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BackgroundInjury prevention report cards that raise awareness about the preventability of childhood injuries have been published by the European Child Safety Alliance and the WHO. These report cards highlight the variance in injury prevention practices around the world. Policymakers and stakeholders have identified research evidence as an important enabler to the enactment of injury legislation. In Canada, there is currently no childhood injury report card that ranks provinces on injury rates or evidence-based prevention policies.MethodsThree key measures, with five metrics, were used to compare provinces on childhood injury prevention rates and strategies, including morbidity, mortality and policy indicators over time (2006–2012). Nine provinces were ranked on five metrics: (1) population-based hospitalisation rate/100 000; (2) per cent change in hospitalisation rate/100 000; (3) population-based mortality rate/100 000; (4) per cent change in mortality rate/100 000; (5) evidence-based policy assessment.ResultsOf the nine provinces analysed, British Columbia ranked highest in Canada and Saskatchewan lowest. British Columbia had a morbidity and mortality rate that was close to the Canadian average and decreased over the study period. British Columbia also had a number of injury prevention policies and legislation in place that followed best practice guidelines. Saskatchewan had a higher rate of injury hospitalisation and death; however, Saskatchewan’s rate decreased over time. Saskatchewan had a number of prevention policies in place but had not enacted bicycle helmet legislation.ConclusionsFuture preventative efforts should focus on harmonising policies across all provinces in Canada that reflect evidence-based best practices.

This article describes the epidemiology of child pedestrian fatalities in British Columbia using data generated by the province's Child Death Review Unit, to demonstrate the unique capacity of child death review to provide an ecological understanding of child mortality and catalyse evidence based, multi-level prevention strategies.All child pedestrian fatalities in British Columbia from 1 January 1 2003 to 31 December 2008 were reviewed. Data on demographics, circumstance of injury, and risk factors related to the child, driver, vehicle, and physical environment were extracted. Frequency of sociodemographic variables and modifiable risk factors were calculated, followed by statistical comparisons against the general population for Aboriginal ancestry, gender, ethnicity, income assistance and driver violations using z and t tests.Analysis of child pedestrian fatalities (n=33) found a significant overrepresentation of Aboriginal children (p=0.06), males (p0.01), and children within low income families (p0.01). The majority of incidents occurred in residential areas (51.5%), with a speed limit of 50 kph or higher (85.7%). Risky pedestrian behaviour was a factor in 56.7% of cases, and 33% of children under 10 years of age were not under active supervision. Drivers had significantly more driving violations than the comparison population (p0.01).Child pedestrian fatalities are highly preventable through the modification of behavioural, social, and environmental risk factors. This paper illustrates the ability of child death review to generate an ecological understanding of injury epidemiology not otherwise available and advance policy and programme interventions designed to reduce preventable child mortality.

There is considerable confusion about the nature of indicators, their use in the injury field and surprisingly little discussion about these important tools. To date discussions of injury indicators have focused on the content and presentation of health outcome measures and on the dearth of data on exposure measures. Whereas these are valuable measures and assessing the optimal use of available routinely collected data in forming indicators is important, they do not provide sufficient information to support comprehensive prevention efforts, nor do they harness the full potential of indicators as tools to support prevention efforts. This paper provides an overview of the characteristics and uses of indicators for the field of injury prevention in order to make the case for action indicators and provide a framework for their appropriate use.

OBJECTIVE: To develop a set of national injury indicators for Canadian children and youth which will eventually be used to reflect and monitor identified prevention priorities. METHODS: The Canadian Injury Indicators Development Team brought together injury researchers, policy makers, and practitioners to develop injury indicators in the following areas: overall health services implications; motor vehicle occupant; sports, recreation, and leisure; violence; and trauma care, quality, and outcomes. A modified-Delphi process was used to establish a set of indicators that met evidence-based criteria, were useful, and that would prompt action. Each indicator was rated by 132 respondent injury experts and stakeholders on its usefulness and ability to prompt action to reduce injury among Canadian children and youth. RESULTS: From an initial list of 51 indicators, a refined set of 34 indicators was established. Indicators were grouped into three categories related to: policies; risk and protective factors; and outcomes. Indicators related to motor vehicle injury were rated as most useful and most able to prompt action. Injury mortality rate and injury hospitalisation rate were also rated highly for both usefulness and ability to prompt action. Policy, violence, sport and recreation, and trauma indicators were all rated higher for usefulness, but somewhat lower for ability to prompt action. CONCLUSION: Results suggest that a broad-based modified-Delphi process is an important first step in developing useful and relevant indicators for injury prevention activity focused on Canadian children and youth. Language: en

