Background Hockey Canada developed the Hockey Canada Skills Test (HCST), which measures skill acquisition and development. Objective To investigate the effect of previous concussion on sport-specific skill performance in youth ice hockey players. Design Cross-sectional. Setting Ice hockey arenas in Calgary, Alberta, Canada. Participants 596 participants [525 males and 71 females, ages 11–17, representing elite (upper 30% by division of play) and non-elite (lower 70%) levels] recruited from minor ice hockey teams over three seasons of play (2012–2015). Assessment of Risk Factors Players completed a baseline questionnaire including the number, date of occurrence, and length of recovery for any previous concussions. Main Outcome Measurements On-ice skill performance was based on the HCST battery (forward agility weave, forward/backward speed skate, forward-to-backward transition agility, 6-repeat endurance skate). Multiple linear regression (adjusted for relative age, level of play, position, elite/non-elite, and musculoskeletal injury in the previous year), accounting for clustering by team, was conducted to explore the effect of history of concussion, number of previous concussions, time since most recent concussion, and severity of most recent concussion on HCST performance. Results A history of concussion and time since most recent concussion were not associated with any HCST component. Players reporting two or more concussions were 7.32 seconds faster (95% CI:3.59–11.05) than those with no history performing forward agility weave with puck. For every additional day to return to play post-concussion, player times were faster by: 0.11 seconds (95% CI:0.05–0.16) on forward agility weave with puck and 0.08 seconds (95% CI:0.04–0.13) without puck, 0.01 seconds (95% CI:0.01–0.02) on transition agility without puck, and 0.06 seconds (95% CI:0.03–0.1) on backward speed with puck and 0.05 seconds (95% CI:0.03–0.07) without puck. Conclusions Players with and without a history of concussion have similar HCST scores. Greater time loss following concussion was associated with better performance. The mechanism for this finding requires further exploration.
Addressing the burden of motor vehicle collisions, specifically for vulnerable road users requires an evidence-based approach; however, there are many interventions embedded in road safety policies that have minimal evidence to support their effectiveness. In addition, there is significant variability in the quality of reporting of interventions. These issues pose significant challenges in decision-making for road safety practitioners and policy makers.
Process
We created a digital resource that summarizes the evidence on the effectiveness of built environment interventions (BEi) embedded in road safety policies in five large urban centres in Canada. We also created resources to support decision-making for BE change to increase active transport (AT).
Analysis
An environmental scan and targeted literature review was used to retrieve and then critically appraise peer-reviewed articles that examined the effectiveness of BEi in existing road safety policies, on collisions or collision pathway outcomes. Stakeholder engagement (e.g., transportation, public health) informed the development of the resources.
Outcomes
An online resource (www.projectchase.ca) summarizing the effectiveness of BEi found in road safety policies was created. The resource provides a description of each intervention and a summary of the outcomes by intervention type. Local products include a summary of local collision and AT rates as well as facilitators and barriers to decision-making for AT and BE change. Stakeholder feedback highlighted the importance of comparing BEi across centres and BEi implementation resources.
Learning Outcomes
Key to the development of these resources was the information collected from our stakeholders. This increased the relevance and usefulness to the target audience.
Bicycling can be a beneficial physical activity for children; however, child and parent perceptions of bicyclist safety may influence participation. The Haddon's Matrix breaks down the factors (human, vehicle, environment) and phases (pre-injury, injury, post-injury) that relate to injury outcomes. It has been widely used in quantitative studies of road safety, but less so in qualitative work. Applying Haddon's Matrix to injured child bicyclist interview data may offer insights across qualitative and quantitative paradigms.
Aim
To explore injured child bicyclists' perceptions of safety using the Haddon's Matrix.
Methods
Injured child bicyclists (aged 5–17) who presented to participating children's hospitals in Vancouver, Calgary, or Toronto from May 2021 - October 2021 were recruited. Forty participants provided responses to open-ended questions on bicycling safety in an interview. A qualitative framework analysis approach was used to identify themes according to the factors and phases of the matrix.
