by an expert advisory panel during the course of developing national guidelines for Canadians and summarises key sets of evidence that were influential.

APPROACH

The underlying reasoning and connection between the evidence and the guidelines is discussed in relation to: (i) how to minimise risk of long-term illnesses; (ii) how to minimise risk of short-term harms, for example injury; and (iii) alcohol use during pregnancy. Both absolute and relative risks were considered in the development of the guidelines.

FINDINGS

Meta-analyses of all-cause mortality were used to identify upper limits for usual drinking levels where potential benefits and risks were balanced for the average person in comparison with lifetime abstainers (10 standard drinks per week for women, 15 for men). Emergency room studies and situational risk factors were considered for advice on reducing short-term: (i) when not to drink at all; (ii) how to reduce intoxication; and (iii) upper limits for occasional daily consumption by adults aged 25 to 64 years (3 standard drinks for women, 4 for men). Shortcomings in the research data were highlighted.

IMPLICATIONS

It was estimated that total compliance with these guidelines at a national level would result in substantially reduced per capita alcohol consumption and approximately 4600 fewer deaths per year.

Alcohol-related injury visits: do we know the true prevalence in U.S. trauma centres?

INTRODUCTION

Alcohol consumption is a significant risk factor for injuries. Further, level I trauma centres are mandated to screen and provide a brief intervention for identified problem drinkers. However, a valid population-based estimate of the magnitude of the problem is unknown. Therefore, the goal of this study is to evaluate the extent to which the present literature provides a valid estimate of the prevalence of alcohol-related visits to U.S. trauma centres.

METHODS

A Medline search for all articles from 1966 to 2007 that might provide prevalence estimates of alcohol-related visits to U.S. trauma centres yielded 836 articles in English language journals. This review included only papers whose main or secondary goal was to estimate the prevalence of positive blood alcohol concentration (BAC) or acute intoxication. Both a crude aggregate estimate and sample size adjusted estimate were calculated from the included papers and the coverage and comparability of methods were evaluated.

RESULTS

Of the 15 studies that met inclusion criteria, incidence estimates of alcohol-related visits ranged from 26.2% to 62.5% and yielded an aggregate, weighted estimate of 32.5%. Target population, capture rate, and threshold for a positive screening result varied considerably across studies. No study provided a comprehensive estimate, i.e., of all trauma patients hospitalised, treated and released, or who died.

CONCLUSIONS

Although the incidence of alcohol-related visits to U.S. trauma centres appears very high perhaps higher than any other medical setting, the validity of our aggregate estimate is threatened by crucial methodological considerations. The lack of a methodologically valid prevalence estimate hinders efforts to devise appropriate policies for trauma centres and across medical settings.

Sensation seekers as a healthcare marketing metasegment

This article discusses "sensation seekers" as a market segment for communication and prevention programs for various lifestyle and/or risk-related health problem areas such as alcohol abuse, drug abuse, suicide attempts, and sexually transmitted diseases. Although sensation seekers tend to be creative, artistic individuals, they are also prone to various negative health behaviors and many population-based prevention programs have over-looked these individuals as an important target. Various inputs to sensation-seeking causation are explored, including biological/chemical, psychological, and the impact of external characteristics. Using a combination for regulatory focus and risk homeostasis, propositions are provided for improving the effectiveness of the communications. Recommendations for prevention efforts focusing on reaching this subculture using television, along with other electronic media are proposed, including recommendations for message construction and presentation venues.

Injury prevention in Australian Indigenous communities

Injury prevention in Indigenous communities in Australia is a continuing national challenge, with Indigenous fatality rates due to injury three times higher than the general population. Suicide and transport are the leading causes of injury mortality, and assault, transport and falls the primary causes of injury morbidity. Addressing the complex range of injury problems in disadvantaged Indigenous communities requires considerable work in building or enhancing existing capacity of communities to address local safety issues. Poor data, lack of funding and absence of targeted programs are some of the issues that impede injury prevention activities. Traditional approaches to injury prevention can be used to highlight key areas of need, however adaptations are needed in keeping with Indigenous peoples' holistic approach to health, linked to land and linked to community in order to address the complex spiritual, emotional and social determinants of Indigenous injury.

The effects of health status, distress, alcohol and medicinal drug use on subsequent motor vehicle injuries

OBJECTIVE

The purpose of this study was to examine the effects of health factors and substance use on subsequent motor vehicle collision (MVC) injuries of three different age groups, using the longitudinal dataset from the Canadian National Population Health Survey (NPHS) for the years 1994-2002.

