Publications by authors named "Steven R McFaull"

17 Publications

  • Page 1 of 1

Sentinel surveillance of substance-related self-harm in Canadian emergency departments, 2011 - 19.

BMC Public Health 2022 05 14;22(1):974. Epub 2022 May 14.

Public Health Agency of Canada, Ottawa, ON, Canada.

Introduction: Self-harm is a public health concern that can result in serious injury or death. This study provides an overview of emergency department (ED) visits for patients presenting with substance-related self-harm.

Methods: Cases of self-harm in the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database were extracted (April 2011 to September 2019; N = 15,682), using various search strategies to identify substance-related self-harm cases for patients 10 years and older. Cases involving alcohol, cannabis, illicit drugs, or medications (or any combinations of these) were included. Additional variables, including age and sex, location and the severity of injury (hospital admission) were examined. Proportionate injury ratios (PIR) were used to compare emergency department outcomes of self-harm and unintentional injuries involving substance use. Time trends were quantified using Joinpoint regression. For cases requiring hospital admission, text fields were analyzed for contextual factors.

Results: A total of 9470 substance-related self-harm cases were reported (28.1% of all intentional injury cases), representing 820.0 records per 100,000 eCHIRPP records. While age patterns for both sexes were similar, the number of cases for females was significantly higher among 15-19 year olds. Over half (55%) of cases that identified substance type involved medications, followed by multi-type substance use (19.8%). In the ED, there were proportionally more treatments, observations, and admissions presenting with substance-related self-harm compared to substance-related unintentional injury cases. Among those aged 20+ years, a statistically significant increasing trend of 15.9% per year was observed, while among those aged 10-19 years a significant annual percent change of 16.9% was noted (2011 to 2019). Text field analysis demonstrated suicide attempt or ideation was a reoccurring theme among all age groups. Poor mental health status or conflict with family or an intimate partner were reported stressors, depending on age group. Additional self-harming injuries, such as cutting, were reported among all age groups.

Conclusion: Our study found that hospital admission for substance-related self-harm was highest for patients aged 15-19 years, especially females, and that they were more likely to use medications. The statistically significant increasing trend of cases found between 2011 and 2019 is notable. Patients showed multiple types of adversities, demonstrating the complexity of this issue.
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http://dx.doi.org/10.1186/s12889-022-13287-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9107222PMC
May 2022

Associations between meteorological factors and emergency department visits for unintentional falls during Ontario winters.

Health Promot Chronic Dis Prev Can 2021 Dec;41(12):401-412

School of Mathematics and Statistics, Faculty of Science, Carleton University, Ottawa, Ontario, Canada.

Introduction: Unintentional falls are a leading cause of injury-related hospital visits among Canadians, especially seniors. While certain meteorological conditions are suspected risk factors for fall-related injuries, few studies have quantified these associations across a wider range of age groups and with population-based datasets.

Methods: We applied a time-stratified case-crossover study design to characterize associations of highly-spatially-resolved meteorological factors and emergency department (ED) visits for falls, in Ontario, among those aged 5 years and older during the winter months (November to March) between 2011 and 2015. Conditional logistic models were used to estimate the odds ratios (ORs) and their 95% confidence intervals (CIs) for these visits in relation to daily snowfall accumulation, including single-day lags of up to one week before the visit, and daily mean temperature on the day of the visit. Analyses were stratified by age and sex.

Results: We identified 761 853 fall-related ED visits. The odds for these visits was increased for most days up to a week after a snowfall of 0.2 cm or greater (OR = 1.05-1.08) compared to days with no snowfall. This association was strongest among adults aged 30 to 64 years (OR = 1.16-1.19). The OR for fall-related ED visits on cold days (less than -9.4 °C) was reduced by 0.05 relative to days with an average daily temperature of 3.0 °C or higher (OR = 0.95; 95% CI: 0.94, 0.96), and this pattern was evident across all ages. There were no substantive differences in the strength of this association by sex.

Conclusion: Snowfall and warmer winter temperatures were associated with an increased risk of fall-related ED visits during Ontario winters. These findings are relevant for developing falls prevention strategies and ensuring timely treatment.
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http://dx.doi.org/10.24095/hpcdp.41.12.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8796965PMC
December 2021

Strengthening surveillance of consumer products in Canada: the vaping example.

