Summary

2_QuantitativeArticle.pdf

strength and balance were collected to measure changes in physical outcomes, and participants completed questionnaires and interviews to assess program acceptability. Ninety-eight participants (mean age=64, 71% women) registered for the program; 77 (85%) completed baseline and follow-up meas- urements. Positive ongoing feedback was received, and attend- ance was good. On average across all sites, there was significant improvement in participant leg strength (time to complete 5 repetition sit-to-stand: 14 s to 11 s, p<0.01), bal- ance (timed single-leg stance: 5.6 s to 7.8 s, p<0.01) and gait speed (timed 4 meter walk: 0.51 m/s to 0.94 m/s, p<0.01), and a significant decrease in BMI (p<0.01). Participants reported both the exercise and yarning components of the program were enjoyable and valuable. The Ironbark program was effective in improving fall-related measures; funding has now been received for a large scale cluster randomized trial to test its effectiveness in preventing falls. Collaboration between Aboriginal community leaders, Aboriginal health and community service providers facilitated development of a unique, culturally appropriate program that addressed a variety of health, social and cultural needs, translating knowledge into action for positive change.

PA 15-5-2704 DIAGNOSTIC ABILITY OF FALL RISK ASSESSMENT SCORES OF INTERNATIONAL PATIENTS AT THE SAME HOSPITAL

1,2,3Krit Pongpirul*, 3Ratanaporn Tamee. 1Chulalongkorn University, Bangkok, Thailand; 2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 3Bumrungrad International Hospital, Bangkok, Thailand

10.1136/injuryprevention-2018-safety.97

To compare and improve the diagnostic ability of standard fall risk scores in a healthcare facility with diverse patient back- ground. Medical records of 200 adult inpatients who fell (case) and the other 200 randomly selected inpatients who were admitted on the same day (control) at Bumrungrad Inter- national Hospital (BIH) during 2014–2016 were reviewed. All data required for calculating the Hendrich II Fall Risk Model (H, 7 items), STRATIFY Risk Assessment Tool (S, 5 items), Morse Fall Scale (M, 6 items), and Johns Hopkins Hospital Fall Risk Assessment Tool (J, 7 items) were extracted. Eight non-clinical determinants proposed by the Fall Risk Committee were also analyzed (B1-B8). The diagnostic ability of the standard scores were assessed using Area under the Receiver Operating Characteristic (AUC) analysis.

The overall mean age was 54.22 years, female 45.25%, Asian 47.00%. The cases were older (58.88 vs 49.57; p<0.001) and male (61.64% vs 35.91%; p<0.001). More Middle Eastern patients (67.48%) fell than other ethnic ori- gins (Caucasian 54.43%, Asian 36.17%; p<0.001).

Five B determinants were significantly associated with fall event: admission on the arrival day vs within 6 days after arrival (B1: 100% vs 39.24%; p<0.001), anticipated surgery with sedation (B2: 28.66% vs 63.79%; p<0.001), first admis- sion (B3: 37.13% vs 68.71%; p<0.001), personal caregiver dependency (B4: 48.40% vs 75.00%; p=0.012), and inter- preter need (B5: 65.57% vs 43.17%; p<0.001). The AUC of the scores were: H 84.97%, M 77.91%, J 57.29%, and S 49.26% whereas the AUC of the B sub-scores were: B1 75.78%, B2 33.25%, B3 34.75%, B4 47.00% and B5

59.50%. Adding B1 and B5 to H improved the AUC from 84.97% to 91.47% and 85.29%, respectively.

Diagnostic ability of fall risk scores is context-specific and could be improved by adding contextual determinants.

PA 15-6-2811 ANATOMICAL AND BIOMECHANICAL CONSIDERATIONS FOR SHUNTING-TYPE HIP PROTECTOR FUNCTION

1,2Richard GD Fernandez*, 2Joan Ozanne-Smith, 2Raphael H Grzebieta. 1La Trobe University, Melbourne, Victoria, Australia; 2Monash University, Melbourne, Victoria, Australia

10.1136/injuryprevention-2018-safety.98

Hip fracture remains a major cause of death and disability among older persons. Anatomical and biomechanical design considerations for shunting-type hip-protectors were investi- gated to address low user compliance among older-persons.

