Patterns of urban violent injury: a spatio-temporal analysis

Police-issued barring notices in Western Australia: An analysis of the type, seriousness and trajectory of associated offences

INTRODUCTION

Police-issued barring notices are currently used in Western Australia in response to alcohol-related disorderly and anti-social behaviour. This paper examines the type, severity and trajectory of the offending behaviours associated with served barring notices.

METHOD

WA Police Force de-identified the data for 3815 individuals who had received one or more police-imposed barring notice/s between 2011 and 2020. The offence category associated with each barring notice was examined to explore the overall breakdown and whether/how offending categories change for recipients of subsequent barring notices.

RESULTS

For single and multiple barring notice recipients, the most common offence categories were fighting/physical violence and public order offences. Within a subset of the data, non-anti-social offences also spiked. Aggressive behaviours predominate for recipients in metropolitan areas, compared with public order offences in regional locations.

DISCUSSION AND CONCLUSIONS

For recipients of multiple barring notices, behaviours do not become more serious but neither do they moderate to any notable extent. The low number of repeat barring notices (5%) may suggest an overall beneficial effect on recipient behaviours but more analysis is needed to examine the potential confounding effects of factors, such as fly-in/fly-out workers, policing and locational differences.

Ambulance service recognition of health inequalities and activities for reduction: An evidence and gap map of the published literature

Background

Emergency medical services (EMS) are often patients' first point of contact for urgent and emergency care needs. Patients are triaged over the phone and may receive an ambulance response, with potential conveyance to the hospital. A recent scoping review suggested disparities in EMS patient care in the United States. However, it is unknown how health inequalities impact EMS care in other developed countries and how inequalities are being addressed.

Objectives

This rapid evidence map of published literature aims to map known health inequalities in EMS patients and describe interventions reducing health inequalities in EMS patient care.

Methods

The search strategy consisted of EMS synonyms and health inequality synonyms. The MEDLINE/PubMed database was searched from 1 January 2010 to 26 July 2022. Studies were included if they described empirical research exploring health inequalities within ambulance service patient care. Studies were mapped on to the EMS care interventions framework and Core20PLUS5 framework. Studies evaluating interventions were synthesised using the United Kingdom Allied Health Professions Public Health Strategic Framework.

Results

The search strategy yielded 771 articles, excluding duplicates, with two more studies added from hand searches. One hundred studies met the inclusion criteria after full-text review. Inequalities in EMS patient care were predominantly situated in assessment, treatment and conveyance, although triage and response performance were also represented. Studies mostly explored EMS health inequalities within ethnic minority populations, populations with protected characteristics and the core issue of social deprivation. Studies evaluating interventions reducing health inequalities (n = 5) were from outside the United Kingdom and focused on older patients, ethnic minorities and those with limited English proficiency. Interventions included community paramedics, awareness campaigns, dedicated language lines and changes to EMS protocols.

Conclusions

Further UK-based research exploring health inequalities of EMS patients would support ambulance service policy and intervention development to reduce health inequality in urgent and emergency care delivery.

Spatial Hotspots and Sociodemographic Profiles Associated With Traumatic Brain Injury in Nova Scotia

Traumatic brain injury (TBI) is a leading cause of death and disability, primarily caused by falls and motor vehicle collisions (MVCs). Although many TBIs are preventable, there is a notable lack of studies exploring the association of geographically defined TBI hotspots with social deprivation. Geographic information systems (GIS) can be used to identify at-risk neighborhoods (hotspots) for targeted interventions. This study aims to determine the spatial distribution of TBI by major causes and to explore the sociodemographic and economic characteristics of TBI hotspots and cold spots in Nova Scotia. Patient data for TBIs from 2003 to 2019 were obtained from the Nova Scotia Trauma Registry. Residential postal codes were geocoded and assigned to dissemination areas (DA). Area-based risk factors and deprivation status (residential instability [RI], economic dependency [ED], ethnocultural composition [EC], and situational vulnerability [SV]) from the national census data were linked to DAs. Spatial autocorrelation was assessed using Moran's I, and hotspot analysis was performed using Getis-Ord Gi* statistic. Differences in risk factors between hot and cold spots were evaluated using the Mann-Whitney U test for numerical variables and the χ2 test or Fisher's exact test for categorical variables. A total of 5394 TBI patients were eligible for inclusion in the study. The distribution of hotspots for falls exhibited no significant difference between urban and rural areas (p = 0.71). Conversely, hotspots related to violence were predominantly urban (p = 0.001), whereas hotspots for MVCs were mostly rural (p < 0.001). Distinct dimensions of deprivation were associated with falls, MVCs, and violent hotspots. Fall hotspots were significantly associated with areas characterized by higher RI (p < 0.001) and greater ethnocultural diversity (p < 0.001). Conversely, the same domains exhibited an inverse relationship with MVC hotspots; areas with low RI and ethnic homogeneity displayed a higher proportion of MVC hotspots. ED and SV exhibited a strong gradient with MVC hotspots; the most deprived quintiles displayed the highest proportion of MVC hotspots compared with cold spots (ED; p = 0.002, SV; p < 0.001). Areas with the highest levels of ethnocultural diversity were found to have a significantly higher proportion of violence-related hotspots than cold spots (p = 0.005). This study offers two significant contributions to spatial epidemiology. First, it demonstrates the distribution of TBI hotspots by major injury causes using the smallest available geographical unit. Second, we disentangle the various pathways through which deprivation impacts the risk of main mechanisms of TBI. These findings provide valuable insights for public health officials to design targeted injury prevention strategies in high-risk areas.

Changes in ambulance departures for assault calls during COVID-19 pandemic restrictions

Restrictions related to COVID-19 changed the daily behavior of people, including the expression of violence. Although an increased incidence of violent behavior, especially domestic violence, was expected during the pandemic, retrospective analyses have yielded mixed results. Records of ambulance departures to address injuries caused by assaults in the Pilsen region, Czech Republic, during the restrictive measures during the national state of emergency were compared to data from 3 previous years using general linear models. The number and severity of assaults were analyzed for the whole sample and separately for patients of either sex, for residential or nonresidential locations, and for domestic violence. Controlling for the seasonal effects, the number of assaults decreased by 39% during the pandemic restrictions compared to the 3 previous years. No difference was found between the effects of restrictions on assaults resulting in an injury of a male or female patient. The decrease was specifically pronounced in the sample of assaults in nonresidential locations, while no effect of restrictions was observed in assaults in residential locations and domestic assaults. Pandemic restrictions were associated with a decreased incidence of violent assaults that required ambulance services. Although the incidence decreased especially in those assaulted outside of their homes, we found no support for an increase in domestic violence or violence against women. Pandemic restrictions may have served as a protective rather than a risk factor for assaults severe enough to warrant a call for ambulance services.

