Search

BackgroundSupracondylar humerus fractures (SCHF) are the most common fractures sustained following a fall onto an outstretched hand among healthy children, and one of the leading causes of hospital admission and surgical intervention. The aim of this study was to examine SCHF occurring at public play spaces—particularly to determine whether or not the playground equipment implicated in injurious falls aligned with Canadian playground safety standards.MethodsCases of children who attended the provincial paediatric orthopaedic clinic following SCHF at a public playground between April 2017 and October 2019 were included in the study. A research assistant visited each playground to measure the play structure type and dimensions, height of the equipment at the point from which the child fell and the type and depth of the surface material, and compare measurements to the 2016 safety standards. Child demographics and injury classification were also noted. Descriptive statistics were calculated and a scatterplot of fall height and surface depth was generated.ResultsForty-three sites, representing 47 SCHF cases (18 female, 29 male), were included in the final analysis. Fourteen children sustained type 1 fracture, 23 had type 2 fracture and the remaining 10 had type 3 fracture. Five children with type 2 fracture and all 10 children with type 3 fracture required surgery. The majority of sites had engineered wood fibre surfacing, with surfacing at 35 sites being less than 300 mm deep. Twenty-six play structures were upper body equipment (ie, monkey bars or similar), seven were track rides, five were rotating structures and the rest comprised a variety of classified and unclassified structures. Twenty-seven children fell from a height exceeding 2 m.ConclusionsThe majority of SCHF cases occurred at playgrounds with insufficient surface depth and/or non-compliant equipment. Upper body equipment, track rides and rotating play structures were of particular concern, as the children fell from heights exceeding the recommended standard, likely reflecting the degradation and compaction of the surfacing material over time.

Canada's opioid crisis has taken thousands of lives, increasing awareness of poisoning-related injuries as an important public health issue. However, in British Columbia (BC), where overdose mortality rates are the highest in Canada, studies have not yet identified which demographic populations most often visit emergency departments (ED) due to all poisonings, nor which substances are most commonly involved. The aim of this study was to explore these gaps, after developing a methodology for calculating ED visit rates in BC.Poisoning-related ED visit rates during fiscal years 2012/13 to 2016/17, inclusive, were calculated by sex, age group, poisoning substance and socioeconomic status, using a novel methodology developed in this study. ED data were sourced from the National Ambulatory Care Reporting System and population data from Statistics Canada's 2016 (or 2011) census profiles.During the study period, there were an estimated 81 463 poisoning-related ED visits (351.2 per 100 000 population). Infants, toddlers, youth and those aged 20-64 years had elevated risks of poisoning-related ED visits. Rates were highest among those in neighbourhoods with the greatest material (607.8 per 100 000 population) or social (484.2 per 100 000 population) deprivation. Over time, narcotics and psychodysleptics became increasingly common poisoning agents, while alcohol remained problematic.A methodology for estimating ED visit rates in BC was developed and applied to determine poisoning-related ED visit rates among various demographic groups within BC. British Columbians most vulnerable to poisoning have been identified, emphasizing the need for efforts to limit drug overdoses and excessive alcohol intoxication to reduce rates of these preventable injuries.La crise des opioïdes au Canada a coûté la vie à des milliers de personnes, mettant davantage en lumière que les blessures liées aux intoxications constituent un problème de santé publique important. Cependant, en Colombie-Britannique, où le taux de mortalité par surdose est le plus élevé au Canada, les études n’ont pas encore permis de déterminer quelles populations visitent le plus souvent les urgences pour une intoxication ni quelles substances sont le plus souvent en cause. L’objectif de cette étude était d’explorer ces lacunes après avoir élaboré une méthodologie pour calculer les taux de visite aux urgences en Colombie Britannique.Grâce à une nouvelle méthodologie élaborée dans cette étude, nous avons calculé les taux de visite aux urgences liée à une intoxication sur la période 2012-2013 à 2016-2017 par sexe, groupe d’âge, substance ayant mené à l’intoxication et statut socioéconomique. Les données relatives aux urgences proviennent du Système national d’information sur les soins ambulatoires et les données de population proviennent des profils de recensements de 2016 (ou 2011) de Statistique Canada.Au cours de la période étudiée, on estime qu’il y a eu 81 463 visites aux urgences en raison d’une intoxication (351,2 pour 100 000 habitants). Les nourrissons, les tout-petits, les jeunes et les personnes de 20 à 64 ans présentaient un risque élevé de visites aux urgences en raison d’une intoxication. Les taux les plus élevés touchaient les personnes vivant dans les quartiers les plus défavorisés sur le plan matériel (607,8 pour 100 000 habitants) ou social (484,2 pour 100 000 habitants). Au fil du temps, les intoxications causées par les narcotiques et les psychodysleptiques sont devenues de plus en plus fréquentes, l’alcool demeurant toujours un problème.Nous avons élaboré et appliqué une méthodologie d’estimation des taux de visite aux urgences en Colombie-Britannique pour déterminer ceux liés à une intoxication au sein de divers groupes de population de la province. Maintenant que nous savons quelles populations sont les plus vulnérables aux intoxications en Colombie-Britannique, il faut déployer des efforts pour limiter les surdoses de drogues et les intoxications liées à une consommation excessive d’alcool afin de réduire les taux de ces blessures évitables.Between 1 April, 2012 and 31 March, 2017, there were about 81 463 poisoning-related emergency department visits in British Columbia, Canada. The highest poisoning-related emergency department visit rates were among individuals aged 25 to 44 years for males and 15 to 19 years for females, while for both sexes the lowest rate was among children aged 5 to 9 years. Broken down by age group and substance, the highest poisoning-related emergency department visit rate resulted from alcohol consumption among those aged 15 to 19 years. Poisoning-related emergency department visits were highest among those living in neighbourhoods with the greatest material and social deprivation. Overall, alcohol was the substance that most commonly resulted in poisoning-related emergency department visits; however, in 2016/17, narcotics and psychodysleptics surpassed alcohol as the substance type associated with the highest rate of poisoning-related emergency department visits.Entre le 1er avril 2012 et le 31 mars 2017, il y a eu environ 81 463 visites aux urgences en raison d’une intoxication en Colombie-Britannique (Canada). Les taux de visite aux urgences liée à une intoxication étaient plus élevés pour les 25 à 44 ans chez les hommes et pour les 15 à 19 ans chez les femmes, les taux les plus faibles ayant été enregistrés, chez les deux sexes, pour les 5 à 9 ans. Les données ventilées par groupe d’âge et substance indiquent que le taux le plus élevé de visites aux urgences en raison d’une intoxication correspondait à la consommation d’alcool chez les 15 à 19 ans. Les visites aux urgences liées à une intoxication étaient plus nombreuses chez les personnes vivant dans les quartiers les plus défavorisés sur le plan matériel et social. Si, dans l’ensemble, l’alcool est la substance qui a entraîné le plus souvent des visites aux urgences liées à une intoxication, les narcotiques et les psychodysleptiques ont, en 2016-2017, dépassé l’alcool comme substance associée au taux le plus élevé de visite aux urgences liée à une intoxication.

Indicators can help decision-makers evaluate interventions in a complex, multi-sectoral injury system. We aimed to create indicators for road safety, seniors falls, and ‘all-injuries’ to inform and evaluate injury prevention initiatives in British Columbia, Canada. The indicator development process involved a five-stage mixed methodology approach, including an environmental scan of existing indicators, generating expert consensus, selection of decision-makers and conducting a survey, selection of final indicators, and specification of indicators. An Indicator Reference Group (IRG) reviewed the list of indicators retrieved in the environmental scan and selected candidate indicators through expert consensus based on importance, modifiability, acceptance, and practicality. Key decision-makers (n = 561) were invited to rank each indicator in terms of importance and actionability (online survey). The IRG applied inclusion criteria and thresholds to survey responses from decision-makers, which resulted in the selection of 47 road safety, 18 seniors falls, and 33 all-injury indicators. After grouping “like” indicators, a final list of 23 road safety, 8 seniors falls, and 13 all-injury indicators were specified. By considering both decision-maker ranking and expert opinion, we anticipate improved injury system performance through advocacy, accountability, and evidence-based resource allocation in priority areas. Our indicators will inform a data management framework for whole-system reporting to drive policy and funding for provincial injury prevention improvement.

