Transient Exposures and the Risk of Childhood Injury

Petridou, Eleni; Mittleman, Murray A.; Trohanis, Dimitrios; Dessypris, Nick; Karpathios, T; Trichopoulos, Dimitrios

doi:10.1097/00001648-199811000-00010

Cited by 40 publications

(58 citation statements)

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“…The method was applied to several studies in progress that had data amenable to case-crossover analysis (5,12,24). Soon it attracted the interest of epidemiologists studying injuries (36,40,52) and adverse drug events (1,2,49,50). The design received widest recognition in 1997 when lay media publicized a study showing that car telephone calls increased the risk of collisions (21,38).…”

Section: How Has the Design Been Used So Far?mentioning

confidence: 99%

“…The second approach seemed more difficult because detailed data on usual wake times and sleep times were hard to collect. A child injury study (36) used the second approach. Sleep time was excluded because few children are seriously injured falling out of bed while asleep.…”

Section: Should Times When Exposure Is Impossible Be Excluded From Thmentioning

confidence: 99%

“…The Greek child injury study (36) found 17 exposures reported for the period 3-4 h before injury vs 11 exposures for the period 25-26 h before injury. This suggests ∼30% underreporting of events for the day before, which was not enough to explain the elevated RRs.…”

Section: Limitationsmentioning

confidence: 99%

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Should We Use a Case-Crossover Design?

Maclure

Mittleman

2000

Annu. Rev. Public Health

638

614

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The first decade of experience with case-crossover studies has shown that the design applies best if the exposure is intermittent, the effect on risk is immediate and transient, and the outcome is abrupt. However, this design has been used to study single changes in exposure level, gradual effects on risk, and outcomes with insidious onsets. To estimate relative risk, the exposure frequency during a window just before outcome onset is compared with exposure frequencies during control times rather than in control persons. One or more control times are supplied by each of the cases themselves, to control for confounding by constant characteristics and self-confounding between the trigger's acute and chronic effects. This review of published case-crossover studies is designed to help the reader prepare a better research proposal by understanding triggers and deterrents, target person times, alternative study bases, crossover cohorts, induction times, effect and hazard periods, exposure windows, the exposure opportunity fallacy, a general likelihood formula, and control crossover analysis. INTRODUCTIONA case-crossover study (18, 26) is a scientific method to answer the question, "Was this event triggered by something unusual that happened just before?" The simple part of the question is "What happened just before?" The challenging part is to quantify "How unusual was that?" The latter question must be answered for all people in the study who experience the outcome event (disease onset, injury, or behavioral change), not just the people who had the hypothesized triggers just before.We started developing the design in 1988 to avoid control selection bias in the Myocardial Infarction (MI) Onset Study (29). The original study aim was to use a case-control approach to investigate why the incidence of MI peaks in the morning. Who should be the controls? We were concerned that noncases drawn from the general population would be a biased sample not only because of healthyvolunteer bias, but also healthy-day bias. These subjects would be more likely to decline to be interviewed on stressful days. We also ruled out patients hospitalized for other emergencies, because they would be biased by whatever triggered their Next we realized that we could make the opposite comparison by also asking morning cases about their afternoon exposures on the previous day. Finally, it dawned on us that we could compare each patient's experience on their MI day with their experience on the day before. This would give us a perfectly matching control for each patient-the same patient at the same time on the day before.Eventually we saw how we could have multiple control days for each patient by asking about exposure frequency during the entire week, month, or year before. When we applied epidemiologic theory to this approach, we realized it was like a nonexperimental crossover experiment observed retrospectively. We are often asked whether a case-crossover design would be appropriate to study a given hypothesis. This review is intended to...

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Section: How Has the Design Been Used So Far?mentioning

confidence: 99%

Section: Should Times When Exposure Is Impossible Be Excluded From Thmentioning

confidence: 99%

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Should We Use a Case-Crossover Design?

Maclure

Mittleman

2000

Annu. Rev. Public Health

638

614

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“…4 In particular, traditional case-control studies may not be well suited to investigate relevant risk factors for sudden events. The case-crossover design, in contrast, has proved to be particularly useful when investigating how transient exposures can trigger acute events, such as cardiovascular events, 5,6 injuries, [7][8][9][10] and death in general. 11,12 The case-crossover design has also been proposed as a useful method in the study of occupational injuries.…”

mentioning

confidence: 99%

“…13 This epidemiologic method has been successfully applied to evaluate the risk of childhood injuries associated with traffic volume and speed on the roads crossed by young pedestrians 7 and with emotional distress and physical activity. 10 The case-crossover design offers a number of advantages. Cases serve as their own controls and a participant's exposure at the time of the event of interest (case period) is compared with another period when the participant was not a case (control period).…”