Objectives: To assess the effects of cataract surgery in improving vision and driving performance while reducing driving-related difficulties. Design: Systematic review and meta-analysis. Data sources: Twelve electronic databases were searched from the date of inception of each database to May 2007. Other sources of potentially relevant information were also identified and examined. Review methods: Eligible study designs included randomized controlled trials (RCT), non-RCT, quasi-experimental, case-control, controlled-before-and-after, and cohort studies that examined driving-related indicators in patients undergoing cataract surgery. Main outcome measures: The outcome measures included any type of driving-related indicator. A secondary outcome measure was motor vehicle (MV) crash involvement. Results: Seven studies were included in the review and five in the meta-analysis. The overall pooled odds ratio (OR) was 0.12 (95% CI 0.10 to 0.16). Results suggest that the risk of driving-related difficulties was reduced by 88% following cataract surgery. Conclusions: Cataract surgery is associated with an 88% reduction in the risk of driving-related difficulties. This supports the efficacy of cataract surgery to improve driving in older people, as well as positive implications for a reduction in MV crashes, overall traffic safety, and individual well-being.

Background Bicycle injuries represent an important proportion of injuries among Canadian children. Since helmet use was mandated in 1996 in BC, Canada, use has increased and head injuries have decreased. Despite the law, many child cyclists don’t wear a helmet. This study determines additional factors that may influence child helmet use by studying caregiver attitudes and behaviours. We study whether intention to wear a bicycle helmet is moderated by planning skills of the individual, and whether individuals exposed to a social marketing campaign have higher scores in risk awareness, intention and behaviour as compared to propensity score (PS) matches without exposure to the campaign. Methods We use the Health Action Process Approach to identify single traits that lead to helmet use. PS is applied to address the lack of a control group: the social marketing campaign is a population-wide campaign. PS allows a matched group to be drawn, enabling comparative analysis of the impact of the social marketing campaign on bicycle helmet use. A survey collects detailed bicycle helmet use information from 25–55 yr olds (n = 300) in BC, as part of the continual monitoring and evaluation of a social marketing campaign. Data is examined using multiple regression to identify factors and moderating effects that influence bicycle helmet use. PS is calculated using socio-economic data and injury history over the past 12-months. PS is used to match pairs of individuals with equal PS but different levels of campaign exposure: exposed vs. not exposed. The matched groups are analysed using tests for independent groups. Results Data will be collected by Dec 2015. Data cleaning and analysis will be completed by Mar 2016, and final results will be presented at Safety 2016. Conclusions An important step to increasing bicycle helmet use is to determine additional factors, beyond laws, that may influence helmet use, such that social marketing campaigns can deliver targeted messages.

Background Visual Analytics (VA) is defined as ‘the science of analytical reasoning facilitated by interactive visual interfaces’. An interactive VA system helps users make sense of complex and massive data and supports decision-making. The goal of this project was to develop an interactive web-based child and youth injury Atlas and Dashboard and populate it with existing and novel research data from the CIHR Team in Child and Youth Injury Prevention. The aim was to assist injury professionals, practitioners and policy makers to make informed and timely decisions and take action to improve child and youth injury prevention in Canada. Methods/description of the problem Broad input from the injury prevention community in Canada was sought to finalise the operational requirements for the Atlas and Dashboard. This took place at several time points: 1) the early stages of development to inform the initial mock-up of the site, 2) once the data visualisations were created to determine if they were useful to users, 3) near completion of the site to obtain feedback on usability from the target audience. Visual Interaction Methodology, which helps users derive insights, acquire knowledge and optimise site use, was used to help stakeholders explore and analyse complex data. Results Provincial level child and youth injury mortality, hospitalisation, drowning and transport data were made available to users in two different formats: 1) interactive data visualisations of injury trends and patterns, 2) user defined outputs from selectable menus allowing users to sort, view and query injury data. Injury professionals, practitioners and policy makers informed the look, feel and function of the site and provided feedback that improved the user experience. Conclusions The Atlas and Dashboard integrates an interactive VA system into a website for child and youth injury prevention aimed at injury professionals, practitioners and policy makers in Canada.

