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Syllabus
Injury Epidemiology
Epidemiology 523
Winter 1996

Course Objectives: This course is designed to give the graduate student an introduction to the relatively new field of injury epidemiology and injury control. The course will introduce the student to some of the literature, data sources, methods, and problems in this area of epidemiology.

Prerequisites: Epidemiology 511 or 512 or permission of instructor.

Class hours: Monday and Thursday, 3:30 PM to 4:50 PM Location: T-474

Instructor: Peter Cummings MD, MPH Assistant Professor of Epidemiology

Office hours set aside for the course: 1/2 hour before each lecture, Room F-351F (3:00 PM to 3:25 PM, Monday & Thursday)

Usual offices hours:

l.Monday, Wednesday, and Friday Harborview Injury Prevention and Research Center, 633 Yesler Way, Seattle, WA Mail Stop ZX-10. Phone: (206) 521-1549. Fax:(206) 521-1562

2.Tuesday, Thursday Children's Hospital and Medical Center, Emergency Services, Mail Stop CH-04, 4800 Sand Point Way NE, P.O. Box 5371, Seattle, WA 98105. (206) 526-2000, ext 5243 or (206) 526-2599 Fax: (206) 527-3945 E-mail: petercu . washington . edu

Textbooks and references

Students are asked to buy one textbook, Baker SP, O'Neill B, Ginsburg MJ, Guohua L. The Injury Fact Book. 2nd ed. New York: Oxford University Press: 1992.

This text provides an excellent introduction to the problem of illness due to injury and the field of injury research. It summarizes much of what is known and is well illustrated with numerous tables and charts. If you do not wish to buy this book, a copy is on reserve at the Health Sciences Library for the winter quarter.

The reading list for the course is at the end of the syllabus. Students are expected to obtain a copy of the syllabus and the required readings from the Copy Center at South Campus E220.

Grading and Student responsibilities:

l.Students are expected to attend the lectures, participate in class discussions, and read the asslgned papers.

2.Term paper: Students are to discuss or summarize one area of injury research in a paper limited to < 10 double-spaced pages. The goal is to pick a relatively limited topic and summarize the relevant literature in a manner that might be appropriate for the background and significance section of a grant application. The paper should summarize what is known about the topic and point out areas where further work is needed, if there are any. Student's should discuss their chosen topic with the instructor before proceeding. The paper is due in class on Thursday, February 29.

3.Class presentation: The last 2 lecture periods will be reserved for student presentations. Each student will be asked to present the findings of their literature review. 4.Final exam: There will be a final exam consisting of short essay questions and/or multiple-choice questions. 5.Grade: Half the grade will be based on the final exam and half on the term paper.

Special resources: The Harborview Injury Research and Prevention Center is located at 633 Yesler Way, Suite 332. This address is about half-way between the Elliott Bay Bookstore and Harborview Medical Center. It is very near the Seattle-King County Health Department. This is one of 8 injury center's funded by the CDCP. HIPRC usually has a research seminar on Friday either at 9:30 AM or 1:30 PM. Research projects, some completed and some in early planning stages, are presented for discussion. Student's are welcome to attend these meetings, either during the course or at other times. To receive information about the meetings, contact Diane Thompson by e-mail: dctu.washington.edu.

The center also maintains a library of materials related to injuries and has files of over 5000 articles and other documents related to injuries. The filed material is indexed in Pro-Cite at the center and students may wish to search this database for their projects.

Outline of lectures:

l.Thursday, January 4 Lecturer: Cummings Topic: Overview of the course, summary of the injury problem, economic cost of injuries, data sources, Haddon matrix

2.Monday, January 8 Lecturer: Cummings Topic: Methodological problems in the study of the causes of injuries; injury severity scales

3.Thursday, January 11 Lecture: Grossman Topic: Motor-vehicle related trauma

4.Monday, January 15 Holiday

5.Thursday, January 18 Lecturer: Rivara Topic: Youth violence

6.Monday, January 22 Lecturer: Cummings Topic: Firearms

7.Thursday, January 25 Lecture: Thompson Topic: Bicycle injuries and their prevention

