Supplement to Application to Undertake Intercalated Year of Study for Bsc Degree - Scheme

Supplement to Application to undertake intercalated year of study for BSc degree - Scheme B(Sonal TRIPATHI)

1. Revised title of project

Injury prevention and control - identification of modifiable risk factors for traumatic injuries sustained by cyclists

2. Background to the project

Most injury is caused when human tissues are exposed to mechanical energy transfer of a magnitude that exceeds tissue tolerances. The complexity of the events surrounding the injury can be best considered by breaking them down into pre-event, event and post-event phases and relating them to host, agent and environmental factors (table 1). It can be seen that a very wide range of research disciplines and methodologies might be applied to elements of injury prevention and control. For example, materials science research related to energy absorption in the event phase or therapeutic research related to the prevention and management of osteoporosis in the pre-event phase.

This research proposed within this BSc project application is a systematic investigation of the factors associated with specified injuries within a defined population. This investigation involves derivation of new knowledge and the testing of hypotheses in order to complete and validate the matrix for the defined injury problem.

Table 1. Injury research matrix

Injury
problem / Host factors / Injurious agent factors / Environment factors
Pre-event
phase / ? / ? / ?
Primary prevention strategies ?
Event
phase / ? / ? / ?
Secondary prevention strategies ?
Post-event
phase / ? / ? / ?
Tertiary prevention strategies ?

3. Revised programme of research

The purpose of this project is to:

(a)Identify and describe the epidemiology of a specific injury problem;

(b)Apply established and novel research methods and tools to identify modifiable risk factors for that problem and;

(c)Develop proposals for a targeted prevention and control strategy specific to that population.

The specific injury problem proposed by the BSc student is injury associated with cycling.

The programme of supervised research within the BSc year would therefore include the following.

(1) Developing a literature search strategy and undertaking a critical appraisal of the relevant literature related to the epidemiology of injury associated with cycling (and any existing evidence for prevention strategies).

(2) Mapping and accessing data related to this injury problem and deriving a minimum data set. This may include data from a range of sources including the Emergency Department, the local government and police road accident data sets, the ambulance service, the coroners and other agencies directly involved in collecting data related to injury associated with cycling.

(3) Analysis of cycle related injuries presenting to the Emergency Department at Leicester Royal Infirmary in order to determine the prevalence of the injury problem locally and support sample size determination for a prospective case-control study.

This analysis will utilise descriptive epidemiology and conventional statistical methods to:

(a) identify contributory factors (related to the host, agent and environment in the pre-event, event and post-event phases);

(b) undertake responsibility and culpability analysis;

(c) undertake geo-demographic and socio-demographic profile analysis;

(d) generate hypotheses for injury prevention and control measures.

(4) Undertaking a prospective population based case-control study to test the hypothesis that the identified factors increase (or decrease) the incidence of the injury associated with cycling.

The population for this study would be defined and may be the resident population of Leicestershire County and/or Leicestershire City (depending on injury prevalence) over a specified time period. The study may also be restricted to a specified body area injured (e.g. limb or head injuries - determined by the sample size required). Cases would be persons presenting to the Emergency Department who are members of the study population and have the injuries associated with cycling (e.g. persons sustaining head injuries in cycle accidents). Controls would be persons presenting to the Emergency Department who are also members of the study population but do not have the specified injury problem (e.g. persons involved in cycle accidents who do not sustain head injuries). Results will be expressed as odds ratios and relative risk estimates.

Having identified and confirmed the key contributory (or risk) factors, the project will conclude with articulating countermeasures for the major contributory factors and proposals for intervention strategies (which may subsequently form the basis of a pragmatic intervention trial).

4. Ethics Committee Approval

Research Ethics Committee approval will be required in order to allow access to the clinical data for each patient and to support access to other sources of data within the community. The Emergency Medicine Academic Group have significant expertise in fulfilling the regulatory, ethical and legal requirements necessary to obtain such approval.

Roderick Mackenzie

10 March 2009