Background Injuries are a serious but preventable health concern in Canada and a growing field of research, attracting a large number of graduate students and other trainees across Canada to identify injury prevention as their field of study. In 2009, the Canadian Institute for Health Research funded a team in Child and Youth (C&Y) Injury Prevention. With this support, the team was able to develop a model of practice involving researchers, stakeholders, knowledge users, and trainees as part of a multidisciplinary approach to reducing the burden of injury in youth. The C&Y team was successful at supporting and highlighting the work of over 40 team trainees. The efforts of this trainee team have resulted in the formation of the Canadian Injury Prevention Trainee Network (CIPTN). Objective The CIPTN aims to build a network of trainees interested in the science and practice of injury prevention (IP) from a multi-disciplinary perspective. Specifically, the goals include increasing opportunities for collaboration, professional development, mentorship and networking. Results The CIPTN has worked to develop a list of learning and research oriented catalyst activities for trainee members. The CIPTN has successfully collaborated with IP experts and organisations from across Canada in the development of a comprehensive IP resource, as well as updating the Canadian Injury Prevention Curriculum, a course for IP practitioners across Canada. Further, an executive board and governance structure has facilitated the identification of future collaborative activities (e.g., bi-monthly seminars, grant writing, and evaluating an injury methods workshop). Conclusions The CIPTN increases opportunities for junior researchers and trainees to work within a network of colleagues to share research, build collaborative projects, expand capacity, and provide training opportunities. This in turn, will develop the quantity and quality of IP science and practice across Canada for future generations.

Background The online Concussion Awareness Training Tool (CATT–www.cattonline.com) includes three toolkits providing training in the recognition and treatment of concussion: Medical Professionals–MP; Parents, Players and Coaches–PPC; School Professionals–SP. Objective To create an accessible, regularly updated online resource based upon the Zurich Consensus Statement on Concussion in Sport and evidence-based resources, intended to support standardise concussion diagnosis, treatment and management. Each toolkit includes a self-paced learning module as well as tailored resources. CATT MP aims to standardise practice in a clinical setting with a focus on the paediatric patient. CATT PPC speaks to concussion identification and management, with Smartphone accessible resources: Concussion Response Tool and Questions to Ask Your Doctor . CATT SP includes Return-to-Learn protocol and resources for teachers, counsellors and others in the school setting. Results For each of the CATT toolkits, evaluation was undertaken with a pre-post intervention survey design. Sample sizes of at least 33 were required to compare the change in scores with the power to detect a large effect size of 0.5. CATT MP was launched mid April, 2013. Physicians demonstrated significant positive change in concussion practices (p = 0.001), and significant change in knowledge by those treating more than 10 concussions/yr (p = 0.039). Nurses had significant positive change in practices (p = 0.005) and attitudes (p = 0.035). CATT PPC was launched mid June, 2014. Parents demonstrated significant positive change in concussion knowledge (p = 0.002). CATT SP is anticipated for launch in November 2015, with an accompanying evaluation. Conclusions Concussion is an under-diagnosed medical condition, requiring both physical and mental rest. CATT addresses this gap by increasing knowledge and awareness among appropriate audiences. Good concussion management can reduce related health problems and the risk of long-term brain damage.

