Data sharing for prevention: a case study in the development of a comprehensive emergency department injury surveillance system and its use in preventing violence and alcohol-related harms

Impacts of Northern Territory banned drinker register on police recorded youth assault

INTRODUCTION

In September 2017 the Northern Territory Government of Australia introduced a banned drinker register (BDR) to mitigate the high levels of alcohol-related harm within the Northern Territory. The current study aimed to examine the impact of the Northern Territory BDR on youth (aged <18 years) using police recorded assault data.

METHODS

Interrupted time-series models were used to assess monthly trends in assaults and alcohol-related assaults perpetration and victimisation in the regions of Greater Darwin, Alice Springs and Katherine between January 2014 and December 2019.

RESULTS

Examining the three regions combined, after the re-introduction of the BDR a significant step decrease in police recorded youth assault perpetration (β = -1.67) and a significant step increase in police recorded youth assault victimisation (β = 1.40) was identified. However, no significant effects were identified at the individual region level.

DISCUSSION AND CONCLUSIONS

Findings suggest that restricting alcohol consumption in high-risk adults through the BDR had a limited immediate effect in police recorded youth assaults. Individual level or contextual factors may have influenced both immediate and long-term impacts of the BDR, and as such, future policy design needs to support and empower community leaders across the policy development and implementation process. A wider evaluation of the BDR currently underway may provide additional understanding behind the mechanisms that underpin alcohol-related harm in the Northern Territory.

Using the Cardiff model to reduce late-night alcohol-related presentations in regional Australia

INTRODUCTION

The Cardiff model is a data sharing approach that aims to reduce the volume of intoxicated patients in emergency departments (EDs). This approach has not been tested in a rural setting.

OBJECTIVE

This study assessed whether this approach would reduce the number of alcohol-associated presentations during high-alcohol hours (HAH) in a regional ED.

DESIGN

From July 2017, people over the age of 18 attending the ED were asked by the triage nurse (1) whether they had consumed alcohol in the past 12 h, (2) their typical alcohol consumption level, (3) the location where most alcohol was purchased and (4) the location of the last drink. From April 2018, quarterly letters were sent to the top five venues reported within the ED. Deidentified, aggregated data were shared with local police, licensing authorities and local government, identifying the top five venues reported in the ED and providing a summary of alcohol-related attendances to the ED. Interrupted time series analyses were used to estimate the influence of the intervention on monthly injury and alcohol-related ED presentations.

FINDINGS

ITS models found that there was a significant gradual decrease in the monthly rate of injury attendances during HAH (Coefficient = -0.004, p = 0.044). No other significant results were found.

DISCUSSION

Our study found that sharing last drinks data collected in the ED with a local violence prevention committee was associated with a small, but significant reduction in the rate of injury presentations compared with all ED presentations.

CONCLUSION

This intervention continues to have promise for reducing alcohol-related harm.

Emergency department-based injury surveillance information system: a conceptual model

BACKGROUND

Injury data play a pivotal role in monitoring public health issues and Injury Surveillance Information Systems (ISIS) are useful for continuous data collection and analysis purposes. Since emergency department (ED) is usually the first place of referral for the injured people, the aim of this study was to develop a conceptual model for an ED-based ISIS.

METHODS

This study was completed in 2020 and the Delphi technique (three rounds) was used to determine the main components of an ED-based ISIS. The participants were selected using the purposive sampling method. A 5-point Likert scale questionnaire was used for data collection and data were analyzed using descriptive statistics.

RESULTS

In the first, second, and third rounds of the Delphi study, 60, 44, and 28 experts participated, respectively. In the first and second rounds, most of the items including the personal data, clinical data, data sources, and system functions were found important. In the third round of the Delphi study, 13 items which did not reach a consensus in the previous rounds were questioned again and five items were removed from the final model.

CONCLUSION

According to the findings, various data elements and functions could be considered for designing an ED-based ISIS and a number of data sources should be taken into count to be integrated with this system. Although the conceptual model presented in the present study can facilitate designing the actual system, the final system needs to be implemented and used in practice to determine how it can meet users' requirements.

Risk factors and predictors of violence: insights from the emergency department at a level 1 trauma center in the USA

BACKGROUND

This study aimed to assess the risk factors and predictors of violence among patients admitted to a Level 1 trauma center in a single institution.

METHODS

We conducted a retrospective analysis of patients who were admitted with a history of violence between 2012 and 2016.

RESULTS

A total of 9855 trauma patients were admitted, of whom 746 (7.6%) had a history of violence prior to the index admission. Patients who had history of violence were younger and more likely to be males, Black, Hispanic and covered by low-income primary payer in comparison to non-assault trauma patients (P < 0.001 for all). Multivariate logistic regression analysis showed that covariate-adjusted predictors of violence were being Black, male having low-income primary payer, Asian, drug user, alcohol intoxicated and smoker.