Assessing Trade-Offs and Optimal Ranges of Density for Life Expectancy and 12 Causes of Mortality in Metro Vancouver, Canada, 1990-2016

Background: Understanding and managing the impacts of population growth and densification are important steps for sustainable development. This study sought to evaluate the health trade-offs associated with increasing densification and to identify the optimal balance of neighbourhood densification for health. Methods: We linked population density with a 27-year mortality dataset in Metro Vancouver that includes census-tract levels of life expectancy (LE), cause-specific mortalities, and area-level deprivation. We applied two methods: (1) difference-in-differences (DID) models to study the impacts of densification changes from the early 1990s on changes in mortality over a 27-year period; and (2) smoothed cubic splines to identify thresholds of densification at which mortality rates accelerated. Results: At densities above ~9400 persons per km², LE began to decrease more rapidly. By cause, densification was linked to decreased mortality for major causes of mortality in the region, such as cardiovascular diseases, neoplasms, and diabetes. Greater inequality with increasing density was observed for causes such as human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS), sexually transmitted infections, and self-harm and interpersonal violence. Conclusions: Areas with higher population densities generally have lower rates of mortality from the major causes, but these environments are also associated with higher relative inequality from largely preventable causes of death.

Cohort study to explore the association between the COVID-19 pandemic lockdown and admissions for violence in North East and North Cumbria

OBJECTIVES

Explore the association between the first national lockdown associated with the COVID-19 pandemic on admissions for violence and the relationship with deprivation.

DESIGN

Population-based longitudinal cohort study.

SETTING

North East and North Cumbria (NENC) area of England.

PARTICIPANTS

All individuals living in the NENC (total population 3.1 million) admitted 2017/2018, 2018/2019, 2019/2020.

MAIN OUTCOME MEASURES

Hospital Episode Statistics were extracted at Lower Layer Super Output Area and the Index of Multiple Deprivation 2019 decile applied. Directly standardised rates were explored for number of accident and emergency (A&E) attendances (per 1000); Alcohol-related admissions using Public Health England (PHE) Fingertips tool (per 100 000, ID 91414) and emergency admissions for violence (including sexual violence) (per 100 000) (ID 11201 classified by International Classification of Diseases (ICD)10 codes X85 to Y09).

RESULTS

A&E attendances are higher in NENC compared with England (409.9 per 1000 v 359.2). A&E attendance was 81% higher in 2019/20 in the most deprived compared with the least deprived. Attendances dropped during the first national COVID-19 lockdown and by September 2020 had not returned to 'normal' levels.Admissions related to violence are a third higher in NENC (29% to 34% higher across 3 years) rates 7-10 times higher in most deprived than least deprived areas. Admission rates reduced during the first UK lock down but this bounced back by August higher than any of the previous 12 months.

CONCLUSION

Emergency admissions with violence appear to associate with the COVID-19 pandemic being initially higher than before the first national lockdown. This is in the context of overall A&E attendances which are lower post lockdown. Given that emergency admissions with violence have been consistently higher in the NENC compared with England over recent years, we suggest that targeted action is required in NENC to address health inequalities.

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.

Examining the impact of cross-domain learning on crime prediction

Nowadays, urban data such as demographics, infrastructure, and criminal records are becoming more accessible to researchers. This has led to improvements in quantitative crime research for predicting future crime occurrence by identifying factors and knowledge from instances that contribute to criminal activities. While crime distribution in the geographic space is asymmetric, there are often analog, implicit criminogenic factors hidden in the data. And, since the data are not as available or comprehensive, especially for smaller cities, it is challenging to build a uniform framework for all geographic regions. This paper addresses the crime prediction task from a cross-domain perspective to tackle the data insufficiency problem in a small city. We create a uniform outline for Halifax, Nova Scotia, one of Canada's geographic regions, by adapting and learning knowledge from two different domains, Toronto and Vancouver, which belong to different but related distributions with Halifax. For transferring knowledge among source and target domains, we propose applying instance-based transfer learning settings. Each setting is directed to learning knowledge based on a seasonal perspective with cross-domain data fusion. We choose ensemble learning methods for model building as it has generalization capabilities over new data. We evaluate the classification performance for both single and multi-domain representations and compare the results with baseline models. Our findings exhibit the satisfactory performance of our proposed data-driven approach by integrating multiple sources of data.

The combined impact of higher-risk on-license venue outlet density and trading hours on serious assaults in night-time entertainment precincts

BACKGROUND

Night-time entertainment precincts (NEPs) are clusters of higher-risk on-licence venues, that pose a significant burden on health and social order services. Outlet density and trading hours are two of the most well researched contributors to alcohol availability within NEPs; increases in outlet density and late-night trading hours within NEPs have been independently associated with increased assaults. This is the first study to examine both factors across cities to predict alcohol-related assaults.

METHODS

Licensing data were used to investigate the effect of outlet density and trading hours on police recorded serious assaults in nine NEPs (9 cross-sectional units) across Queensland from January 2010 to July 2018 at monthly intervals (102 longitudinal units). Multi-level models were used to determine i) whether precinct-level trading hours moderated the relationship between outlet density and serious assaults; and ii) the impact of outlets closing before 12am, 3am, and 5am on serious assaults.

FINDINGS

The positive relationship between outlet density and assaults was stronger in precincts with trading hours ending at 5am compared to 3am (IRR = 1.01, p = 0.03). The amount of venues closing before 12am was associated with reduced numbers of assaults (IRR = 0.97, p = 0.04), while venues closing between 12:01am-3am and 3:01am-5am were associated with increased assaults (IRR = 1.02, p<0.01; IRR = 1.01, p = 0.02).

CONCLUSIONS

Late night service of alcohol creates more harm in areas of high outlet density, whereas early closing venues in areas where outlet density is low is associated with reduced number of assaults. This relationship should be taken into account in the development of future alcohol policies.

Open data and injuries in urban areas-A spatial analytical framework of Toronto using machine learning and spatial regressions

Injuries have become devastating and often under-recognized public health concerns. In Canada, injuries are the leading cause of potential years of life lost before the age of 65. The geographical patterns of injury, however, are evident both over space and time, suggesting the possibility of spatial optimization of policies at the neighborhood scale to mitigate injury risk, foster prevention, and control within metropolitan regions. In this paper, Canada’s National Ambulatory Care Reporting System is used to assess unintentional and intentional injuries for Toronto between 2004 and 2010, exploring the spatial relations of injury throughout the city, together with Wellbeing Toronto data. Corroborating with these findings, spatial autocorrelations at global and local levels are performed for the reported over 1.7 million injuries. The sub-categorization for Toronto’s neighborhood further distills the most vulnerable communities throughout the city, registering a robust spatial profile throughout. Individual neighborhoods pave the need for distinct policy profiles for injury prevention. This brings one of the main novelties of this contribution. A comparison of the three regression models is carried out. The findings suggest that the performance of spatial regression models is significantly stronger, showing evidence that spatial regressions should be used for injury research. Wellbeing Toronto data performs reasonably well in assessing unintentional injuries, morbidity, and falls. Less so to understand the dynamics of intentional injuries. The results enable a framework to allow tailor-made injury prevention initiatives at the neighborhood level as a vital source for planning and participatory decision making in the medical field in developed cities such as Toronto.

Demographics and Incident Location of Gunshot Wounds at a Single Level I Trauma Center

Introduction

Kansas has seen a steady increase in the rate of firearm deaths and injuries. Little is known surrounding the demographic and geospatial factors of these firearm-related traumas. The purpose of this study was to describe the overall incidence of firearm-related traumas, identify high injury locations, and examine any racial/ethnic disparities that may exist.