Background Intentional and unintentional injuries are a significant and preventable health concern in Canada with 4.27 million Canadians ages 12 or older suffering an activity limiting injury. Knowledge translation and education among researchers, practitioners and policy makers as well as the continual development of trainees in the area of injury prevention, is paramount for the future health of Canadians. Methods The Canadian Injury Prevention Curriculum (CIPC) was designed to provide practitioners the understanding of the theory and practice of injury prevention along with the tools needed to develop and implement effective injury prevention programs. The CIPC is targeted toward adult learners (researchers, practitioners and/or policy makers) who develop, implement and/or evaluate programs aimed at reducing the frequency and severity of both intentional and unintentional injury. The last update of this curriculum was in 2010. This project aimed to update the CIPC, using an integrated knowledge translation approach to reflect an evidence-informed approach to injury prevention. Results The revision occurred over a series of phases: PHASE 1 – Update to the current curriculum to reflect an evidence-informed approach to injury prevention (what is injury prevention and defining the problem, risk and protective factors and key determinants of injury, designing/selecting an intervention, implementation and evaluation) in consultation with an adult learning expert; PHASE 2 – Modules were developed for practitioners to further knowledge and application of core knowledge; PHASE 3 – The updated curriculum was made available across Canada to researchers, practitioners and policy makers interested in preventing injury in Canada. Conclusions The CIPC was updated using an integrated knowledge translation approach. The result was an education tool using an evidence-informed approach to the prevention of injury, applicable for researchers, practitioners, policy makers, and junior trainees.

Background Child fatalities due to motor vehicle collisions (MVCs) are a significant burden in Canada. Data specific to these deaths are often referenced, yet few Canadian jurisdictions systematically collect comprehensive details of all child occupant and pedestrian MV fatalities reducing the effectiveness of informing and setting targets for injury prevention initiatives. Methods This project had two objectives; 1): To document the details of injuries and specific crash circumstances of all fatally injured child and youth (0–18 years) occupants and pedestrians through review of two provincial coroner case files (2004–2012). 2): To introduce recommendations toward standardised data collection procedures for use by coroners, specific to child and youth occupants and pedestrians involved in fatal MVC to: a) support revision of procedures, processes, and practices to facilitate detailed data capture by coroners; and b) to improve information transfer to inform prevention initiatives. Results Phase 1: Review of death investigation files (n = 317) did not allow ascertainment of suitable detail about injuries (56.5%, n = 160), restraint status (38.1%, n = 121) and crash type (7.3%, n = 23). Data obtained in the retrospective review revealed 43% (95% CI: 36.3, 50.0) of cases were side impact collisions, and 40.0% (95% CI: 33.0, 48.0) of the fatalities were reported improperly or unrestrained. Phase 2: A standardised form was developed and provided to each provincial coroner service to facilitate consistent and detailed data collection. Prospective data collection reduced missing data to 0%. Conclusions Review of data obtained from review of child and youth fatalities demonstrated a significant proportion of deaths followed side impact collisions without use of restraint systems; however, detailed information about MVC circumstances and injury details were not present in the investigation files. Stakeholder involvement plays a pivotal role in attaining data that are imperative to the development of effective injury prevention products, policies and practices.

Background Well-developed social marketing campaigns can shift health-related societal attitudes and behaviours. The purpose of this study was to determine the efficacy of a social marketing campaign to raise awareness, change attitudes and behaviours to reduce the number and severity of injuries among citizens aged 25–54 in BC, Canada. Methods A 2-year, 2-phase formative evaluation comprised focus groups and on-line survey. Phase I consisted 8 focus groups of 6–8 participants aged 25–54 throughout BC. The goal was to understand perceptions, attitudes, knowledge and behaviours, and to understand potentially effective injury prevention messages and channels. Phase II comprised on-line survey of 300 citizens 25–54 in May 2009. Demographic, knowledge, attitudes and behaviour variables around injuries served as pre-campaign baseline metrics. A multi-year, multi-faceted campaign, using TV, radio, print, signage, guerrilla events and social media launched in June 2009. Data from random samples (n = 700) were gathered at 4-month intervals and used to monitor changes in awareness, attitudes, behaviours, together with changes in injury deaths. Results Some 50% of BC population (2M) were reached weekly, and over 100 M media impressions were generated during the 6-month launch period. 50,000 visited http://www.preventable.ca. Campaign recall increased 45%; TV ads were considered informative, relevant, credible and generated self-reflection with no advertising fatigue. Positive shifts (5–10%) in attitudes and behaviours were observed, and significant differences persist over 7-years between those who have seen the campaign vs those who have not. Reduction in injury deaths among the target population was associated with the campaign period. Conclusions A well-developed injury prevention social marketing campaign based upon input from the target audience can result in significant changes in awareness, attitudes and behaviours, which was associated with decreased injury mortality.