Health Promot Chronic Dis Prev Can 2020 Oct;40(10):309-313

Consumer and Hazardous Products Safety Directorate, Health Canada, Ottawa, Ontario, Canada.

Introduction: The overall objective of this study was to demonstrate how information collected by the Consumer Product Safety Program ("the Program") can be used to identify emerging hazards. Specifically, this study characterized and quantified trends associated with vaping reports received by the Program over the past five years.

Methods: Data collated by the Program were extracted for the period from 1 January, 2015 to 30 September, 2019. The data were summarized using descriptive statistics and trends were quantified for annual percent change. In order to compare characteristics of vaping reports, the proportionate injury ratios (PIRs) and corresponding 95% CIs were used to compare vaping-related injuries to all other reports received by the Program.

Results: A total of 71 vaping-related reports were received between 1 January, 2015 and 30 September, 2019. During this period, the annual percent change increase in the number of reports received was approximately 73% annually (p < .05). Among the reported injuries, 41% were burn injuries. Proportionally, there were more vaping reports involving males (PIR = 1.89; 95% CI: 1.51-2.36) and individuals between the ages of 15 and 19 years (PIR = 11.53; 95 % CI: 4.95-26.8) as compared to all other reports submitted to the Program.

Conclusions: While the number of reports relating to vaping products is small, the results of this analysis suggest that certain groups, including males and youth, are more likely to be the subject of a vaping-related incident.
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http://dx.doi.org/10.24095/hpcdp.40.10.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608933PMC
October 2020

A population-based study of fall-related traumatic brain injury identified in older adults in hospital emergency departments.

Neurosurg Focus 2020 10;49(4):E20

4Injury Section, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada.

Objective: The purpose of this study was to examine the population-based trends and factors associated with hospitalization of patients with traumatic brain injury (TBI) treated in the Emergency Department (ED) among those 65 years and older. The implications of these trends for neurosurgery and the broader society are discussed.

Method: With a national, mandatory reporting system of ED visits, the authors used Poisson regression controlling for age and sex to analyze trends in fall-related TBI of those aged 65 years and older between 2002 and 2017.

Results: The overall rate of ED visits for TBI increased by 78%-from 689.51 per 100,000 (95% CI 676.5-702.8) to 1229 per 100,000 (95% CI 1215-1243) between 2002 and 2017. Females consistently experienced higher rates of fall-related TBI than did males. All age groups 65 years and older experienced significant increases in fall-related TBI rate over the study period; however, the highest rates occurred among the oldest individuals (90+ and 85-89 years). The hospital admission rate increased with age and Charlson Comorbidity Index. Males experienced both a higher admission rate and a greater percentage change in admission rate than females.

Conclusions: Rates of ED visits for fall-related TBI, hospitalization, and in-ED mortality in those aged 65 years and older are increasing for both sexes. The increasing hospital admission rate is related to more advanced comorbidities, male sex, and increasing age. These findings have significant implications for neurosurgical resources; they emphasize that health professionals should work proactively with patients, families, and caregivers to clarify goals of care, and they also outline the need for more high-level and, preferably, randomized evidence to support outcomes-based decisions. Additionally, the findings highlight the urgent need for improved population-based measures for prevention in not only this age demographic but in younger ones, and the need for changes in the planning of health service delivery and long-term care.
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http://dx.doi.org/10.3171/2020.7.FOCUS20520DOI Listing
October 2020

Injuries and poisonings associated with e-cigarettes and vaping substances, electronic Canadian Hospitals Injury Reporting and Prevention Program, 2011-2019.

Health Promot Chronic Dis Prev Can 2020 Aug;40(7-8):250-254

Public Health Agency of Canada, Ottawa, Ontario, Canada.