8.Monday, January 29 Lecturer: Grossman Topic: Suicide

9.Thursday, February 1 Lecturer: Rivara Topic: Burns

10.Monday, February 5 Lecturer: Larry Gentillelo Topic: Alcohol and trauma

11.Thursday, February 8 Lecturer: Koepsell Topic: Elderly drivers and pedestrians

12.Monday, February 12 Lecturer: Cummings Topic: Outcome prediction models

13.Thursday, February 15 Lecturer: Cummings Topic: Meta-analysis and the treatment of injuries

14.Monday, February 19 Holiday

15.Thursday, February 22 Lecturer: Cummings Poisoning Practice final exam

17.Monday, February 26 Lecturer: Alexander Topic: Occupational injuries

18.Thursday, February 29 Lecturer: Quan Topic: Drowning Term paper due

l9.Monday, March 4 Student presentations

20.Thursday, March 7 Student presentations

21.Monday, March 11: exam week

Lecturers

Bruce Alexander MS, PhD Post-doctoral Research Associate, Dept. of Epidemiology. Office: T341Q. Mail Stop SC-36. Phone: 685-8431

Larry Gentilello MD Assistant Professor of Surgery Harborview Medical Center, Rm 7C-9, 325 Ninth Ave Mail Stop ZA-16. Phone 223-8741

David Grossman MD, MPH Assistant Professor of Pediatrics Co-Director, Harborview Injury Prevention and Research Center Office: Kobe Park Building, 633 Yesler Way, Suite 332 Mail Stop ZX-10. Phone 521-1537

Thomas D. Koepsell MD, MPH Professor and Chair, Department of Epidemiology Mail Stop SC-36. Phone 685-1788

Linda Quan MD Associate Professor of Pediatrics Director, Emergency Medical Services Children's Hospital and Medical Center Mail Stop CH-04. Phone 526-2599.

Frederick P. Rivara MD, MPH Professor of Pediatrics, Adjunct Professor of Epidemiology Director, Harborview Injury Prevention and Research Center Office: Kobe Park Building, 633 Yesler Way, Suite 332 Mail Stop ZX-10. Phone 521-1530.

Diane Thompson MS Research Associate Harborview Injury Prevention and Research Center Office: Kobe Park Building, 633 Yesler Way, Suite 332 Mail Stop ZX-10. Phone 521-1527

Books of interest:

In addition to the assigned text by Baker, et al, several other books discuss aspects of the injury problem:

National Research Council. Injury in America: A Continuing Public Health Problem. Washington, D.C.: National Academy Press: 1985. This book has served to guide the CDC national injury program.

The National Committee for Injury Prevention and Control. Injury Prevention: Meeting the Challenge. New York: Oxford University Press: 1989. This book was published as a supplement to the American Journal of Preventive Medicine and is a handbook for agencies that wish to start an injury control program.

Rosenberg ML, Fenley MA, eds. Violence in America: A Public Health Approach. New York: Oxford University Press: 1991. This book on intentional injuries includes suicide.

Wilson MH, Baker SP, Teret SP, Shock S, Garbarino J. Saving Children: A Guide to Injury Prevention. New York: Oxford University Press: 1991. This book is oriented toward prevention, rather than the study of causation.

Robertson, LS. Injury Epidemiology. New York: Oxford University Press: 1992. A useful book about the application of epidemiology to the study of injuries.

Bergman, Abraham B. Political Approaches to Injury Control at the State Level. Seattle: University of Washington Press: 1992. These essays cover specific topics, including alcohol and driving, drowning, burns, "safe" cigarettes, drowning, and gun laws.

Christoffel T, Teret SP. Protecting the Public: Legal Issues in Injury Prevention. New York: Oxford University Press: 1993. The authors are both attorneys and the book is heavily weighted with court decisions.

Reiss AJ Jr., Roth JA, eds. Understanding and Preventing Violence. Washington, D.C.: National Academy Press: 1993. This volume from the National Research Council summarizes a large body of literature.

Health Affairs (Vol 12, No 4, Winter of 1993) is devoted to intentional injuries.