Background: Refugees are susceptible to various types of injury mechanisms associated with their dire living conditions and settlements. This study aims to compare and characterize the emergency department admissions due to physical trauma and injuries among local residents and refugees in greater Beirut. Methods: This epidemiological study analyzes injury incidence and characteristics of patients presenting to Emergency Departments of 5 sentinel hospitals between 2017 and 2019. Using the WHO Injury Surveillance Guidelines and Pan-Asia Trauma Outcomes Study form, an injury data surveillance form was designed and used in hospital settings to collect data on injuries. Chi-square test analysis was performed to compare differences in injury characteristics between local residents and refugees. Regression models were constructed to assess the effect of being a refugee on the characteristics of injuries and outcomes of interest. Results: A total of 4847 injuries (3933 local residents and 914 refugees)were reported. 87.4% of the total injuries among refugees were sustained by the younger age groups 0-45 years compared to 68.8% among local residents. The most prevalent injury mechanism was fall (39.4%) for locals and road traffic injury (31.5%) for refugees. The most injured body part was extremities for both populations (78.2% and 80.1%). Injuries mostly occurred at home or its vicinity (garden or inside the camp) for both populations (29.3% and 23.1%). Refugees sustained a higher proportion of injuries at work (6%) compared to locals (1.3%). On multivariate analysis, refugee status was associated with higher odds of having an injury due to a stab/gunshot (odds ratio (OR) = 3.392, 95% confidence interval (CI) = 2.605-4.416), having a concussion injury (OR = 1.718, 95% CI = 1.151-2.565), and being injured at work (OR = 4.147, 95% CI = 2.74-6.278). Refugee status was associated with increased odds of leaving the hospital with injury-related disability (OR = 2.271, 95% CI = 1.891-2.728)] Conclusions: Injury remains a major public health problem among resident and refugee communities in Beirut, Lebanon. Refugees face several injury-related vulnerabilities, which adversely affect their treatment outcomes and long-term disabilities. The high prevalence of occupational and violence-related injuries among refugees necessitates the introduction of targeted occupational safety and financial security interventions, aiming at reducing injuries while enhancing social justice among residents.

Burn-related injury is a global public health problem with significant rates of morbidity and mortality. The adverse effect of burn leads to substantial functional, psychological, and economic repercussions. Low- and middle-income countries, including Lebanon, carry a disproportionately greater burden of burn injuries. This study adopted a mixed method approach to explore burn-related injuries in a sample (n = 347) of refugee children settling in Lebanon. We reviewed 179 cases of patients records that met the criteria of a child aged 0 to 19 years and has sustained a burn due to living conditions. War-related burn injuries were excluded. The findings demonstrate that there is a significantly higher proportion of 0- to 4-year-olds with burn injuries (53.6%) compared with the older age groups. Scald burns, caused by boiling liquid, were the most common cause of burns (58.6%), followed by fire/open flame (12.8%) and heat contact (6.7%). Upper trunk and arm burns were significantly higher than other body parts (35.2%), females were among the potential at-risk group with due to boiling liquids caused by food preparation and serving. Fifteen to nineteen years showed a high proportion of fire/flame burn caused by labor accident. Qualitative analysis of case reports further confirmed our findings and emphasized the impact of low socioeconomic status, overcrowded living conditions and open floor cooking and heating on increasing risk of pediatric burns. Additional research is needed to increase understanding on risk factors pertaining to pediatric burns in the refugee community with a view to integrating appropriate preventive measures and informing evidence-based policies and programs.

Background Active transportation, such as walking and biking, is a healthy way for children to explore their environment and develop independence. However, children can be injured while walking and biking. Many cities make changes to the built environment (e.g., traffic calming features, separated bike lanes) to keep people safe. There is some research on how effective these changes are in preventing adult pedestrians and bicyclists from getting hurt, but very little research has been done to show how safe various environments are for children and youth. Our research program will study how features of the built environment affect whether children travel (e.g., to school) using active modes, and whether certain features increase or decrease their likelihood of injury. Methods First, we will use a cross-sectional study design to estimate associations between objectively measured built environment and objectively measured active transportation to school among child elementary students. We will examine the associations between objectively measured built environment and child and youth pedestrian-motor vehicle collisions (MVCs) and bicyclist-MVCs. We will also use these data to determine the space-time distribution of pedestrian-MVCs and bicyclist-MVCs. Second, we will use a case-crossover design to compare the built environment characteristics of the site where child and youth bicyclists sustain emergency department reported injuries and two randomly selected sites (control sites) along the bicyclist’s route before the injury occurred. Third, to identify implementation strategies for built environment change at the municipal level to encourage active transportation we will conduct: 1) an environmental scan, 2) key informant interviews, 3) focus groups, and 4) a national survey to identify facilitators and barriers for implementing built environment change in municipalities. Finally, we will develop a built environment implementation toolkit to promote active transportation and prevent child pedestrian and bicyclist injuries. Discussion This program of research will identify the built environment associated with active transportation safety and form an evidence base from which municipalities can draw information to support change. Our team’s national scope will be invaluable in providing information regarding the variability in built environment characteristics and is vital to producing evidence-based recommendations that will increase safe active transportation.

Child and youth self-poisoning is a growing public health issue in many regions of the world, including British Columbia (BC), Canada, where 15–19-year-olds have the highest rates of self-poisoning hospitalizations compared with those of all other ages. The purpose of this study was to identify what substances children and youth commonly used to poison themselves in BC and how socioeconomic status may impact self-poisoning risk. Self-poisoning hospitalization rates among 10–14 and 15–19-year-olds from 1 April 2012 to 31 March 2020 were calculated by substance using ICD-10-CA codes X60-X69 and T36-T65, as well as by socioeconomic status using the Institut National de Santé Publique du Québec’s Deprivation Index. Nonopioid analgesics, antipyretics, and antirheumatics were the most common substances involved, with rates of 27.6 and 74.3 per 100,000 population among 10–14 and 15–19-year-olds, respectively, followed by antiepileptic, sedative–hypnotic, antiparkinsonism, and psychotropic drugs, with rates of 20.2 and 68.1 per 100,000 population among 10–14 and 15–19-year-olds, respectively. In terms of socioeconomic status, rates were highest among 10–19-year-olds living in neighbourhoods with the fewest social connections (243.7 per 100,000 population). These findings can inform poisoning prevention strategies and relevant policies, thereby reducing the number of self-poisoning events among children and youth.

BackgroundIn 2010 in British Columbia (BC), Canada, total injury costs per capita were higher among youth aged 15–24 years than in any other age group. Injury prevention efforts have targeted injuries with high mortality (transportation injuries) or morbidity (concussions). However, the profile and health costs of common youth injuries (types, locations, treatment choices and prevention strategies) and how these change from adolescence to young adulthood is not known.MethodsParticipants (n=662) were a randomly recruited cohort of BC youth, aged 12–18, in 2003. They were followed biennially across a decade (six assessments).ResultsSerious injuries (defined as serious enough to limit normal daily activities) in the last year were reported by 27%–41% of participants at each assessment. Most common injuries were sprains or strains, broken bones, cuts, punctures or animal bites, and severe bruises. Most occurred when playing a sport or from falling. Estimated total direct cost of treatment per injury was approximately $2500. In addition, 25% experienced serious injuries at three or more assessments, indicating possible differences that warrents further investigation.ConclusionsThe occurence and health cost of common injuries to youth and young adults are underestimated in this study but are nevertheless substantial. Ongoing surveillence, awareness raising, and prevention efforts may be needed to reduce these costs.

ObjectivesAn online, evidence-based resource was created to support the development of sport and recreational injury prevention programmes. The resource, called Active & Safe Central (www.activesafe.ca), provides evidence-based information across the public health approach for a number of sport and recreational activities. The objective of this project was to evaluate the perceived usefulness of Active & Safe Central as an educational tool.DesignA mixed-methods study design, guided by the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework, was used to evaluate Active & Safe Central.SettingData were collected using an online survey, available to all users of the site, and focus groups (n=2) that took place in Vancouver and Toronto, Canada.ParticipantsSurvey respondents (n=87) were recruited online, including parents, coaches, youth and adult athletes, and teachers. Focus group participants (n=16) were key stakeholders and end users, recruited from academia, local health sectors, sport and recreational organisations, and not-for-profit injury prevention organisations.ResultsPost launch, there were 1712 users visiting the website 2306 times (sessions), with the majority representing new users, over returning users (87.5% and 12.5%, respectively). There were 6340 page visits, with the most popular pages including soccer, playgrounds and ice hockey. Active & Safe Central was reported as a credible source of evidence-based sport and recreational information and that the site would be recommended to others. Information collected from focus group participants was used to inform necessary adaptations to the online platform, including critical navigation issues, visualisations and interactivity. The major themes that emerged from focus group and survey data included increased awareness of injury prevention recommendations and that the recommendations would be used in one’s own sporting activity and/or practice.ConclusionsThe results of the evaluation suggest the tool is a useful resource for sport and recreational injury information that has significant potential to impact prevention practice.