Background Injury prevention policy is crucial for the safety of Canada’s children; however, legislation is not adopted uniformly across the country. Researchers and policy makers must work together to develop effective legislation that is evidence-based but little is known regarding policy makers views regarding the importance of research in facilitating the legislative process. Methods Purposive snowball sampling identified individuals involved in injury prevention practice and policy throughout Canada. In an online survey, respondents identified injury topics relevant to them and rated the importance of enablers to injury legislation using a 5 point Likert scale. Results There were 57 respondents with representation from all 10 provinces. The most common topics were, bicycle helmets (77%), cell phone-distracted driving (63%), booster seats (49%), ski helmets (42%), and graduated driver’s licensing (37%). The most frequently identified enabler was that research/surveillance was readily available (59%). Other commonly reported research enablers were: research of sufficient quality/quantity that was easy to understand and in a useful format and affiliation of researchers with reputable organisations. Less important was researchers having similar priorities as policy makers and understanding the policy process. The importance of different research enablers varied by injury topic. Conclusions Although policy makers identified the importance that injury prevention research was readily available, it appeared to be less important that researchers had similar priorities or understood the policy process, with variability by topic. This presents a challenge for researchers to conduct timely research and emphasises the need for ongoing relationships with policy makers with discussions early in the research process. This would facilitate the development of common injury prevention priorities to ensure research is used effectively in the legislative process.

Statement of purpose To determine the efficacy of a social marketing campaign to raise awareness, change attitudes and behaviours to reduce the number and severity of injuries among citizens aged 25–54 in British Columbia, Canada. Methods/approach A two-year, two-phase formative evaluation comprised focus groups and on-line survey. Phase I consisted eight focus groups of 6–8 participants aged 25–54 throughout BC. The goal was to understand perceptions, attitudes, knowledge and behaviours, and to understand potentially effective injury prevention messages and channels. Phase II comprised on-line survey of 300 citizens 24–54 in May, 2009. Demographic, knowledge, attitudes and behaviour variables around injuries served as pre-campaign baseline measures. A multi-year, multi-faceted campaign, utilising TV, radio, print, signage, guerrilla events and social media launched in June, 2009. Data from random samples were gathered at 4-month intervals and used to monitor changes in awareness, attitudes, behaviours, together with changes in injury deaths and hospitalizations. Results Approximately 50% of BC population (2 million) were reached weekly, and over 100 million media impressions were generated during the 6-month launch period. 50,000 visited http://www.preventable.ca. Campaign recall increased 45%; TV ads were considered informative, relevant, credible and generated self-reflection with no advertising fatigue. Positive shifts (5–10%; p Conclusions A social marketing campaign resulted in significant changes in awareness, attitudes and behaviours, which was associated with decreased injury mortality. Significance and contributions This project is the first jurisdiction wide, multi-partner collaboration, to support a social marketing campaign to address attitudes and behaviours to reduce injuries in BC. Based upon the results in BC, Alberta has adopted the campaign in that province.