Electronic cigarettes are devices that deliver nicotine to the user by heating an e-liquid. In Canada, the Tobacco and Vaping Products Act became law on May 23, 2018. The purpose of this study was to describe the cases of injuries and poisonings associated with e-cigarette and vaping substances that presented to Canadian emergency departments within the electronic Canadian Hospitals Injury Reporting and Prevention Program network between 2011 and 2019. A total of 68 cases were retrieved (54.4% males). Of the 68 cases, 8 occurred between 2011 and 2014, while 35 (51.5%) occurred in 2018 or 2019. Ingestions, inhalations and burns were observed.
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http://dx.doi.org/10.24095/hpcdp.40.7/8.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450903PMC
August 2020

Child injuries in land vehicles that do not require restraints.

Int J Inj Contr Saf Promot 2020 Sep 15;27(3):347-354. Epub 2020 Jun 15.

Children's Hospital Research Institute on Manitoba, Winnipeg, MB, Canada.

The goal of this study was to determine the injury profiles of Canadian children who presented to the Emergency Department from 1990 to 2016 due to an injury caused while traveling in a form of land transportation that did not require child restraint. A case series was conducted using data from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP). Children who were injured while travelling on land transportation for which child restraint is not required, who presented to a Canadian Emergency Department that participates in eCHIRPP between April 1, 1990 to August 29, 2016, were included. Overall, 1856 children sustained 2139 injuries (mean age: 9.8 years (SD 4.5), 45.5% male). The majority of children were injured on a school bus (49.3%). The most commonly injured body part was the head or neck (52.6%). The most common type of injury was a superficial or open wound (33.1%), followed by traumatic brain injury (19.3%). Overall, 39.4% of injuries required no treatment in hospital. Overall, approximately 70 children presented to eCHIRPP EDs per year on a land transportation vehicle that does not require restraints. Biomechanical studies are needed to improve safety on land transportation vehicles that do not require seatbelts.
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http://dx.doi.org/10.1080/17457300.2020.1778039DOI Listing
September 2020

Surveillance from the high ground: sentinel surveillance of injuries and poisonings associated with cannabis.

Health Promot Chronic Dis Prev Can 2020 Jun;40(5-6):184-192

Public Health Agency of Canada, Ottawa, Ontario, Canada.

Introduction: In October 2018, Canada legalized the nonmedical use of cannabis for adults. The aim of our study was to present a more recent temporal pattern of cannabis-related injuries and poisonings found in the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database and provide a descriptive summary of the injury characteristics of cannabis-related cases captured in a nine-year period.

Methods: We conducted a search for cannabis-related cases in the eCHIRPP database reported between April 2011 and August 2019. The study population consisted of patients between the ages of 0 and 79 years presenting to the 19 selected emergency departments across Canada participating in the eCHIRPP program. We calculated descriptive estimates examining the intentionality, external cause, type and severity of cannabis-related cases to better understand the contextual factors of such cases. We also conducted time trend analyses using Joinpoint software establishing the directionality of cannabis-related cases over the years among both children and adults.

Results: Between 1 April 2011, and 9 August, 2019, there were 2823 cannabis-related cases reported in eCHIRPP, representing 252.3 cases/100 000 eCHIRPP cases. Of the 2823 cannabis-related cases, a majority involved cannabis use in combination with one or more substances (63.1%; 1780 cases). There were 885 (31.3%) cases that involved only cannabis, and 158 cases (5.6%) that related to cannabis edibles. The leading external cause of injury among children and adults was poisoning. A large proportion of cannabis-related cases were unintentional in nature, and time trend analyses revealed that cannabis-related cases have recently been increasing among both children and adults. Overall, 15.1% of cases involved serious injuries requiring admission to hospital.

Conclusion: Cannabis-related cases in the eCHIRPP database are relatively rate, a finding that may point to the fact that mental and behavioural disorders resulting from cannabis exposure are not generally captured in this surveillance system and the limited number of sites found across Canada. With Canada's recent amendments to cannabis regulations, ongoing surveillance of the health impacts of cannabis will be imperative to help advance evidence to protect the health of Canadians.
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http://dx.doi.org/10.24095/hpcdp.40.5/6.07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367429PMC
June 2020

Trends in emergency department visits for acetaminophen-related poisonings: 2011-2019.

Health Promot Chronic Dis Prev Can 2020 Apr;40(4):130-133

Public Health Agency of Canada, Ottawa, Ontario, Canada.

