BACKGROUND: Road safety for older adults should receive more attention in low-income and middle-income countries with rapidly ageing populations.
METHODS: Using injury surveillance data from Khon Kaen Regional Hospital in northeastern Thailand, we calculated the proportion of older adults in the total number of patients who were fatally and non-fatally injured in road traffic crashes in each year from 2001 to 2020 and the proportion of road user type in the fatal and non-fatal patients by age groups for the entire study period to examine the extent to which older adults were involved in the crashes and with what mode of transportation.
RESULTS: During the 20-year period, there were 5046 fatal and 180 353 non-fatal patients of whom 509 (10%) and 6087 (3%) were aged 65 years or older, respectively. From 2001 to 2020, this proportion increased from 3% to 20% among the fatal patients and from 1% to 6% among the non-fatal patients. Of the fatal and non-fatal patients aged 65 years or older, 50% and 54% were involved in road traffic crashes while driving motorcycles and 28% and 22% while riding bicycles or walking, respectively. Compared with patients aged 65-74 years, those aged 75 years or older tended to be bicyclists or pedestrians in the crashes, though as high as 40% of them were motorcycle drivers.
CONCLUSIONS: Older adults are increasingly injured in road traffic crashes as vulnerable road users in Thailand. Therefore, road safety efforts should consider their presence on the road.

BACKGROUND: Paediatric drowning is an injury associated with significant morbidity and mortality.
OBJECTIVE: The objective is to describe drowning trends, including associations with inpatient hospitalisation or fatality, in a state-wide paediatric cohort to inform prevention strategies.
METHODS: In this retrospective cohort study using the Health Services Cost Review Commission database, we used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify patients aged 0-19 years with an outpatient (including emergency department) or inpatient medical encounter following a non-fatal or fatal drowning event between 2016 and 2019. Descriptive statistics and logistic regression were used to summarise the data and evaluate associations with inpatient hospitalisation or fatality.
RESULTS: There were 541 medical encounters for drowning events, including 483 non-fatal outpatient encounters, 42 non-fatal inpatient encounters and 16 fatal cases. Overall, most patients were boys, 0-4 years, white and lived in urban settings. White children accounted for 66% of encounters among those aged 0-4 years, whereas non-white children accounted for 62% of visits among those aged 10-19 years. Non-white children were more likely than white children to experience a fatal drowning (OR 3.6, 95% CI: 1.2 to 11.5). Adolescents were more likely than younger children to be hospitalised (OR 3.1, 95% CI: 1.6 to 6.5) and had higher charges in outpatient (p=0.002) and inpatient settings (p=0.003).
CONCLUSIONS: Our study revealed high fatality rates among non-white children and high admission rates among adolescents.

BACKGROUND: Commotio cordis is a rare event that occurs following blunt, non-penetrating trauma to the chest, precipitating a ventricular arrhythmia. Commotio cordis requires immediate medical attention through cardiopulmonary resuscitation and defibrillation, often resulting in death. Commotio cordis is most common condition among young male athletes. The purpose of this study was to describe the incidents and patterns of commotio cordis among young athletes participating in organised sports in the USA from academic years 1982-1983 through 2022-2023.
METHODS: This was a retrospective, descriptive epidemiology study using surveillance data from the National Center for Catastrophic Sport Injury Research. The study included all commotio cordis incidents captured in the database. We calculated descriptive statistics (counts and proportions) overall and stratified by outcome and athlete sport.
RESULTS: Over the study period, 64 incidents of commotio cordis were captured. The majority occurred among males (n=60) and were caused by contact with an object/apparatus (n=39) or contact with another player (n=20). The most common sports were baseball (n=20), lacrosse (n=17) and football (n=13). Over half of these incidents resulted in death (n=34), although survival from commotio cordis increased over the study period. A higher proportion of fatal incidents occurred among football athletes and were caused by contact with another player.
CONCLUSIONS: Commotio cordis remains most common among young male athletes who participate in organised baseball, lacrosse and football. Although survival has improved over time, greater awareness and emergency preparedness for commotio cordis in an organised sport are needed to facilitate prompt recognition and intervention.

BACKGROUND: Pedestrian and bicycling injuries may be less likely to be captured by traffic injury surveillance relying on police reports. Non-collision injuries, including pedestrian falls and single bicycle crashes, may be more likely than motor vehicle collisions to be missed. This study uses healthcare records to expand the ascertainment of active transportation injuries and evaluate their demographic and clinical features.
METHODS: We identified pedestrian and bicyclist injuries in records of deaths, hospitalisations and emergency department visits in Ontario, Canada, between 2002 and 2017. We described the most common types of clinical injury codes among these records and assessed overall counts and proportions of injury types captured by each ascertainment definition. We also ascertained relevant fall injuries where the location was indicated as \'street or highway\'.
RESULTS: Pedestrian falls represented over 50% of all pedestrian injuries and affected all age groups, particularly non-fatal falls. Emergency department records indicating in-traffic bicycle injuries not involving a collision with motor vehicles increased from 14% of all bicycling injury records in 2003 to 34% in 2017. The overall number of injuries indicated by these ascertainment methods was substantially higher than official counts derived from police reports.
CONCLUSIONS: The use of healthcare system records to ascertain bicyclist and pedestrian injuries, particularly to include non-collision falls, can more fully capture the burden of injury associated with these transportation modes.