Statement of purpose Prevention, recognition and treatment of concussion, particularly in sport, is important nationally and internationally. The online Concussion Awareness Training Toolkit (CATT) was developed to standardise diagnosis, treatment and management. Methods/approach Based upon the Zurich Consensus Statement on Concussion in Sport, CATT is a resource designed for specific audiences. The first, for health practitioners (CATT HP) aims to standardise practice in a clinical setting. CATT HP includes a self-paced learning module; diagnostic tools; clinical resources, patient handouts, journal articles, websites, videos and individual case studies. The second tool is specific to parents, players and coaches (CATT PPC) and speaks to the identification and appropriate management of concussion, including smartphone accessible resources: ‘concussion response tool’ and ‘questions to ask your doctor’. The final tool is for educators (CATT E). It includes the return-to-learn protocol and resources for teachers, administrators, counsellors, aides. Results CATT HP was launched mid April, 2013. To date, it has received 28,000 hits worldwide and has been evaluated using a pre/post intervention self-report survey. Physicians demonstrated significant positive change in concussion practices (p = 0.001), and significant change in knowledge by those treating more than 10 concussions/yr (p = 0.039). Nurses had significant positive change in practices (p = 0.005) and attitudes (p = 0.035). CATT PPC was launched mid June, 2014 and evaluation data is currently being analysed. Results will be prepared by December, 2014. Conclusion Concussion is an under-recognised, -diagnosed and -treated medical condition, requiring both physical and mental rest. The CATT addresses this gap by increasing knowledge and awareness among appropriate specific audiences. Significance and contributions Good concussion management can reduce related health problems and the risk of long-term brain damage, potentially lowering total health care costs among those who are injured.

Statement of purpose Among Canadian youth, injury is the most common reason for Emergency Department presentations. Youth who participate in activities that increase their injury risk commonly engage in multiple risk-taking behaviours. This study aimed to determine if clusters of risk-taking behaviours were associated with injury in youth and how these patterns varied across contexts. Methods/approach Risk-taking behaviours and injury outcome data were collected from grade 9–10 students using the 2009–2010 Health Behaviours in School-Aged Children Survey (n = 10,429). Principal components analysis identified clusters of risk-taking behaviours. Within each identified cluster, the degree of risk-taking was stratified into quartiles from none to highest. Adjusted risk ratios with 95% confidence intervals described the association between injury risk and the degree of risk-taking behaviour within each cluster. For each cluster, the injury risk was stratified by home, school, neighbourhood, and sport contexts. Results Four clusters of risk-taking behaviour were identified – substance use, high-risk substance use, externalising behaviours (eg, stealing, impaired driver/passenger), and physical activity. For each cluster, there was a significantly increased injury risk and the highest injury risk occurred among youth who performed the most risk-taking behaviours. Youth who engaged in the highest level of physical activity had the highest injury risk (aRR: 1.98; 95% CI: 1.75–2.23) compared with non-participants. Compared with youth who engage in no externalising behaviours, those who engaged in the highest level had the highest injury risk (aRR: 1.63; 95% CI: 1.48–1.79). The gradient between increased risk-taking behaviours and increased injury risk was most pronounced for injuries sustained in the neighbourhood. Conclusions This study delineates clusters of risk-taking behaviours that put youth at progressively increasing injury risk. Significance and contributions Understanding the clustered and cumulative nature of increasing risk-taking behaviours, and how these relate to context, highlight potential modifiable factors that may be important avenues for intervention.

Background For Canadians under the age of 45, injury is the leading cause of death and remains the leading cause of potential years of life lost for those up to the age of 70. Coordination of health services, particularly trauma systems, has the potential to improve treatment and management of the victims. Some research has suggested that trauma systems are associated with a reduction in preventable deaths for injured patients, a reduction in gross mortality, and a reduction in motor vehicle-collision mortality. With the support for the regionalisation of trauma services growing information regarding the effectiveness of trauma systems themselves is key. Objective To conduct a systematic review of the effectiveness of trauma systems in reducing mortality. Methods We will use the method outlined by the Cochrane Collaboration, and conduct a systematic review of the literature using the following key words: Trauma systems, mortality and injury. To date, 1665 potential articles have been identified including 200 review articles. Articles are currently being screened and will be reviewed when they include relevant evidence regarding traumas systems and mortality for both the adult and paediatric populations. Relevance This work will provide information to inform policies related to the development and maintenance of trauma systems.