Methods

A retrospective review was conducted of all patients 14 years or older who were admitted with a gunshot wound (GSW) to a Level I trauma center between 2016 and 2017.

Results

Forty-nine percent of patients were Caucasian, 26.5% African American, and 19.6% Hispanic/Latino. Hispanic/Latino patients were the youngest (25.8 ± 8.8 years) and Caucasians were the oldest (34.3 ± 14.1 years, p = 0.002). Compared to Caucasian patients, African American (42.0%) and Hispanic/Latino (54.1%) patients were more likely to be admitted to the intensive care unit (ICU; p = 0.034) and experienced longer ICU lengths of stay (2.5 ± 6.3 and 2.4 ± 4.7 days, p = 0.031, respectively). African American patients (96.0%) experienced more assaults, while Caucasians were more likely to receive gunshot wounds accidentally (26.9%, p = 0.001). More African American (86.0%) and Hispanic/Latino (89.2%) patients were injured with a handgun and Caucasians sustained the highest percentage of shotgun/rifle related injuries (16.1%, p = 0.012). Most GSWs occurred in zip codes 67202, 67203, 67213, 67211, and 67214. Geographical maps indicated that GSWs occur in neighborhoods with low-income and high minority residents and in the downtown and nightclub areas of the city.

Conclusions

Most GSW victims were older Caucasian males. Racial differences were noted and injury locations concentrated in certain locations.

The prospective impact of 10-day patron bans on crime in Queensland's largest entertainment precincts

INTRODUCTION

Night-time entertainment precincts (NEP) are the site of a disproportionate amount of alcohol-related violence, injuries and anti-social behaviour. To combat this the Queensland government introduced patron bans in October 2014, giving police the power to exclude individuals from NEPs and preventing patrons from remaining in or entering the designated area or from designated premises for the ban duration. Mandatory identification scanners within licensed venues were also introduced, which are used to enforce patron bans. This study aimed to evaluate the effectiveness of police-issued 10-day patron bans for preventing alcohol-related violence or anti-social behaviour occurring within NEPs during high-alcohol hours.

METHODS

Queensland's largest NEPs; Brisbane central business district, Fortitude Valley and Surfers Paradise central business district; were examined. Time-series autoregressive integrated moving average analyses were used to estimate the influence of 10-day patron bans on police-recorded serious assaults, common assaults and good order offences. Analyses controlled for the introduction of relevant policy and identification scanners.

RESULTS

The number of police-issued patron bans did not significantly predict changes in serious assault, common assault or good order offence trends the weekend following the ban (within the 10-day period).

DISCUSSION AND CONCLUSIONS

The current study was unable to find evidence indicating that 10-day patron bans reduced alcohol-related harms experienced in Queensland's largest NEPs in the short term. Further research needs to be conducted examining other types of patron bans, particularly longer bans issued in other jurisdictions or by licensees, and whether bans change individual's behaviour.

Workplace Violence in Outpatient Physician Clinics: A Systematic Review

Workplace violence (WPV) has been extensively studied in hospitals, yet little is known about WPV in outpatient physician clinics. These settings and work tasks may present different risk factors for WPV compared to hospitals, including the handling/exchange of cash, and being remotely located without security presence. We conducted a systematic literature review to describe what is currently known about WPV in outpatient physician clinics. Six literature databases were searched and reference lists from included articles published from 2000-2019. Thirteen quantitative and five qualitative manuscripts were included which all focused on patient/family-perpetrated violence in outpatient physician clinics. No studies examined other violence types (e.g., worker-on-worker; burglary). The overall prevalence of Type II violence ranged from 9.5% to 74.6%, with the most common form being verbal abuse (42.1-94.3%), followed by threat of assault (14.0-57.4%), bullying (2.5-5.7%), physical assault, (0.5-15.9%) and sexual harassment/assault (0.2-9.3%). Worker consequences included reduced work performance, anger, and depression. Most workers did not receive training on how to manage a violent patient. More work is needed to examine the prevalence and risk factors of WPV in outpatient physician clinics for purposes of informing prevention efforts in these settings.

Geospatial relationship of trauma and violent crime: An analysis of violent crime and trauma center utilization

Introduction

Descriptive epidemiologic and geographic analysis utilizing geographic information science (GIS) has been used to determine the utilization of trauma systems and to spatially describe patterns of trauma and crime. We examined the relationship between spatial components of criminality and injuries in order to evaluate the optimal trauma center location and determine a correlation between reported violent crime and trauma center utilization.

Methods

All adult trauma and violent crime (VC) encounters in a defined area over a single year were included. Geospatial statistics pattern analysis tools of Median Center (MC) and the Average Nearest Neighbor analysis (ANNa) were used to determine if mapped points occurred in complete spatial randomness or were clustered in a significant pattern.

Results

ANNa of VC resulted in a z-score of –20.54 and a p-value of <0.001, indicating a <1% likelihood that violent crimes were distributed randomly. Further ANNa yielded a zscore of –5.67 and p-value of <0.001 for injuries. Our trauma center is 1.45 miles from the MC of VC and 2.28 miles from the MC for injuries. Spatial autocorrelation failed to demonstrate a direct relationship between criminality and trauma center utilization with a z-score of 0.030 and p-value of 0.98.

Conclusion

While not statistically significant, the spatial trends of violent crime and trauma center utilization demonstrated a clear pattern. GIS is a powerful tool for the trauma director, and examination of the local regional patterns of trauma should be undertaken by health systems to assist with optimizing outreach, expansion, and response times.

Measuring spatio-temporal accessibility to emergency medical services through big GPS data

Medical accessibility is an important indicator for evaluating the effectiveness of public health services. However, the previous medical accessibility studies mainly focus on spatial accessibility without considering temporal variation in population distribution which is significant for evaluating access to emergency medical service (EMS). This paper proposes a model of spatio-temporal accessibility to EMS called ST-E2SFCA based on adapting the enhanced two-step floating catchment area (E2SFCA) method. We apply our method to the greater Tokyo area for a large volume of GPS dataset with millions of users and compare the accessibility difference over space and time. To evaluate our model, we also analyze the distinction of our model over different weight sets and compare the performance of ST-E2SFCA with the traditional E2SFCA. The result shows that our method can illustrate the temporal difference and is suitable for measuring the spatio-temporal accessibility to EMS, thus can guide the hospital location selection and urban planning.