CONCLUSIONS

Violence is a major problem among young age subjects with certain demographic, social and ethnic characteristics. Trauma centers should establish violence injury prevention programs for youth and diverse communities.

Implementation and initial analysis of Cardiff Model data collection procedures in a level I trauma adult emergency department

OBJECTIVES

Our understanding of community violence is limited by incomplete information, which can potentially be resolved by collecting violence-related injury information through healthcare systems in tandem with prior data streams. This study assessed the feasibility of implementing Cardiff Model data collection procedures in the emergency department (ED) setting to improve multisystem data sharing capabilities and create more representative datasets.

DESIGN

Information collection fields were incorporated into the ED electronic health record (EHR), which gathered additional information from patients reporting assaultive injuries. ED nurses were surveyed to evaluate implementation and feasibility of information collection. Logistic regression was performed to determine associations between missing location information and patient demographic data.

SETTING

60-bed academic level I trauma adult ED in a large Midwestern city.

PARTICIPANTS

2648 patients screened positive for assault injuries between 2017 and 2020. 198 patients were omitted due to age outside the range served by this ED. Unselected inclusion of 150 ED nurses was surveyed.

MAIN OUTCOME MEASURES

Main outcomes include nursing staff survey responses and ORs for providing complete injury information across various patient demographics.

RESULTS

Most ED nurses believed that information collection aligned with the hospital's mission (92%), wanted information collection to continue (88%), did not believe that information collection impacted their workflow (88%), and reported taking under 1 min to screen and document violence information (77%). 825 patients (31.2%) provided sufficient information for geospatial mapping. Likelihood of providing complete location information was significantly associated with patient gender, race, arrival means, accompaniment, trauma type and year.

CONCLUSIONS

It is feasible to implement information collection procedures about location-based, assault-related injuries through the EHR in the adult ED setting. Nurses reported being receptive to collecting information. Analyses suggest patient-level and time variables impact information collection completeness. The geospatial information collected can greatly improve preexisting law enforcement and emergency medical systems datasets.

Partners in prevention: the role of health systems in the prevention of youth violence in post-conflict Northern Ireland

Interpersonal violence is a wicked and complex issue with youth disproportionately affected. Its effects are multifaceted, placing an additional burden across systems. Despite this, there continues to be an exclusive focus on police recorded crime data in the context of post-conflict Northern Ireland. Given the enduring issue around police legitimacy, it is likely that police-related crime data are limited in its capacity to estimate incidences and trends of youth violence. Leveraging insights from other sources of data can add significant value in the prevention of youth violence. For example, there is significant utility in the use of health-related data in the prevention of higher-harm violence; however, in the context of Northern Ireland this has been under-evaluated. This retrospective cohort study sought to illustrate what could be gleaned using a novel approach to Emergency Department (ED) data. Routinely collected data captured from youth aged 12–25 attending an ED trauma centre for violence-related injuries between August 2020 and August 2021 were collated, coded and analysed. We found that young men were most likely to present to ED with violence-related injuries; incidences were temporally clustered across several months of the year (i.e. Summer); and younger aged youth were at greater risk of violence-related injuries during the afternoon and early evening. These findings illustrate the utility of health data for violence prevention and the potential for integrating administrative datasets in the design of prevention policy. Limitations and implications for practice are discussed.

Geographies of Sexual Assault: A Spatial Analyses to Identify Neighborhoods Affected by Sexual and Gender-Based Violence

Emergency departments are a common access point for survivors of sexual and gender-based violence (SGBV), but very little is known about where survivors live and the neighborhoods they return to. The objectives of this study were to describe the patient population that present for a sexual or partner-based assault and explore the geographic distribution of cases across the Ottawa-Gatineau area. Data for this study were extracted from the Sexual Assault and Partner Abuse Care Program (SAPACP) case registry (January 1 to December 31, 2015) at The Ottawa Hospital. Spatial analyses were conducted using six-digit postal codes converted into Canadian Census Tract units to identify geographic areas with concentrated cases of SGBV. Concentrated areas were defined as Census Tracts with seven or more SGBV cases within a single calendar year. In 2015, there were 406 patients seen at the SAPACP and 348 had valid postal codes and were included in the analyses. More than 90% of patients were female and 152 (43.68%) were below 24 years of age. More than 70% knew their assailant and the most common locations of the assault were at the survivors' home (31.03%), assailants' home (27.01%), or outdoors (10.92%). Eight concentrated areas were identified including three in the downtown entertainment district, three lower income areas, one high-income neighborhood, and one suburb more than 20 km from downtown. The findings from this study describe the typical clinical presentation of sexual and domestic assault survivors and also challenge geographic stereotypes of where survivors live and what areas of the city are most affected by SGBV. Using residential information provides a survivor-centric approach that highlights the widespread nature of SGBV and supports the need for population-based approaches to improve care for survivors.