When children do not have sufficient height or weight to use seatbelts, the straps tend to rest on the wrong places: the lap belt on their bellies and the shoulder belt across their necks. As a result, in the event of a motor vehicle crash, there may be injuries to internal organs and the spine. Thus, it is recommended that children use booster seats to ensure correct fit of the seatbelt. Unfortunately, research indicates that: (a) rates of booster seat use are low even in jurisdictions where it is mandatory, and (b) many parents believe that booster seats are not necessary. Using fuzzy-trace theory, we propose that injuries to children riding in automobiles are stereotypically (and incorrectly) seen as ejection related. This ejection stereotype undermines the perceived safety benefit of booster seats, because seatbelts alone can prevent ejection and, therefore, are thought to provide adequate protection. Interventions to promote booster seat use can be improved, if they include mechanisms to diffuse the ejection stereotype.

Background Routinely gathered injury data, such as hospitalisations, may be subject to variation from sources other than injury incidence. There is a need for an indicator that defines severe injury, which may be less vulnerable to fluctuations due to changes in care policies. The purpose of this study was to identify International Classification of Diseases-10 codes associated with severe paediatric injuries and to specify and validate a severe paediatric injury indicator. Methods Two data sets that included the ISS and the survival risk ratio were used to produce a list of diagnoses to define severe paediatric injury. The list was sent to trauma surgeons who classified each code as severe enough or not severe enough to require care in a trauma centre. The indicator was fully specified, then validated by using a different data set to validate the codes in a real-world situation. Results Sixty diagnoses were identified as representing severe paediatric injury. Following specification, the indicator was applied to an existing comprehensive data set of paediatric injuries. The decline in hospitalisation of paediatric injuries was significantly steeper for severe than non-severe injuries, suggesting that factors related to the decline in this trauma subset are unlikely to be related to changes in access or other components of trauma care delivery. Conclusions This indicator can be used for the evaluation of trends in severe paediatric trauma and will help identify populations at risk. This research may inform policies and procedures for referrals of severe childhood injury to appropriate levels of care.

To reflect on the role of risk-taking and risky play in child development and consider recommendations for the injury prevention field, a symposium was held prior to the November 2013 Canadian Injury Prevention and Safety Promotion Conference. Delegates heard from Canadian and international researchers, practitioners and play safety experts on child development, play space design and playground safety, provision of recreation, and legal and societal perceptions of risk and hazard. The presenters provided multidisciplinary evidence and perspectives indicating the potential negative effect on children's development of approaches to injury prevention that prioritise safety and limit children's opportunities for risky play. Delegates considered the state of the field of injury prevention and whether alternative approaches were warranted. Each presenter prepared a discussion paper to provide the opportunity for dialogue beyond attendees at the symposium. The resulting discussion papers provide a unique opportunity to consider and learn from multiple perspectives in order to develop a path forward.

BackgroundThe British Columbia Coroners Service implemented a policy in 2010 advising the reclassification of underlying causes of deaths due to falls from ‘natural’ to ‘accidental’. This study investigates whether observed data trends reflect this change in practice, are artefacts of inconsistent reporting, or indicate a true increase in fall-related deaths.MethodsMortality data were analysed from 2004 to 2017 for cases with International Statistical Classification of Diseases and Related Health Problems, 10th Revision fall codes W00–W19, occurring among adults aged 60 years and older.ResultsFrom 2010 to 2012, accidental fall-related deaths increased among those aged 80 years and older, followed by an increase in natural deaths with fall as the contributing cause.ConclusionsChanges in reporting resulting from the 2010 policy change were observed; however, post-2012 data indicate a reversion to previous reporting practices.

Children under the age of 5 years have the highest rate of hospitalization and mortality from burns. Studies of costs associated with pediatric burns have included a limited number of patients and focused on inpatient and complication costs, limiting our understanding of the full economic burden of pediatric burns. This study aimed to develop a costing model for burn injuries among children to estimate the economic burden of child burns in British Columbia, Canada. Costs of services and resources used by children aged 0 to 4 years old who were treated at BC Children’s Hospital (BCCH) between January 1, 2014 and March 15, 2018 for a burn injury were estimated and summed, using a micro-costing approach. The average cost of burn injuries per percentage of total body surface area (%TBSA) was then applied to the number of 0 to 4 years old children treated for a burn injury across British Columbia between January 1 and December 31, 2016. Based on 342 included children, a 1–5%, 6–10%, 11–20%, and >20% burn, respectively cost an average of $3338.80, $13,460.00, $20,228.80, and $109,881.00 to society. The societal cost of child burns in BC in 2016 totaled $2,711,255.01. In conclusion, pediatric burn injuries place an important, yet preventable economic burden on society. Preventing even a small number of severe pediatric burns or multiple small burns may have considerable economic impacts on society and allow for the reallocation of healthcare funds toward other clinical priorities.

Education is a common strategy used to prevent occupational injuries. However, its effectiveness is often measured using surrogate measures instead of true injury outcomes. To evaluate the effectiveness of workplace educational interventions, we selectively analyzed studies that reported injury outcomes (PROSPERO ID: CRD42019140631). We searched databases for peer-reviewed journal articles and sources of grey literature such as abstracts, registered trials, and theses published between 2000 and 2019. Studies on educational interventions that reported fatal or non-fatal occupational injury outcomes were selected. Two reviewers independently and in duplicate screened the studies, extracted data, and assessed risk of bias. Heterogeneity in the data precluded meta-analysis, and the results were reviewed narratively. In total, 35 studies were included. Of which, 17 found a significant reduction in injuries, most of which featured a multifaceted approach or non-didactic education. The remaining studies either described equivocal results or did not report statistical significance. Overall, interventions in the manufacturing industry were more effective than those in the construction sector. Risk of bias among included studies was moderate to high. In conclusion, educational interventions could be an effective part of multifaceted injury prevention programs. However, over-reliance on didactic education alone is not advised.

This case study describes a participatory research project that engaged young people (ages 11 to 13) in examining the play-friendliness of their local neighborhoods. Part of a larger study related to the city’s ‘Child and Youth Friendly Community Strategy,’ the project involved youth in creating and sharing knowledge about their neighborhood play environments. University researchers, a youth leadership group, city staff, and school personnel collaborated in designing and carrying out the project. Through regular in-school sessions over 3 months, 51 youth participants engaged in activities related to children’s rights, child-friendly cities, outdoor play, photography, and municipal decision making. They also went on a neighborhood walk and took photographs of places and things they perceived as ‘friendly’ and ‘not friendly’ for play. These photographs—and accompanying narratives—were displayed at City Hall and the School Board office. A number of youth participants also delivered presentations and recommendations to City Council and the Board of Education about making the city better for young people. This case study outlines the process of carrying out the research project and identifies impacts of such a project on youth participants, the city’s Child and Youth Friendly Community Strategy, and the local community.

The purpose of this commentary is to discuss how legalization of non-medical marijuana (LNMM) in Canada can potentially influence child and adolescent unintentional injuries based on evidence from states (American) and jurisdictions that have already legalized cannabis for recreational purposes. Although the evidence is still not conclusive, LNMM can bring about higher exposure, lower perceived harms, and higher prevalence of cannabis use by minors through role modeling and normalization of behaviour within the household and the community, and higher rates of driving under the influence of cannabis, which can contribute to a higher burden of road traffic injuries. Experience of American states with LNMM shows higher rates of emergency visits for pediatric poisoning due to unintentional ingestion of cannabis-containing foods and severe burns due to explosions during the course of home-based cannabis extraction. While the justification for legalization has created a strict legal framework for improved control of cannabis in Canada, the implications for health and safety of children and adolescents necessitate further study, communication with policy-makers and public health practitioners, and evidence-based education of parents, caregivers, and youth.

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.