Useful web sites for injury data include:

• CDC at http://www.cdc.gov/
• National Center for Health Statistics at http://www.cdc.gov/nchswww/nchshome.htm

Course reading materials:

1. Thursday, January 4 1. Chapters 2 and 3 in The Injury Fact Book, pages 8-38. 2. The National Committee for Injury Prevention and Control. Injury Prevention: Meeting the Challenge. New York: Oxford University Press: 1989. Introduction: A History of Injury Prevention, pages 4-18. 3. The National Committee for Injury Prevention and Control. Injury Prevention: Meeting the Challenge. New York: Oxford University Press: 1989. Chapter 2: Learning from Data, pages 35-48. 4. Brown ST, Foege WH, Bender TR, Axnick N. Injury prevention and control: Prospects for the 1990's. Annu Rev Public Health 1990;11:251-66.

2. Monday, January 8 1. Cummings P, Koepsell TD, Mueller BA. Methodological challenges in injury epidemiology and injury prevention research. Annu Rev Public Health 1995;16:381-400. 2. Ray WA, Griff1n MR, Schaffner W, Baugh DK, Melton LJ III. Psychotropic drug use and the risk of hip fracture. N Eng J Med 1987;316:363-9. 3. Waller JA. Methodologic issues in hospital-based injury research. J Trauma 1988;28:1632-6 4. MacKenzie EJ. Injury severity scales: overview and directions for future research. Am J Emerg Med 1984;2:537-49.

3. Thursday, January 11 1. Chapters 16, 17, 19, and 20 in the Injury Fact Book, pages 211-261, 272-286. 2. Rivara FP. Child pedestrian injuries in the United States. Current status of the problem, potential interventions, and future research needs. Am J Dis Child 1990;144:692-696.

4. Monday, January 15 Holiday

5. Thursday, January 18 1. Chapter on Homicide in The Injury Fact Book, pages 78-88. 2. Rivara FP, Farrington DP. Prevention of violence: role of the pediatrician. Arch Pediatr Adolesc Med: 1995; 149:421-9.

6. Monday, January 22 1. Chapter on Firearms in The Injury Fact Book, pages 149-60. 2. Kellermann AL, Rivara FP, Somes G, Reay DT, Fancisco J, Banton JG, Prodzinski J, Fligner C, Hackman BB. Suicide in the home in relation to gun ownership. N Eng J Med 1992;327:467-72. 3. Suicide in the home in relation to gun ownership. Letters in N Eng J Med 1992;327:1878-81. 4. Kellermann AL, Rivara FP, Rushforth NB, Banton JG, Reay DT, Francisco JT, Locci AB, Prodzinzki J, Hackman BB, Somes G. N Eng J Med 1993;329:1084-91. 5. Guns and homicide in the home. Letters in N Eng J Med 1994;330:365-8.

7. Thursday, January 25 1. Chapter on Bicyclists in The Injury Fact Book, pages 287-291. 2. Thompson RS, Rivara FP, Thompson DC. A case-control study of the effectiveness of bicycle safety helmets. N Eng J Med 1989;320:1361-67. 3. Rivara FP, Thompson DC, Thompson RS, Rogers LW, Alexander B, Felix D, Bergman AB. The Seattle children's bicycle helmet campaign: changes in helmet use and head injury admissions. Pediatrics 1994;93:567-9. 4. Thompson, Diane C. Chapter on bicycle injuries in Epidemiology of Sports Injuries edited by Caine, Caine, and Lindner. Published by Human Kinetics, Champaign, Il (phone 217-351-5076), in press.

8. Monday, January 29 1. Chapter on Suicide in The Injury Fact Book, pages 65-77. 2. Shaffer D. The epidemiology of teen suicide: an examination of risk factors. J Clin Psychiatry 1 988 ;49(9, Suppl) : 36-4 1 . 3. Brent DA, Perper JA, Allman CJ, Moritz GM, Wartella ME, Zelenak JP. The presence and accessibility of firearms in the homes of adolescent suicides. A case-control study. JAMA 1991;266:2989-995. 4. Rosenberg MA, Mercy JA, Houk VN. Guns and adolescent suicides. JAMA 1991;266:3030.

9. Thursday, February 1 1. Chapter on Burns in The Injury Fact Book, pages 161-173. 2. Runyan CW, Bangdiwala SI, Linzer MA, Sacks JJ, Butts J. Risk factors for fatal residential f1res. N Eng J Med 1992;327:859-863. 3. Ballard JE, Koepsell TD, Rivara F. Association of smoking and alcohol drinking with residential f1re injuries. Am J Epidemiol 1992; 135:26-34.