METHODS

Path analysis technique was used to determine the relations between MVC injury and four risk factors: binge drinking; health status; distress; and medication use. The three demographic variables, age at 'baseline', sex, and immigration status were added into the model as control variables. Three age groups were examined: young=12-29.9; middle-aged=30-59.9 and old=60-85 years of age. The total sample size was 16,093.

RESULTS

A lower percentage of males, older persons, immigrants, and non-binge drinkers reported a subsequent MVC injury, as did respondents reporting better health and lower distress scores. Medication use was associated with higher subsequent MVC injuries. Path analysis found that among younger individuals, the variable binge drinking, was the only significant risk factor associated with subsequent injuries. In contrast, among middle-aged individuals, the variable medication use, was the only statistically significant risk factor for subsequent injuries. No variables were significant risk factors of injuries for older individuals.

CONCLUSIONS

Various demographic and risk factors were found to influence injuries among a nationally representative sample of Canadians. Reported binge drinking among young individuals and medication use among middle-aged individuals were found to be risk factors for subsequent MVC injury. These findings support the need for continued focus on alcohol, drugs and traffic safety.

A comparison of self-reported motor vehicle collision injuries compared with official collision data: an analysis of age and sex trends using the Canadian National Population Health Survey and Transport Canada data

OBJECTIVE

The purpose of this study was to compare the age and sex trends of motor vehicle collision injuries between a nationally representative self-report survey and official police motor vehicle collision report data. To do this, population-based estimates of motor vehicle collision injuries were established using data from the National Population Health Survey (NPHS), a prospective, population-based, longitudinal survey that was compared to Transport Canada's official motor vehicle collision report statistics.

METHODS

Aggregated mean data (1994-1996) were compared for seven age groups (15-19, 20-24, 25-34, 35-44, 45-54, 55-64, and 65+) from both data sets.

RESULTS

No significant differences were found between males' and females' MVC injuries for any age category in the NPHS. A comparison of the NPHS and Transport Canada data found two small (significant) within-sex differences between the data sets, but overall, the analysis largely revealed similar trends for self-reported injury for all age categories and sex.

CONCLUSIONS

The results indicate that the incidence of injuries based on self-report data in a nationally representative sample is similar to official sources of reporting and are thus a valid indicator or motor vehicle collision injury incidence. The results also confirm that injury trends differ from fatality trends.

Predictors of motor vehicle collision injuries among a nationally representative sample of Canadians

OBJECTIVE

The purpose of this study was to examine predictors of subsequent motor vehicle collision injuries, with a particular focus on health-related variables, using the longitudinal dataset from the Canadian National Population Health Survey (NPHS) for the years 1994-2002.

METHODS

Multiple logistic regression analysis was used to determine the relations between motor vehicle collision injury and four risk factors: binge drinking, health status, distress, and medication use. Age and sex were included as control variables. The total sample size was 14,529.

RESULTS

A higher percentage of females and younger persons reported a motor vehicle collision injury. Binge drinkers, respondents with poor health, respondents with distress, and respondents reported using two or more medications reported a higher percentage of subsequent injuries. Logistic regression analysis found that persons with poorer health status and persons who used more medications had higher odds of motor vehicle injuries. Only one statistically significant interaction effect was found: alcohol bingeing and medication use.

CONCLUSIONS

Among a nationally representative sample of Canadians, various demographic and risk factors predict subsequent injuries. Given that this number represents a considerable economic burden, this study underscores the need for continued research and countermeasures on alcohol, drugs, and driving.

Self-reported motorcycle riding behaviour among school children in India

Studies on traffic accidents among underage users of motorcycles are seldom seen in literature. This study was done in Yamunanagar, India where boys as young as 8 years ride motorcycles. It attempts to find out the behavioural and non-behavioural factors leading to motorcycle use and the predisposition to accidents among male school children aged between 10 and 16 years. A questionnaire was used to evaluate those factors among 1760 subjects in 38 schools. Fifteen percent of subjects had had an accident while riding motorcycle. Most of the behavioural and all the non-behavioural factors have a statistically significant influence on accident proneness. Aggressive behaviour and previous encounter with the police are the two strong predictors of accidents (p<0.001). Children as riders are exposed to higher risks of accident and longer life with disability. It also explains how these children behaviourally take up adult roles and seek adult risk taking attitudes. The implications of child motorcycle riders upon children themselves and on the society are discussed for a greater discourse on road safety motorcycle riding policy and to highlight the behavioural and non-behavioural factors that are associated with traffic accidents.