OBJECTIVES: The primary objectives of this work were to (1) identify the risk and/or protective factors associated with playground injuries among children less than 18 years of age and (2) identify interventions/programs/policies aimed at preventing playground-related injuries among children less than 18 years of age. Secondary objectives include a summary of the data that reflect alignment with current playground standards. METHODS: For the primary outcome, 4 databases and 12 online resources were systematically searched to include observational and experimental studies examining risk and/or protective factors or interventions associated with playground injury or outcomes related to playground injury (e.g., risky playground behaviour). Data extraction included study design, participants, outcome, exposure or intervention, data analysis, and effect estimates. The quality of evidence for all studies was assessed using the Downs and Black criteria. RESULTS: This review included studies of moderate quality, revealing a number of risk factors and effective interventions for playground injury. Risk factors included absence of handrails and guardrails on playground equipment, non-impact-absorbing surfacing, and critical fall heights. Effective interventions included modifying playground surfacing and reducing equipment height to less than 1.5 m. CONCLUSION: Equipment- and structure-based playgrounds should adhere to and maintain playground standards in order to reduce the risk of serious injury. Organizations responsible for installing and maintaining playgrounds should consider alternative play spaces that allow children to play outdoors, in a natural environment that supports healthy child development and promotes physical activity.

Objectives: To explore the relationship between neighborhood social and material deprivation and the rates of abusive head trauma (AHT), and whether it differs according to sex, and following the implementation of the Period of PURPLE Crying ( PURPLE) program. Method: A cross-sectional study design was applied to data from children 0 to 24 months old with a confirmed AHT diagnosis between 2005 and 2017 in British Columbia. Dissemination area–based social and material deprivation scores were assigned to residential areas, where AHT cases were recorded. Poisson regression models tested the relationship between deprivation scores and AHT rates, adding sex and pre–post program implementation as interaction terms. Results: With each increase in material and social deprivation quintiles, AHT rates increased by 42% (95% CI [1.18, 1.72]) and 25% (95% CI [1.06, 1.51]), respectively, following a social gradient. AHT rate disparities between neighborhoods did not change following the PURPLE program implementation. Conclusions: This study stresses the need to provide additional AHT prevention services proportionately to the levels of neighborhood disadvantage, in addition to universal AHT programs, to successfully protect all children.

ObjectivesThe objective of this study was to explore parent perspectives of and interest in an interactive knowledge translation platform called Child-Sized KT that proposes to catalyse the collaboration of patients, families, practitioners and researchers in patient-oriented research at British Columbia Children’s Hospital (BCCH).MethodsAn explanatory sequential mixed methods design was used over 1 year. Over 500 parents across BC completed an online survey, including a subsample of 102 parents who had accessed care at BCCH within the past 2 years. The survey explored parent perspectives about the value of their engagement at all stages of the research process and their interest in and concerns with using an online platform. Following the online survey, two focus groups were held with parents in the Vancouver area to explore themes emerging from the survey.ResultsParents expressed keen interest in engaging in research at BCCH. Parents perceived benefit from their input at all stages of the research process; however, they were most interested in helping to identify the problem, develop the research question and share the results. Although parents preferred online participation, they had concerns about protecting the privacy of their child’s information.ConclusionsParents see value in their involvement in all stages of child health research at BCCH. Their input suggests that Child-Sized KT, a hypothetical online platform, would facilitate meaningful stakeholder engagement in child health research, but should offer a customised experience and ensure the highest standard of data privacy and protection.

Introduction In 2010, British Columbia (BC) introduced new traffic laws designed to deter impaired driving, speeding, and distracted driving. These laws generated significant media attention and were associated with reductions in fatal crashes and in ambulance calls and hospital admissions for road trauma. Objective To understand the extent and type of media coverage of the new traffic laws and to identify how the laws were framed by the media. Methods We reviewed a database of injury related news coverage (May 2010–December 2012) and extracted reports that mentioned distracted driving, impaired driving, or speeding. Articles were classified according to: (i) Type, (ii) Issue discussed, (iii) ‘Reference to new laws’, and (iv) ‘Pro/anti traffic law’. Articles mentioning the new laws were reread and common themes in how the laws were framed were identified and discussed. Results Over the course of the study, 1848 articles mentioned distraction, impairment, or speeding and 597 reports mentioned the new laws: 65 against, 227 neutral, and 305 supportive. Reports against the new laws framed them as unfair or as causing economic damage to the entertainment industry. Reports in favor of the new laws framed them in terms of preventing impaired driving and related trauma or of bringing justice to drinking drivers. Growing evidence of the effectiveness of the new laws generated media support. Conclusions BC's new traffic laws generated considerable media attention both pro and con. We believe that this media attention helped inform the public of the new laws and enhanced their deterrent effect.

BackgroundSchool-based injuries represent a sizeable portion of child injuries. This study investigated the rates of school-based injuries in Lebanon, examining injury mechanisms, outcomes and associated risk factors.MethodsData were prospectively collected by intern school nurses at 11 private schools for the 2018-2019 academic year. Descriptive and inferential analyses were performed. Chi-square comparisons were conducted to determine the significance of any differences in injury rates between boys and girls for each category of school.Results4,619 injury cases were collected. The yearly rate for school injuries was 419.1 per 1,000 children for the year 2018-2019. Boys demonstrated a significantly higher injury rate for all mechanisms of injuries, with the exception of being injured while walking, injured in the gym/sports areas, and other areas outside the playground and classroom. Elementary school children had the highest rate of injuries, nearly 2.4 times higher than kindergarten, 2.8 times higher than middle school, and 14.5 times higher than high school. Injuries to the face, upper extremities, and lower extremities were nearly 3 times more common than injuries to other areas of the body. Bumps/hits and bruises were most common-almost 3 times more likely than all other injury types. Injuries were mainly minor or moderate in severity-severe injuries were about 10 times less likely. Most injuries were unintentional, with rates nearly 5 times higher than those with unclear intent and 12 times higher than intentional injuries.ConclusionsSchool injuries represent a relatively common problem. Compliance with playground safety standards coupled with the implementation of injury prevention strategies and active supervision at schools can curtail child injuries and ensure a safe and injury-free school environment.

Injury prevention plays a key role in keeping children safe, but emerging research suggests that imposing too many restrictions on children’s outdoor risky play hinders their development. We explore the relationship between child development, play, and conceptions of risk taking with the aim of informing child injury prevention. Generational trends indicate children’s diminishing engagement in outdoor play is influenced by parental and societal concerns. We outline the importance of play as a necessary ingredient for healthy child development and review the evidence for arguments supporting the need for outdoor risky play, including: (1) children have a natural propensity towards risky play; and, (2) keeping children safe involves letting them take and manage risks. Literature from many disciplines supports the notion that safety efforts should be balanced with opportunities for child development through outdoor risky play. New avenues for investigation and action are emerging seeking optimal strategies for keeping children “as safe as necessary,” not “as safe as possible.” This paradigm shift represents a potential for epistemological growth as well as cross-disciplinary collaboration to foster optimal child development while preserving children’s safety.

Introduction Children under the age of five years are particularly vulnerable to scalds and contact burns and have the highest rate of hospitalization and mortality from burns. Studies of costs associated with pediatric burns have included a limited number of patients and focused on inpatient and complication costs, limiting our understanding of the full economic burden of pediatric burns, including costs incurred through outpatient care and caregivers’ productivity loss. This study aimed to develop a societal costing model for burn injuries among children aged 0 to 4 years. Methods Children aged 0 to 4 years identified through the local Burn Registry with a burn injury between January 1, 2014 and March 15, 2018 were included in this study. Patients with inhalation injury, electrical, chemical and friction burns were excluded. An incidence-based cost-of-illness analysis with a human capital approach was used to quantify the cost of partial and full-thickness burns according to the percentage of total body surface area (%TBSA) involved. The cost of a burn injury was assessed from a societal perspective through the following cost categories: emergency department visits, inpatient, outpatient dressing changes, outpatient burnbaths, day surgeries, clinic visits and caregiver productivity losses. A list of resource items for each category were extracted from patient chart review, the local Burn Registry, and the local Hospital Finance Database, and assigned unit prices. Costs were discounted to a present value in 2017 dollars at 1.5% per annum. Results Burn injuries were observed for 342 children, of which 249 (73%) had their burn severity classified (%TBSA and partial/full thickness) and were included in this study. Burn severity categories (1–5%, 6–10%, 11–20%, and >20%) were developed based on the differential distribution of the costs allocated to each burn incident. The majority of children (60.8%) suffered from a 1–5% burn. A 1–5%, 6–10%, 11–20%, and >20% burn respectively cost an average of $2,229, $8,653, $13,663, and $98,634 to society. Costs incurred by the 1–5% burns were related mostly to emergency department visits and dressing changes, while costs incurred by the >20% were related mostly to inpatient and clinic visits (garments) costs. Conclusions This costing approach raises awareness about the important, yet preventable economic burden that pediatric burn injuries place on society. Applicability of Research to Practice This evidence may persuade policymakers and clinicians to invest in pediatric burns prevention programs in order to decrease pediatric burns costs allowing for the allocation of funds towards other clinical initiatives. This costing model may also facilitate cost-effectiveness analyses of burn prevention programs in the coming years.