Epidemiological and spatial characteristics of interpersonal physical violence in a Brazilian city: A comparative study of violent injury hotspots in familial versus non-familial settings, 2012-2014

This study explores both epidemiological and spatial characteristics of domestic and community interpersonal violence. We evaluated three years of violent trauma data in the medium-sized city of Campina Grande in North-Eastern Brazil. 3559 medical and police records were analysed and 2563 cases were included to identify socioeconomic and geographic patterns. The associations between sociodemographic, temporal, and incident characteristics and domestic violence were evaluated using logistic regression. Using Geographical Information Systems (GIS), we mapped victims' household addresses to identify spatial patterns. We observed a higher incidence of domestic violence among female, divorced, or co-habitant persons when the violent event was perpetrated by males. There was only a minor chance of occurrence of domestic violence involving firearms. 8 out of 10 victims of domestic violence were women and the female/male ratio was 3.3 times greater than that of community violence (violence not occurring in the home). Unmarried couples were twice as likely to have a victim in the family unit (OR = 2.03), compared to married couples. Seven geographical hotspots were identified. The greatest density of hotspots was found in the East side of the study area and was spatially coincident with the lowest average family income. Aggressor sex, marital status, and mechanism of injury were most associated with domestic violence, and low-income neighbourhoods were coincident with both domestic and non-domestic violence hotspots. These results provide further evidence that economic poverty may play a significant role in interpersonal, and particularly domestic violence.

A model for spatiotemporal injury surveillance: implications for the evolution of a trauma system

BACKGROUND

Geographic variations in case volume have important implications for trauma system configuration and have been recognized for some time. However, temporal trends in these distributions have received relatively little attention. The aim of this study was to propose a model to facilitate the spatiotemporal surveillance of injuries, using Scotland as a case study.

METHODS

Retrospective analysis of 5 years (2009-2013) of trauma incident location data. We analyzed the study population as a whole, as well as predefined subgroups, such as those with abnormal physiologic signs. To leverage sufficient statistical power to detect temporal trends in rare events over short time periods and small spatial units, we used a geographically weighted regression model.

RESULTS

There were 509,725 incidents. There were increases in case volume in Glasgow, the central southern part of the country, the northern parts of the Highlands, the Northeast, and the Orkney and Shetland Islands. Statistically significant changes were mostly restricted to major cities. Decreases in the number of incidents were seen in the Hebrides, Western Scotland, Fife and Lothian, and the Borders. Statistically significant changes were seen mostly in Fife and Lothian, the West, some areas of the Borders, and in the Peterhead area. Subgroup analyses showed markedly different spatiotemporal patterns.

CONCLUSIONS

This project has demonstrated the feasibility of population-based spatiotemporal injury surveillance. Even over a relatively short period, the geographic distribution of where injuries occur may change, and different injuries present different spatiotemporal patterns. These findings have implications for health policy and service delivery.

LEVEL OF EVIDENCE

Epidemiologic study, level V.

Trauma-Informed Care for Violently Injured Patients in the Emergency Department

Violent traumatic injury remains a common condition treated by emergency physicians. The medical management of these patients is well described and remains an area of focus for providers. However, violently injured patients disproportionately carry a history of physical and psychological trauma that frequently affects clinical care in the emergency department. The alteration of our clinical approach, taking into consideration how a patient's previous experiences influence how he or she may perceive and react to medical care, is a concept referred to as trauma-informed care. This approach is based on 4 pillars: knowledge of the effect of trauma, recognition of the signs and symptoms of trauma, avoidance of retraumatization, and the development of appropriate policies and procedures. Using this framework, we provide practical considerations for emergency physicians in the delivery of trauma-informed care for violently injured patients.

Are injury admissions on weekends and weeknights different from weekday admissions?

PURPOSE

To examine whether hours of a day and days of a week influence injury pattern, means of evacuation, and hospital resource utilization.

METHODS

A study based on the Israeli National Trauma Registry of patients hospitalized due to injury between 2008 and 2015.

RESULTS

Of 293,077 subjects included; 32.8% were admitted on weekends (weekend-days 16.7% and weekend-nights 16.1%), 20.0% on weeknights and 47.2% on weekdays. Compared with weekday admissions, weekend and weeknight admissions had higher risk of hospitalization from violence and fall-related injuries, but lower risk from road traffic injuries (RTI) except for weekend-day admissions adjusted for age, gender, and ethnicity. Hospitalization due to burn injuries was greater on weekends, particularly on weekend-days. Hospitalization for violence and burn injuries was greater on weekend-nights vs weeknights, while injuries from other unintentional causes were greater on weeknights than weekend-nights. Furthermore, patients admitted on weekends and weeknights were more likely to have severe and critical injuries, greater utilization of intensive care unit and to be referred for rehabilitation, but were less likely to receive prehospital emergency medical service. In stratified analyses, RTI-related hospitalization was greater on weekends among youth and adults aged 15-64 years, males and Arabs, while burn injuries were more likely among weekend admissions for children aged 0-14 years, female and Jews.

CONCLUSIONS

Injury pattern and resource utilization are related to time. Therefore, injury prevention and intervention efforts should account for hours of a day and days of a week, particularly in relation with age, gender, and ethnicity.

Local vs. national: Epidemiology of pedestrian injury in a mid-Atlantic city

OBJECTIVE

Understanding pedestrian injury trends at the local level is essential for program planning and allocation of funds for urban planning and improvement. Because we hypothesize that local injury trends differ from national trends in significant and meaningful ways, we investigated citywide pedestrian injury trends to assess injury risk among nationally identified risk groups, as well as identify risk groups and locations specific to Baltimore City.

METHODS

Pedestrian injury data, obtained from the Baltimore City Fire Department, were gathered through emergency medical services (EMS) records collected from January 1 to December 31, 2014. Locations of pedestrian injuries were geocoded and mapped. Pearson's chi-square test of independence was used to investigate differences in injury severity level across risk groups. Pedestrian injury rates by age group, gender, and race were compared to national rates.

RESULTS

A total of 699 pedestrians were involved in motor vehicle crashes in 2014-an average of 2 EMS transports each day. The distribution of injuries throughout the city did not coincide with population or income distributions, indicating that there was not a consistent correlation between areas of concentrated population or concentrated poverty and areas of concentrated pedestrian injury. Twenty percent (n = 138) of all injuries occurred among children age ≤14, and 22% (n = 73) of severe injuries occurred among young children. The rate of injury in this age group was 5 times the national rate (Incident Rate Ratio [IRR] = 4.81, 95% confidence interval [CI], [4.05, 5.71]). Injury rates for adults ≥65 were less than the national average.

CONCLUSIONS

As the urban landscape and associated pedestrian behavior transform, continued investigation of local pedestrian injury trends and evolving public health prevention strategies is necessary to ensure pedestrian safety.

Novel Methods for Environmental Assessment of Pedestrian Injury: Creation and Validation of the Inventory for Pedestrian Safety Infrastructure

Nationally, 80% of pedestrian fatalities occur in urban environments, yet the distribution of injuries across urban areas is not uniform. Identifying street-level risk factors for pedestrian injury is essential for urban planning and improvement projects, as well as targeted injury prevention efforts. However, creating and maintaining a comprehensive database of a city's traffic safety infrastructure can be cumbersome and costly. The purpose of this study was to create and validate a neighborhood environmental observational assessment tool to capture evidence-based pedestrian safety infrastructure using Google Street View (GSV)-The Inventory for Pedestrian Safety Infrastructure (IPSI). We collected measures in-person at 172 liquor stores in Baltimore City from June to August 2015 to assess the tool's reliability; we then collected IPSI measures at the same 172 locations using GSV from February to March 2016 to assess IPSI reliability using GSV. The majority of items had good or excellent levels of inter-rater reliability (ICC ≥ 0.8), with intersection features showing the highest agreement across raters. Two scales were also developed using exploratory factor analysis, and both showed strong internal consistency (Cronbach's alpha ≥ 0.6). The IPSI provides a valid, economically efficient tool for assessing pedestrian safety infrastructure that can be employed for a variety of research and urban planning needs. It can also be used for in-person or GSV observation. Reliable and valid measurement of pedestrian safety infrastructure is essential to effectively prevent future pedestrian injuries.

