Sport and recreation is beneficial for health and wellbeing but comes with a probability of loss, including occasional fatal injuries. Following high-profile injury deaths in Australia, concerns are ...raised regarding the safety of sport participation. To understand the scale and scope of injury deaths, and identify potential prevention opportunities, the aim of this investigation was to describe the number and nature of fatal injuries in Australian sport and recreation.
This is a retrospective cohort study of injury deaths reported between 1 July 2000 to 31 December 2019 using data from the National Coronial Information System, Australia. Unintentional deaths with an external cause, where the activity was recorded as sport and exercise during leisure time were included. Drowning deaths were excluded. Presented are the number and % of cases by age, sex, sport, broad cause and annual crude death rate (population).
There were 1192 deaths, averaging 63 per year. Deaths were mostly in males (84.4%), with the largest proportion in people aged 15-24 years (23.1%). Wheeled motor (26.9%) and non-motor (16.2%) sports accounted for the highest proportion of cases. The primary mechanism of death was most commonly blunt force (85.4%), followed by piercing/penetrating force (5.0%). The years 2001 and 2005 recorded the highest crude injury death rate (2001, n = 92, 0.47 per 100,000 population; 2005, n = 95, 0.47 per 100,000 population).
On average, there is more than one injury death per week in a sport or recreation setting in Australia. Cases occurred in many sports and recreation activities, including those generally considered to be safe (e.g. individual athletic activities, team ball sports.) Detailed investigation of the coronial recommendations that are present within each case is now needed to understand and identify potential prevention opportunities.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This paper is a revision and update of the recommendations developed following the 1st (Vienna 2001), 2nd (Prague 2004), and 3rd (Zurich 2008) International Consensus Conference on Concussion in ...Sport and is based on the deliberations at the 4th International Conference on Concussion in Sport held in Zurich, November 2012. The new 2012 Zurich Consensus statement is designed to build on the principles outlined in the previous documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. While agreement exists pertaining to principle messages conveyed within this document, the authors acknowledge that the science of concussion is evolving, and therefore, management and RTP decisions remain in the realm of clinical judgment on an individualized basis. There was acknowledgement by the Concussion in Sport Group that, although the terms mild traumatic brain injury and concussion are often used interchangeably in the sporting context and particularly in the US literature, others use the term to refer to different injury constructs.
Objective: To assess the factors, including helmet use, that contribute to head linear and angular acceleration in bicycle crash simulation tests.
Method: A series of laboratory tests was undertaken ...using an oblique impact rig. The impact rig included a drop assembly with a Hybrid III head and neck. The head struck a horizontally moving striker plate. Head linear and angular acceleration and striker plate force were measured. The Head Injury Criterion was derived. The following test parameters were varied: drop height to a maximum of 1.5 m, horizontal speed to a maximum of 25 km/h, helmet/no helmet, impact orientation/location, and restraint adjustment. Additional radial impacts were conducted on the same helmet models for comparison purposes. Descriptive statistics were derived and multiple regression was applied to examine the role of each parameter.
Results: Helmet use was the most significant factor in reducing the magnitude of all outcome variables. Linear acceleration and the Head Injury Criterion were influenced by the drop height, whereas angular acceleration tended to be influenced by the horizontal speed and impact orientation/location. The restraint adjustment influenced the outcome variables, with lower coefficients of variation observed with the tight restraint.
Conclusions: The study reinforces the benefits of wearing a bicycle helmet in a crash. The study also demonstrates that helmets do not increase angular head acceleration. The study assists in establishing the need for an agreed-upon international oblique helmet test as well as the boundary conditions for oblique helmet testing.
Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.
Physical reconstructions are a valuable methodology for quantifying head kinematics in sports impacts. By recreating the motion of human heads observed in video using instrumented test dummies in a ...laboratory, physical reconstructions allow for in-depth study of real-world head impacts using well-established surrogates such as the Hybrid III crash test dummy. The purpose of this paper is to review all aspects of the physical reconstruction methodology and discuss the advantages and limitations associated with different choices in case selection, study design, test surrogate, test apparatus, text matrix, instrumentation, and data processing. Physical reconstructions require significant resources to perform and are therefore typically limited to small sample sizes and a case series or case–control study design. Their accuracy may also be limited by a lack of dummy biofidelity. The accuracy, repeatability, and sensitivity of the reconstruction process can be characterized and improved by good laboratory practices and iterative testing. Because wearable sensors have their own limitations and are not available or practical for many sports, physical reconstructions will continue to provide a useful and complementary approach to measuring head acceleration in sport for the foreseeable future.
Background:
Wearable sensor systems have the potential to quantify head kinematic responses of head impacts in soccer. However, on-field use of sensors (eg, accelerometers) remains challenging, owing ...to poor coupling to the head and difficulties discriminating low-severity direct head impacts from inertial loading of the head from human movements, such as jumping and landing.
Purpose:
To test the validity of an in-ear sensor for quantifying head impacts in youth soccer.
Study Design:
Descriptive laboratory study.
Methods:
First, the sensor was mounted to a Hybrid III headform and impacted with a linear impactor or a soccer ball. Peak linear acceleration (PLA), peak rotational acceleration (PRA), and peak rotational velocity (PRV) were obtained from both systems; random and systematic errors were calculated with Hybrid III as reference. Then, 6 youth soccer players wore sensors and performed a structured training protocol, including heading and nonheading exercises; they also completed 2 regular soccer sessions. For each accelerative event recorded, PLA, PRA, and PRV outputs were compared with video recordings. Receiver operating characteristic curves were used to determine the sensor’s discriminatory capacity in both on-field settings, establishing cutoff values for predicting outcomes.