Background In Canada, road traffic injuries are the leading cause of death among children and youth ≤19. Across the country, there is variability in road traffic injury prevention policies and legislation. Our objective was to compare pediatric road traffic related injury hospitalization and death rates across Canadian provinces. Methods Population-based hospitalization and death rates per 100,000 were analyzed using data from the Discharge Abstract Database and provincial coroner’s reports. Road traffic related injuries sustained by children and youth ≤19 years were analyzed by province and cause between 2006 and 2012. Results The overall transport-related injury morbidity rate for children in Canada was 70.91 per 100,000 population between 2006 and 2012. The Canadian population-based injury hospitalization rates from all transport-related causes significantly decreased from 85.51 to 58.77 per 100,000 (− 4.42; p

In BC, the population of adults over 65 years of age is growing rapidly. The risk of injurious falls increases with age, resulting in a major threat to the quality of life of older adults. Fall-related injuries are the leading cause of injury-related deaths among seniors (>65 years) in BC, and there are over 13 000 hospitalizations per year, resulting in $485 million in direct healthcare costs. The majority of these falls occur among community living seniors. Public education on the magnitude of the problem, and the fact that falls and injuries are preventable with evidence informed strategies, is important for the implementation and sustained use of these prevention strategies. The FindingBalanceBC website has been providing falls prevention information to citizens across BC for the last 3 years. The purpose of our study was to evaluate the level of knowledge retention of visitors to the Finding Balance BC website, which promotes the Senior Falls Prevention Campaign, for the purposes of quality assurance and program improvement. During the month of November, visitors to the FindingBalanceBC website were invited to participate in the survey and those who expressed their consent were enrolled in the study. A questionnaire assessing knowledge of evidence-informed falls prevention strategies among seniors (exercise, vision check, medication review and home safety) based on the website content was prepared and pre-tested. Participants completed the questionnaire at the 4th week and 10th week following their first visit to the website. Respondent composite scores for each of the fall prevention strategies will be calculated and the respective scores for the 4th week and 10th week will be compared using paired t-tests. Results and policy implications will be presented at the conference.

Professional firefighters are exposed to a variety of injury hazards over the course of their occupation, including: extreme temperatures, toxic substances, strenuous physical labour, unstable structures, falling objects, extreme heights, violence and traumatic events. The purpose of this study is to describe the determinants of injury, disease and death among Canadian firefighters by age, gender, region, and employment status. A descriptive analysis of the Association of Workers’ Compensation Boards of Canada and WorkSafeBC data was undertaken to define priority issues for targeted intervention. Outcome measures included time-loss and fatality claims accepted by compensation boards between 2006 and 2015, and submitted by professional and volunteer firefighters over the age of 14 years. An analysis of AWCBC data revealed five principal determinants of injury and death among Canadian firefighters: cancer, traumatic injury, cardiovascular disease, respiratory disease and mental health. Cancer represented over 86% of all fatality claims, while traumatic injuries represented 90% of all time-loss claims among firefighters. Firefighter time-loss claims due to traumatic injury occurred at a rate of 1,661.3 per 1 00 000 firefighter population per year. Mental health was the third leading cause of time-loss claims among Canadian firefighters, occurring at a rate of 23.95 per 1 00 000 firefighter population per year. Volunteer firefighters in British Columbia reported lower rates of time-loss claims per 1 00 000 firefighter population than professional firefighters for traumatic injury, cancer, mental health, cardiovascular disease and respiratory disease. Given inherent limitations of claims data to analyze injury and death within an occupation, a dedicated national firefighter injury surveillance model is needed to support timely and responsive prevention and intervention, as well as specific research. The results of this study suggest that cancer, injury and mental health should be priority issues for researchers, employers and policy-makers working to improve firefighter health and safety.

Background In British Columbia (BC), there are approximately 430 deaths, 6500 hospitalizations and 79,000 injuries due to motor vehicle crashes each year. Direct and indirect costs of transport-related injury was estimated at $639 million in 2010. Currently, there is no single suite of indicators to describe and monitor road safety in BC, making it difficult to assess performance across communities within the province. Development and validation of indicators enables road safety to be consistently assessed. Objectives Identify and ultimately establish a suite of road safety indicators for monitoring and evaluating road safety performance in BC. Methods A review of relevant literature identified previously established evidence-based road safety indicators used successfully in other jurisdictions. Experts were consulted to identify preferred indicators specific to BC. A secondary feedback and validation process followed to reach consensus on appropriate indicators for further approval and consensus by experts and decision-makers in road safety. Results 107 indicators were identified through literature review and 60 preferred indicators were identified through expert consultation for the BC context. Indicators were grouped into four categories based on the Safe Systems Approach: Safe Roads, Safe Vehicles, Safe Speed, and Safe Road Users. Through analysis and synthesis of this information key content and themes were identified. Conclusion This work serves as foundational to the establishment of a suite of road safety indicators in BC by which to gauge road safety efforts. A suite of indicators will allow performance comparisons to be made between communities and local, regional, and provincial trends may be monitored over time. Policy implications Indicators will be used to recommend a data management framework for policy-relevant whole-system reporting that could drive policy and funding for province-wide improvements in road safety.

Background Sport and recreation-related injuries have a significant cost in terms of the impact on the health care system. As prevention researchers and practitioners, we have a responsibility to provide guidance toward prevention to those who participate in sport, and those that coach, treat, and parent children that participate in sport. There are effective interventions to reduce injury in many sport and recreational activities; however, the accessibility of this information, as well as the guidance required to implement it, is often not available and accessible to the public. Objective The objective of this project was to complete a large-scale systematic review and synthesis of the literature across 51 sport and recreational activities. The evidence was used to inform the development of an end-user driven, digital platform that provides injury prevention information and resources. Methods An evidence synthesis framework was used to guide a review of reviews of 51 sport and recreational activities by 18 injury prevention trainees from across Canada. Data collection included evidence on the incidence, risk factors, interventions and implementation and evaluation of interventions to reduce the risk of injury in sport. Evidence was critically appraised, extracted, synthesized and translated into clear messaging for use in an online tool. Findings The ‘Active and Safe’ platform provides web-based sport injury and prevention information. Navigation through the tool brings the user to a sport specific content page subdivided into 4 sections: 1) sport injury overview, 2) incidence, 3) risk factors, and 4) prevention. Users are given evidence-informed, actionable prevention messaging from a personalized sporting context. Conclusion and policy implications This user friendly, web and mobile accessible tool can increase the reach, awareness and implementation of prevention programming in sport and recreational activity.

Background Injuries are the leading cause of death for British Columbians during their first four decades of life costing $3.7 billion annually. Lack of transfer of national and provincial injury prevention efforts to the grass-root level and underutilization of proven preventive strategies at this level has been identified as one of the barriers for injury prevention in BC. Objective To implement a community mobilization outreach program to strengthen injury prevention efforts at the grass roots level. Methods A rapid environmental assessment was completed together with the development of an online directory mapping existing and potential injury prevention stakeholders and community groups working on injury prevention priorities across BC. This information was used to facilitate consistent communication, networking and collaboration, and to increase the efficiency and effectiveness of injury prevention initiatives. Findings The online directory served as a hub for forging new connections and greater collaboration among the stakeholder and community groups. Connecting and activating these channels enhanced community involvement in injury prevention initiatives. Provincial health authorities and community involvement in injury prevention programs such as, Safe Kids Week and National Teen Driver Safety Week increased significantly, ranging from 2- to 6-fold increases during the implementation of this grass-roots initiative. As well, a number of new organizations joined to support the effort. Conclusion Coordinating injury prevention efforts at the community level throughout the province has allowed stakeholders to co-build programs that are mutually supportive, reducing duplication of projects and programs and which facilitated the efficient allocation of limited resources. Policy implications More efforts should be taken to strengthen community network engagement and stakeholder relations. The evidence from this project indicates that a community mobilization outreach program can have significant positive effect on injury prevention efforts.