Descriptive Correlates of Urban Pediatric Violent Injury Using Emergency Medical Service Patient-Level Data

OBJECTIVE

This study aimed to describe spatiotemporal correlates of pediatric violent injury in an urban community.

METHODS

We performed a retrospective cohort study using patient-level data (2009-2011) from a novel emergency medical service computerized entry system for violent injury resulting in an ambulance dispatch among children aged 0 to 16 years. Assault location and patient residence location were cleaned and geocoded at a success rate of 98%. Distances from the assault location to both home and nearest school were calculated. Time and day of injury were used to evaluate temporal trends. Data from the event points were analyzed to locate injury "hotspots."

RESULTS

Seventy-six percent of events occurred within 2 blocks of the patient's home. Clusters of violent injury correlated with areas with high adult crime and areas with multiple schools. More than half of the events occurred between 3:00 PM and 11:00 PM. During these peak hours, Sundays had significantly fewer events.

CONCLUSIONS

Pediatric violent injuries occurred in identifiable geographic and temporal patterns. This has implications for injury prevention programming to prioritize highest-risk areas.

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.

Spatial distribution of child pedestrian injuries along census tract boundaries: Implications for identifying area-based correlates

Census tracts are often used to investigate area-based correlates of a variety of health outcomes. This approach has been shown to be valuable in understanding the ways that health is shaped by place and to design appropriate interventions that account for community-level processes. Following this line of inquiry, it is common in the study of pedestrian injuries to aggregate the point level locations of these injuries to the census tracts in which they occur. Such aggregation enables investigation of the relationships between a range of socioeconomic variables and areas of notably high or low incidence. This study reports on the spatial distribution of child pedestrian injuries in a mid-sized U.S. city over a three-year period. Utilizing a combination of geospatial approaches, Near Analysis, Kernel Density Estimation, and Local Moran’s I, enables identification, visualization, and quantification of close proximity between incidents and tract boundaries. Specifically, results reveal that nearly half of the 100 incidents occur within roads that are also census tract boundaries. Results also uncover incidents that occur on tract boundaries, not merely near them. This geographic pattern raises the question of the utility of associating area-based census data from any one tract to the injuries occurring in these border zones. Furthermore, using a standard spatial join technique in a Geographic Information System (GIS), these points located on the border are counted as falling into census tracts on both sides of the boundary, which introduces uncertainty in any subsequent analysis. Therefore, two additional approaches of aggregating points to polygons were tested in this study. Results differ with each approach, but without any alert of such differences to the GIS user. This finding raises a fundamental concern about techniques through which points are aggregated to polygons in any study using point level incidents and their surrounding census tract socioeconomic data to understand health and place. This study concludes with a suggested protocol to test for this source of uncertainty in analysis and an approach that may remove it.

Prediction of crime occurrence from multi-modal data using deep learning

In recent years, various studies have been conducted on the prediction of crime occurrences. This predictive capability is intended to assist in crime prevention by facilitating effective implementation of police patrols. Previous studies have used data from multiple domains such as demographics, economics, and education. Their prediction models treat data from different domains equally. These methods have problems in crime occurrence prediction, such as difficulty in discovering highly nonlinear relationships, redundancies, and dependencies between multiple datasets. In order to enhance crime prediction models, we consider environmental context information, such as broken windows theory and crime prevention through environmental design. In this paper, we propose a feature-level data fusion method with environmental context based on a deep neural network (DNN). Our dataset consists of data collected from various online databases of crime statistics, demographic and meteorological data, and images in Chicago, Illinois. Prior to generating training data, we select crime-related data by conducting statistical analyses. Finally, we train our DNN, which consists of the following four kinds of layers: spatial, temporal, environmental context, and joint feature representation layers. Coupled with crucial data extracted from various domains, our fusion DNN is a product of an efficient decision-making process that statistically analyzes data redundancy. Experimental performance results show that our DNN model is more accurate in predicting crime occurrence than other prediction models.

Life-threatening motor vehicle crashes in bright sunlight

Bright sunlight may create visual illusions that lead to driver error, including fallible distance judgment from aerial perspective. We tested whether the risk of a life-threatening motor vehicle crash was increased when driving in bright sunlight.This longitudinal, case-only, paired-comparison analysis evaluated patients hospitalized because of a motor vehicle crash between January 1, 1995 and December 31, 2014. The relative risk of a crash associated with bright sunlight was estimated by evaluating the prevailing weather at the time and place of the crash compared with the weather at the same hour and location on control days a week earlier and a week later.The majority of patients (n = 6962) were injured during daylight hours and bright sunlight was the most common weather condition at the time and place of the crash. The risk of a life-threatening crash was 16% higher during bright sunlight than normal weather (95% confidence interval: 9-24, P < 0.001). The increased risk was accentuated in the early afternoon, disappeared at night, extended to patients with different characteristics, involved crashes with diverse features, not apparent with cloudy weather, and contributed to about 5000 additional patient-days in hospital. The increased risk extended to patients with high crash severity as indicated by ambulance involvement, surgical procedures, length of hospital stay, intensive care unit admission, and patient mortality. The increased risk was not easily attributed to differences in alcohol consumption, driving distances, or anomalies of adverse weather.Bright sunlight is associated with an increased risk of a life-threatening motor vehicle crash. An awareness of this risk might inform driver education, trauma staffing, and safety warnings to prevent a life-threatening motor vehicle crash.

LEVEL OF EVIDENCE

Epidemiologic Study, level III.

Improving risk management for violence in mental health services: a multimethods approach

Background

Mental health professionals increasingly carry out risk assessments to prevent future violence by their patients. However, there are problems with accuracy and these assessments do not always translate into successful risk management.

Objectives

Our aim was to improve the accuracy of assessment and identify risk factors that are causal to be targeted by clinicians to ensure good risk management. Our objectives were to investigate key risks at the population level, construct new static and dynamic instruments, test validity and construct new models of risk management using Bayesian networks.

Methods and results

We utilised existing data sets from two national and commissioned a survey to identify risk factors at the population level. We confirmed that certain mental health factors previously thought to convey risk were important in future assessments and excluded others from subsequent parts of the study. Using a first-episode psychosis cohort, we constructed a risk assessment instrument for men and women and showed important sex differences in pathways to violence. We included a 1-year follow-up of patients discharged from medium secure services and validated a previously developed risk assessment guide, the Medium Security Recidivism Assessment Guide (MSRAG). We found that it is essential to combine ratings from static instruments such as the MSRAG with dynamic risk factors. Static levels of risk have important modifying effects on dynamic risk factors for their effects on violence and we further demonstrated this using a sample of released prisoners to construct risk assessment instruments for violence, robbery, drugs and acquisitive convictions. We constructed a preliminary instrument including dynamic risk measures and validated this in a second large data set of released prisoners. Finally, we incorporated findings from the follow-up of psychiatric patients discharged from medium secure services and two samples of released prisoners to construct Bayesian models to guide clinicians in risk management.

