Harborview Medical Center Project Descriptions
Frederick Rivara, MD, MPH Researchers will work closely with community partners currently involved in
drowning prevention programs. It is hoped the work will establish a basis
for future collaborative intervention studies. It is anticipated that an estimate of the burden of disease associated with
substance abuse in this context will set the stage for policies and
interventions geared toward minimizing the adverse functional outcomes
following injury in this population of patients. Results of this study will help identify possible barriers to ownership and
maintenance of working smoke detectors, assess the accuracy of self reported
smoke detector information, and help improve future fire related injury
research and prevention efforts.
University of Washington
Harborview Injury Prevention & Research
325 Ninth Avenue, Box 359960
Seattle, WA 98104
Phone: 205-521-1530
Fax: 206-521-1562
E-mail: fpr@u.washington.edu
Project Title: Improving Firearm Storage: Improving Practices in Alaska
Native Villages
Project Period: 08/01/04-07/31/07
Description: Rates of suicide among young Alaska Native males are
more than 10 times higher than those among a similar age cohort in the rest
of the United States. A high proportion of these deaths are associated with
firearms. Firearms are an important part of the subsistence lifestyle of
this population; however, restriction of access to guns by youth may be a
promising strategy to reduce the risk of suicides in this population.
Building on the foundation of a recently completed HIPRC series of studies,
the aims of this research are to:
Project Title: Barriers to PFD Use: Analysis of the Use of Personal
Flotation Devices in Drowning from Boating Accidents and Evaluation of Key
Factors for Intervention
Project Period: 08/01/07-07/31/09
Description: Almost all (95%) recreational boating deaths occur to
adults or adolescents. The use of personal flotation devices (PFDs) in this
group is low, with estimates ranging from 13% to 25% in recent observational
studies. To date, drowning prevention programs have related to drowning in
general or have focused on children. Little is known about why adult boaters
do not use PFDs. This knowledge is important for designing interventions
targeting this group. With a goal of identifying barriers to PFD use by
adult boaters (specifically, those in small motorboats, where most boat
related drowning events occur), this research will:
Project Title: Inclusive vs. Exclusive Trauma Systems: Determining
Optimal Configuration of Organized Systems of Trauma Care
Project Period: 08/01/07-07/31/09
Description: It is postulated that inclusive trauma systems provide
better, more timely access to a higher standard of trauma care than
exclusive trauma systems. The investigators will attempt to determine
whether patients within an inclusive system are more likely to be cared for
at designated centers with resources appropriate for their needs; whether
the easier and more timely access to care reduces overall motor vehicle
crash mortality within the region; and whether this improved access to
designated centers reduces the rate of injury related complications. A
population based interrupted time series analysis approach will be used to
determine the effect of system implementation on motor vehicle crash
mortality using data from the National Highway Traffic Safety
Administration’s Fatality Analysis Reporting System. Multistate inpatient
discharge data derived from Harm’s Healthcare Cost and Utilization Project (HCUP)
will be used to determine the effect of system configuration on the ultimate
field triage and complication rate of the injured patient.
Many states are in the process of developing regional trauma care systems.
Multistate In-patient discharge data will be critical in defining the
optimal system configuration to provide optimal matching of individual
hospital resources to patient needs and to provide the lowest risk of
mortality and complications following injury. Taken together, the
fulfillment of these specific aims will provide insight of the relative
merits of inclusive versus exclusive trauma system configurations.
Project Title: Trauma System Audit Filters: Development and Validation of
Audit Filters for Transfer Patients and Their Predictive Value for
Mortality, Morbidity, Length of Stay, and Cost
Project Period: 08/01/04-07/31/06
Description: The rationale for any trauma system is to provide a
coordinated, predictable, and multidisciplinary approach to managing the
injured patient. To operate effectively and efficiently, a trauma system
must undergo monitoring, evaluation, and improvement as defined by
performance improvement (PI). A detailed PI framework with specific, well
defined criteria measuring trauma system performance has not been
established or validated. The American College of Surgeons' audit filters,
developed as standards of care for trauma patients, have focused on PI in
individual trauma centers. None of the filters was designed to monitor the
trauma system as a whole. Thus, no systematic mechanism exists for
evaluating other critical components of a system including pre-hospital
care, inter-hospital transfers, and post acute care. It is hypothesized that
a set of audit filters that evaluate the trauma system can be identified.
These filters will be sensitive to identifying deviations in the integrated
function of the trauma system and will optimize patient outcomes as defined
by mortality, morbidity, and resource use. This project will use the Delphi
method to obtain expert consensus on trauma system audit filters that are
specific to the pre-hospital and inter-hospital transfer phases of the
trauma system. After these filters are developed, 3 years of pre-hospital
and trauma registry data from King County Washington will be linked.