Results:
For the laboratory tests, the random error was 11% for PLA, 20% for PRA, and 5% for PRV; the systematic error was 11%, 19%, and 5%, respectively. For the structured training protocol, heading events resulted in higher absolute values (PLA = 15.6g± 11.8g) than nonheading events (PLA = 4.6g± 1.2g); the area under the curve was 0.98 for PLA. In regular training sessions, the area under the curve was >0.99 for PLA. A 9g cutoff value yielded a positive predictive value of 100% in the structured training protocol versus 65% in the regular soccer sessions.
Conclusion:
The in-ear sensor displayed considerable random error and substantially overestimated head impact exposure. Despite the sensor’s excellent on-field accuracy for discriminating headings from other accelerative events in youth soccer, absolute values must be interpreted with caution, and there is a need for secondary means of verification (eg, video analysis) in real-life settings.
Clinical Relevance:
Wearable sensor systems can potentially provide valuable insights into head impact exposures in contact sports, but their limitations require careful consideration.
The paper presents a novel laboratory method for assessing boxing headguard impact performance. The method is applied to examine the effects of headguards on head impact dynamics and injury risk.
A ...linear impactor was developed, and a range of impacts was delivered to an instrumented Hybrid III head and neck system both with and without an AIBA (Association Internationale de Boxe Amateur)-approved headguard. Impacts at selected speeds between 4.1 and 8.3 m/s were undertaken. The impactor mass was approximately 4 kg and an interface comprising a semirigid 'fist' with a glove was used.
The peak contact forces were in the range 1.9-5.9 kN. Differences in head impact responses between the Top Ten AIBA-approved headguard and bare headform in the lateral and forehead tests were large and/or significant. In the 8.3 m/s fist-glove impacts, the mean peak resultant headform accelerations for bare headform tests was approximately 130 g compared with approximately 85 g in the forehead impacts. In the 6.85 m/s bare headform impacts, mean peak resultant angular head accelerations were in the range of 5200-5600 rad/s(2) and almost halved by the headguard. Linear and angular accelerations in 45° forehead and 60° jaw impacts were reduced by the headguard.
The data support the opinion that current AIBA headguards can play an important role in reducing the risk of concussion and superficial injury in boxing competition and training.
To critically review the evidence to determine the efficacy and effectiveness of protective equipment, rule changes, neck strength and legislation in reducing sport concussion risk.
Electronic ...databases, grey literature and bibliographies were used to search the evidence using Medical Subject Headings and text words. Inclusion/exclusion criteria were used to select articles for the clinical equipment studies. The quality of evidence was assessed using epidemiological criteria regarding internal/external validity (eg, strength of design, sample size/power, bias and confounding).
No new valid, conclusive evidence was provided to suggest the use of headgear in rugby, or mouth guards in American football, significantly reduced players' risk of concussion. No evidence was provided to suggest an association between neck strength increases and concussion risk reduction. There was evidence in ice hockey to suggest fair-play rules and eliminating body checking among 11-years-olds to 12-years-olds were effective injury prevention strategies. Evidence is lacking on the effects of legislation on concussion prevention. Equipment self-selection bias was a common limitation, as was the lack of measurement and control for potential confounding variables. Lastly, helmets need to be able to protect from impacts resulting in a head change in velocities of up to 10 and 7 m/s in professional American and Australian football, respectively, as well as reduce head resultant linear and angular acceleration to below 50 g and 1500 rad/s(2), respectively, to optimise their effectiveness.
A multifactorial approach is needed for concussion prevention. Future well-designed and sport-specific prospective analytical studies of sufficient power are warranted.
Forty rail safety investigation reports were reviewed and a theoretical framework (the Human Factors Analysis and Classification System; HFACS) adopted as a means of identifying errors associated ...with rail accidents/incidents in Australia. Overall, HFACS proved useful in categorising errors from existing investigation reports and in capturing the full range of relevant rail human factors data. It was revealed that nearly half the incidents resulted from an equipment failure, most of these the product of inadequate maintenance or monitoring programs. In the remaining cases, slips of attention (i.e. skilled-based errors), associated with decreased alertness and physical fatigue, were the most common unsafe acts leading to accidents and incidents. Inadequate equipment design (e.g. driver safety systems) was frequently identified as an organisational influence and possibly contributed to the relatively large number of incidents/accidents resulting from attention failures. Nearly all incidents were associated with at least one organisational influence, suggesting that improvements to resource management, organisational climate and organisational processes are critical for Australian accident and incident reduction. Future work will aim to modify HFACS to generate a rail-specific framework for future error identification, accident analysis and accident investigation.
Biomechanical studies of concussions have progressed from qualitative observations of head impacts to physical and numerical reconstructions, direct impact measurements, and finite element analyses. ...Supplementary to a previous study, which investigated maximum principal strain, the current study used a detailed finite element head model to simulate unhelmeted concussion and no-injury head impacts and evaluate the effectiveness of various tissue-level brain injury predictors: strain rate, product of strain and strain rate, cumulative strain damage measure, von Mises stress, and intracranial pressure. Von Mises stress was found to be the most effective predictor of concussion. It was also found that the thalamus and corpus callosum were brain regions with strong associations with concussion. Tentative tolerance limits for tissue-level predictors were proposed in an attempt to broaden the understanding of unhelmeted concussions. For the thalamus, tolerance limits were proposed for a 50% likelihood of concussion: 2.24 kPa, 24.0 s-1, and 2.49 s-1 for von Mises stress, strain rate, and the product of strain and strain rate, respectively. For the corpus callosum, tolerance limits were proposed for a 50% likelihood of concussion: 3.51 kPa, 25.1 s-1, and 2.76 s-1 for von Mises stress, strain rate, and the product of strain and strain rate, respectively.
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