Variations of alcohol impairment in different types, causes and contexts of injuries: results of emergency room studies from 16 countries

OBJECTIVE

The purpose of this paper is to document alcohol impairment (based on a blood alcohol content (BAC) of at least 80 mg%) for different types, causes and location contexts of injuries.

DESIGN AND SETTING

Data from 45 studies with 11,536 injury patients were merged to determine variations in the percent of alcohol impairment among injury patients. In each study, emergency room (ER) injury patients were given a short interview on the circumstances of their injury and BAC was measured.

RESULTS

Injury severity, measured by number of body regions injured was significantly associated with BACs over 80 mg%. The highest percentage of injury type to involve alcohol was head injury/concussion. In terms of causes of injuries, patients with alcohol impairment were significantly more likely to be involved in violence than any other cause (i.e., vehicle, falling, poisoning or burns). Finally, injuries occurring at a bar or restaurant were significantly more likely to involve alcohol impairment than any other setting.

CONCLUSIONS

The results demonstrate considerable variation in the circumstances where alcohol is involved in injuries. These results may be useful for the development of prevention initiatives.

Injury severity: role of alcohol, substance use and risk-taking

OBJECTIVE

The objective of the present study was to quantify the relationship between acute alcohol consumption and injury severity.

METHODS

A cross-sectional study was conducted at the Gold Coast Hospital, Gold Coast, Queensland, Australia between October 2000 and October 2001. Data were collected from a systematic sample of patients greater than 15 years of age who presented to the ED for treatment of an injury sustained less than 24 h prior to presentation. Study participants were interviewed face to face on-site. Information obtained included: demographics details; situational variables relative to time of injury (i.e. location, activity and companions at time of injury); self-reported alcohol consumption in the 6 and 24 h prior to time of injury; usual alcohol consumption patterns; self-reported substance use in the 6 and 24 h prior to time of injury; and risk-taking behaviour. Injury severity was coded from patient medical records using the New Injury Severity Score.

RESULTS

Of 789 eligible patients presenting during the study periods, 593 were interviewed (75.2%). Patients who reported drinking above low-risk levels (odds ratio [OR] = 3.35; 95% confidence interval [CI] 1.2-9.6) or who drank beer (OR = 3.54; 95% CI 1.1-11.1) in 6 h prior to injury were significantly more likely to sustain serious than minor injury. Drinking setting and usual drinking patterns were not significantly associated with injury severity, either in crude analyses, or after adjusting for relevant variables.

CONCLUSION

The results of the present study support the conclusion that among injured patients who presented for treatment at a large metropolitan ED, although acute alcohol consumption does not appear to be associated with minor or moderate injury, there is some evidence to suggest that acute alcohol consumption is associated with serious injury.

Alcohol consumption, risk of injury, and high-cost medical care

This study examined the effect of alcohol use on the probabilities of injury, inpatient hospital stay, and emergency department visit. Data were obtained from a sample of adults (N = 1219) recruited from a Northern California county. Alcohol use measures included number of drinks, heavy drinking days, and an indicator variable for problem drinking. Models were estimated for men and women separately while controlling for confounders. Results indicate that most alcohol use measures were not significantly related to injury probability or medical care utilization. Among the exceptions, problem drinking was a significant positive predictor of any emergency department visit for both sexes. When drinkers during the past year were divided into light, moderate, and heavy drinking groups and compared to lifetime abstainers, all male drinkers had a higher probability of injury, and light and moderate female drinkers had a lower probability of an emergency department visit.

Prevention of injuries at work: the role of the occupational physician

OBJECTIVES

To highlight the role of occupational physician (OP) in occupational injuries (OI) prevention and management. To suggest an approach beyond traditional focus on descriptive epidemiology, engineering interventions, administrative aspects of OI prevention. To promote a person- and enterprise-tailored approach, entailing greater attention to human factors and to practical problems of the specific workplace, with a call to a leading role played by OP.

METHODS AND RESULTS

Analysis of the literature on the broader topic of OI prevention revealed thousands of publications; however, only a handful of them mention or describe the participation of OP in OI prevention. While recognizing that literature search is not the proper and only way to appreciate the current role of OP in this field, therefore, it seems necessary to call OP to a stronger effort in prevention and management of OI, through the context of a comprehensive intervention in cooperation with managers, supervisors, safety personnel and workers, focusing on specific needs of each enterprise. The following areas of OP intervention were examined: risk assessment, health surveillance, management, scientific research and health education. Within each of these topics, possible contributions, methodologies, instruments available for the OP were discussed, taking into account the relevant literature. Pathways for practical applications were illustrated, e.g., OI data generation and analyses, predictors of OI, fitness for work, case management, team work, educational issues, first aid, suggestion for OP contribution in specific research questions.