Background Injuries are the leading killer of Canadians in the prime of their lives. On average, over 1300 British Columbians die and 27 000 are hospitalised because of injury every year. Formative evaluation revealed 76% of BC residents considered injuries a serious problem; 72% considered injuries to be inevitable and that a social marketing campaign could contribute to injury prevention in BC. Purpose Through a province-wide, multi-partner collaboration, the purpose was to determine the efficacy of a social marketing campaign to change awareness, attitudes, self-reported behaviours and to significantly reduce the number and severity of injuries among BC residents aged 25-55. Methods A multi-year, multi-faceted campaign, focused on what people can do to prevent injury was developed. Utilising TV, Radio, print, guerilla events and social media, the campaign launched in June 2009. Results 2 million BC customers (≈50% of BC population) were reached each week and over 100 million media impressions were generated. 50 000 residents visited http://www.preventable.ca Campaign recall increased 45% between June and December 2009. Ads were considered informative, relevant, credible and generated self-reflection; there was no advertising fatigue. Significant positive shifts (5-10%; p Significance/Contribution to the Field A well-developed injury prevention social marketing campaign based upon input from, and discussion with the target audience, can result in significant changes in attitudes and behaviours, and is associated with significantly reduced injury mortality. This is an abstract of a presentation at Safety 2012, the 11th World Conference on Injury Prevention and Safety Promotion, 1-4 October 2012, Michael Fowler Center, Wellington, New Zealand. Full text does not seem to be available for this abstract.

Background To date research has suggested that paediatric trauma systems are associated with a reduction in preventable deaths. However, there has been little work to determine what factors are associated with determining where a severely injured paediatric patient is treated. Aims/Objectives/Purpose To determine factors that are associated with where a paediatric patient with a severe injury receives definitive treatment. Treatment location will be classified by hospital type; paediatric trauma centre (level I/II), adult trauma centre (level I/II) or other. Methods The Discharge Abstract Database will be used to discern factors that are associated with where a severely injured child receives definitive treatment. Children (≤16 years) who have sustained a severe injury (defined by ICD-10 codes) will be isolated. The primary outcome variable will be treatment location classified into three groups by hospital type; paediatric trauma centre (level I/II), adult trauma centre (level I/II) or other. Demographic, hospital and other care related factors will be included in the final adjusted models Outcome Analysis is currently underway. Significance/Contribution This study will provide an overview of the current functioning of the regional Canadian paediatric trauma systems and what factors are related to definitive care. This will provide key information to address any disparities in access to proper trauma care for severely injured paediatric patients. Additionally, it will allow for future work to determine if where definitive treatment is received impacts on patient outcomes.

Introduction Bicycle use is common among Canadian children. Legislation to promote bicycle helmet use varies by province and previous publications examining the association between legislation and head injuries are now outdated due to changes in legislation status over time. Purpose To determine bicycle-related injury rates (head and other injuries) in Canada over the past 10 years using hospitalisation data as well to compare those provinces with and without legislation. Methods Childhood bicycle related injuries were extracted from the Canadian Institute for Health Information hospital admissions database. Injury rates were calculated for each province for children aged 5–19 using 2001 census data. Results During the 10 years there were 23 685 hospital admissions due to bicycle-related injuries among Canadian children age 5–19 (76% men and 24% women). A total of 22% of the children sustained a head injury while 78% had other injuries due to a bicycle incident. 22% of men and 21% of women incurred a head injury. The injury rate varied by age group and by provincial legislation status. In general the rate of head injuries is declining, but this is not consistent across the country, nor is it attributable to legislation as some provinces with legislation experienced a decline while others did not. Conclusion Although bicycle-related injuries are generally declining, this decline is not consistent, nor is it clearly associated with helmet laws.