Patterns of referral for fractured nose during major sporting events: a 10-year follow up

INTRODUCTION

Nasal fracture is a common form of ear, nose and throat (ENT) trauma with prompt referral required for assessment and potentially manipulation of nasal bones. The aetiology of nasal fracture is multifactorial, and injury occurs across all ages. Previous study has suggested a temporal relationship between nasal injury and major sporting events.

METHODS

A total of 1966 adult patients with nasal injuries referred to emergency clinics across three London ENT centres between September 2016 and August 2019 were analysed.

RESULTS

The majority of those referred were male (66.58%). Mean age at referral was 36.29±18.38 in males and 49.14±21.43 in females; 10.27% were 75 years and over. Incidence was highest during April-September 2018 (p=0.02). Mean incidence was higher in this period in the male 16-35 subgroup (p=0.039), with 53.1% of their injuries concentrated between Friday and Sunday.

CONCLUSIONS

Most nasal injuries occurred in young males. Mean age at referral was higher in females, and there was slightly increased incidence in over-75s, predominantly females. This incidence could be due to increased longevity or greater tendency to injury in females of this age. The injury patterns across the week also differed, with males injured proportionately more at the weekend. Nasal injury referrals of young men increased around the 2018 summer period, coinciding with the 2018 FIFA World Cup. This lends support to the association between major sporting events and the incidence of nasal injury, particularly in young males.

Cycles of violence in England and Wales: the contribution of childhood abuse to risk of violence revictimisation in adulthood

BACKGROUND

Interpersonal violence is a leading cause of death and disability globally, has immediate and long-term impacts on individuals' health and wellbeing, and impacts global health care expenditures and national economies. A public health approach to violence prevention is crucial, and addressing risk factors is a key priority. Global research has demonstrated that childhood adversity increases risk of a range of poor outcomes across the lifecourse. This study examined the association between being a victim of child abuse and the risk of physical assault (PA), intimate partner violence (IPV), and sexual violence (SV) victimisation in adulthood.

METHODS

Data from a nationally representative survey of household residents (adults aged 16 to 59 years; n = 21,845) was analysed. Types of child abuse examined included physical, sexual, and psychological abuse and witnessing domestic violence. Logistic regressions examined the independent relationships between child abuse types, experiencing multiple types, and adulthood violence outcomes.

RESULTS

Most individual types of child abuse were significantly associated with each adulthood violence outcome, after controlling for sociodemographics and other abuse types. Compared to individuals who experienced no abuse in childhood, those who experienced one form of abuse were over twice as likely to experience PA in the past year and three times as likely to have experienced IPV and/or SV since age 16 years, whilst individuals who experienced multiple types were three, six, and seven times more likely to experience PA, IPV, and SV, respectively. After controlling for sociodemographics and multi-type childhood victimisation, the type or combination of types which remained significant differed by violence outcome; child psychological and physical abuse were significantly associated with IPV; psychological and sexual abuse with SV; and psychological abuse with PA.

CONCLUSIONS

Prevention of child abuse is an important goal, and evidence from the current study suggests such efforts will have a downstream effect on preventing interpersonal violence across the lifecourse. With adulthood victimisation likely to compound the already detrimental effects of childhood abuse, and given that many associated outcomes also represent adversities for the next generation, breaking the cycle of violence should be a public health priority.

The Emergency Medicine Facing the Challenge of Open Science

(1) Background: The availability of research datasets can strengthen and facilitate research processes. This is specifically relevant in the emergency medicine field due to the importance of providing immediate care in critical situations as the very current Coronavirus (COVID-19) Pandemic is showing to the scientific community. This work aims to show which Emergency Medicine journals indexed in Journal Citation Reports (JCR) currently meet data sharing criteria. (2) Methods: This study analyzes the editorial policies regarding the data deposit of the journals in the emergency medicine category of the JCR and evaluates the Supplementary material of the articles published in these journals that have been deposited in the PubMed Central repository. (3) Results: It has been observed that 19 out of the 24 journals contained in the emergency medicine category of Journal Citation Reports are also located in PubMed Central (PMC), yielding a total of 5983 articles. Out of these, only 9.4% of the articles contain supplemental material. Although second quartile journals of JCR emergency medicine category have quantitatively more articles in PMC, the main journals involved in the deposit of supplemental material belong to the first quartile, of which the most used format in the articles is pdf, followed by text documents. (4) Conclusion: This study reveals that data sharing remains an incipient practice in the emergency medicine field, as there are still barriers between researchers to participate in data sharing. Therefore, it is necessary to promote dynamics to improve this practice both qualitatively (the quality and format of datasets) and quantitatively (the quantity of datasets in absolute terms) in research.

Is the introduction of violence and injury observatories associated with a reduction in violence-related injury in adult populations? A systematic review and meta-analysis

OBJECTIVE

The aim of this study was to summarise the results from existing studies reporting on the effectiveness of the introduction of violence and injury observatories (VIOs).