We examined trends in emergency department (ED) presentation rates for acetaminophenrelated poisonings across Canada. A total of 27123 cases of poisoning were seen in the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) sentinel sites between April 2011 and February 2019; of these, 13.7% were related to acetaminophen use. A significant decreasing trend for both sexes was observed for unintentional poisonings (males: -10.3%; females: -8.0%). For intentional poisonings, there was a significant decrease among females only (-5.9%). Females have consistently displayed higher rates of ED presentations for both unintentional and intentional poisoning.
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http://dx.doi.org/10.24095/hpcdp.40.4.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197639PMC
April 2020

Injuries and poisonings associated with methamphetamine use: sentinel surveillance, the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP), 2011-2019.

Health Promot Chronic Dis Prev Can 2020 Apr;40(4):126-129

Public Health Agency of Canada, Ottawa, Ontario, Canada.

Information from emergency department (ED) visits for methamphetamine-related injuries and poisonings between 1 April 2011 and 9 August 2019 were captured from 19 sentinel sites across Canada for all ages. Overall, 1093 cases (97.6/100 000 eCHIRPP cases) were identified (59.4% male), with female patients experiencing more poisonings (71% vs 57.4% for males). Unintentional injuries and poisoning accounted for 14.8% of ED presentations. Self-harm (while or as a result of consuming methamphetamine) accounted for 11.4% of cases. The circumstances surrounding injuries and poisonings associated with methamphetamine are varied and include self-harm, fall-related brain injuries, mental illness, criminal activity and other circumstances. These domains should be taken into account when developing mitigation strategies.
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http://dx.doi.org/10.24095/hpcdp.40.4.04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197642PMC
April 2020

The ups and downs of trampolines: Injuries associated with backyard trampolines and trampoline parks.

Paediatr Child Health 2019 Feb 17;24(1):e19-e25. Epub 2018 May 17.

Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Ontario.

Objective: To compare characteristics associated with backyard trampoline injuries (BTI) and trampoline park injuries (TPI) using records from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP).

Methods: eCHIRPP records for trampoline injuries (2012 to 2016) were extracted using variable codes and narratives, and injuries were examined among individuals 17 years and younger. Descriptive estimates for BTI and TPI, as well as age and sex adjusted odds ratios (OR) for the mechanism, source, body part and type of injury associated with TPIs relative to BTIs, are presented.

Results: Trampoline injuries are increasing in Canada (P<0.01). Patients with TPIs were older than those with BTIs. Relative to BTIs, TPIs were more associated with impact as the mechanism (OR 2.6, 95% CI: 2.2 to 3.1), trampoline beds as the source (OR 1.7, 95% CI: 1.4 to 2.1), lower extremity as the body part (OR 3.7, 95% CI: 3.0 to 4.4) and sprains as the type of injury (OR 2.0, 95% CI: 1.6 to 2.4). In contrast, another jumper (OR 0.5, 95% CI: 0.4 to 0.6) or fall (OR 0.4, 95% CI: 0.4 to 0.6) as the mechanism, surface (OR 0.7, 95% CI: 0.5 to 0.9) or another jumper (OR 0.5, 95% CI: 0.4 to 0.7) as the source, face or neck (OR 0.6, 95% CI: 0.4 to 0.7) as the body part, and lacerations (OR 0.6, 95% CI: 0.3 to 0.9) or soft tissue injury (OR 0.7, 95% CI: 0.6 to 0.9) as the type of injury were more associated with BTIs relative to TPIs.

Conclusion: Trampoline parks result in injuries different than those from backyard trampolines. This examination into the distinct injury characteristics can help to inform future prevention measures.
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http://dx.doi.org/10.1093/pch/pxy066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376289PMC
February 2019

Cheerleading injuries in children: What can be learned?

Paediatr Child Health 2017 Jun 5;22(3):130-133. Epub 2017 May 5.

Sainte-Justine Hospital, Department of Paediatrics, Université de Montréal, Montréal, Québec.

Introduction: Cheerleading has gradually become more popular in Canada and represents an accessible way for youth to be physically active.

Objective: To determine the differences in the injuries encountered by cheerleaders according to their age, in order to propose safety guidelines that take into account the developmental stages of children.