Logistic regression analysis will be performed to evaluate each audit
filter's ability to predict adverse trauma outcomes such as morbidity,
length of hospital stay, hospital costs, and mortality. The development and
validation of these trauma filters will provide quality improvement measures
by which to evaluate trauma systems and trauma care in the future.
Project Title: Substance Abuse and Injuries: Determining the Impact of
Alcohol, Tobacco, and Illicit Drug Use on Functional Outcome After Injury
Project Period: 08/01/04-07/31/05
Description: This study tests two hypotheses:
Project Title: Airbags and Pregnancy
Project Period: 08/01/06-07/31/08
Description: Motor vehicle crashes (MVCs) are one of the leading
causes of injury related maternal and fetal deaths and the most common cause
of injury related hospitalizations during pregnancy. Although much research
has focused on the effects of seat belts and airbags in MVCs, relatively
little research has evaluated how these safety features affect pregnant
women. To assess the effects of airbags in pregnancy, this study will use a
retrospective cohort design to identify pregnant women involved in MVCs in
Washington State by linking the Washington State Patrol crash data to
Washington State birth and fetal death certificates. The exposures of
interest will be airbag availability without deployment and airbag
deployment. The outcomes of interest will be adverse maternal and infant
outcomes including types of maternal injuries, pre-term labor and delivery,
placental abruption, cesarean delivery, low birth weight, fetal distress,
fetal injury, and fetal death. This study will also evaluate the effects of
seat belt use on maternal and infant outcomes following MVCs. Knowledge
about the effects of airbags on pregnancy outcomes is essential for
health-care providers to adequately counsel women during prenatal care about
motor vehicle safety.
Project Title: Raise the Alarms Sub-analyses: Improving Ownership, Smoke
Detector Maintenance, and Safety Practices among Low- to Middle-income
Families
Project Period: 08/01/04-07/31/06
Description: Residential fires are responsible for the majority of
fire related deaths in the United States. Smoke detectors are recognized to
be an economical and efficient injury intervention, capable of reducing risk
of death by up to 70%. Currently it is estimated that the great majority
(>90%) of U.S. homeowners report having at least one smoke detector.
However, in homes where detectors are installed, 20% to 50% are
nonoperational. These may also be installed in suboptimal locations, thereby
decreasing the effectiveness in preventing injuries should a fire occur.
This study will:
Project Title: Antilock Brakes: Estimation of the Association Between
Antilock Brake Systems and the Risk of Traffic Crash Injury
Project Period: 08/01/04-07/31/06
Description: A few studies have tried to estimate the association
between the presence of antilock brakes in a vehicle and either the risk of
a crash or the risk of injury in a crash. To date, there is little evidence
that antilock brakes are effective. This project consists of a case control
study to estimate the association between the presence of an antilock brake
system in a passenger vehicle and the risk of a traffic crash injury. It
will use data from a large insurance carrier. Cases will be cars with a
driver owner injured in a crash. Controls will be other cars matched to each
case car on date of crash, and selected randomly from insured cars at the
time of the crash. The analysis will adjust for potential confounding
factors related to the car and to the driver owner. The final risk ratio
estimates will be useful in understanding how antilock brakes may help
reduce traffic crash injuries.
Project Title: Window Falls: Environmental Risks and Protective Factors
for Falls of Children under 10 from Windows Resulting in Emergency Room
Visits, Hospital Admissions, and Death
Project Period: 08/01/07-07/31/09
Description: Falls among children ages 0 to 5 years in the United
States led to 64 deaths (2001), approximately 13,800 hospitalizations
(2002), and 1.2 million emergency department visits (2001). A large
proportion of hospitalizations result from falls from windows of buildings.
Despite the magnitude and frequency of this problem, no controlled studies
could be found to determine environmental risk factors for this type of fall
in children. The only known strategy for preventing window falls is the
installation of window bars. Other environmental approaches to prevention
could be possible if more were known about risk factors for window falls.
Factors such as window size, height, and opening mechanism; use of screens;
and windowsill size could potentially affect the risk of a fall of a young
child. Planning prevention strategies for these types of falls requires an
enhanced understanding of risk and protective factors.
This pilot study has several aims:
Project Title: Alcohol Excise Taxes: Estimating the Association Between
Amount of State Alcohol Excise Tax and Mortality from Intentional and
Unintentional Injury
Project Period: 08/01/05-07/31/07
Description: A large body of literature demonstrates that alcohol
consumption is related to the price of alcohol. This study will examine the
impact of different levels of alcohol excise taxes on trauma deaths in the
United States. Specifically, researchers will estimate the association
between the amount of the state excise tax on alcohol and mortality from
intentional and unintentional injury. It is hypothesized that higher alcohol
excise taxes are associated with a lower rate of fatal injury, especially
due to motor vehicle crashes and homicide.