Aims were to assess the hip muscle morphology as a load- attenuating medium during shunting: determine the material properties of skeletal muscle; and assess shunting-type hip-pro- tector function in lateral falls.

Low and high hip fracture risk groups were identified based on BMI. A three dimensional map was developed to measure muscle thickness at 15 points and volume (of gluteal and quadriceps) using CT. A new method was developed to measure material properties of skeletal muscle under fall con- ditions by impacting muscles in the in-situ state, substituting ovine for human specimens. Biomechanical kinematic data, the effect of specimen size and impact velocity were also analysed. Finite element simulations were then conducted to evaluate hip-protector function.

Significant differences in muscle thickness were revealed between hip fracture risk groups. The strong relationship of muscle thickness to subjects’ body mass allowed development of mathematical models that estimate the maximum muscle thickness and muscle thickness based on location, both from subject mass. An average 17% increase in muscle volume was quantified for an equivalent 10 kg increase in subject mass. Males exhibited 3%–23% increased volume over females depending on the muscle. Material properties of skeletal muscle revealed an average Young’s Modulus of 0.06 MPa. Fall simulations quantified peak loads shunted to the iliac bone, greater trochanter and femoral shaft. Findings Suggest reducing protector size for greater wearer acceptance may cause injury elsewhere, especially for lean individuals at high fracture risk. Rather, hip-protector design should be based more on individual body constitution to increase effectiveness and comfort, and therefore user compli- ance. Muscle size should be maintained to allow effective use of preventive strategies within normal anatomical limits.

PA 15-7-2839 HISTORY OF FREQUENT FALLS PREDICT STRONGLY FALLS BUT ONLY WEAKLY SUBSEQUENT FRACTURES IN POSTMENOPAUSAL WOMEN

1Risto Honkanen, 1Nadia Afrin*, 2Heli Koivumaa-Honkanen, 3Heikki Kröger. 1Clinical Research Center, KMRU (Kuopio Musculoskeletal Research Unit)/UEF, University of Eastern, Finland; 2Psychiatry; 3Surgery, Kuopio University Hospital, Kuopio, Finland

10.1136/injuryprevention-2018-safety.99

Abstracts

A36 Injury Prevention 2018;24(Suppl 1):A1–A278

Objective To access does falling history predict falls and frac- tures in postmenopausal women. Introduction Falling tendency and low BMD are risk factors for fractures in the elderly. The purpose of this study was to evaluate if fall history is a predictor of postmenopausal falls and fractures. In addition, if fall risk predicts fractures differ- ently according to type of fall and site of fracture, this associ- ation will also be estimated. Methods Prospective cohort study. Falls were asked in postal enquiry of the population-based Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) Study in 1999 and 2004. Fractures in 1999–2004 were asked in 2004. A total of 8656 women responded to the fall and fractures questions. Women with falls were classified as occasional fallers (1 fall/year) and frequent fallers (2+falls/year). Odds Ratios (OR) was com- puted with logistic regression. Results Women were 57–66 years old at baseline. Falling his- tory predicted future falls with an OR of 2.59 (p<0.001) even more frequent future falls (OR=4.59, p<0.001). Falling history also predicted fractures with an OR of 1.39 (p<0.001). Fracture predictions according to different sites (wrist, hip and ankle) in association with falling history have been tasted and there were no significant differences were observed. The results remain statistically significant after adjustment with several confounding factors. Conclusions Fall history is a stronger powerful predictor of future falls than fractures in postmenopausal women.