Method: Retrospective database review of cheerleading injuries extracted from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database between 1990 and 2010. The injuries were compared by age group (5 to 11 versus 12 to 19) according to their sex, mechanism of injury and injury severity.

Results: Overall, in 20 years, there were 1496 cases of injuries documented secondary to cheerleading (median age 15, 4 (interquartile range [IQR]=2, 2) years); mostly females (1410 [94%]). Of that number, 101 cases were 5 to 11 years old (age group [AG]1), while 1385 were 12 to 19 (AG2). Participants in AG1 were found to have a higher proportion of moderate-to-severe injury (46.5% compared with 28.2% in AG2). The odds ratio of moderate/severe injury for AG1 compared with AG2 was found to be 2.217 (95% CI [1.472; 3.339]). No fatalities were known to have occurred.

Conclusion: Children's developmental stages affect their ability to participate in sports and the responses of their bodies to impact forces. Our findings concerning cheerleading injuries indicate that younger children (5 to 11 years old) are more likely to suffer moderate-to-severe injuries. Thus, on a local basis, the use of appropriate safety measures including appropriate flooring/safety mats and spotters to catch falling athletes should be mandatory.
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http://dx.doi.org/10.1093/pch/pxx048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805112PMC
June 2017

Predictors of falls and mortality among elderly adults with traumatic brain injury: A nationwide, population-based study.

PLoS One 2017 21;12(4):e0175868. Epub 2017 Apr 21.

Division of Neurosurgery, Department of Surgery, St. Michael's Hospital; Injury Prevention Research Office, Li Ka Shing Knowledge Institute, Keenan Research Centre; University of Toronto; Toronto, Canada.

Background: Elderly adults are at particular risk of sustaining a traumatic brain injury (TBI), and tend to suffer worse outcomes compared to other age groups. Falls are the leading cause of TBI among the elderly.

Methods: We examined nationwide trends in TBI hospitalizations among elderly adults (ages 65 and older) between April 2006 and March 2011 using a population-based database that is mandatory for all hospitals in Canada. Trends in admission rates were analyzed using linear regression. Predictors of falls and in-hospital mortality were identified using logistic regression.

Results: Between 2006 and 2011, there were 43,823 TBI hospitalizations resulting in 6,939 deaths among elderly adults in Canada. Over the five-year study period, the overall rate of TBI admissions increased by an average of 6% per year from 173.2 to 214.7 per 100,000, while the rate of fall-related TBI increased by 7% annually from 138.6 to 179.2 per 100,000. There were significant trends towards increasing age and comorbidity level (p<0.001 and p = 0.002). Advanced age, comorbidity, and injury severity were independent predictors of both TBI-related falls and mortality on multivariate analysis.

Conclusion: Prevention efforts should be targeted towards vulnerable demographics including the "older old" (ages 85 and older) and those with multiple medical comorbidities. Additionally, hospitals and long-term care facilities should be prepared to manage the burgeoning population of older patients with more complex comorbidities.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0175868PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400247PMC
September 2017

Health & Economic Burden of Traumatic Brain Injury in the Emergency Department.

Can J Neurol Sci 2016 Mar 4;43(2):238-47. Epub 2016 Feb 4.

1Division of Neurosurgery,Department of Surgery,St. Michael's Hospital,Toronto,Ontario,Canada.

Objective: To evaluate epidemiological patterns and lifetime costs of traumatic brain injury (TBI) identified in the emergency department (ED) within a publicly insured population in Ontario, Canada, in 2009.

Methods: A nationally representative, population-based database was used to identify TBI cases presenting to Ontario EDs between April 2009 and March 2010. We calculated unit costs for medical treatment and productivity loss, and multiplied these by corresponding incidence estimates to determine the lifetime costs of identified TBI cases across age group, sex, and mechanism of injury.

Results: In 2009, there were more than 133,000 ED visits for TBI in Ontario, resulting in a conservative estimate of $945 million in lifetime costs. Lifetime cost estimates ranged from $279 million to $1.22 billion depending on the diagnostic criteria used to define TBI. Peak rates of TBI occurred among young children (ages 0-4 year) and the elderly (ages 85+ years). Males experienced a 53% greater rate of TBI and incurred two-fold higher costs compared with females. Falls, sports/bicyclist-related injuries, and motor vehicle crashes represented 47%, 12%, and 10% of TBI presenting to ED, respectively, and accounted for a significant proportion of costs.

