Trampoline related injuries in children: risk factors and radiographic findings

BACKGROUND

Backyard trampolines are immensely popular among children, but are associated with an increase of trampoline-related injuries. The aim of this study was to evaluate radiographs of children with trampoline related injuries and to determine the risk factors.

METHODS

Between 2003 and 2009, 286 children under the age of 16 with backyard trampoline injuries were included in the study. The number of injuries increased from 13 patients in 2003 to 86 in 2009. The median age of the 286 patients was 7 years (range: 1-15 years). Totally 140 (49%) patients were males, and 146 (51%) females. Medical records and all available diagnostic imaging were reviewed. A questionnaire was sent to the parents to evaluate the circumstances of each injury, the type of trampoline, the protection equipment and the experience of the children using the trampoline. The study was approved by the Institutional Ethics Committee of the University Hospital of Bern.

RESULTS

The questionnaires and radiographs of the 104 patients were available for evaluation. A fracture was sustained in 51 of the 104 patients. More than 75% of all patients sustaining injuries and in 90% of patients with fractures were jumping on the trampoline with other children at the time of the accident. The most common fractures were supracondylar humeral fractures (29%) and forearm fractures (25%). Fractures of the proximal tibia occurred especially in younger children between 2-5 years of age.

CONCLUSIONS

Children younger than 5 years old are at risk for specific proximal tibia fractures ("Trampoline Fracture"). A child jumping simultaneously with other children has a higher risk of suffering from a fracture.

Intestinal fistula after magnets ingestion

Accidental ingestion of magnetic foreign bodies has become more common due to increased availability of objects and toys with magnetic elements. The majority of them traverse the gastrointestinal system spontaneously without complication. However, ingestion of multiple magnets may require surgical resolution. The case of an 18-month girl who developed an intestinal fistula after ingestion of two magnets is reported.

Traumatic injuries in the primary teeth of 4- to 6-year-old school children in gulbarga city, India. A prevalence study

AIMS

The aims of the study were: to assess the prevalence of traumatic injuries to the teeth of 4- to 6-year-old children living in Gulbarga City, India, to determine prevalence of such dental traumatic injuries at the ages of 4, 5, and 6 years and to compare the prevalence of these injuries between male and female children.

METHODS

A cross-sectional survey was performed. It consisted of a clinical examination of upper and lower deciduous anterior teeth by one examiner and an interview using a questionnaire with a sample of 1500 children aged 4 to 6 years who attended kindergarten and primary schools in Gulbarga city. Garcia-Godoy's (1981) classification was used to classify the traumatic injuries. Intra-examiner consistency was assessed by kappa values on tooth-by-tooth basis. The chisquare test was used to analyse any gender and age differences.

RESULTS

The prevalence of traumatic dental injuries was 76.13%, of which crown fracture with enamel involvement of teeth was the most prevalent, followed by crown fracture with both enamel and dentine involvement. Significant and highly significant differences were found between boys and girls for discoloration of teeth (P<0.05), crown fracture involving enamel (P<0.001) and crown fracture involving both enamel and dentine (P<0.001). The prevalence of traumatic dental injuries in the 5-year-old children was higher than that in the 4- and 6-year-olds. The commonest cause of injury was due to a fall (60%) and in 40% of cases of traumatic injury, they occurred in a field/playground.

CONCLUSIONS

The prevalence of traumatic injuries to the anterior teeth of the 4- to 6-year-olds who took part in this study was very high. There is a need to run educational programmes to increase parents' awareness of the risks of dental trauma.

[Near fatal attraction of ingested magnets]

We report a case of intestinal perforation in a 20 month old girl following the ingestion of 2 small magnets. Ingestion of multiple magnets constitutes a unique problem. Magnets in adjacent intestinal loops may forcefully attract each other and produce pressure necrosis of the bowel wall, leading to perforation, fistula formation or intestinal obstruction. Therefore, these children should be observed carefully. Early surgical intervention should be considered when clinical symptoms develop, especially when, on sequential abdominal radiographs, there is no change in the magnets' location. Since toys with small magnets are ubiquitous, efforts should be made to increase parents' awareness on the one hand, and to alert toy manufacturers on the other hand.

Fatal subcutaneous emphysema by manja: a deadly string

'Manja' is an abrasive string which is gummed, coloured and coated with powdered glass used in fighter kites in Afghanistan, Bangladesh, Chile, India, Nepal, Pakistan, etc. Subcutaneous emphysema occurs when gas or air is present in the subcutaneous layer of the skin either because of blunt and penetrating trauma, chest surgeries or by necrotising skin infections such as gangrene. Here, we present a case of subcutaneous emphysema owing to a cut-throat injury by 'manja', which is rare and has not been reported to date to the best of our knowledge.