BACKGROUND: Firearm-related injury represents a significant public health problem in the USA. Firearm purchasing has risen nationwide and there has been increased efforts to deploy injury prevention initiatives within gun establishments. However, firearm-related risks and harms that may occur inside these high-exposure settings are not well characterized.
METHODS: This secondary analysis leveraged Gun Violence Archive data to quantify firearm injury prevalence rates within different types of gun establishments from 1 January 2015 to 31 December 2022. Data were restricted to incidents that occurred in gun ranges, gun shops, and public and private ranges. The following incident characteristics were available in the individual-level data: date, location, injury count, fatality count, victim demographics (age, sex), shooting intent (suicide/self-inflicted, assault/homicide, unintentional, undetermined) and establishment type.
RESULTS: Over 7 years, 445 non-fatal and 183 fatal shooting events occurred across 576 unique establishments. Non-fatal, unintentional injuries predominated in stand-alone firing ranges whereas fatal, self-inflicted injuries concentrated in retail shops with accompanying firing ranges. Firearm-related assaults were prevalent among stand-alone retail shops.
CONCLUSIONS: Overall, this secondary analysis underscores that the prevalence of firearm injury in gun establishments across the USA is low, and these settings should continue to be studied as important contexts for intervention. Interweaving public health interventions into gun establishments presents an opportunity to potentially reduce associated harms to consumers interacting within these environments.

BACKGROUND: The Fire service Organizational Culture of Safety (FOCUS) survey is an assessment tool comprised of psychometrically validated metrics of safety climate, safety behavior, and downstream outcomes (organizational and injury) that are specific to the U.S. fire and rescue service.
METHODS: This analysis consists of a descriptive summary of two independent survey waves (FOCUS 1.0 and 2.0). The fire departments included in these survey waves were from convenience sampling (n1.0 = 275; n2.0 = 170). In addition to department level characteristics, we examined individual level characteristics for firefighters and EMS providers in participating departments (n1.0 = 22,719; n2.0 = 16,882). We conducted regression analyses to examine the associations between safety climate and safety behaviors, organizational outcomes, and safety outcomes. All analyses were stratified by organization type (career, volunteer).
RESULTS: Our analysis indicated that a majority of respondents were males (90.7%FOCUS 1.0; 90.4%FOCUS 2.0), non-officers (68.4%FOCUS 1.0; 66.4%FOCUS 2.0), and non-Hispanic Whites (70.8%FOCUS 1.0; 69.5%FOCUS 2.0). For both samples there was a higher prevalence of injuries among individuals in career departments (nFOCUS 1.0 = 3778 [17.5%]; nFOCUS 2.0 = 3072 [18.7%]) than volunteer departments (nFOCUS 1.0 = 103 [8.8%]; nFOCUS 2.0 = 34 [7.4%]). We observed an approximate 10-point difference between the mean scores of Management Commitment to Safety for career and volunteer departments in both samples. We observed associations for two organizational outcomes, Safety Behavior and Job Satisfaction, with Management Commitment to Safety and Supervisor Support for Safety overall and when stratified by organization type. We observed a decrease in the odds of injuries associated with a one-unit increase in Management Commitment to Safety (OR1.0 overall: 0.98, 95% CI 0.97-0.99; OR2.0 volunteer: 0.90, 95% CI 0.85-0.95) and Supervisor Support for Safety (OR1.0 overall: 0.95, 95% CI 0.93-0.97; OR1.0 career: 0.95, 95% CI 0.92-0.98).
CONCLUSIONS: From our current study, and a prior analysis of a geographically stratified random sample of U.S. fire departments, we identified that from all the organizational outcomes, job satisfaction was most consistently associated with FOCUS safety climate. Further, firefighters in our samples consistently rated Supervisor Support for Safety higher than Management Commitment to Safety. Future interventions should support fire departments in improving their departmental Management Commitment to Safety and maintaining their Supervisor for Safety.

