BIOMECHANICAL EPIDEMIOLOGY A fresh approach to data gathering and injury reduction in motor sport: an Australian perspective Dr Michael Henderson, Fellow, FIA Institute for Motor Sport Safety and Sustainability ICMS Annual Congress, Orlando, November 30-December 1, 2011 v004

Background What is “biomechanical epidemiology”? Incorporates the approach of multiple disciplines into injury research Requires that issues relevant to all disciplines are addressed at outset Includes inception, design, execution, analysis and application of research Intended to overcome approaches that differ between disciplines and foster collaborative studies Concept developed by Johns Hopkins Center for Injury Research and Policy; courses sponsored by George Snively Foundation Wholly adaptable to motor sport injury research

The problem defined Different languages and approaches Disciplines have unique languages and approaches to research and publication Particularly applies to basic sciences of injury control: biomechanical engineering, epidemiology and clinical medicine Epidemiological and medical studies usually lack mechanical data needed by the engineers Clinical and biomechanical injury studies that lack epidemiological input usually cannot be applied validly to groups

A different framework An integrated approach So-called collaborative research often simply means that one discipline presents its results to another discipline That worked when simple changes led to big improvements (the “silver bullets”) But future improvements in injury control require a more subtle and sophisticated approach This involves applying biomechanical principles to the epidemiological study of injury Incorporates expertise of engineers, epidemiologists, clinicians and other relevant disciplines

The application of biomechanical epidemiology in motor sport Data collection and analysis may be applied at three levels Level 1: mass data collection For overview, surveillance, trend analysis; important for priority setting and review Level 2: data collection for research More detailed data, sampled over time on a defined basis such as hospitalisation or crash severity Level 3: detailed analysis for data on injury causation and prevention Crash-specific analysis requiring expert medical, engineering, biomechanical and legal input – focussed on fatal and catastrophic injury

Incident data collected at events Mostly generated by event officials Completed forms, diagrams, photos where possible

Injury data collected at event by medical and paramedical teams

Use of mass data collection at events An example of a “snapshot” analysis - example from CAMS incident and injury data collection Comparison of the incidence, in closed car circuit racing and rallies, of serious injury (with hospitalisation) in reported incidents in 2006. (from Gibson et al, AIMSS 2008)

Fatality data from www.motorsportmemorial.org An international mass data collection A unique collection of fatality data, including narratives and enabling trend analysis Annual motorsport fatalities worldwide, 1990-2008, by competition category Fatality data from www.motorsportmemorial.org

Mass data collected at events Problems and deficiencies Data specific to sanctioning body Quality of data often suspect Lax approaches to form-filling Injury data rarely complete or confirmed Little enthusiasm in sanctioning bodies for financing routine data analysis

Mass injury data collected by hospitals Injury data more accurate than that collected at events Useful guide to the bigger picture Over-simple categorisation: e.g. “wheeled motor sports” No mechanical incident data No biomechanical input and rarely AIS coding Capacity for injury reduction research limited

Injury Research and Statistics Series Number 27 Mass injury data collected by hospitals Example of public data analysis – a first base for research Hospitalisations from wheeled motor sports injury and all sports injury, by principal body region injured, Australia, 2002-2003 From Flood L and Harrison JE 2006 ,Hospitalised sports injury, Australia 2002–03 Injury Research and Statistics Series Number 27

Data collection for research Steps towards biomechanical epidemiology

In-depth crash investigation Crash video when available

In-depth crash investigation On-scene photographs

In-depth crash investigation Detailed vehicle and personal protective equipment photographs

In-depth crash investigation Links medicine, biomechanics, engineering and legal aspects Statements witnesses event officials medical and paramedical personnel Review ADR data where available possible contribution to FIA database Panel of Inquiry legal technical/biomechanical medical/paramedical official (track worker) driver adviser

Towards a multidisciplinary framework for biomechanical epidemiology Where are the linkages? Medicine Engineering First intervention Extrication Survey Treatment Injury mechanisms Injury tolerance Personal protection Rehabilitation Anti-doping Energy management Vehicle protective systems Roadside and trackside, features and design Epidemiology Mass data – accident databases In-depth serious crash investigation Data collation and analysis

Building a multidisciplinary framework for biomechanical epidemiology The application of biomechanical principles to the epidemiological study of injury Medicine Engineering THE LINKS Epidemiology From Winston FK et al, Biomechanical epidemiology: a new approach to injury control research, J Trauma, 1996, 40(5):820-4

Summary The application of biomechanical epidemiology to motor sport A researcher identifies a motor sport injury problem relevant to their discipline Epidemiologists study the prevalence of the injury pattern in their databases Engineers describe the real-world data needed to address the problem Clinicians describe the pathology of the injury pattern THEN Epidemiologists design a study incorporating the engineer’s study needs Clinicians identify cases for inclusion in the study Engineers reconstruct circumstances leading to the injury Epidemiologists implement the study and analyse the data

Summary The application of biomechanical epidemiology to motor sport THE POTENTIAL BENEFITS Engineers can apply knowledge of the injury mechanisms to improved safety technology Clinicians can improve response, reaction, triage and emergency care of the injury pattern Epidemiologists can generalise the results to other injury patterns AND Rule-makers can where appropriate apply new regulations based on evidence Behavioural scientists can study behaviours that put individuals at risk of sustaining the injuries Economists can put a cost on the injury pattern(s) and on the measures designed to address them

Finally . . . Things don’t always end badly:

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