Background Injuries are the leading cause of death among First Nations in Canada from 1 to 44 years, Health Canada 2001. The Ontario First Nation population was 175 178 within 133 First Nation communities in 2008. Ontario First Nations identified Motor Vehicle Collisions, Violence including Suicide and Falls, as injury issues and recommended priorities in education, training and research. An Injury Prevention Initiative was established to address issues, implement priorities and develop an Ontario First Nation Injury Prevention Strategy and Action Plan. It is coordinated by the Chiefs in Ontario. Several projects were initiated to establish baseline information upon which to develop the Strategy and Action Plan. While data on Emergency Department visits and hospitalisations are available for all Ontarians, the data does not identify First Nation people, however, residential codes provided an opportunity to determine the rate of injuries for First Nation communities. Objective To calculate the frequency of ED visits for injury in Ontario First Nations communities, stratified by sex and intent. Methods Population-based data including all ED visits in Ontario were used based on Indian Reservation residential codes assigned by the Ontario Ministry of Health and Long-Term Care. Results The results showed that although injury rates were similar to the Ontario population, the incidence of intentional injury was 2.7 times higher among First Nations, and self-inflicted injuries were 4.6 times higher. Conclusion The findings validate that injuries are a serious issue in Ontario First Nations and the strategy and action plan needs to address violence and self-inflicted injuries.

Introduction Bicycle-related injuries are an important cause of hospitalisation among Canadian children. There is variation in the nature and enforcement of bicycle helmet laws in Canada. The Canadian Injury Indicators Development Team was established to define and evaluate key indicators, including helmet use and bicycle helmet laws. Purpose To assess the prevalence of helmet use in elementary school aged children in four Canadian cities representing varied geographic and socioeconomic settings. Methods Observations were made at schools in Halifax, Toronto, Barrie and Vancouver. Schools were identified using school board websites and DMTI, a company that partners with universities to disseminate spatial data. Schools were classified into quintiles based on the after-tax income of their census tract (2006 census). Trained observers attended each site at the beginning of the school day in May/June 2009. Information on the sex, helmet use, correct helmet use and group riding were documented. Results 397 observations were made at 91 schools. The helmet use rate was 83% across the four cities. 68% of those riding bicycles were males and 47% of children rode in a group. Group influence on helmet use varied by province. The influence of socioeconomic status (SES) on helmet use also varied. Vancouver9s poorest neighbourhoods had the most riders (42%), whereas Toronto had the most of riders in the richest neighbourhoods (39%). Conclusion There is variation in helmet use across Canadian cities generally, and by SES specifically. Helmet use rates were higher in the medium sized city (Barrie) compared to the other, larger cities.

Introduction Motor vehicle crashes are a leading cause of injury and hospitalisation for Canadian youth. Graduated Drivers Licensing have been implemented in several Canadian provinces. Purpose To assess the prevalence of compliance with rules and driving distractions among high school students in three Canadian cities (Halifax, Barrie and Vancouver) representing different geographic, socioeconomic and jurisdictional settings. Methods Observations were made at schools in the three cities. Schools were identified using school board websites and DMTI, a company that partners with universities to disseminate spatial data. Schools were classified into tertiles based on the income of their neighbourhood census tract, (2006 census). Trained observers attended each site for 30 min at end of the school day in May and June, 2009. Information on: drivers sex, driver seatbelt use, presence of an adult, number of youth passengers and four driver distractions: cell phone use, loud music, eating and smoking were noted. Results 417 observations were made at 40 schools. Among young drivers, the presence of at least one driver distraction was common (30.2% of cases). However, the type of distractions varied by province. The most common distraction was cell phone use in Vancouver. In Barrie and Halifax, the most common distraction was loud music. Distractions were seen more frequently among male drivers and drivers living in Vancouver. The effect of socioeconomic status varied by city. Seatbelt use was high in all sites. Conclusion Although many young drivers follow the rules, distractions remain common. Ongoing education and enforcement may improve youth driving behaviours further.

We were pleased to see the excellent article on child and family safety device affordability by country income level by Hendrie et al (2004).1 International research has shown that the use of child restraint seats (CRS) significantly reduces the risk and severity of injuries resulting from motor vehicle crashes.2 In the USA proper use of CRS is estimated to prevent approximately 53 000 injuries and 500 fatalities among children under 5 years.3 This conclusion is supported by one systematic review.4 Consequently, CRS laws and …