Conclusions

Risk factors for violence identified at the population level, including paranoid delusions and anxiety disorder, should be integrated in risk assessments together with established high-risk psychiatric morbidity such as substance misuse and antisocial personality disorder. The incorporation of dynamic factors resulted in improved accuracy, especially when combined in assessments using actuarial measures to obtain levels of risk using static factors. It is important to continue developing dynamic risk and protective measures with the aim of identifying factors that are causally related to violence. Only causal factors should be targeted in violence prevention interventions. Bayesian networks show considerable promise in developing software for clinicians to identify targets for intervention in the field. The Bayesian models developed in this programme are at the prototypical stage and require further programmer development into applications for use on tablets. These should be further tested in the field and then compared with structured professional judgement in a randomised controlled trial in terms of their effectiveness in preventing future violence.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

Demographic and socioeconomic inequalities in the risk of emergency hospital admission for violence: cross-sectional analysis of a national database in Wales

OBJECTIVES

To investigate the risk of emergency hospital admissions for violence (EHAV) associated with demographic and socioeconomic factors in Wales between 2007/2008 and 2013/2014, and to describe the site of injury causing admission.

DESIGN

Database analysis of 7 years' hospital admissions using the Patient Episode Database for Wales (PEDW).

SETTING AND PARTICIPANTS

Wales, UK, successive annual populations ∼2.8 million aged 0-74 years.

PRIMARY OUTCOME

The first emergency admission for violence in each year of the study, defined by the International Classification of Diseases V.10 (ICD-10) codes for assaults (X85-X99, Y00-Y09) in any coding position.

RESULTS

A total of 11 033 admissions for assault. The majority of admissions resulted from head injuries. The overall crude admission rate declined over the study period, from 69.9 per 100 000 to 43.2 per 100 000, with the largest decrease in the most deprived quintile of deprivation. A generalised linear count model with a negative binomial log link, adjusted for year, age group, gender, deprivation quintile and settlement type, showed the relative risk was highest in age group 18-19 years (RR=6.75, 95% CI 5.88 to 7.75) compared with the reference category aged 10-14 years. The risk decreased with age after 25 years. Risk of admission was substantially higher in males (RR=4.55, 95% CI 4.31 to 4.81), for residents of the most deprived areas of Wales (RR=3.60, 95% CI 3.32 to 3.90) compared with the least deprived, and higher in cities (RR=1.37, 95% CI 1.27 to 1.49) and towns (RR=1.32, 95% CI 1.21 to 1.45) compared with villages.

CONCLUSIONS

Despite identifying a narrowing in the gap between prevalence of violence in richer and poorer communities, violence remains strongly associated with young men living in areas of socioeconomic deprivation. There is potential for a greater reduction, given that violence is mostly preventable. Recommendations for reducing inequalities in the risk of admission for violence are discussed.

Use of geographic information systems to assess the error associated with the use of place of residence in injury research

Background

In any spatial research, the use of accurate location data is critical to the reliability of the results. Unfortunately, however, many of the administrative data sets used in injury research do not include the location at which the injury takes place. The aim of this paper is to examine the error associated with using place of residence as opposed to place of injury when identifying injury hotspots and hospital access.

Methods

Traumatic Brian Injury (TBI) data from the BC Trauma Registry (BCTR) was used to identify all TBI patients admitted to BC hospitals between January 2000 and March 2013. In order to estimate how locational error impacts the identification of injury hotspots, the data was aggregated to the level of dissemination area (DA) and census tract (CT) and a linear regression was performed using place of residence as a predictor for place of injury.

In order to assess the impact of locational error in studies examining hospital access, an analysis of the driving time between place of injury and place of residence and the difference in driving time between place of residence and the treatment hospital, and place of injury and the same hospital was conducted.

Results

The driving time analysis indicated that 73.3 % of the injuries occurred within 5 min of place of residence, 11.2 % between five and ten minutes and 15.5 % over 20 min. Misclassification error occurs at both the DA and CT level. The residual map of the DA clearly shows more detailed misclassification.

As expected, the driving time between place of residence and place of injury and the difference between these same two locations and the treatment hospital share a positive relationship. In fact, the larger the distance was between the two locations, the larger the error was when estimating access to hospital.

Conclusions

Our results highlight the need for more systematic recording of place of injury as this will allow researchers to more accurately pinpoint where injuries occur. It will also allow researchers to identify the causes of these injuries and to determine how these injuries might be prevented.

Close to home: an analysis of the relationship between location of residence and location of injury

BACKGROUND

Injury surveillance is critical in identifying the need for targeted prevention initiatives. Understanding the geographic distribution of injuries facilitates matching prevention programs with the population most likely to benefit. At the population level, however, the geographic site of injury is rarely known, leading to the use of location of residence as a surrogate. To determine the accuracy of this approach, we evaluated the relationship between the site of injury and of residence over a large geographic area.

METHODS

Data were derived from a population-based, prehospital registry of persons meeting triage criteria for major trauma. Patients dying at the scene or transported to the hospital were included. Distance between locations of residence and of injury was calculated using geographic information system network analysis.

RESULTS

Among 3,280 patients (2005-2010), 88% were injured within 10 miles of home (median, 0.2 miles). There were significant differences in distance between residence and location of injury based on mechanism of injury, age, and hospital disposition. The large majority of injuries involving children, the elderly, pedestrians, cyclists, falls, and assaults occurred less than 10 miles from the patient's residence. Only 77% of motor vehicle collision occurred within 10 miles of the patient's residence.

CONCLUSION

Although the majority of patients are injured less than 10 miles from their residence, the probability of injury occurring "close to home" depends on patient and injury characteristics.

LEVEL OF EVIDENCE

Epidemiologic study, level III.

Cannabis cultivation in Quebec: between space-time hotspots and coldspots

BACKGROUND

Cannabis cultivation has become increasingly localized, whether soil-based or hydroponic growing methods are used. Characteristics of a given location, such as its climate and the equipment it requires may influence general accessibility or attract different types of offenders based on potential profits. The location of crops, especially hydroponic crops, suggests a certain proximity to the consumer market via semi-urban and urban environments, while making it possible to avoid detection. This article examines the cannabis market through its cultivation.

METHODS

The stability of temporal and spatial clusters of cannabis cultivation, hotspots, and coldspots between 2001 and 2009 in the province of Quebec, Canada, are addressed. Studying the geography of crime is not a new endeavor, but coldspots are rarely documented in drug market research. Using arrests and general population data, as well as Kulldorff's scan statistics, results show that the temporal distribution of cannabis cultivation is highly seasonal for soil-based methods.

RESULTS

Hydroponic production shows adaptation to its soil-based counterpart. Stable patterns are found for both spatial distributions. Hotspots for soil-based cultivation are found near several urban centers and the Ontario border. For hydroponic cannabis cultivation, a new hotspot suggests the emergence of an American demand for Quebec-grown cannabis between 2007 and 2009. Curiously, the region surrounding Montreal, the largest urban center in Quebec, is a recurrent and stable coldspot for both methods of cultivation.