DESIGN

This is a systematic review and meta-analysis study.

DATA SOURCES

We searched multiple electronic databases including but not limited to PubMed, PsycINFO, SCOPUS, Cochrane Collaboration, Campbell Collaboration and Web of Knowledge.

ELIGIBILITY CRITERIA

We included non-randomised controlled trials, quasi-experimental designs, prospective and retrospective cohort studies, controlled before-and-after studies and cross-sectional studies. We sought to include studies performed in any country and published in any language. The primary outcome was homicide, while the secondary outcome was assault.

DATA EXTRACTION AND SYNTHESIS

We searched a number of databases, supplemented by searches in grey literature including technical reports. Searches comprised studies from January 1990 to October 2018.

RESULTS

Of 3105 potentially relevant unique citations from all literature searches, 3 empirical studies and 4 technical reports met our inclusion criteria. Studies were conducted in the UK (n=3), Colombia (n=2), Brazil (n=1) and Uruguay (n=1). Subgroup analyses according to the two types of models implemented, the VIO and the injury surveillance system (ISS), provided evidence for an association between implementing the VIO model and a reduction in homicide count in high-violence settings (incidence rate ratio (IRR)=0.06; 95% CI 0.02 to 0.19; four studies), while the introduction of ISS showed significant results in reducing assault (IRR=0.80; 95% CI 0.71 to 0.91; three studies).

CONCLUSION

This systematic review provides the best evidence available for the effectiveness of the introduction of VIOs and ISSs in reducing violence outcomes in adults in high-violence settings. The implementation of VIOs should be considered in high-violence communities where reduction in homicide rates is desired.

PROSPERO REGISTRATION NUMBER

CRD42014009818.

Building capacity for injury prevention: a process evaluation of a replication of the Cardiff Violence Prevention Programme in the Southeastern USA

OBJECTIVES

Violence is a major public health problem in the USA. In 2016, more than 1.6 million assault-related injuries were treated in US emergency departments (EDs). Unfortunately, information about the magnitude and patterns of violent incidents is often incomplete and underreported to law enforcement (LE). In an effort to identify more complete information on violence for the development of prevention programme, a cross-sectoral Cardiff Violence Prevention Programme (Cardiff Model) partnership was established at a large, urban ED with a level I trauma designation and local metropolitan LE agency in the Atlanta, Georgia metropolitan area. The Cardiff Model is a promising violence prevention approach that promotes combining injury data from hospitals and LE. The objective was to describe the Cardiff Model implementation and collaboration between hospital and LE partners.

METHODS

The Cardiff Model was replicated in the USA. A process evaluation was conducted by reviewing project materials, nurse surveys and interviews and ED-LE records.

RESULTS

Cardiff Model replication centred around four activities: (1) collaboration between the hospital and LE to form a community safety partnership locally called the US Injury Prevention Partnership; (2) building hospital capacity for data collection; (3) data aggregation and analysis and (4) developing and implementing violence prevention interventions based on the data.

CONCLUSIONS

The Cardiff Model can be implemented in the USA for sustainable violent injury data surveillance and sharing. Key components include building a strong ED-LE partnership, communicating with each other and hospital staff, engaging in capacity building and sustainability planning.

Changing epidemiology of assault victims in an emergency department participating in information sharing with police: a time series analysis

INTRODUCTION

Violent injury places a large burden on the NHS. We had implemented information sharing in our ED in 2007 and aimed to see which patient groups were most affected by information sharing, as this would provide clues as to how this complex intervention works.

METHODS

Retrospective time series study of all the assault victims presenting for ED care between 2005 and 2014 at a single ED in England.

RESULTS

10 328 patients presented during the study period. There was a 37% decrease in the number of patients presenting after assault, consistent with national trends. The proportions of people arriving by ambulance, and the proportion of men did not change during the study period. There were no important changes in the age of our assault patients in this study. Greater, disproportionate, decreases in rates of violence were seen in patients who presented at the weekend up (incidence rate ratio (IRR)=0.57, 95% CI 0.50 to 0.64) versus weekdays (IRR=0.72; 95% CI 0.62 to 0.83) There were also disproportionately greater decreases over the study period in patients who were discharged with no hospital follow-up (IRR=0.51, 95% CI 0.45 to 0.56) versus those leading to either an inpatient admission (IRR=1.05, 95% CI 0.84 to 1.31) or outpatient follow-up (IRR=1.23, 95% CI 0.93 to 1.64).

CONCLUSIONS

The epidemiology of violent injury at our institution has changed over the last 10 years and is most marked in a reduction of visits at the weekend, and in those who leave without follow up.