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confidence: 99%

A Case-Crossover Study of Sleep and Childhood Injury

2001

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ABSTRACT. Objective. To evaluate the association between sleep and wakefulness duration and childhood unintentional injury.Study Design. Case-crossover study. Methods. Two hundred ninety-two injured children who presented at the Children's Emergency Center of Udine, Italy, or their parents were interviewed after a structured questionnaire. Information was collected concerning sociodemographic variables, participant's habits, and injury characteristics, including a brief description of the accident dynamics. Sleep or wakefulness status of the child was assessed retrospectively for each of the 48 hours before injury. For each child, we compared the 24 hours immediately before the injury (hours 1-24; case period) with hours 25 to 48 (control period). Nonparametric tests were conducted to compare the difference of sleep duration between case and control periods. In addition, we conducted intrapersonal conditional logistic regression analyses and estimated relative risks (RRs) and 95% confidence intervals (CIs).Results. Overall, more children had longer hours of sleep during the control period than during the case period. However, this difference was significant for boys only. A direct association between injury risk and sleeping <10 hours was found among boys (RR: 2.33; 95% CI: 1.07-5.09) but not among girls (RR: 1.00; 95% CI: .29 -3.45). This association was particularly strong among boys attending nursery school. We also found a direct association between injury occurring between 4 PM and midnight, and being awake for at least 8 hours before injury occurred (both sexes, RR: 4.00; 95% CI: 1.13-14.17).Conclusions. Our findings show that inadequate sleep duration and lack of daytime naps are transient exposures that may increase the risk of injury among children. These results suggest new prospects for injury prevention in childhood. Pediatrics 2001;107(2). URL: http://www.pediatrics.org/cgi/content/full/107/2/e23; children, injury, sleep, case-crossover, epidemiology.ABBREVIATIONS. CERP, children's emergency room of the pediatrics department; RR, relative risk; CI, confidence interval. I n Italy (ϳ56 million inhabitants; 9 million children Ͻ15 years of age), ϳ500 children Ͻ15 years of age are killed each year in unintentional injuries. 1 Homicides and suicides are much less frequent, accounting for Ͻ10% of all fatal injuries among children. 1 In Northern Italy, in 1995, injury mortality rates (International Classification of Diseases, Ninth Revision codes from 800 to 999) were 10 deaths/100 000 inhabitants under 1 year of age, 5/100 000 from 1 to 4 years of age, and 6/100 000 from 5 to 14 years of age. Among infants, injury represented only 2% of overall mortality, whereas in the 2 older age groups injuries accounted for 18% and 33% of all deaths, respectively. 2 Mortality, however, is just the tip of a pyramid, where for each injury resulting in a death there are many injuries causing hospitalization and treatment in emergency centers, by general practitioners or by paramedics only. 3 Sudden events are often caused...

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Association of Drugs With Acute Angle Closure

Park

2022

JAMA Ophthalmol

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ImportanceAcute angle-closure (AAC) glaucoma is a sight-threatening disease and can reportedly occur in association with various drugs.ObjectiveTo identify drugs that are associated with AAC glaucoma occurrence and evaluate the risk of AACassociated with each drug.Design, Setting, and ParticipantsA case-crossover study was conducted using the Health Insurance Review and Assessment Service database, which contains medical information of the entire Korean population. Patients who were first diagnosed with AAC and treated between 2013 and 2019 were identified using diagnostic and procedure codes. All drugs that the study participants were prescribed as well as prescription dates during the period of 1 to 180 days before the onset of AAC were extracted from the database. For each patient, 1 to 30 days before onset was considered the hazard period, and 91 to 180 days before AAC onset was considered the control period.Main Outcomes and MeasuresDrugs associated with AAC and odds (calculated as odds ratios [ORs] with 95% CIs) of AAC development associated with each identified drug.ResultsA total of 949 drugs that were prescribed to 13 531 patients with AAC (mean [SD] age, 66.8 [10.6] years; 9585 [70.8%] female) during the period of 1 to 180 days before the onset of AAC were analyzed. A total of 61 drugs were found to be associated with AAC, among which sumatriptan (OR, 12.60 [95% CI, 4.13-38.44]) was associated with the highest odds of AAC development, followed by topiramate (OR, 5.10 [95% CI, 2.22-11.70]) and duloxetine (OR, 4.04 [95% CI, 2.95-5.54]). The median (IQR) period from prescription of the drug to the onset of AAC for the 61 drugs was 11.9 days (10.9-12.8). A number of drugs not previously considered to be associated with AAC, including lactulose (OR, 2.81 [95% CI, 1.72-4.61]) and metoclopramide (OR, 2.52 [95% CI, 1.95-3.25]), were identified.Conclusions and RelevanceResults of this case-crossover study suggest a need to consider AAC risk in patients taking any of the 61 drugs found to be associated with AAC.

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Transient Exposures and the Risk of Childhood Injury

Cited by 40 publications

References 0 publications

Should We Use a Case-Crossover Design?

Should We Use a Case-Crossover Design?

A Case-Crossover Study of Sleep and Childhood Injury

Association of Drugs With Acute Angle Closure

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