CONCLUSION

For all periods, spatial clusters are stronger for soil-based methods than in the hydroponic context. Temporal differences and spatial similarities between soil-based cultivation and hydroponic cultivation are discussed. The role of the metropolis is also addressed.

Operation CeaseFire-New Orleans: an infectious disease model for addressing community recidivism from penetrating trauma

BACKGROUND

CeaseFire, using an infectious disease approach, addresses violence by partnering hospital resources with the community by providing violence interruption and community-based services for an area roughly composed of a single city zip code (70113). Community-based violence interrupters start in the trauma center from the moment penetrating trauma occurs, through hospital stay, and in the community after release. This study interprets statistics from this pilot program, begun May 2012. We hypothesize a decrease in penetrating trauma rates in the target area compared with others after program implementation.

METHODS

This was a 3-year prospective data collection of trauma registry from May 2010 to May 2013. All intentional, target area, penetrating trauma treated at our Level I trauma center received immediate activation of CeaseFire personnel. Incidences of violent trauma and rates of change, by zip code, were compared with the same period for 2 years before implementation.

RESULTS

During this period, the yearly incidence of penetrating trauma in Orleans Parish increased. Four of the highest rates were found in adjacent zip codes: 70112, 70113, 70119, and 70125. Average rates per 100,000 were 722.7, 523.6, 286.4, and 248, respectively. These areas represent four of the six zip codes citywide that saw year-to-year increases in violent trauma during this period. Zip 70113 saw a lower rate of rise in trauma compared with 70112 and a higher but comparable rise compared with that of 70119 and 70125.

CONCLUSION

Hospital-based intervention programs that partner with culturally appropriate personnel and resources outside the institution walls have potential to have meaningful impact over the long term. While few conclusions of the effect of such a program can be drawn in a 12-month period, we anticipate long-term changes in the numbers of penetrating injuries in the target area and in the rest of the city as this program expands.

LEVEL OF EVIDENCE

Therapeutic study, level IV.

A GIS-based spatiotemporal analysis of violent trauma hotspots in Vancouver, Canada: identification, contextualisation and intervention

BACKGROUND

In 2002, the WHO declared interpersonal violence to be a leading public health problem. Previous research demonstrates that urban spaces with a high incidence of violent trauma (hotspots) correlate with features of built environment and social determinants. However, there are few studies that analyse injury data across the axes of both space and time to characterise injury-environment relationships. This paper describes a spatiotemporal analysis of violent injuries in Vancouver, Canada, from 2001 to 2008.

METHODS

Using geographic information systems, 575 violent trauma incidents were mapped and analysed using kernel density estimation to identify hotspot locations. Patterns between space, time, victim age and sex and mechanism of injury were investigated with an exploratory approach.

RESULTS

Several patterns in space and time were identified and described, corresponding to distinct neighbourhood characteristics. Violent trauma hotspots were most prevalent in Vancouver's nightclub district on Friday and Saturday nights, with higher rates in the most socioeconomically deprived neighbourhoods. Victim sex, age and mechanism of injury also formed strong patterns. Three neighbourhood profiles are presented using the dual axis of space/time to describe the hotspot environments.

CONCLUSIONS

This work posits the value of exploratory spatial data analysis using geographic information systems in trauma epidemiology studies and further suggests that using both space and time concurrently to understand urban environmental correlates of injury provides a more granular or higher resolution picture of risk. We discuss implications for injury prevention and control, focusing on education, regulation, the built environment and injury surveillance.

Improving the coding and classification of ambulance data through the application of International Classification of Disease 10th revision

Objectives This paper aims to examine whether an adaptation of the International Classification of Disease (ICD) coding system can be applied retrospectively to final paramedic assessment data in an ambulance dataset with a view to developing more fine-grained, clinically relevant case definitions than are available through point-of-call data. Methods Over 1.2 million case records were extracted from the Ambulance Victoria data warehouse. Data fields included dispatch code, cause (CN) and final primary assessment (FPA). Each FPA was converted to an ICD-10-AM code using word matching or best fit. ICD-10-AM codes were then converted into Major Diagnostic Categories (MDC). CN was aligned with the ICD-10-AM codes for external cause of morbidity and mortality. Results The most accurate results were obtained when ICD-10-AM codes were assigned using information from both FPA and CN. Comparison of cases coded as unconscious at point-of-call with the associated paramedic assessment highlighted the extra clinical detail obtained when paramedic assessment data are used. Conclusions Ambulance paramedic assessment data can be aligned with ICD-10-AM and MDC with relative ease, allowing retrospective coding of large datasets. Coding of ambulance data using ICD-10-AM allows for comparison of not only ambulance service users but also with other population groups. What is known about the topic? There is no reliable and standard coding and categorising system for paramedic assessment data contained in ambulance service databases. What does this paper add? This study demonstrates that ambulance paramedic assessment data can be aligned with ICD-10-AM and MDC with relative ease, allowing retrospective coding of large datasets. Representation of ambulance case types using ICD-10-AM-coded information obtained after paramedic assessment is more fine grained and clinically relevant than point-of-call data, which uses caller information before ambulance attendance. What are the implications for practitioners? This paper describes a model of coding using an internationally recognised standard coding and categorising system to support analysis of paramedic assessment. Ambulance data coded using ICD-10-AM allows for reliable reporting and comparison within the prehospital setting and across the healthcare industry.

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.

The Spatiotemporal Pattern of Trauma in Victims of Violence Visited in Emergency Room of Rajaei Hospital, Shiraz, Iran

OBJECTIVE

To explain an important aspect of violence, the spatiotemporal pattern of trauma in victims of violence visited in emergency room of Rajaei hospital, Shiraz, Iran.

METHODS

This cross-sectional prospective study comprised 109 randomly selected victims of violence visited in emergency room of Rajaei hospital, a tertiary referral hospital affiliated to Shiraz University of Medical Sciences in winter 2013. We recorded the demographic information as well as data regarding the type and time of the injuries. The data collected for each victim was then entered in a data gathering form.

RESULTS

The study included 88% males with mean age 27.8 ± 8.8 years, which encompassed more than 60% young adults. Our study showed a temporal pattern with triple peaks. Moreover, 64% of assault trauma occurred at night. Furthermore, our study showed the majority of our patients suffered from stab wounds and about 57% of patients studied lacked high school diploma. Moreover it was revealed that violence was more common in downtown Shiraz, especially in the Fifth city district with simultaneous presence of many risk factors for violence.

CONCLUSION

The result of this study showed that age, gender, educational status and temporal peak of violence were shown to be similar to other investigations conducted  in other countries. Despite these similarities, stabbing were more prevalent in our study. Additionally, the Fifth city district of Shiraz seems to be the main city district where preventive intervention is needed to reduce violence- related injuries.

Ambulance demand: random events or predicable patterns?