Background Reports of injury burden related to residential fires affecting children in Canada are outdated. Objective To explore the association between rates of injury and death among children ≤19 years old in Canada and the presence or absence of residential smoke alarms and sprinklers. Methods Using the National Fire Information Database (NFID), 2005 to 2015, a retrospective analysis was conducted to describe the relationship between residential fire protection features, and injury and death rates among children ≤19 years old within the Canadian provinces of British Columbia, Alberta, Saskatchewan, Manitoba, and Ontario. Rates of injury and death per 10,000 fires were calculated and compared. Results Structures with a working smoke alarm were associated with lower death rates and higher injury rates, compared to those with no smoke alarms (7.2 vs 12.9, and 87.5 vs 34.5, respectively). Inactive smoke alarms were associated with the highest rates of death and injury (19.8 and 94.2, respectively). Structures with sprinkler protection were associated with no deaths and few injuries. Discussion The presence of activated smoke alarms and sprinklers were associated with low rates of death among children. While sprinklers appeared to be particularly effective, the presence of smoke alarms – activated or not – was associated with higher rates of injuries when compared with no smoke alarms. Smoke alarms reduced the risk of death, however their effectiveness has been debated in the literature, as children do not consistently respond appropriately to an activated smoke alarm. Sprinklers do not require children to respond; therefore, a combination of smoke alarms and sprinklers may offer the most protection for children. Maintenance of smoke alarms through regular testing, mandating sprinklers in new buildings, as well as promoting child knowledge in fire prevention and fire safety, may help to address the burden of fire-related injury and death among Canadian children.

Background Until recently, fire statistics in Canada have been difficult to obtain. The National Fire Information Database (NFID) is a pilot project of the Canadian Association of Fire Chiefs and the Council of Canadian Fire Marshals and Fire Commissioners. For the first time, 10 years of fire information from across Canada is unified in a single database and available for research and analysis. Objective To illustrate fire-related injuries and deaths among Canadian children≤19 years old, and to compare age-related rates between 5 Canadian provinces. Methods All residential fire incidents causing injury and death to children≤19 years old within the Canadian provinces of British Columbia, Alberta, Saskatchewan, Manitoba, and Ontario, from 2005–2014 were included in the analysis. Rates per 10 000 fires were calculated and compared between age groups and across provinces. Results The rates of injury and death among the study population were 60.5 and 10.6, respectively. Children aged 0–4 and 15–19 suffered the highest rates of injuries and deaths. The rate of injury among 0–4 and 5–9 year-olds was highest in Ontario (32.0 and 18.6, respectively), while Alberta showed the highest rate of injuries among 10–14 and 15–19 year-olds (16.1 and 43.8, respectively). Finally, the death among 0–4 year-olds in Manitoba was 2.3 times higher than the Canadian average (8.3 vs 3.6). Discussion Rates of injury exceeded rates of death in every province, with the exception of 0–4 year olds in Manitoba. External factors, such as severity of the fire, response time of emergency services, and distance to the pediatric care facility, may contribute to this difference. The youngest children and oldest teens appear to be most at risk, indicating that developmental stage is an important consideration for strategic intervention. Further research is needed to clarify and address disparities between provinces.

Context The Concussion Awareness Training Tool (CATT) is a series of online educational modules and resources with the goal of standardizing concussion recognition, diagnosis, treatment, and management. Based upon the established principles of the Consensus Statement on Concussion in Sport and other evidence-based resources, this tool includes a new self-paced learning module for medical professionals to address current gaps and variations in practice for the initial assessment and management of acute concussion patients in the office setting. CATT for medical professionals originally launched in 2013, focusing on the recognition and diagnosis of concussion. Evaluation found physicians demonstrated significant positive change in concussion practices (p=0.001), and significant change in knowledge by those treating more than 10 concussions per year (p=0.039). Objective To support physicians and other medical professionals in treating and managing concussion. Key messages The new e-learning course covers medical assessment for concussion, concussion management, addressing persistent symptoms, and providing medical clearance following recovery. The course is available in both English and French. Beyond medical professionals, CATT also caters to coaches, players/participants, parents and school professionals. Resources for workers and workplaces are currently being developed. To date, over 100 relationships have been developed with organizations and key stakeholders in British Columbia and beyond,>15 000 print resources have been distributed,>30 000 coaches and parents and >3000 school professionals have completed CATT, and >15 sporting organizations and schools have mandated CATT training. Discussion and conclusions Concussion is an under-recognized, -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 (www.cattonline.com). 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.

Background Recreational boating-related injuries are a preventable cause of morbidity and mortality in Canada. Implementing a targeted social marketing campaign will encourage meaningful behaviour change and result in increased compliance with safe boating practices, and reduced incidence of injury. Objective To provide a foundation to guide the development of a targeted boating safety social marketing campaign, this phase of the project aimed to: (1) summarize the existing evidence related to the risk factors and interventions for recreational boating-related injury; and (2) describe the burden of recreational boating-related injury in British Columbia (BC). Methods: We conducted (1) a review of the English language literature related to recreational boating injury; and (2) a retrospective analysis of fatalities, hospitalizations, and emergency department visits caused by recreational boating-related injuries in BC from April 1, 2009 – March 31, 2014. Findings Alcohol consumption and low PFD use are widely established risk factors for recreational boating-related injury. Existing studies suggest that legislation and targeted educational initiatives may improve recreational boating safety practices and reduce injury. In BC, recreational boating-related injuries primarily occurred among adult males during the warmer months. Most injuries occurred during powerboat use. One third of individuals who were fatally injured in a recreational boating incident had consumed alcohol and the majority were not wearing a PFD at the time of the incident. Recreational boating-related deaths most frequently occurred in a lake. Conclusion A targeted social marketing campaign aimed at improving safe boating behaviors is warranted. The campaign should include messaging related to avoiding alcohol use and wearing a PFD while boating. High-risk groups for targeted messaging include males, teenagers, young adults, and middle-aged adults. The campaign should be developed with emphasis on the flat water recreational boating community, and delivery should occur during the warmer months of the year, especially July and August.

Objectives To perform an interprovincial comparison of unintentional population-based injury hospitalization and death rates for Canadian children ages 0–19 years and compare trends between 2006 and 2012. Methods Annual population-based hospitalization rates per 100,000 from unintentional injuries were calculated for children/youth (< 19 years) using data from the Discharge Abstract Database between 2006 and 2012. Annual mortality rates were analyzed using provincial coronial data. The mean annual change in the rate of hospitalizations due to unintentional injuries was reported for each province. Results The average annual rate of hospital admissions for unintentional injuries was 305.10 per 100,000 population between 2006 and 2012, and this decreased by − 11.91 over time (p < 0.01, − 15.85; − 7.77). Saskatchewan had the highest average annual morbidity rate (550.76 per 100,000) from all unintentional causes, and Ontario had the lowest average annual rate (238.89 per 100,000). Saskatchewan had the highest average annual rate for all subcauses except for drowning. Ontario was the only province with an average annual injury morbidity rate that was consistently below the Canadian average. The average annual mortality rate from all unintentional injury was highest in Saskatchewan (17.51 per 100,000) and lowest in Ontario (5.99 per 100,000) when compared to Canada (7.97 per 100,000). Conclusion Injury prevention policies vary considerably among provinces. Although the unintentional injury hospitalization rate is decreasing over time, some subcauses such as choking/suffocation have shown an increase in certain provinces. Evidencebased childhood injury prevention policies, such as playground equipment safety and four-sided pool fencing among others, should be standardized across Canada.

Low incidence rates and economic recession have hampered interpretation of educational prevention efforts to reduce abusive head trauma (AHT). Our objective was to determine whether the British Columbia experience implementing a province-wide prevention program reduced AHT hospitalization rates. A 3-dose primary, universal education program (the Period of PURPLE Crying) was implemented through maternal and public health units and assessed by retrospective-prospective surveillance. With parents of all newborn infants born between January 2009 and December 2016 (n = 354,477), nurses discussed crying and shaking while delivering a booklet and DVD during maternity admission (dose 1). Public health nurses reinforced Talking Points by telephone and/or home visits post-discharge (dose 2) and community education was instituted annually (dose 3). During admission, program delivery occurred for 90% of mothers. Fathers were present 74.4% of the time. By 2-4 months, 70.9% of mothers and 50.5% of fathers watched the DVD and/or read the booklet. AHT admissions decreased for12-month-olds from 10.6 (95% CI: 8.3-13.5) to 7.1 (95% CI: 4.8-10.5) or, for24-month-olds, from 6.7 (95% CI: 5.4-8.3) to 4.4 (95% CI: 3.1-6.2) cases per 100,000 person-years. Relative risk of admission was 0.67 (95% CI: 0.42-1.07, P = 0.090) and 0.65 (95% CI: 0.43-0.99, P = 0.048) respectively. We conclude that the intervention was associated with a 35% reduction in infant AHT admissions that was significant for24-month-olds. The results are encouraging that, despite a low initial incidence and economic recession, reductions in AHT may be achievable with a system-wide implementation of a comprehensive parental education prevention program.

