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In this paper, we describe the design and baseline data of a study aimed at improving injury surveillance data quality of hospitals contributing to the Victorian Emergency Minimum Dataset (VEMD). The sequential study phases include a baseline analysis of data quality, direct engagement and communication with each of the emergency department (ED) hospital sites, collection of survey and interview data and ongoing monitoring. In 2019/20, there were 371,683 injury‐related ED presentations recorded in the VEMD. Percentage unspecified, the indicator of (poor) data quality, was lowest for ‘body region’ (2.7%) and ‘injury type’ (7.4%), and highest for ‘activity when injured’ (29.4%). In the latter, contributing hospitals ranged from 3.0–99.9% unspecified. The ‘description of event’ variable had a mean word count of 10; 16/38 hospitals had a narrative word count of <5. Baseline hospital injury surveillance data vary vastly in data quality, leaving much room for improvement and justifying intervention as described. Hospital engagement and feedback described in this study is expected to have a marked effect on data quality from 2021 onwards. This will ensure that Victorian injury surveillance data can fulfil their purpose to accurately inform injury prevention policy and practice.

To describe recent trends in opioid prescribing and prescription opioid poisoning resulting in hospitalisation or death in Victoria, Australia. This is a population‐based ecological study of residents of Victoria, 2006 – 14. Australian Bureau of Statistics residential population data were combined with Pharmaceutical Benefits Scheme (PBS) opioid prescription data, Victorian Admitted Episodes Data (VAED) and cause of death data. Annual opioid dispensings increased by 78% in 2006 – 13, from 0.33 to 0.58 per population. Opioid use increased with age: in 2013, 14% of Victorian residents aged ≥65 years filled at least one oxycodone prescription. In 2006 – 14, prescription opioid related hospital admissions increased by 6.8% per year, from 107 to 187 /1,000,000 person‐years; 56% were due to intentional self‐poisoning. Annual deaths increased from 21 to 28 /1,000,000 persons, in 2007 – 11. Admissions and deaths peaked at 25–44 years. Although both opioid prescribing and poisoning have increased, there is discrepancy between the exposed group (dispensings increased with age) and those with adverse consequences (rates peaked at ages 25–44 years). A better understanding is needed of drivers of prescribing and adverse consequences. Together with monitoring of prescribing and poisoning, this will facilitate early detection and prevention of a public health problem.

Due to advancements in trauma treatment methods, it is expected that survivability of hospital-admitted injuries gradually improves over time. However, measurement of trends in all-cause injury survivability is complicated by changes in case mix, demographics and hospital admission policy. The aim of this study is to determine trends in hospital-admitted injury survivability in Victoria, Australia, taking case-mix and patient demographics into account, and to explore the potential impact of changes in hospital admission practices. Injury admission records (ICD-10-AM codes S00-T75 and T79) between 1 July 2001 and 30 June 2021 were extracted from the Victorian Admitted Episodes Dataset. ICD-based Injury Severity Score (ICISS) calculated from Survival Risk Ratios for Victoria was used as an injury severity measure. Death-in-hospital was modelled as a function of financial year, adjusting for age group, sex and ICISS, as well as admission type and length of stay. There were 19,064 in-hospital deaths recorded in 2,362,991 injury-related hospital admissions in 2001/02–2020/21. Rates of in-hospital death decreased from 1.00% (866/86,998) in 2001/02 to 0.72% (1115/154,009) in 2020/21. ICISS was a good predictor of in-hospital death with an area-under-the-curve of 0.91. In-hospital death was associated with financial year (Odds Ratio 0.950 [95%CI 0.947, 0.952]), in logistic regression modelling adjusted for ICISS, age and sex. In stratified modelling, decreasing injury death trends were observed in each of the top 10 injury diagnoses (together constituting > 50% of cases). Admission type and length of stay were added to the model: these did not alter the effect of year on in-hospital death. In conclusion, a 28% reduction in rates of in-hospital deaths in Victoria was observed over the 20-year study period, in spite of aging of the injured population. This amounts to 1222 additional lives saved in 2020/21 alone. Survival Risk Ratios therefore change markedly over time. A better understanding of the drivers of positive change will help to further reduce the injury burden in Victoria.