BACKGROUND: Respiratory syncytial virus (RSV) is a major cause of morbidity and mortality among US infants. A child\'s calendar birth month determines their age at first exposure(s) to RSV. We estimated birth month-specific risk of medically attended (MA) RSV lower respiratory tract infection (LRTI) among infants during their first RSV season and first year of life (FYOL).
METHODS: We analyzed infants born in the USA between July 2016 and February 2020 using three insurance claims databases (two commercial, one Medicaid). We classified infants\' first MA RSV LRTI episode by the highest level of care incurred (outpatient, emergency department, or inpatient), employing specific and sensitive diagnostic coding algorithms to define index RSV diagnoses. In our main analysis, we focused on infants\' first RSV season. In our secondary analysis, we compared the risk of MA RSV LRTI during infants\' first RSV season to that of their FYOL.
RESULTS: Infants born from May through September generally had the highest risk of first-season MA RSV LRTI-approximately 6-10% under the specific RSV index diagnosis definition and 16-26% under the sensitive. Infants born between October and December had the highest risk of RSV-related hospitalization during their first season. The proportion of MA RSV LRTI events classified as inpatient ranged from 9% to 54% (specific) and 5% to 33% (sensitive) across birth month and comorbidity group. Through the FYOL, the overall risk of MA RSV LRTI is comparable across birth months within each claims database (6-11% under the specific definition, 17-30% under the sensitive), with additional cases progressing to care at outpatient or ED settings.
CONCLUSIONS: Our data support recent national recommendations for the use of nirsevimab in the USA. For infants born at the tail end of an RSV season who do not receive nirsevimab, a dose administered prior to the onset of their second RSV season could reduce the incidence of outpatient- and ED-related events.

BACKGROUND: Determining industry of decedents and victim-perpetrator relationships is crucial to inform and evaluate occupational homicide prevention strategies. In this study, we examine occupational homicide rates in North Carolina (NC) by victim characteristics, industry and victim-perpetrator relationship from 1992 to 2017.
METHODS: Occupational homicides were identified from records of the NC Office of the Chief Medical Examiner system and the NC death certificates. Sex, age, race, ethnicity, class of worker, manner of death, victim-perpetrator relationship and industry were abstracted. Crude and age-standardised homicide rates were calculated as the number of homicides that occurred at work divided by an estimate of worker-years (w-y). Rate ratios and 95% CIs were calculated, and trends over calendar time in occupational homicide rates were examined overall and by industry.
RESULTS: 456 homicides over 111 573 049 w-y were observed. Occupational homicide rates decreased from 0.82 per 100 000 w-y for the period 1992-1995 to 0.21 per 100 000 w-y for the period 2011-2015, but increased to 0.32 per 100 000 w-y in the period 2016-2017. Fifty-five per cent (252) of homicides were perpetrated by strangers. Taxi drivers experienced an occupational homicide rate that was 110 times (95% CI 76.52 to 160.19) the overall occupational homicide rate in NC; however, this rate declined by 76.5% between 1992 and 2017. Disparities were observed among workers 65+ years old, racially and ethnically minoritised workers and self-employed workers.
CONCLUSIONS: Our findings identify industries and worker demographics that experienced high occupational homicide fatality rates. Targeted and tailored mitigation strategies among vulnerable industries and workers are recommended.

BACKGROUND: Australia has made significant efforts in recent years to promote cycling.
METHODS: Trends in cyclist fatalities in Australia between 1991 and 2022, particularly in those aged 60 years and over, were examined using Poisson regression modelling.
RESULTS: Overall, cyclist fatalities decreased by 1.1% annually. However, while there was an annual decline of 2.5% in those aged <60 years, fatalities in the 60+ age group increased by 3.3% annually. Mortality rates also showed an annual decrease of 3.5% for cyclists aged <60 years but remained almost stable in the 60+ age group over the study period. Single vehicle fatalities increased markedly, particularly among the 60+ age group (4.4% annually).
CONCLUSIONS: The observed increase in 60+ fatalities is due to the ageing of the population rather than a rise in cycling popularity as previously thought. The rise in single vehicle fatalities is likely to be related to the increase in the availability and use of dedicated cycling infrastructure.

BACKGROUND: The \'Prospective Outcomes of Injury Study-10 years on\' (POIS-10) aims to contribute to improving long-term disability, health and well-being outcomes for injured New Zealanders. This brief report describes recruitment, characteristics and key outcomes to 12 years post-injury.
METHODS: Between 2007 and 2009, the study recruited 2856 people, including 566 Māori, from New Zealand\'s Accident Compensation Corporation\'s entitlement claims register. People experienced a range of injury types, causes and settings; 25% had been hospitalised for their injury. POIS-10 data were primarily collected via interviewer-administered structured questionnaires.
RESULTS: Of the original participants, 2068 (92%) were eligible for follow-up in POIS-10. Of these, 1543 (75%) people participated between March 2020 and July 2021, including 240 Māori. Half of the participants (n=757; 50%) reported ongoing problems attributed to their injury 12 years earlier. Most reported difficulties with items assessing disability (WHO Disability Assessment Schedule II). For health-related quality of life (HRQoL), measured using the EQ-5D-5L, the prevalence of problems was higher 12 years post-injury compared with 12 months post-injury for four of five dimensions. Importantly, the prevalence of problems did not reduce to pre-injury levels for any HRQoL dimension.
CONCLUSIONS: POIS-10 highlights the importance of early post-injury interventions to improve health, disability and well-being outcomes of injured New Zealanders.