A shared data approach more accurately represents the rates and patterns of violence with injury assaults

Background

To investigate whether sharing and linking routinely collected violence data across health and criminal justice systems can provide a more comprehensive understanding of violence, establish patterns of under-reporting and better inform the development, implementation and evaluation of violence prevention initiatives.

Methods

Police violence with injury (VWI) crimed data and emergency department (ED) assault attendee data for South Wales were collected between 1 April 2014 and 31 March 2016 to examine the rates and patterns of VWI. Person identifiable data (PID) were cross-referenced to establish if certain victims or events were less likely to be reported to criminal justice services.

Results

A total of 18 316 police crimed VWI victims and 10 260 individual ED attendances with an assault-related injury were considered. The majority of ED assault attendances (59.0%) were unknown to police. The key demographic identified as under-reporting to police were young males aged 18–34 years, while a significant amount of non-reported assaults involved a stranger. The combined monthly age-standardised rates were recalculated and on average were 74.7 (95% CI 72.1 to 77.2) and 66.1 (95% CI 64.0 to 68.2) per 100 000 population for males and females, respectively. Consideration of the additional ED cases resulted in a 35.3% and 18.1% increase on the original police totals for male and female VWI victims.

Conclusions

This study identified that violence is currently undermeasured, demonstrated the importance of continued sharing of routinely collected ED data and highlighted the benefits of using PID from a number of services in a linked way to provide a more comprehensive picture of violence.

A cross-national comparison of violence among young men in China and the UK: psychiatric and cultural explanations

PURPOSE

Public health psychiatry has a key role in violence prevention. Cross-national comparisons of violence and associated psychiatric morbidity can indicate targets for preventive interventions.

METHOD

Data on young adult men in households, 18-34 years, were drawn from the Second Men's Modern Lifestyles survey in Great Britain (n = 2046) and from a corresponding survey in Chengdu, China (n = 4132), using a translated questionnaire. Binary logistic regression models were carried out to estimate the cross-national differences for different types of violence and to identify explanatory variables.

RESULTS

Chinese men were less likely to report violence in the past 5 years (AOR 0.59, 95% CI 0.48-0.72, P < 0.001). All levels of violence were lower among Chinese men except intimate partner violence (AOR 2.43, 95% CI 1.65-3.59, P < 0.001) and a higher proportion of Chinese men were only violent towards their partners (AOR 7.90, 95% CI 3.27-19.07, P < 0.001).

CONCLUSIONS

Cross-national differences were explained by British men's reports of early violence persisting into adulthood, confidence in fighting ability, perception that violence is acceptable behaviour, and experience of violent victimization. More British men screened positive for antisocial personality disorder and substance misuse. Attitudes which condone violence and a serious problem of alcohol-related, male-on-male violence are key targets for preventive interventions among British men. The higher prevalence of life course-persistent antisocial behaviour among British men is of concern and requires further investigation. Higher prevalence of intimate partner violence among Chinese men reflects patriarchal approaches to conflict resolution and confirms an important public health problem in China which requires further cross-national investigation.

Health system and law enforcement synergies for injury surveillance, control and prevention: a scoping review

BACKGROUND

Healthcare providers and law enforcement (LE) officers are among the most common first responders to injuring events. Despite frequent interface between the health system (HS) and LE sectors, the published evidence that supports their collaboration in injury surveillance, control and prevention has not been comprehensively reviewed.

METHODS

We conducted a scoping review of literature published from 1990 to 2016 that focused on local and regional HS and LE collaborations in injury surveillance, control and prevention. Our aim was to describe what is known and what remains unexplored about these cross-sector efforts.

RESULTS

128 articles were included in the final review. These were categorised by their focus on either surveillance activities or partnerships in injury control and prevention programmes. The majority of surveillance articles focused on road traffic injuries. Conversely, articles describing partnerships and programme evaluations primarily targeted the prevention of interpersonal violence.

DISCUSSION

This review yielded two major findings: overall, the combination of HS and LE injury data added value to surveillance systems, especially as HS data augmented LE data; and HS and LE partnerships have been developed to improve injury control and prevention. However, there are few studies that have evaluated the impact and sustainability of these partnerships.

CONCLUSIONS

The current evidence to support HS and LE collaboration in injury surveillance and control and prevention programmes is heterogeneous. Notable gaps suggest ample opportunity for further research and programme evaluation across all types of injury.

Transforming fire prevention: a case study

Purpose

– The purpose of this paper was to examine the transformation of fire prevention processes via improved targeting of fire prevention interventions over a four-year period.

Design/methodology/approach

– A four-year case study of the transformation of fire prevention processes involving a UK fire and rescue service, local council, National Health Service primary care trust and a police force was undertaken.

Findings

– Understanding the socio-economic causal factors underlying unintentional dwelling fires, and the need to work in collaborative partnerships to achieve change in such factors can support more targeted and effective fire prevention activities.