Standing up elicits a host of cardiovascular changes which all affect the cerebral circulation. Lowered mean arterial blood pressure (ABP) at brain level, change in the cerebral venous outflow path, lowered end‐tidal PCO2 (PETCO2), and intracranial pressure (ICP) modify cerebral blood flow (CBF). The question we undertook to answer is whether gravity‐induced blood pressure (BP) changes are compensated in CBF with the same dynamics as are spontaneous or induced ABP changes in a stable position. Twenty‐two healthy subjects (18/4 m/f, 40 ± 8 years) were subjected to 30° and 70° head‐up tilt (HUT) and sinusoidal tilts (SinTilt, 0°↨60° around 30° at 2.5–10 tilts/min). Additionally, at those three tilt levels, they performed paced breathing at 6–15 breaths/min to induce larger than spontaneous cardiovascular oscillations. We measured continuous finger BP and cerebral blood flow velocity (CBFv) in the middle cerebral artery by transcranial Doppler to compute transfer functions (TFs) from ABP‐ to CBFv oscillations. SinTilt induces the largest ABP oscillations at brain level with CBFv gains strikingly lower than for paced breathing or spontaneous variations. This would imply better autoregulation for dynamic gravitational changes. We demonstrate in a mathematical model that this difference is explained by ICP changes due to movement of cerebrospinal fluid (CSF) into and out of the spinal dural sack. Dynamic cerebrovascular autoregulation seems insensitive to how BP oscillations originate if the effect of ICP is factored in. CSF‐movement in‐and‐out of the spinal dural space contributes importantly to orthostatic tolerance by its effect on cerebral perfusion pressure. Cerebrovascular autoregulation in the face of orthostatic challenged seems more effective than when guessed from resting, supine measurements. This effect is mainly due to changes in intracranial pressure when cerebrospinal fluid flows from the cerebral to the spinal compartment, thus improving the inflow of arterial blood. This appears to be an important mechanism to uphold cerebral blood flow in orthostasis.

ObjectiveThe emergency department (ED) is pivotal in treating serious injuries, making it a valuable source for population-based injury surveillance. In Victoria, information that is relevant to injury surveillance is collected in the Victorian Emergency Minimum Dataset (VEMD). This study aims to assess the data quality of the VEMD as an injury data source by comparing it with the Victorian Admitted Episodes Dataset (VAED).DesignA retrospective observational study of administrative healthcare data.Setting and participantsVEMD and VAED data from July 2014 to June 2019 were compared. Including only hospitals contributing to both datasets, cases that (1) arrived at the ED and (2) were subsequently admitted, were selected.ResultsWhile the overall number of cases was similar, VAED outnumbered VEMD cases (414 630 vs 404 608), suggesting potential under-reporting of injuries in the ED. Age-related differences indicated a relative under-representation of older individuals in the VEMD. Injuries caused by falls or transport, and intentional injuries were relatively under-reported in the VEMD.ConclusionsInjury cases were more numerous in the VAED than in the VEMD even though the number is expected to be equal based on case selection. Older patients were under-represented in the VEMD; this could partly be attributed to patients being admitted for an injury after they presented to the ED with a non-injury ailment. The patterns of under-representation described in this study should be taken into account in ED-based injury incidence reporting.

The majority of suicide decedents have had contact with health services close to their death. Some of these contacts include admissions to hospitals for physical and mental health conditions, injury and intentional self-harm. This study aims to establish and quantify the risks of suicide following hospital admission for a range of mental and physical illnesses. A retrospective analysis was carried out on existing morbidity and mortality data in Victoria. Data was extracted from the Victorian Admitted Episodes Dataset and the Victorian Suicide Register. Unplanned hospital admissions among adult patients (> = 15 years of age), discharged between 01 January 2011 and 31 December 2016 (2,430,154 admissions), were selected. Standardised Mortality Ratios were calculated for conditions with at least five linked suicides within one year of discharge from hospital. Forty-three conditions defined at the three-digit level of the International Statistical Classification of Diseases and Related Health Problems 10th Revision, were associated with at least five subsequent suicides (within one year of hospital discharge); 14 physical illnesses, 5 symptoms, signs and abnormal clinical and laboratory findings, 12 mental health conditions, and 12 types of injury and poisonings. The highest Standardised Mortality Ratios were for poisonings (range; 27.8 to 140.0) and intentional self-harm (78.8), followed by mental health conditions (range; 15.5 to 72.9), symptoms, signs and abnormal clinical and laboratory findings (range; 1.4 to 43.2) and physical illnesses (range; 0.7 to 4.9). Hospital admissions related to mental health conditions and injury and poisonings including self-harm were associated with a greater risk of suicide than physical conditions. Mental health conditions such as depressive episodes, personality disorders and psychotic episodes, injuries caused by intentional-self-harm and poisonings by certain types of drugs, carbon monoxide and hormones such as insulin can be prioritised for targeting suicide prevention initiatives for persons discharged from hospitals.