Accidents due to falls from roof slabs

CONTEXT AND OBJECTIVE Falls from the roof slabs of houses are accidents of high potential severity that occur in large Brazilian cities and often affect children and adolescents. The aims of this study were to characterize the factors that predispose towards this type of fall involving children and adolescents, quantify the severity of associated lesions and suggest preventive measures. DESIGN AND SETTING Descriptive observational prospective longitudinal study in two hospitals in the metropolitan region of São Paulo. METHODS Data were collected from 29 cases of falls from roof slabs involving children and adolescents between October 2008 and October 2009. RESULTS Cases involving males were more prevalent, accounting for 84%. The predominant age group was schoolchildren (7 to 12 years old; 44%). Leisure activities were most frequently being practiced on the roof slab at the time of the fall (86%), and flying a kite was the most prevalent game (37.9%). In 72% of the cases, the children were unaccompanied by an adult responsible for them. Severe conditions such as multiple trauma and traumatic brain injuries resulted from 79% of the accidents. CONCLUSION Falls from roof slabs are accidents of high potential severity, and preventive measures aimed towards informing parents and guardians about the dangers and risk factors associated with this type of accident are needed, along with physical protective measures, such as low walls around the slab and gates with locks to restrict free access to these places.

Trampoline safety in childhood and adolescence

Despite previous recommendations from the American Academy of Pediatrics discouraging home use of trampolines, recreational use of trampolines in the home setting continues to be a popular activity among children and adolescents. This policy statement is an update to previous statements, reflecting the current literature on prevalence, patterns, and mechanisms of trampoline-related injuries. Most trampoline injuries occur with multiple simultaneous users on the mat. Cervical spine injuries often occur with falls off the trampoline or with attempts at somersaults or flips. Studies on the efficacy of trampoline safety measures are reviewed, and although there is a paucity of data, current implementation of safety measures have not appeared to mitigate risk substantially. Therefore, the home use of trampolines is strongly discouraged. The role of trampoline as a competitive sport and in structured training settings is reviewed, and recommendations for enhancing safety in these environments are made.

[Mathematical simulation of mild brain injury in children heading soccer balls]

BACKGROUND

Heading professional soccer balls can generate mild traumatic brain injury in children. The long-term consequences could include difficulty in solving problems and deficits in memory and language.

AIM

To assess the impact of a professional adult soccer ball on a child's head, using the finite element method and dynamic effects to predict brain damage.

MATERIAL AND METHODS

The minimum conditions of an adult game were considered: the ball speed was 6 m/s and the diffuse blow was 345 and 369 Newtons (N), on the forehead and top of the head, respectively. A head was modeled in order to know the stresses, strains and displacements generated by the impacts. The extent of the alteration was determined by comparing the strength of brain tissue, with predictions of computed stresses. The geometric characteristics of the head were transferred from medical images. The input data of the materials of a child's head was obtained from the literature.

RESULTS

In the case of heading with the forehead, mathematical simulation showed frontal lobe alterations, with brain stresses between 0.064 and 0.059 N/mm(2). When the heading was with the upper head zone, the brain alterations were in the parietal lobe, with stresses between 0.089 and 0.067 N/mm(2). In the cerebral spinal fluid the pressure was 3.61 to 3.24 N/mm(2).

CONCLUSIONS

The mathematical simulations reveal evidence of brain alterations caused by a child heading adult soccer balls. The model presented is an economical and quick tool that can help predict brain damage. It demonstrates the ability of the cerebral spinal fluid (CSF) to absorb shock loads.

Pattern of ocular trauma

This prospective observational study was conducted in the department of Ophthalmology Mymensingh Medical College Hospital during the period of November, 2009 to October, 2010. Two hundred & fifty (250) patients of both sexes and all ages with ocular trauma were selected randomly for this study. A detailed history of patients, duration of trauma, relation of trauma with work, visual status prior to injury, any surgery prior to injury & patients were alcoholic or not were taken. Male patients were 190(76%) and female patients were 60(24%). Majority of patients were 11-20 years group (39.2%). Most of patients (40%) attended into hospital within 60 hours of ocular trauma. Accidental occupational trauma were more common (51.2%) and assault injury were less common (12.8%). Greater number of ocular trauma was caused by sharp objects (59.2%) and less number of ocular trauma was caused by chemical injuries (2.4%). Open globe injuries were more common (62%) than closed globe injury (38%). Visual acuity on admission between 6/60 to PL comprises highest number (64%) and also on discharge between 6/60 to PL comprises highest number of cases (50%). Most of the patients came from poor socioeconomic group (60%).