Conclusions: This study revealed an enormous health and economic burden associated with TBI identified in the ED setting. Our findings underscore the importance of ongoing surveillance and prevention efforts targeted to vulnerable populations. More research is needed to fully appreciate the burden of TBI across a variety of health care settings.
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http://dx.doi.org/10.1017/cjn.2015.320DOI Listing
March 2016

Recent trends in hospitalization and in-hospital mortality associated with traumatic brain injury in Canada: A nationwide, population-based study.

J Trauma Acute Care Surg 2015 Sep;79(3):449-54

Background: Traumatic brain injury (TBI) is the leading cause of traumatic death and disability worldwide.We examined nationwide trends in TBI-related hospitalizations and in-hospital mortality between April 2006 and March 2011 using a nationwide, population based database that is mandatory for all hospitals in Canada.

Methods: Trends in hospitalization rates for all acute hospital separations in Canada were analyzed using linear regression. Independent predictors of in-hospital mortality were evaluated using logistic regression.

Results: Hospitalization rates remained stable for children and young adults but increased considerably among elderly adults (age Q65 years). Falls and motor vehicle collisions (MVCs) were the most common causes of TBI hospitalizations. TBIs caused by falls increased by 24% (p = 0.01), while MVC-related hospitalization rates decreased by 18% (p = 0.03). Elderly adults were most vulnerable to falls and experienced the greatest increase (29%) in fall-related hospitalization rates. Young adults (ages, 15Y24 years) were most at risk for MVCs but experienced the greatest decline (28%) in MVC-related admissions. There were significant trends toward increasing age, injury severity, comorbidity, hospital length of stay, and rate of in-hospital mortality.However, multivariate regression showed that odds of death decreased over time after controlling for relevant factors. Injury severity, comorbidity, and advanced age were the most important predictors of in-hospital mortality for TBI inpatients.

Conclusion: Hospitalizations for TBI are increasing in severity and involve older populations with more complex comorbidities. Although preventive strategies for MVC-related TBI are likely having some effects, there is a critical need for effective fall prevention strategies, especially among elderly adults.
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http://dx.doi.org/10.1097/ta.0000000000000733DOI Listing
September 2015

Epidemiology of sports-related injuries in children and youth presenting to Canadian emergency departments from 2007-2010.

BMC Sports Sci Med Rehabil 2013 Dec 23;5(1):30. Epub 2013 Dec 23.

School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3 Canada.

Background: Although injuries related to sports and recreation represent a significant burden to children and youth, few studies have examined the descriptive epidemiology of sports-related injury since 2005, and some sports such as ringette have not been evaluated to date. The primary purpose of this study was to provide the descriptive epidemiology of sports-related injuries treated in emergency departments for children and youth aged 5 - 19.

Methods: A retrospective data analysis was performed using data from the Canadian Hospitals Injury Reporting and Prevention Program [CHIRPP] from fiscal years (April - March) 2007/08 to 2009/10. CHIRPP is a computerized information system designed by the Public Health Agency of Canada that collects information about injuries to people evaluated in emergency departments across 11 pediatric hospitals and 5 general hospitals in Canada. Thirteen sports or activities were analyzed (baseball, basketball, cycling, football, ice hockey, lacrosse, ringette, rugby, skiing, sledding, snowboarding, soccer, and volleyball). Descriptive statistics, including frequency by sport, age and sex, as well as the percent of concussions within each sport were calculated.

Results: Out of a total of 56, 691 reported sports and recreational injuries, soccer accounted for the largest proportion of injuries with 11,941 reported cases over the 3 year time period. Of these, approximately 30% were fractures. The 10 - 14 year age group reported the greatest proportion of injuries in 10 out of the 13 sports analyzed. In addition, males reported a greater number of overall injuries than females in 11 out of the 13 sports analyzed. The largest percentage of concussions was reported in ringette; these injuries accounted for 17.1% of overall injuries within this sport.