Research limitations/implications

– Analysis of underlying causal factors and their relationships, together with population segmentation and working in coordinated collaborative partnerships, can support enhanced fire risk assessment and community safety. This supported more pro-active early intervention fire risk management.

Practical implications

– Analysis of socio-economic causal factors and socio-economic groups associated with unintentional dwelling fires can assist in targeting fire prevention activities in a more effective and efficient manner. This enabled the fire and rescue service to target fire prevention to social groups most at risk of dwelling fires and the types of fires (for example, kitchen fires) relevant to the different social groups.

Social implications

– Collaborative public sector partnerships can achieve change in the socio-economic circumstances of at-risk individuals to support fire prevention. This enables the social- and health-related factors underlying fire risk to be addressed by the relevant partner health or social services agencies.

Originality/value

– The detailed analysis of the transformation of fire prevention activities that led to an implemented approach to enhance community safety. In particular, the analysis and evaluation of the move to collaborative multi-agency partnerships to support and improve fire prevention activities.

Violence and non-violence-related injuries and alcohol in women from developed and developing countries: a multi-site emergency room study

This study sought to analyze the association between alcohol consumption and the occurrence of injuries in women attending the emergency room (ER) from developing and developed countries. The sample consisted of ER data from women in 15 countries that were collected as part of two multi-site studies using similar methodologies: the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP), and World Health Organization Collaborative Study on Alcohol and Injuries (WHO Study). Women ranged in age from 18 to 98years. Those from developed countries had higher levels of education (43% completed high-school) than women from developing countries (37%). Over half of the women from developing countries reported they had not consumed alcohol in the last 12months (abstentious), while 2% reported drinking every day. In addition, current drinking women from developing countries reported more binge drinking episodes (33% reported 5 to 11 drinks and 15% reported 12 or more drinks on an occasion) compared to those from developed countries (28% and 11%, respectively). Violence-related injury was more prevalent in developing countries (18%) compared to developed countries (9%). An association between injury and the frequency of alcohol consumption in the last 12months was observed in both developing and developed countries. Although women from developing countries who suffered violence-related injuries were more likely to demonstrate alcohol abstinence or have lower rates of daily alcohol consumption, these women drank in a more dangerous way, and violence-related injuries were more likely to occur in these women than in those living in developed countries.

Reducing intoxication among bar patrons: some lessons from prevention of drinking and driving

Intoxication in and around licensed premises continues to be common, despite widespread training in the responsible service of alcohol and laws prohibiting service to intoxicated individuals. However, research suggests that training and the existence of laws are unlikely to have an impact on intoxication without enforcement, and evidence from a number of countries indicates that laws prohibiting service to intoxicated individuals are rarely enforced. Enforcement is currently hampered by the lack of a standardized validated measure for defining intoxication clearly, a systematic approach to enforcement and the political will to address intoxication. We argue that adoption of key principles from successful interventions to prevent driving while intoxicated could be used to develop a model of consistent and sustainable enforcement. These principles include: applying validated and widely accepted criteria for defining when a person is 'intoxicated'; adopting a structure of enforceable consequences for violations; implementing procedures of unbiased enforcement; using publicity to ensure that there is a perceived high risk of being caught and punished; and developing the political will to support ongoing enforcement. Research can play a critical role in this process by: developing and validating criteria for defining intoxication based on observable behaviour; documenting the harms arising from intoxication, including risk curves associated with different levels of intoxication; estimating the policing, medical and social costs from intoxicated bar patrons; and conducting studies of the cost-effectiveness of different interventions to reduce intoxication.

Developing a data sharing framework: a case study

Purpose

– The purpose of the research project was to examine the process of developing a data sharing framework between different public sector organisations.

Design/methodology/approach

– A two-year case study of a data sharing project between a UK fire and rescue service, local council, NHS primary care trust and a police force was undertaken.

Findings

– It is important to carefully determine the requirements for data sharing, to establish data sharing agreements, to have secure arrangements for data sharing, and to ensure compliance with data protection legislation.

Research limitations/implications

– Data sharing between public sector organisations can operate effectively if appropriate care is taken when creating data sharing agreements between partner organisations.

Practical implications

– Data sharing can assist in reducing duplication of effort between public sector organisations and can reduce costs and enable more co-ordinated provision of public services.

Originality/value

– The detailed analysis of a data sharing case study identified the need for a systematic data sharing framework. Such a framework is proposed and illustrated with practical examples of specification, implementation and evaluation.

A comprehensive approach to pediatric injury prevention in the emergency department

Injury is the leading cause of pediatric mortality and long-term disability. Although the primary care setting has traditionally been considered as the main venue to address injury anticipatory guidance, an emergency department (ED) visit may serve as a "teachable moment" because most injured children are cared for in this setting and the experience may elicit a greater chance of behavior change. However, EDs can also provide additional information and services beyond counseling to prevent injuries. These adjunct efforts and activities focus on primary injury prevention (screening for and promoting safe behaviors and collecting data to survey high-risk community locations), secondary prevention (use of safety products to mitigate injury), and tertiary prevention (maximizing injury care and minimizing injury sequelae). This review will describe several ways an ED can help to mitigate the epidemic of pediatric injuries through surveillance, screening, education, product disbursement, community engagement, and quality improvement efforts.