Results
Of the factors children perceived as influencing safety, the majority were in the pre-injury phase, with fewer factors in the injury and post-injury phases. Within the pre-injury phase, over half of the factors mentioned related to the physical environment such as surface quality, gravel, and bicycling infrastructure. Children consistently perceived interactions with motor vehicles and a lack of separation from them as reasons for feeling unsafe while bicycling.
Conclusion
Children can express factors that influence their perceptions of safety and that align with the Haddon's Matrix. It is important to integrate children's voices to better understand their perceptions of bicycling safety.
Motor-vehicle collisions (MVCs) are a leading cause of child active transportation (AT) injuries in Canada. Efforts to improve built environment (BE) safety often occur following an incident or are based on citizen complaints. Machine learning (ML) models may be able to uniquely address the complexity within the road system. As such, developing a ML algorithm that can predict injury rates and AT prevalence can provide municipalities with an important tool to help prevent child injuries and improve child AT.
Methods
The Canadian CHASE spatial database, which includes population demographics, BE, school, transportation, and MVC data will be used. Data were collected in five Canadian municipalities containing over 8,000 police-reported child (age 1–17) bicyclist and pedestrian-MVC injuries. Injury and AT data aggregated by Dissemination Area will be further aggregated at community level. The dataset will be split into training (80%) and validation (20%) datasets, with models trained through 10-fold cross-validation. Prediction accuracy measures will be estimated for both regression models and regression trees.
Results
Models with highest prediction accuracy on validation data will be used to predict the prevalence of child AT and rates of child MVCs per community per year, based on the BE characteristics of the community.
Conclusion
This study is setting up to develop ML models useful in predicting child AT prevalence and MVC injury rates in communities across Canadian municipalities, providing additional tools to efficiently allocate road safety resources. Improving effectiveness of BE interventions may reduce MVC injury rates while improving AT prevalence in Canadian children.
Injuries and deaths from motor vehicle collisions are a significant public health issue. As public health researchers and practitioners, we must support the work of municipalities by advocating for effective interventions to reduce this burden. This requires an evidence-based approach; however, many interventions embedded in existing road safety policies in Canada are not supported by evidence. The objective of this work was to review the built environment (BE) interventions in road safety policies in five, urban municipalities in Canada and summarize the peer-reviewed literature to support them. Data were retrieved through an environmental scan of road safety policies across five Canadian urban municipalities, supplemented by a scoping review of articles indexed in MEDLINE and a grey literature search. Inclusion criteria were: 1) BE interventions, 2) collision or collision pathway outcomes (e.g., vehicle speed, vehicle volume), 3) evaluative study designs, and 4) studies published less than 20 years ago (i.e., 1999–2019). We critically appraised the included studies using the TREND checklist. Data were extracted and summarized, grouped by intervention type. The environmental scan yielded 42 BE interventions within the existing road safety policies across CHASE regions. The scoping review found a total of 124 studies; the final sample included 45 studies with 29 interventions. The median TREND score [interquartile range (IQR)] was 16 (15, 17) out of 22. Published scientific evidence was not found for 13interventions. A low proportion of included studies specific to the existing road safety policies in urban areas in Canada demonstrated a reduction in collisions. Further, significant variability in the level of effectiveness across interventions exists. Information specific to the effectiveness of interventions should be an integral part of the decision making process for BE change; however, more work is needed to better understand critical decision making factors. collisions, traffic; injuries and wounds; policy; review, scoping.