Conclusions: Injury prevention programs in Canada should focus on improving evidence-based programs to reduce the burden of injuries in all sports.
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http://dx.doi.org/10.1186/2052-1847-5-30DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878023PMC
December 2013

Mechanisms of team-sport-related brain injuries in children 5 to 19 years old: opportunities for prevention.

PLoS One 2013 28;8(3):e58868. Epub 2013 Mar 28.

Injury Prevention Research Office, St. Michael's Hospital, University of Toronto, Toronto, Canada.

Background: There is a gap in knowledge about the mechanisms of sports-related brain injuries. The objective of this study was to determine the mechanisms of brain injuries among children and youth participating in team sports.

Methods: We conducted a retrospective case series of brain injuries suffered by children participating in team sports. The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database was searched for brain injury cases among 5-19 year-olds playing ice hockey, soccer, American football (football), basketball, baseball, or rugby between 1990 and 2009. Mechanisms of injury were classified as "struck by player," "struck by object," "struck by sport implement," "struck surface," and "other." A descriptive analysis was performed.

Results: There were 12,799 brain injuries related to six team sports (16.2% of all brain injuries registered in CHIRPP). Males represented 81% of injuries and the mean age was 13.2 years. Ice hockey accounted for the greatest number of brain injuries (44.3%), followed by soccer (19.0%) and football (12.9%). In ice hockey, rugby, and basketball, striking another player was the most common injury mechanism. Football, basketball, and soccer also demonstrated high proportions of injuries due to contact with an object (e.g., post) among younger players. In baseball, a common mechanism in the 5-9 year-old group was being hit with a bat as a result of standing too close to the batter (26.1% males, 28.3% females).

Interpretation: Many sports-related brain injury mechanisms are preventable. The results suggest that further efforts aimed at universal rule changes, safer playing environments, and the education of coaches, players, and parents should be targeted in maximizing prevention of sport-related brain injury using a multifaceted approach.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0058868PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3610710PMC
October 2013

Effect of bodychecking on rate of injuries among minor hockey players.

Open Med 2011 15;5(1):e57-64. Epub 2011 Mar 15.

Division of Neurosurgery and Injury Prevention Research Office, St. Michael’s Hospital, University of Toronto, 30 Bond St., Toronto, Ontario, Canada.

Background: Bodychecking is a leading cause of injury among minor hockey players. Its value has been the subject of heated debate since Hockey Canada introduced bodychecking for competitive players as young as 9 years in the 1998/1999 season. Our goal was to determine whether lowering the legal age of bodychecking from 11 to 9 years affected the numbers of all hockey-related injuries and of those specifically related to bodychecking among minor hockey players in Ontario.

Methods: In this retrospective study, we evaluated data collected through the Canadian Hospitals Injury Reporting and Prevention Program. The study's participants were male hockey league players aged 6-17 years who visited the emergency departments of 5 hospitals in Ontario for hockey-related injuries during 10 hockey seasons (September 1994 to May 2004). Injuries were classified as bodychecking-related or non-bodychecking-related. Injuries that occurred after the rule change took effect were compared with those that occurred before the rule's introduction.

Results: During the study period, a total of 8552 hockey-related injuries were reported, 4460 (52.2%) of which were attributable to bodychecking. The odds ratio (OR) of a visit to the emergency department because of a bodychecking-related injury increased after the rule change (OR 1.26, 95% confidence interval [CI] 1.16-1.38), the head and neck (OR 1.52, 95% CI 1.26-1.84) and the shoulder and arm (OR 1.18, 95% CI 1.04-1.35) being the body parts with the most substantial increases in injury rate. The OR of an emergency visit because of concussion increased significantly in the Atom division after the rule change, which allowed bodychecking in the Atom division. After the rule change, the odds of a bodychecking-related injury was significantly higher in the Atom division (OR 2.20, 95% CI 1.70-2.84).

Interpretation: In this study, the odds of injury increased with decreasing age of exposure to bodychecking. These findings add to the growing evidence that bodychecking holds greater risk than benefit for youth and support widespread calls to ban this practice.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205817PMC
April 2012
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