This study will be a time series analysis in which the association between
different levels of alcohol excise taxes and injury mortality in a state
will be assessed. Researcher will examine all injury deaths with 800–949 ICD
codes for the years 1979–2000. They will also review statutes of each state
for 1979–2000 to obtain information about the date on which each law went
into effect. In addition to changes in the age and sex distribution of the
population, other potential confounders may include the cost of alcohol
apart from taxes, the cost of living in a state, calendar year, and the
poverty level in a state. In all states, the minimum legal age for purchase
is 21. The cost of alcohol, apart from taxes, will be adjusted for in the
analysis; this will allow the effect of the excise tax as an independent
variable to be examined. The main analysis will use count data methods to
estimate the change in mortality rates associated with changes in the
alcohol excise tax. Negative binomial regression will be used, which may be
thought of as a form of random effects Poisson regression.
This study will provide useful data to policy makers about the effectiveness
of alcohol excise taxes, the size of the effect, and the amount of tax
necessary to reduce injury mortality. This information can then be directly
translated into policy changes at the state level.
Project Title: Side Impact Crashes and Pregnancy: Study of Mechanisms of
Pelvic Fractures in Side Impact Collisions and Methods to Reduce Injuries to
Pregnant Women
Project Period: 08/01/05-07/31/07
Description: Researchers on this project hypothesize that during side
impact collisions, occupants may be trapped between the incoming door and
the rigid center console that extends above the seat in some vehicles. Arm
rest contact at the hip from the intruding door results in lateral
compression and fracture of the pelvis, resulting in major trauma. A
yielding or breakaway center console might reduce the potential for pelvic
fracture during side impacts by eliminating the trapping effect. Researchers
will first conduct epidemiological studies to determine demographics and
risk factors for pelvic fractures to all occupants in side impacts, and
specifically to the subpopulation of pregnant women involved in nearside
impacts. The proposed mechanism of injury will be studied using an existing,
pendulum-based, door punch, side impact test fixture, with a side impact
test dummy, and by Mathematical Dynamical Models (MADYMO), mathematical
modeling of the injury mechanism. This mechanism, while of concern for all
occupants, may be particularly relevant to late-stage pregnant female
occupants because of their enlarged abdominal regions. Based on the
findings, a modification to the center console may be proposed that might
reduce pelvic forces during side impact collisions.
Project Title: Rear-seat Side Airbags and Children
Project Period: 08/01/07-07/31/09
Description: There has been little survey of side air bag
performance, especially for rear-seated child passengers. Children are
common rear-seat passengers. While the optimal position for a child may be
in the rear-center seat, out of the way of the side airbag, when more than
one child is being transported, or in smaller vehicles, a child may occupy
an outboard rear seat near the airbag. Only a few studies have addressed the
risks side airbags pose for outboard rear-seated children. One researcher
concluded that current side airbag designs may cause serious or fatal neck
and chest injuries to out of position occupants. However, no studies have
been conducted to model the dynamic door punch that occurs in a side impact.
In this project, investigators will create a dynamic model of door/sidewall
intrusion and airbag deployment resulting from a side impact collision. This
research may provide a more realistic assessment of the interaction of the
occupant with a rear-seat side airbag during a simulated side impact
collision.
The study (scheduled for 2½ years) will consist first of an epidemiological
review of NASS CDS data to determine demographics and risk factors for
school-age children in side impacts in vehicles with side airbags. Next,
modeling will be performed using MADYMO, and the model will be verified
using a pendulum side impact apparatus, onto which a vehicle door with a
side airbag has been mounted impacting a 6-year-old hybrid III impact dummy.
Head and neck injury parameters will be determined for out of-position
occupants, both in and out of a booster seat, on the nearside with a
deployed airbag. Based on observation and measurements of head and neck
injury mechanisms, seated positions for child occupants with the least risk
of injury will be identified.
Project Title: Hospital-acquired Pneumonia in Persons with Spinal Cord
Injury
Project Period: 08/01/06/-07/31/08
Description: Pneumonia is the leading cause of death in persons with
spinal cord injury (SCI). Community-acquired pneumonia (CAP) in persons with
SCI is caused by a different spectrum of bacterial pathogens than those seen
in the general population, and the case fatality rate for CAP is
significantly higher at hospitals without specialized SCI services than at
those with these services. Hospital acquired pneumonia (HAP) in the general
population has a case fatality rate of 36% and the risk factors and
pathogens are different from CAP. HAP in persons with chronic SCI has not
previously been investigated. This study will determine the incidence, crude
and attributable mortality rates, risk factors, and etiologic pathogens for
HAP in hospitalized patients with SCI. It will also characterize HAP
management at specialized SCI centers. Researchers will conduct a
retrospective, matched case control study using data abstracted from
inpatient medical records from Veterans Affairs (VA) hospitals with SCI
services. Additionally, a cohort study will be performed using national VA
administrative data to compare mortality rates at VA hospitals with and
without specialized SCI services. Characterization of the epidemiology,
pathogenesis, and current treatment practices for HAP in persons with SCI
may allow development of improved strategies for prevention and treatment.