Background. A common tenet in emergency medical services (EMS) is that faster response equates to better patient outcome, translated by some EMS operations into a goal of a response time of 8 minutes or less for advanced life support (ALS) units responding to life-threatening events. Objective. To explore whether an 8-minute EMS response time was associated with mortality. Methods. This was a one-year retrospective cohort study of adults with a life-threatening event as assessed at the time of the 9-1-1 call (Medical Priority Dispatch System Echo- or Delta-level event). The study setting was an urban all-ALS EMS system serving a population of approximately 1 million. Response time was defined as 9-1-1 call receipt to ALS unit arrival on scene, and outcome was defined as all-cause mortality at hospital discharge. Potential covariates included patient acuity, age, gender, and combined scene and transport interval time. Stratified analysis and logistic regression were used to assess the response time–mortality association. Results. There were 7,760 unit responses that met the inclusion criteria; 1,865 (24%) were ≥8 minutes. The average patient age was 56.7 years (standard deviation = 21.5). For patients with a response time ≥8 minutes, 7.1% died, compared with 6.4% for patients with a response time ≤7 minutes 59 seconds (risk difference 0.7%; 95% confidence interval [CI]: –0.5%, 2.0%). The adjusted odds ratio of mortality for ≥8 minutes was 1.19 (95% CI: 0.97, 1.47). An exploratory analysis suggested there may be a small beneficial effect of response ≤7 minutes 59 seconds for those who survived to become an inpatient (adjusted odds ratio = 1.30; 95% CI: 1.00, 1.69). Conclusions. These results call into question the clinical effectiveness of a dichotomous 8-minute ALS response time on decreasing mortality for the majority of adult patients identified as having a life-threatening event at the time of the 9-1-1 call. However, this study does not suggest that rapid EMS response is undesirable or unimportant for certain patients. This analysis highlights the need for further research on who may benefit from rapid EMS response, whether these individuals can be identified at the time of the 9-1-1 call, and what the optimum response time is.
In a case-control study, the authors examined the relation between helmet use and neck injury among Québec, Canada, skiers and snowboarders using 10 years of ski patrol data (1995–1996 to 2004–2005). Cases were defined as persons with any neck injury (n = 2,986), an isolated neck injury requiring ambulance evacuation (n = 522), or a cervical spine fracture or dislocation (n = 318). The control group included persons with non-head, non-neck injuries (n = 97,408) in an unmatched analysis. The authors also matched cases with controls injured at the same ski area, during the same activity (skiing vs. snowboarding), and during the same season. Helmet use was the primary exposure variable. For the unmatched analysis, the authors used unconditional logistic regression and adjusted for clustering by ski area and other covariates. They used conditional logistic regression for the matched analysis. Multiple imputation was used to address missing values. The adjusted odds ratio was 1.09 (95% confidence interval (CI): 0.95, 1.25) for any neck injury, 1.28 (95% CI: 0.96, 1.71) for isolated ambulance-evacuated neck injuries, and 1.02 (95% CI: 0.79, 1.31) for cervical spine fractures or dislocations. Similar results were found in the conditional logistic regression analysis and in analyses restricted to children under age 11 years. These results do not suggest that helmets increase the risk of neck injuries among skiers and snowboarders.
Background Policy disallowing body checking in youth ice hockey significantly reduces the risk of injury and concussion. Based on video analysis, frequency and intensity of player to player physical contacts (PCs) are higher in Pee Wee players (ages 11–12) in leagues allowing body checking, however this has not been examined in Bantam leagues (ages 13–14). Objective To determine the association between body checking policy and the frequency and intensity of physical contacts in Bantam ice hockey players (ages 13–14). Design Cohort study. Setting Ice hockey arenas. Participants Thirteen non-elite (lowest 60% by division of play) Bantam ice hockey games in Calgary, Alberta, Canada (2014–15 season) and 13 non-elite games in Vancouver, British Columbia, Canada (2014–15 season) were videotaped. Intervention Policy allowed body checking in Calgary and not Vancouver in the non-elite levels (2014–15). Main Outcome Measurements Incidence rate ratios [IRRs] (adjusted for player position) were estimated using multiple Poisson regression to examine the effect of body checking policy on player-to-player PCs [levels 1–5 with increasing intensity (levels correspond to 4–5 body checking)] and hooking/slashing behaviours. Results Lower rates of higher intensity contacts (levels 4–5 body checking) were observed in Bantam ice hockey players in a league where body checking was disallowed [IRR=0.09; 95% CI: 0.05–0.15]. Players in a league where body checking was disallowed, however, had significantly higher rates of hooking and slashing behaviours [IRR=1.81; 95% CI: 1.33–2.47]. Conclusions Bantam ice hockey players in a league where policy disallowed body checking are at a lower risk of high intensity physical contacts, but commit higher rates of hooking and slashing behaviours. This research informs the mechanisms explaining injury risk reduction related to body checking policy change and have important national public health implications for policy decisions related to rule enforcement in youth sport.