Parallel sessions

Wednesday 7 November 2018 9:00–10:00

PA 16 Road traffic injury

PA 16-1-0420 MODELING THE SEVERITY OF MOTORCYCLE CRASHES USING THE DATA FROM SRI LANKA

Niranga Amarasingha*. Sri Lanka Institute of Information Technology, Malabe, Sri Lanka

10.1136/injuryprevention-2018-safety.100

Compared to other vehicle drivers, motorcycle riders vulner- able road users as they have lack of protection in the case of a crash. Therefore, motorcycle riders are often associated with high injury risks in the case of crashes. Also, it is widely recognized that motorcyclists have a particularly high crash risk, but our knowledge of the mechanisms avoiding this crash risk is incomplete. Different factors affecting the motorcycle crashes consisting environmental, road, vehicle, and human elements. However, literature produced mixed results on the importance of different factors. These inconsis- tencies may be because differences in traffic composition at the road, driver behavior, vehicle, and road factors in differ- ent geographical areas studied. Other reasons may be differ- ence methodologies for data collection or different statistical methods for data analysis. Hence, it is important to con- ducted more studies using different estimation techniques and data from different geographical areas to provide a more

complete picture on the safety effects of these factors. The present research investigates the risk factors of crashes involving motorcycles and contributory causes using data from Sri Lanka. The binary-logistic regression technique was used to model the severity of motorcycle crashes in Sri Lanka during the five-year period from 2009 to 2013. Vari- ous characteristics such as environment, roadway, driver, and vehicle are analysed investigating the Odds-ratios so that potential countermeasures can be developed to improve road- side safety. More frequent crash conditions for motorcycle crashes occurred while driving on rural roadways, driving during week days, and driving newer motorcycles. Dry road surfaces, clear weather conditions predominantly character- ized motorcycle-crashes. This study adds detailed information about characteristics of motorcycle crashes and measures to improve motorcycle safety in Sri Lanka to the transportation safety literature.

PA 16-2-1073 DESIGN AND IMPLEMENTATION OF AN INITIATIVE TO REDUCE DRIVING SPEED AS A RISK FACTOR FOR ROAD TRAFFIC INJURIES (RTI)

1Francisco Ramon Mojarro*, 2Elisa Hidalgo Solorzano, 2Maria de la Luz Arenas Monreal. 1Mexican Red Cross, Mexico City, Mexico; 2National Institute of Public Health, Cuernavaca, Mexico

10.1136/injuryprevention-2018-safety.101

Objective To design and implement an educational initiative to reduce driving speed with local law enforcement (LLE) of the city of Cuernavaca, Morelos. Methodology A quasi-experimental study was carried out using both quantitative and qualitative methodologies. The quantitative portion was obtaining Cuernavaca’s driving speed prevalence using a laser speed detection device; a legislation review about speed limits and the application of a ‘knowl- edge’ survey on speed limits, driving speed and safe driving to LLE. The qualitative portion was semi-structured inter- views to LLE to explore their risk perception of driving speed and the correct application of legislation. All portions of the study served as inputs for the design of an educa- tional initiative (using the Precede-Procede methodology) aimed at strengthening the technical capacities of LLE to apply the current regulations. Results 47% of the vehicles observed were driving above the speed limit. The knowledge survey indicated that LLE identi- fied speed as a risk factor for RTI, however they don’t have technical knowledge on speed control and safe driving; we also found that current legislation stablishes appropriate speed limits (40 km/hr urban areas and 20 km/hr in school areas). 24 LLE officers participated in the initiative; the findings coincide with the information obtained from interviews, the capacity of officers to enforce regulation on speed is dimin- ished due the lack of speed measurement equipment and their reduced technical capabilities. Conclusion The speed prevalence, analyzing legislation, obtain- ing information from interviews and implementing the initia- tive, helped documented ‘speed’ in the LLE’s working context and to identify their limitations that hinders the application of speed regulation. For a local speed control strategy to be suc- cessful in reducing RTI, a modification of this context is

Abstracts

Injury Prevention 2018;24(Suppl 1):A1–A278 A37