CONCLUSIONS

OI continue to take a remarkable toll from individuals and society. New multidisciplinary interventions are needed to prevent OI. Focused activities at the single worksite with a central role from OP are definite options. OP is an effective interface between workforce and management and may offer, through a proactive approach, valuable practical and cultural contributions, while respecting technical and ethical guidelines of occupational health professionals.

THE RELATIONSHIP BETWEEN ACUTE ALCOHOL CONSUMPTION AND CONSEQUENT INJURY TYPE

AIMS

The aim of this study was to quantify the relationship between acute alcohol consumption and injury type (nature of injury, body region injured), while adjusting for the effect of known confounders (i.e. demographic and situational variables, usual drinking patterns, substance use and risk-taking behaviour).

METHODS

A cross-sectional study was conducted between October, 2000 and October, 2001 of patients aged >or=15 years presenting to a Queensland Emergency Department for treatment of an injury sustained in the preceding 24 h. There were three measures of acute alcohol consumption: drinking setting, quantity, and beverage type consumed in the 6 h prior to injury. Two variables were used to quantify injury type: nature of injury (fracture/dislocation, superficial, internal, and CNS injury) and body part injured (head/neck, facial, chest, abdominal, external, and extremities). Both were derived from patient medical records.

RESULTS

Five hundred and ninety three patients were interviewed. Logistic regression analyses indicated that, after controlling for relevant confounding variables, there was no significant association between any of the three measures of acute alcohol consumption and injury type.

CONCLUSIONS

The effects of acute alcohol consumption are not specific to injury type. Interventions aimed at reducing the incidence of alcohol-related injury should not be targeted at specific injury types.

Risk of injury from acute alcohol consumption and the influence of confounders

AIM

To quantify the relationship between acute alcohol consumption and risk of injury, in the context of other potential confounding factors (i.e. usual alcohol intake, risk-taking behaviour and substance use-defined as prescription/over-the-counter medication or illicit substances), using three separate measures of alcohol consumption.

DESIGN

A hospital-based, case-control study.

SETTING

The accident and emergency department at a large metropolitan teaching hospital in Queensland, Australia.

PARTICIPANTS

Four hundred and eighty-eight cases were matched to 488 population controls on gender, age group, neighbourhood, day and time of injury.

MEASUREMENTS

Risk factor and injury information was obtained by questionnaire and medical record review.

RESULTS

After controlling for demographic and situational variables (i.e. activity, location and companions at time of injury), consuming any alcohol in the 6 hours prior to time of injury significantly increased risk of injury [odds ratio (OR) = 2.13, 95% confidence interval (CI): 1.3-3.9]. Drinking at levels above low-risk guidelines for short-term health (i.e. drinking > 40 g alcohol per occasion if female, and drinking > 60 g alcohol if male) increased injury risk by a factor of almost 2.5 (OR = 2.41; 95% CI = 1.1-5.2). Finally, drinking beer (OR = 1.86; 95% CI = 0.9-3.9), spirits (OR = 3.05; 95% CI = 1.1-8.2) or a combination of beverages (OR = 3.16; 95% CI = 1.1-8.8) increased risk of injury. When usual alcohol consumption patterns were adjusted for, substantial increases in the alcohol-injury odds ratios were observed for all measures of alcohol. When risk-taking behaviour and substance use were considered, changes in the effect of alcohol on injury risk were observed, for all measures of alcohol. These data support the hypotheses that some confounding exists in the alcohol-injury relationship due to usual drinking patterns, risk-taking and substance use.

CONCLUSIONS

In this study, acute alcohol consumption significantly increased the risk of injury, even when situational and other risk factors were considered. However, the relationship between alcohol and injury appears confounded by usual drinking patterns, risk-taking behaviour and substance use. Therefore, these variables should be considered in any analysis of the alcohol-injury relationship, and also considered when developing public health strategies to reduce alcohol-related injury. Further research is required to elucidate the nature of this relationship, and to identify the effect of risk-taking and substance use on different types of injuries (e.g. mechanism of injury; body region injured) and injury severity. The stability of the models and the consistency of the findings across all measures of alcohol used support claims for the validity of the observed effects.