ObjectivesElectronic cigarettes and fluid (e-cigarettes, e-fluid) are hazardous materials that when inhaled or ingested may pose significant health risks to children and adolescents. The objective of this work was to explore the spectrum of injury related to e-cigarette exposure among Canadian children and adolescents.MethodsA one-time survey was sent to all paediatricians in Canada. Information was collected on children and adolescents who presented with e-cigarette exposure (inhalation and ingestion cases) in the previous 12 months. Questions included the number of injuries and symptoms, in addition to age, sex, treatment setting, intentional e-cigarette use, and how the products were accessed.ResultsA total of 520 surveys were completed and returned, identifying 35 cases. Symptoms related to inhalation were present in 30 cases and in 5 ingestion cases (5 unintentional, 0 intentional). For inhalation cases, most were male, ages 15 to 19 years, who sought treatment for nausea/vomiting, cough, throat irritation, or acute nicotine toxicity in an outpatient clinic/office. Most inhalation cases reported e-cigarette use 2 to 3 days/week, and e-cigarettes purchases from a mall kiosk/store. For ingestion cases, most were male, ages 1 to 4 years presenting to an emergency department with nausea/vomiting, cough, or respiratory irritation. Younger cases accessed e-fluid at home, older cases purchased in a mall kiosk/store. E-fluid flavours reported consumed were fruit, candy, and tobacco.ConclusionsE-cigarettes, recently introduced into the North American market are hazardous to children and adolescents. Given the low response rate to the survey, further investigation into the true burden of injury, as well as the risks that e-cigarettes pose, together with ways to reduce exposure, is needed.

INTRODUCTION: In 2010, British Columbia (BC) introduced new traffic laws designed to deter impaired driving, speeding, and distracted driving. These laws generated significant media attention and were associated with reductions in fatal crashes and in ambulance calls and hospital admissions for road trauma. OBJECTIVE: To understand the extent and type of media coverage of the new traffic laws and to identify how the laws were framed by the media. METHODS: We reviewed a database of injury related news coverage (May 2010-December 2012) and extracted reports that mentioned distracted driving, impaired driving, or speeding. Articles were classified according to: (i) Type, (ii) Issue discussed, (iii) 'Reference to new laws', and (iv) 'Pro/anti traffic law'. Articles mentioning the new laws were reread and common themes in how the laws were framed were identified and discussed. RESULTS: Over the course of the study, 1848 articles mentioned distraction, impairment, or speeding and 597 reports mentioned the new laws: 65 against, 227 neutral, and 305 supportive. Reports against the new laws framed them as unfair or as causing economic damage to the entertainment industry. Reports in favor of the new laws framed them in terms of preventing impaired driving and related trauma or of bringing justice to drinking drivers. Growing evidence of the effectiveness of the new laws generated media support. CONCLUSIONS: BC's new traffic laws generated considerable media attention both pro and con. We believe that this media attention helped inform the public of the new laws and enhanced their deterrent effect. Keywords: Driver distraction; Language: en

Background: Children’s risky play is associated with a variety of positive developmental, physical and mental health outcomes, including greater physical activity, self-confidence and risk-management skills. Children’s opportunities for risky play have eroded over time, limited by parents’ fears and beliefs about risk, particularly among mothers. We developed a digital tool and in-person Risk-reframing (RR) workshop to reframe parents’ perceptions of risk and change parenting behaviours. The purpose of this paper is to describe our RR intervention, rationale and protocol for a randomised controlled trial to examine whether it leads to increases in mothers’ tolerance of risk in play and goal attainment relating to promoting their child’s opportunities for risky play. Methods: We use a randomised controlled trial design and will recruit a total of 501 mothers of children aged 6–12 years. The RR digital tool is designed for a one-time visit and includes three chapters of self-reflection and experiential learning tasks. The RR in-person tool is a 2-h facilitated workshop in which participants are guided through discussion of the same tasks contained within the digital tool. The control condition consists of reading the Position Statement on Active Outdoor Play. Primary outcome is increased tolerance of risk in play, as measured by the Tolerance of Risk in Play Scale. Secondary outcome is self-reported attainment of a behaviour-change goal that participants set for themselves. We will test the hypothesis that there will be differences between the experimental and control conditions with respect to tolerance of risk in play using mixed-effects models. We will test the hypothesis that there will be differences between the experimental and control conditions with respect to goal attainment using logistic regression. Discussion: The results of this trial will have important implications for facilitating the widespread change in parents’ risk perception that is necessary for promoting broad societal understanding of the importance of children’s risky play. In addition, the findings may provide relevant information for the design of behaviour-change tools to increase parental tolerance of risk. Trial registration ClinicalTrials.gov, ID: NCT03374683 . Retrospectively registered on 15 December 2017.

Background: Accurate understanding of complex health data is critical in order to deal with wicked health problems and make timely decisions. Wicked problems refer to ill-structured and dynamic problems that combine multidimensional elements, which often preclude the conventional problem solving approach. This pilot study introduces visual analytics (VA) methods to multi-stakeholder decision-making sessions about child injury prevention; Methods: Inspired by the Delphi method, we introduced a novel methodology—group analytics (GA). GA was pilot-tested to evaluate the impact of collaborative visual analytics on facilitating problem solving and supporting decision-making. We conducted two GA sessions. Collected data included stakeholders’ observations, audio and video recordings, questionnaires, and follow up interviews. The GA sessions were analyzed using the Joint Activity Theory protocol analysis methods; Results: The GA methodology triggered the emergence of ‘common ground’ among stakeholders. This common ground evolved throughout the sessions to enhance stakeholders’ verbal and non-verbal communication, as well as coordination of joint activities and ultimately collaboration on problem solving and decision-making; Conclusions: Understanding complex health data is necessary for informed decisions. Equally important, in this case, is the use of the group analytics methodology to achieve ‘common ground’ among diverse stakeholders about health data and their implications.

Introduction The purpose of this research was to take the initial step in developing valid indicators that reflect the injury issues facing First Nations and Inuit children and youth in Canada. Methods Using a modified-Delphi process, relevant expert and community stakeholders rated each indicator on its perceived usefulness and ability to prompt action to reduce injury among children and youth in indigenous communities. The Delphi process included 5 phases and resulted in a refined set of 27 indicators. Results Indicators related to motorized vehicle collisions, mortality and hospitalization rates were rated the most useful and most likely to prompt action. These were followed by indicators for community injury prevention training and response systems, violent and inflicted injury, burns and falls, and suicide. Conclusion The results suggest that a broad-based modified-Delphi process is a practical and appropriate method, within the OCAP™ (Ownership, Control, Access and Possession) principles, for developing a proposed set of indicators for injury prevention activity focused on First Nations and Inuit children and youth. Following additional work to validate and populate the indicators, it is anticipated that communities will utilize them to monitor injury and prompt decisions and action to reduce injuries among children and youth.

We evaluated evidence of community interventions to improve Aboriginal child passenger safety (CPS) in terms of its scientific merit and cultural relevance. We included studies if they reported interventions to improve CPS in Aboriginal communities, compared at least pre- and postintervention conditions, and evaluated rates and severity of child passenger injuries, child restraint use, or knowledge of CPS. We also appraised quality and cultural relevance of studies. Study quality was associated with community participation and cultural relevance. Strong evidence showed that multicomponent interventions tailored to each community improves CPS. Interventions in Aboriginal communities should incorporate Aboriginal views of health, involve the community, and be multicomponent and tailored to the community’s circumstances and culture.

Background Abusive head trauma (AHT) is a severe form of child abuse causing devastating outcomes for children and families, but its economic costs in Canada has yet to be determined. The Period of PURPLE crying program (PURPLE) is an AHT prevention program implemented in British Columbia for which success in reducing AHT events was recently reported. Objective This study estimated the lifetime costs to society of incidental AHT events and compared the benefits and associated costs of AHT before and after the implementation of the PURPLE program. Participants and Setting: Children aged 0–24 months old with a definite diagnosis of AHT between 2002 and 2014 in British Columbia were included in this study. Methods An incidence-based cost-of-illness analysis, using the human capital approach was used to quantify the lifetime costs of AHT events according to their severity (least severe, severe and fatal). A cost-effectiveness analysis of the PURPLE program was conducted from both a societal and a health services’ perspectives using decision tree models. Results There were sixty-four AHT events between 2002–2014, resulting in a total cost of $354,359,080 to society. The costs associated with fatal, severe and least severe AHT averaged $7,147,548, $6,057,761 and $1,675,099, respectively. The investment of $5 per newborn through the PURPLE program resulted in a $273.52 and $14.49 per child cost avoidance by society and by the healthcare system. Conclusions This study provides evidence to policymakers and health practitioners that investing upstream in well-developed AHT prevention programs, such as PURPLE, not only promote child safety and health, but also translates into avoided costs to society.