BACKGROUND

Occupational, social and recreational routines follow temporal patterns, as does the onset of certain acute medical diseases and injuries. It is not known if the temporal nature of injury and disease transfers into patterns that can be observed in ambulance demand. This review examines eligible study findings that reported temporal (time of day, day of week and seasonal) patterns in ambulance demand.

METHODS

Electronic searches of Medline and Cumulative Index of Nursing and Allied Health Literature were conducted for papers published between 1980 and 2011. In addition, hand searching was conducted for unpublished government and ambulance service documents and reports for the same period.

RESULTS

38 studies examined temporal patterns in ambulance demand. Six studies reported trends in overall workload and 32 studies reported trends in a subset of ambulance demand, either as a specific case type or demographic group. Temporal patterns in overall demand were consistent between jurisdictions for time of day but varied for day of week and season. When analysed by case type, all jurisdictions reported similar time of day patterns, most jurisdictions had similar day of week patterns except for out-of-hospital cardiac arrest and similar seasonal patterns, except for trauma. Temporal patterns in case types were influenced by age and gender.

CONCLUSIONS

Temporal patterns are present in ambulance demand and importantly these populations are distinct from those found in hospital datasets suggesting that variation in ambulance demand should not be inferred from hospital data alone. Case types seem to have similar temporal patterns across jurisdictions; thus, research where demand is broken down into case types would be generalisable to many ambulance services. This type of research can lead to improvements in ambulance service deliverables.

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.

Getting drunk safely? Night-life policy in the UK and its public health consequences

ISSUES

Pubs, bars and nightclubs are central features of recreational night-life in the towns and cities of many countries. The last two decades have seen UK towns and cities regenerated through the provision of night-life environments aimed at servicing youth-focused monocultures typified by heavy drinking, loud music and dancing. Such changes in night-life settings have created major problems with management of alcohol-related violence.

APPROACH

We examine what policies and interventions have been implemented to reduce violence in public night-life environments. We critically appraise the outcomes of such measures and whether they simply create environments in which it appears 'safe' for people to routinely get drunk while displacing violence and adding to health and social problems elsewhere. KEY FINDINGS/IMPLICATIONS: A variety of initiatives have been put in place to reduce violence and alcohol-related harm in night-time environments. These include changes to licensing laws, high profile policing, late night transport security, street lighting and closed circuit television camera networks. In some circumstances, the evidence for their effectiveness in containing night-life violence is relatively good. However, such approaches can also reduce incentives to stay sober, potentially act as a mechanism for displacing violence into surrounding areas, and divert public monies to city centre drinking environments at the expense of services in local communities.

CONCLUSION

We argue that a public health approach to night-life is required which addresses drunkenness rather than pandering to the economic benefits of excessive alcohol use and managing any violence that is on public display.

Pedestrian injury and human behaviour: observing road-rule violations at high-incident intersections

Background

Human behaviour is an obvious, yet under-studied factor in pedestrian injury. Behavioural interventions that address rule violations by pedestrians and motorists could potentially reduce the frequency of pedestrian injury. In this study, a method was developed to examine road-rule non-compliance by pedestrians and motorists. The purpose of the study was to examine the potential association between violations made by pedestrians and motorists at signalized intersections, and collisions between pedestrians and motor-vehicles. The underlying hypothesis is that high-incident pedestrian intersections are likely to vary with respect to their aetiology, and thus are likely to require individualized interventions – based on the type and rate of pedestrian and motorist violation.

Methods

High-incident pedestrian injury intersections in Vancouver, Canada were identified using geographic information systems. Road-rule violations by pedestrians and motorists were documented at each incident hotspot by a team of observers at several different time periods during the day.

Results

Approximately 9,000 pedestrians and 18,000 vehicles were observed in total. In total for all observed intersections, over 2000 (21%) pedestrians committed one of the observed pedestrian road-crossing violations, while approximately 1000 (5.9%) drivers committed one of the observed motorist violations. Great variability in road-rule violations was observed between intersections, and also within intersections at different observation periods.

Conclusions

Both motorists and pedestrians were frequently observed committing road-rule violations at signalized intersections, suggesting a potential human behavioural contribution to pedestrian injury at the study sites. These results suggest that each intersection may have unique mechanisms that contribute to pedestrian injury, and may require targeted behavioural interventions. The method described in this study provides the basis for understanding the relationship between violations and pedestrian injury risk at urban intersections. Findings could be applied to targeted prevention campaigns designed to reduce the number of pedestrian injuries at signalized intersections.

Trauma in the neighborhood: a geospatial analysis and assessment of social determinants of major injury in North America

OBJECTIVES

We sought to identify and characterize areas with high rates of major trauma events in 9 diverse cities and counties in the United States and Canada.

METHODS

We analyzed a prospective, population-based cohort of injured individuals evaluated by 163 emergency medical service agencies transporting patients to 177 hospitals across the study sites between December 2005 and April 2007. Locations of injuries were geocoded, aggregated by census tract, assessed for geospatial clustering, and matched to sociodemographic measures. Negative binomial models were used to evaluate population measures.

RESULTS

Emergency personnel evaluated 8786 major trauma patients, and data on 7326 of these patients were available for analysis. We identified 529 (13.7%) census tracts with a higher than expected incidence of major trauma events. In multivariable models, trauma events were associated with higher unemployment rates, larger percentages of non-White residents, smaller percentages of foreign-born residents, lower educational levels, smaller household sizes, younger age, and lower income levels.

CONCLUSIONS

Major trauma events tend to cluster in census tracts with distinct population characteristics, suggesting that social and contextual factors may play a role in the occurrence of significant injury events.

Aggressive behaviors in the psychiatric emergency service

Introduction:

Studies of aggressive behaviors in a nonforensic mental health setting have focused primarily on the inpatient ward and, on event prediction, using behavior-based clinical rating scales. Few studies have specifically targeted aggressive behaviors in the psychiatric emergency service or determined whether assessing the demographic and clinical characteristics of such patients might prove useful for their more rapid identification.

Methods:

We used a prospectively acquired database of over 20,900 visits to four services in the province of Quebec, Canada, over a two-year period from September 2002 onwards. A maximum of 72 variables could be acquired per visit. Visits with aggression (any verbally or physically intimidating behavior), both present and past, were tagged. Binary logistic regressions and cross-tabulations were used to determine whether the profile of a variable differed in visits with aggression from those without aggression.

Results:

About 7% of visits were marked by current aggression (verbal 49%, physical 12%, verbal and physical 39%). Including visits with a “past only” history of aggression increased this number to 20%. Variables associated with aggression were gender (male), marital status (single/separated), education (high school or less), employment (none), judicial history (any type), substance abuse (prior or active), medication compliance (poor), type of arrival to psychiatric emergency services (involuntary, police, judiciary, landlord), reason for referral (behavioral dyscontrol), diagnosis (less frequent in anxiety disorders), and outcome (more frequently placed under observation or admitted).

Conclusion:

Our results suggest that many state-independent variables are associated with aggressive behaviors in the psychiatric emergency service. Although their sum may not add up to a specific patient profile, they can nevertheless be useful in service planning, being easily integrated alongside state-dependent rating scales in a triage and/or observation instrument for daily use in the psychiatric emergency service.