Alcohol-related violence presenting to the emergency department: is 'glassing' the big issue?

OBJECTIVE

The study aims to describe the characteristics of patients presenting to EDs within Queensland, Australia with injuries because of assault with a glass implement ('glassing') and to set this within the broader context of presentations because of alcohol-related violence.

METHODS

This is an analysis of prospectively collected ED injury surveillance data collated by the Queensland Injury Surveillance Unit between 1999 and 2011. Cases of injury because of alcohol-related violence were identified and analysed using coded fields supplemented with qualitative data contained within the injury description text. Descriptive statistics were used to assess the characteristics of injury presentations because of alcohol-related violence. Violence included interpersonal violence and aggression (verbal aggression and object violence).

RESULTS

A total of 4629 cases were studied. The study population was predominantly men (72%) and aged 18 to 24 (36%), with men in this age group comprising more than a quarter of the study population (28%). Nine per cent of alcohol-related assault injuries were a consequence of 'glassing'. The home was the most common location for alcohol-related violence (31%) and alcohol-related 'glassings' (33%). Overall, the most common glass object involved was a bottle (75%); however, within licensed venues an even mix of a drinking glass (44%) and glass bottle (45%) was identified.

CONCLUSIONS

Contrary to public perception generated by media, 'glassing' incidents, particularly at licensed venues, constitute a relatively small proportion of all alcohol-related violence. The current study highlights the predominance of young men injured following alcohol-related violence, demonstrating a key focus area within the population for aiming prevention strategies.

Child injury: using national emergency department monitoring systems to identify temporal and demographic risk factors

BACKGROUND

Injury is a leading cause of death in children. Emergency department (ED) data offer a potentially rich source of data on child injury. This study uses an emerging national ED data collection system to examine sociodemographics and temporal trends in child injury attendances in England.

METHODS

Cross sectional examination of ED attendances for key injury types made by children aged 0-14 years between April 2010 and March 2011 (road traffic injury (RTI) n=21 670; assault n=9529; deliberate self harm (DSH) n=3066; sports injury n=88 250; burns n=22 222; poisoning n=12 446). Multivariate analyses examined the impact of demographics (age, gender, residential deprivation) and temporal events (day, month, school and public holidays) on risk of attendance for different injury types.

RESULTS

For most injury types, attendance increased with deprivation. The attendance ratio between children from the poorest and richest deprivation quintiles was greatest for assaults (4.21:1). Conversely, sports injury attendance decreased with deprivation. Males made more attendances than females for all but DSH. Age and temporal profiles varied by injury type. Assault attendances reduced at weekends while burns attendances increased. RTI and sports injury attendances were increased during school term times.

CONCLUSIONS

ED data can provide a major epidemiological resource for examining both temporal and demographic risks of child injury. Emerging systems, such as the one analysed here, can already inform the targeting of prevention, and with improved data coding and use, their utility would be greatly strengthened.

Cross-country comparison of victimisation-related injury admission in children and adolescents in England and Western Australia

Background

A single, standardised measure of victimisation-related (VR) injury admission in hospital administrative datasets could allow monitoring of preventive and response strategies and international comparisons of policy. Consistency of risk factors and incidence rates for a measure of victimisation-related injury in different countries with similar access to healthcare services would provide indirect evidence for measure validity.

Methods

Cohorts were derived from hospital administrative data for children aged less than 18 years who were admitted for acute injury to hospitals in England or Western Australia (WA) in 2000 to 2008. We compared the effects of age, sex and deprivation on the annual incidence of acute admission for VR injury defined by a cluster of ICD-10 codes reflecting characteristics that should alert clinicians to consider victimisation as a cause of injury. Four subcategories comprised codes specifically indicating child maltreatment, assault, undetermined cause, or adverse social circumstances.

Results

The incidence of VR injury followed a similar ‘J’-shaped association with age in both countries with increasing rates from 10 years onwards and peaks in infancy and in 16–17 year-olds. In both countries, rates increased with deprivation. Girls had lower rates than boys except in the 11–15 age group where girls had higher rates than boys in WA but not in England. Adjusted incidence rates were similar in both countries for children aged 3 to 15 years old, but were higher in WA compared with England in children under 3 years old and in those aged 16–17 years. Higher rates in WA in 16–17 year-olds were explained by more admissions coded for the subcategories of adverse social circumstances, and to a lesser extent, assault, than in England. Children less than 3 years old were more often coded specifically for maltreatment in WA than in England.