BackgroundThe International Classification of Disease Injury Severity Score (ICISS) provides an efficient method to determine injury severity in hospitalised injury patients. Injury severity metrics are of particular interest for the tracking of road transport injury rates and trends. The aims of this study were to calculate ICISS using linked morbidity and mortality datasets and to compare predictive ability of various methods and metrics.MethodsThis was a retrospective analysis of Admitted Patient Data Collection records from New South Wales, Australia, linked with mortality data. Using a split sample approach, design data (2008–2014; n=1 035 174 periods of care) was used to derive survival risk ratios and calculate various ICISS scales based on in-hospital death and 3-month death. These scales were applied to testing data (2015–2017; n=575 306). Logistic regression modelling was used to determine model discrimination and calibration.ResultsThere were 12 347 (1.19%) in-hospital deaths and 29 275 (2.83%) 3-month deaths in the design data. Model discrimination ranged from acceptable to excellent (area under the curve 0.75–0.88). Serious injury (ICISS≤0.941) rates in the testing data varied, with a range of 10%–31% depending on the methodology. The ‘worst injury’ ICISS was always superior to ‘multiplicative injury’ ICISS in model discrimination and calibration.ConclusionsIn-hospital death and 3-month death were used to generate ICISS; the former is recommended for settings with a focus on short-term threat to life, such as in trauma care settings. The 3-month death approach is recommended for outcomes beyond immediate clinical care, such as injury compensation schemes.

To deter the performance of illegal driving behaviours, traffic infringement notices may be issued. Whilst there is a substantial body of research that has examined rates of reoffending following a traffic infringement, there have been few studies examining the length of time to next traffic offence. Where this research has been conducted, the findings do not provide current understandings, given the substantial changes in traffic sanctioning over time. The aim of this study was to address this gap, by examining risk factors for recidivism following a driver receiving a traffic infringement notice, as well as the time to next traffic offence. Licensing and infringements data held in the Driver Licensing System (DLS), maintained by the road authority in Victoria, Australia were used. All drivers included in the study were born prior to 1975, and received their first Victorian drivers licence between 1994 and 2016. Data from 203,620 drivers were used. Cox proportional hazards modelling was undertaken to examine factors associated with recidivism within 12 months of receiving a traffic infringement. 131,691 (64.7%) drivers had received at least one traffic infringement in Victoria, Australia since receiving their Victorian driver's licence. Factors found to be associated with longer time to further traffic offending in the year that followed the first infringement included being female; receiving a first Victorian driver's licence when aged 45+ years; and being licenced 10+ years. Traffic infringements deter some groups of Victorian drivers, but not others. If drivers are to be deterred from further illegal driving behaviour, it is important other countermeasures are developed and trialled.

Truck drivers are a vulnerable population due to the high number of workplace injuries and fatalities predominant in their occupation. In Australia, the road freight transportation industry has been identified as a national priority area in terms of creating preventative measures to improve the health and safety of its workers. With an environment conducive to poor nutritional food choices and unhealthy lifestyle behaviours, many barriers exist to creating a safe and healthy workforce. Thus, the current study aimed to describe the pre-injury hospital-recorded health conditions and health service use of truck drivers with a worker’s injury compensation claim/s when compared to workers in other industries. Data was obtained from a compensation claims database and linked with hospital admissions data recorded five years prior to the injury claim. Health and lifestyle behaviour data for the occupational code of truck drivers was compared to other occupational drivers, as well as to all other occupations. Analysis was conducted via logistic regression. The results found that when compared to other occupational drivers, truck drivers were significantly more likely to have a hospital-recorded diagnosis of diabetes and/or hypertension, as well as being significantly more likely to have a hospital record of tobacco use and/or alcohol misuse/abuse. The findings show that there is a need to review and revise existing health strategies to promote the health and wellbeing of truck drivers, especially given their challenging work environment.

By being able to communicate the speed limit to drivers using speed sign recognition cameras, Intelligent Speed Assist (ISA) is expected to bring significant road safety gains through increased speed compliance. In the absence of complete digital speed maps and due to limited cellular connectivity throughout Australia, this study estimated the forgone savings of ISA in the event that speed signs are solely relied upon for optimal advisory ISA function. First, speed-related fatalities and serious injuries (FSI) in the Australian states of Victoria, South Australia, and Queensland (2013–2018) were identified, and published effectiveness estimates of ISA were applied to determine the potential benefits of ISA. Subsequently, taking into account speed sign presence across the three states, the forgone savings of ISA were estimated as FSI that would not be prevented due to absent speed signage. Annually, 27–35% of speed-related FSI in each state are unlikely to be prevented by ISA because speed sign infrastructure is absent, equating to economic losses of between AUD 62 and 153 million. Despite a number of assumptions being made regarding ISA fitment and driver acceptance of the technology, conservative estimates suggest that the benefits of speed signs placed consistently across road classes and remoteness levels would far outweigh the costs expected from the absence of speed signs. The development and utilisation of a methodology for estimating the foregone benefits of ISA due to suboptimal road infrastructure constitutes a novel contribution to research. This work provides a means of identifying where infrastructure investments should be targeted to capitalise on benefits offered by advanced driver assist technologies.