Along with the rise in the use chemical allergens in in fragrances and cosmetic products, increased reporting of allergic contact dermatitis (ACD) continues to be a public health concern. So far, risk assessment of potential allergens essentially relies upon animal testing. New proteomics technologies combined with appropriate cell culture models and bioinformatics tools open up the window to transfer logical pathway information into biomarker assays. Sensiderm™ TMT-SRM 10-plex is a multiparametric assay, which is based on the established principles of selected reaction monitoring (SRM) mass spectrometry. The assay uses the human dendritic model MUTZ-3 exposed to chemical sensitizers to measure a response signature of ten proteins. In a model-building phase, the ten protein targets were initially discovered using a set of chemical sensitizers provided by the European Integrated Project Sens-it-iv. Currently, the Sensiderm assay has been pre-validated in two analytical laboratories, and a set of testing chemicals has been investigated in both non-blinded and blinded manner. In summary, the Sensiderm 10-plex assay reflects the activation of different sensitization-related pathways. A proper interpretation of this information may be integrated in decision-making processes of suspicious chemicals.

Liquid chromatography-selected reaction monitoring (LC-SRM) mass spectrometry has developed into a versatile tool for quantification of proteins with a wide range of applications in basic science, translational research, and clinical patient assessment. This strategy uniquely complements traditional pathology approaches, like hematoxylin and eosin (H&E) staining and immunohistochemistry (IHC). The multiplexing capabilities offered by mass spectrometry are currently unmatched by other techniques. However, quantification of biomarkers in tissue specimens without the other data obtained from H&E-stained slides or IHC, including tumor cellularity or percentage of positively stained cells inter alia, may not provide as much information that is needed to fully understand tumor biology or properly assess the patient. Therefore, additional characterization of the tissue proteome is needed, which in turn requires the ability to assess protein markers across a wide range of expression levels from a single sample. This protocol provides an example of multiplexed analysis in breast tumor tissue quantifying specific biomarkers, specifically estrogen receptor, progesterone receptor, and the HER2 receptor tyrosine kinase, in combination with other proteins that can report on tissue content and other aspects of tumor biology.

Injury is the leading cause of death among children and youth in Canada. Significant disparities in injury mortality rates have been observed between Aboriginal and non-Aboriginal populations, but little is known about the age-, sex-, and mechanism-specific patterns of injury causing death. This study examines paediatric mortality in British Columbia from 2001 to 2009 using comprehensive vital statistics registry data. We highlight important disparities in Aboriginal and non-Aboriginal mortality rates, and use the Preventable Years of Life Lost (PrYLL) metric to identify differences between age groups and the mechanisms of injury causing death. A significantly greater age-adjusted mortality rate was observed among Aboriginal children (OR = 2.08, 95% CI: 1.41, 3.06), and significantly higher rates of death due to assault, suffocation, and fire were detected for specific age groups. Mapped results highlight regional disparities in PrYLL across the province, which may reflect higher Aboriginal populations in rural and remote areas. Crucially, these disparities underscore the need for community-specific injury prevention policies, particularly in regions with high PrYLL.

Passive surveillance using ICD codes for hospital discharges has been used to estimate the incidence of abusive head trauma (AHT) utilizing ICD-9-CM, but not ICD-10, codes. There have been no incidence estimates of AHT in Canada where ICD-10 codes have been used since 2002. The Discharge Abstract Database from the Canadian Institute of Health Information (CIHI) for 2002-2007 was used for analyses conducted in 2011. A case was defined by code combinations that indexed injury specificity (narrow or broad) and degree of certainty (presumptive or probable) that the injury was inflicted. Estimated incidences for the populations at risk in those aged12 months and 12-23 months from 2002-2007 were determined. For those aged12 months, the mean incidence for "narrow, presumptive" AHT was 13.0 (95% CIs=11.3, 14.9) per 100,000 person-years; for "broad, probable" it was 15.5 (13.6, 17.6) per 100,000 person-years. For those aged 12-23 months, the "narrow, presumptive" incidence was 2.4 (1.7, 3.3) and the "broad, probable" incidence was 2.8 (2.0, 3.8) per 100,000 person-years, respectively. Month and year of age patterns were similar to previous reports. ICD-10 codes can be used to estimate incidence of AHT. Narrower classifications provide estimates consistent with those from other surveillance programs in Canada and internationally.

The objective of this review was to assess the risk of obesity in injuries and fatalities resulting from motor vehicle crash (MVC), as compared with individuals with a normal-range body mass index. A systematic review of the literature was conducted yielding 824 potential studies. Nine of these studies met our inclusion criteria. Meta-analyses examining obesity as a risk factor for various injury types and risk of fatality were conducted using data from these studies. Obesity was associated with higher fatality risk (odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.51-2.37, P = .0001; pooled estimate from 6 studies), and increased risk of lower extremity fractures (OR = 1.39, 95% CI = 1.18-1.65, P = .0001; pooled estimate from 2 studies). No significant differences were observed when considering abdominal injuries or pelvic fractures. Interestingly, for head injuries obesity was a protective factor (OR = 0.67, 95% CI = 0.46-0.97, P = .0001; pooled data from 3 studies). Evidence strongly supports the association of obesity with higher fatality and fractures of the lower extremities in MVCs. Contrary to our hypothesis, 3 studies showed that obesity was a protective factor in reducing head injuries. Furthermore, the review shows that obesity was not a risk factor of MVC-related pelvic fractures and abdominal injuries.

Estrogen receptor alpha (ER) is the first biomarker to have been clinically validated as a predictor of cancer therapy response. Measurements of tumor ER expression were based on radiolabeled ligand binding to receptor present in tumor lysates. Despite substantial tissue requirement, lack of specificity for ER isoforms (alpha versus beta) or receptor integrity, quantitative determination of tumor ER content (fmol/mg total protein) was possible. Introduction of anti-ER antibodies later permitted immunohistochemical (***lHC) evaluation of ER expression. IHC determination of ER status in newly diagnosed breast cancer is now a standard of care. While these IHC assays have been shown to be as predictive of endocrine responsiveness as ligand binding assays, they remain semi-quantitative at best reporting tumor ER status either categorically (e.g. + or -) or as a numeric score which is subjective and lacks a linear relationship with endocrine responsiveness. Thus the lack of precision for quantifying ER as a predictive biomarker is one of the most important unresolved issues in breast cancer. We are working to develop a proteomic liquid chromatography-mass spectrometry (LC-MS) assay to help resolve this issue. Samples included recombinant ER (rER), immunoprecipitated (IP) rER, and IP ER from MCF7 cells. ER was digested with trypsin, lyophilised and solubilised in 5 femto-mol/microliter (100 μl) heavy peptide internal standard mix. ER peptides were resolved by LC (100 μl/minute) and detected by selected reaction monitoring MS. The area under the total ion chromatogram for each peptide were used to quantify the amount of analyte present in each sample as a single point reference to the signal of the heavy peptide spike. An 11 point calibration curve (0.1-1000 fmol on column (o/c)) of light peptides with each point in the curve spiked with 100 fmol heavy peptide was also produced to determine assay characteristics such as limits of detection (LOD), limits of quantification (LOQ), linearity, accuracy and precision. Three ER peptides were selected for quantification as they gave the greatest LOD, LOQ, linearity as well as reasonable intra- and inter-assay precision following multiple digestions of rER (intra = 3 digestions in 1 day; inter = 9 digestions over 3 weeks). Following IP of ER from four replicate MCF7 cell lysates (1mg/ml total protein) and measurement of ion intensities of the three ER peptides the mean concentration of ER was calculated to be 52 fmol (S.D of 7.5 fmol; n=4) per mg of total cell lysate after normalising for IP efficiency. We continue to develop the method to improve sensitivity and normalise for variability in IP and digestion. With the inclusion of reference peptides to known ER phosphorylation sites we are also in the process of quantifying ER phosphorylation. We aim to accurately determine ER concentration and phosphorylation status in tumor lysates and assess how these correlate with responsiveness to antiestrogen therapies. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-07-23.