Conclusions

The similarities in risk factors and in the adjusted rates of victimisation-related injury admission in both countries suggest that the VR cluster of ICD-10 codes is measuring a similar underlying problem. Differential use of coding subcategories highlights the need to use the entire VR cluster for comparisons across settings.

A needle in a haystack: the use of routinely collected emergency department injury surveillance data to help identify physical child abuse

A retrospective, descriptive analysis of a sample of children under 18 years presenting to a hospital emergency department (ED) for treatment of an injury was conducted. The aim was to explore characteristics and identify differences between children assigned abuse codes and children assigned unintentional injury codes using an injury surveillance database. Only 0.1% of children had been assigned the abuse code and 3.9% a code indicating possible abuse. Children between 2 and 5 years formed the largest proportion of those coded to abuse. Superficial injury and bruising were the most common types of injury seen in children in the abuse group and the possible abuse group (26.9% and 18.8%, respectively), whereas those with unintentional injury were most likely to present with open wounds (18.4%). This study demonstrates that routinely collected injury surveillance data can be a useful source of information for describing injury characteristics in children assigned abuse codes compared to those assigned no abuse codes.

The association of alcohol drinking pattern and self-inflicted intentional injury in Korea: a cross-sectional WHO collaborative emergency room study

OBJECTIVES

Self-inflicted intentional injuries are increasing at an alarming rate in the Republic of Korea, yet few reports describe their relationship with alcohol consumption. The aim of this study was to characterise the association of alcohol drinking patterns and self-inflicted intentional injury in Korean emergency departments (EDs) using WHO collaborative study protocol.

DESIGN

Cross-sectional study.

SETTING

Data were collected from four general hospital EDs in four geographically diverse regions of Korea: Seoul, Suwon, Chuncheon and Gwangju.

PARTICIPANTS

Information was collected on 1989 patients aged 18 and above. A representative probability sample was drawn from patients admitted to each ED for the first time within 6 h of injury.

PRIMARY AND SECONDARY OUTCOME MEASURES

Alcohol-related non-fatal injuries.

RESULTS

Among 467 persons with alcohol-related injuries, 33 (7.1%), were self-inflicted intentional injuries and 137 (29.3%) were intentional injuries caused by someone else. The adjusted odds of self-inflicted intentional injury verses unintentional injury were calculated for heavy (OR 1.764; 95% CI 0.783 to 3.976), binge (OR 2.125; 95% CI 0.930 to 4.858) and moderate drinking (OR 3.039; 95% CI 1.129 to 8.178) after controlling for demographic variables. Similar odds were reported for pooled intentional injury data (self-inflicted and caused by someone else) and drinking patterns.

CONCLUSIONS

These data show a strong association between all patterns of acute alcohol consumption and self-inflicted intentional injury in the Republic of Korea.

Nighttime assaults: using a national emergency department monitoring system to predict occurrence, target prevention and plan services

BACKGROUND

Emergency department (ED) data have the potential to provide critical intelligence on when violence is most likely to occur and the characteristics of those who suffer the greatest health impacts. We use a national experimental ED monitoring system to examine how it could target violence prevention interventions towards at risk communities and optimise acute responses to calendar, holiday and other celebration-related changes in nighttime assaults.

METHODS

A cross-sectional examination of nighttime assault presentations (6.01 pm to 6.00 am; n = 330,172) over a three-year period (31st March 2008 to 30th March 2011) to English EDs analysing changes by weekday, month, holidays, major sporting events, and demographics of those presenting.

RESULTS

Males are at greater risk of assault presentation (adjusted odds ratio [AOR] 3.14, 95% confidence intervals [CIs] 3.11-3.16; P < 0.001); with male:female ratios increasing on more violent nights. Risks peak at age 18 years. Deprived individuals have greater risks of presenting across all ages (AOR 3.87, 95% CIs 3.82-3.92; P < 0.001). Proportions of assaults from deprived communities increase midweek. Female presentations in affluent areas peak aged 20 years. By age 13, females from deprived communities exceed this peak. Presentations peak on Friday and Saturday nights and the eves of public holidays; the largest peak is on New Year's Eve. Assaults increase over summer with a nadir in January. Impacts of annual celebrations without holidays vary. Some (Halloween, Guy Fawkes and St Patrick's nights) see increased assaults while others (St George's and Valentine's Day nights) do not. Home nation World Cup football matches are associated with nearly a three times increase in midweek assault presentation. Other football and rugby events examined show no impact. The 2008 Olympics saw assaults fall. The overall calendar model strongly predicts observed presentations (R2 = 0.918; P < 0.001).

CONCLUSIONS

To date, the role of ED data has focused on helping target nightlife police activity. Its utility is much greater; capable of targeting and evaluating multi-agency life course approaches to violence prevention and optimising frontline resources. National ED data are critical for fully engaging health services in the prevention of violence.