10. Monday, February 5 1. Jurkovich GJ, Rivara FP, Gurney JG, Fligner C, Ries R, Mueller BA, Copass M. The effect of acute alcohol intoxication and chronic alcohol abuse on outcome from trauma. JAMA 1993;270:51-56. 2. Soderstrom CA, Smith GS. Alcohol's effect on trauma outcomes. A reappraisal of conventional wisdom. JAMA 1993;270:93-94. 3. Gentillo LM, Duggan P. Family intervention with the alcoholic after major injury in the trauma center setting. In: O'Farrell TJ, ed. Marital and family therapy in alcoholism treatment. New York: Guilford Publications; 1993:381-402.

11. Thursday, February 8 1. Retchin SM, Anapolle J. An overview of the older driver. Clin Geriatr Med 1993;9:279-96.

12. Monday, February 12 1. Wasson JH, Sox HC, Neff RK, Goldman L. Clinical prediction rules: applications and methodological standards. N Eng J Med 1985;313:793-9. 2. Longstreth WT Jr, Diehr P, Inui TS. Prediction of awakening after out-of-hospital cardiac arrest. N Eng J Med 1983;308:1378-82. 3. Jennett B, Bond M. Assessment of outcome after severe brain damage. A practical scale. Lancet 1975;i:480-4. 4. Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, Johns C, Worthington JR. Implementation of the Ottawa Ankle Rules. JAMA 1994;271:827-832. 5. McDonald CJ, Overhage JM. Guidelines you can follow and can trust. An ideal and an example. JAMA 1994;271:872-3.

13. Thursday, February 15 1. Chapter on Drowning in The Injury Fact Book, pages 174-85. 2. Quan L, Gore EJ, Wentz K, Allen J, Novack AH. Ten-year study of pediatric drownings and near-drownings in King County, Washington: lessons in injury prevention. Pediatrics 1989;83:1035-40. 3. Diekema DS, Quan L, Holt VL. Epilepsy as a risk factor for submersion injury in children. Pediatrics 1993;91:612-6.

14. Monday, February 19 Holiday

15. Thursday, February 22 1. Chapter on Poisoning in The Injury Fact Book, pages 194-210. 2. Clarke A, Walton WW. Effect of safety packaging on aspirin ingestion by children. Pediatrics 1979;63:687-693 . 3. Wysowski DK, Schober SE, Wise RP, Kopstein A. Mortality attributed to misuse of psychoactive drugs, 1979-88. 4. Chafee-Bahamon C, Lovejoy FH. Effectiveness of a regional poison center in reducing excess emergency room visits for children's poisonings. Pediatrics 1983; 72: 164-9. 5. Read last year's final exam and be prepared to discuss it in class.

17. Monday, February 26 1. Chapter on Occupational Injury in The Injury Fact Book, pages 114-33. 2. Kraus JF. Homicide while at work: persons, industries, and occupations at high risk. Am J Public Health 1987;77:1285-9. 3. Stout N, Bell C. Effectiveness of source documents for identifying fatal occupational injuries: a synthesis of studies. Am J Public Health 1991;82:725-8. 4. Request for Assistance in Preventing Homicide in the Workplace. Cincinnatti, OH: DHSS (NIOSH) Publication No. 93-109; 1933. 5. Kisner SM, Fosbroke DE. Injury hazards in the construction industry. J Occup Med 1994;36:137-43.

18. Thursday, February 29 1. Sacks HS, Berrier J, Reitman D, Pagano D, Chalmers TC. Meta-analyses of randomized control trials: an update of the quality and methodology. In: Bailer JC III, Mosteller F (eds). Medical Uses of Statistics, 2nd ed. Boston: NEJM Books: 1992; 427-42. 2. Cummings P. Antibiotics to prevent infection in patients with dog bite wounds: a meta-analysis of randomized trials. Ann Emerg Med 1994;23:535-40. 3. Koren G, Graham K, Shear H, Einarson T. Bias against the null hypothesis: the reproductive hazards of cocaine. Lancet 1989;2:1440-2. 4. Greenland S. Invited commentary: a critical look at some popular meta-analytic methods Am J Epidemiol 1994;140:290-6.

19. Monday, March 4. Student presentations

20. Thursday, March 7. Student presentations

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