Toys in the upper aerodigestive tract: evidence on their risk as emerging from the ESFBI study

OBJECTIVE

Foreign body inhalation/aspiration or ingestion is a relatively common event in young children and, despite many efforts made in several Countries to reach acceptable safety levels for products devoted to children, small toys or toy parts are frequently mentioned among risky foreign bodies. The aim of the present study is to characterize the risk of complications and prolonged hospitalization due to toys inhalation/aspiration or ingestion according to age and gender of patients, FB characteristics and FB location, circumstances of the accident, as emerging from the ESFBI study.

METHODS

A retrospective study in major hospitals of 19 European Countries was realized on children aged 0-14 having inhaled/aspired or ingested a toy, with regard to the characteristics of the child and the FB (shape, volume, consistency), the FB location, the hospitalization's details and the occurrence of complications.

RESULTS

In the years 2000-2003 a total of 2094 FB injuries occurred in children aged 0-14 years. Among them 121 (5.8%) were due to toys (mainly parts of toys) and 95 (4.5%) occurred in the lower/upper aero-digestive tract. 58 children needed hospitalization. The first determinant of a damage requiring hospitalization is the rigid consistence of the object. Almost 27% of toys related injuries happened under adults' supervision.

CONCLUSIONS

Despite the adoption of preventive strategies, including products modification by manufacturers, has resulted in a decrease of children's mortality rate for choking in the last decades, our results seem to testify that preventive strategies imposing a regulation of industrial production, even if fundamental, are not sufficient and need to be integrated with other preventive intervention addressed to improve parents ability to be conscious of FB injuries and attentive toward a proper surveillance of children.

Product quality risk perceptions and decisions: contaminated pet food and lead-painted toys

In the context of the recent recalls of contaminated pet food and lead-painted toys in the United States, we examine patterns of risk perceptions and decisions when facing consumer product-caused quality risks. Two approaches were used to explore risk perceptions of the product recalls. In the first approach, we elicited judged probabilities and found that people appear to have greatly overestimated the actual risks for both product scenarios. In the second approach, we applied the psychometric paradigm to examine risk perception dimensions concerning these two specific products through factor analysis. There was a similar risk perception pattern for both products: they are seen as unknown risks and are relatively not dread risks. This pattern was also similar to what prior research found for lead paint. Further, we studied people's potential actions to deal with the recalls of these two products. Several factors were found to be significant predictors of respondents' cautious actions for both product scenarios. Policy considerations regarding product quality risks are discussed. For example, risk communicators could reframe information messages to prompt people to consider total risks packed together from different causes, even when the risk message has been initiated due to a specific recall event.

Common things are common: a case series of oral foreign bodies in paediatric patients

Reports of foreign bodies in the oral cavity are few in number. Three cases of children of varying ages, presenting with oral foreign bodies, and their subsequent diagnosis and management, are described. The importance of considering foreign bodies, as part of a differential diagnosis in paediatric patients, where aetiology is uncertain and clinical appearance is unusual, is highlighted.

Preventing injuries on horizontal ladders and track rides

OBJECTIVES

This study examined the type of injury, fall heights and measures of impact attenuation of surfaces on which children fell from horizontal ladders and track rides.

METHOD

All injured children who presented to two children's hospitals and received medical attention following a fall from a horizontal ladder or track ride in a public school or park during 1996--1997 were interviewed and the playground visited.

RESULTS

The number of children who fell from horizontal ladders and track rides and presented to hospitals with injury was 118. Of those children, 105 were injured when they hit the ground and data were available on 102 of those playground undersurfaces. Fractures to the arm or wrist were the most common injury. The median height fallen by children was 1930 mm, 73% of injuries were from falls greater than 1800mm. In 41% of sites, the surface was deficient in impact absorbing properties for the height of the equipment. Fractures were no more likely on loose surfaces than other surfaces, such as rubber matting (p = 0.556) but more prevalent on compliant than non-compliant surfaces. Relative to falls occurring on noncompliant surfaces, the odds of a fracture occurring on a compliant surface was 2.67 (95% CI 0.88-8.14).

CONCLUSIONS

Modification of the height of horizontal ladders and track rides to 1800mm is preferable to removal of such equipment. The prevalence of fractures on compliant surfaces suggests that the threshold of 200g or 1000 head injury criteria (HIC) needs to be revisited, or additional test criteria added to take account of change in momentum that is not presently accounted for with either g-max on HIC calculations.

Preventive strategies for traumatic dental injuries

Traumatic dental and maxillofacial injuries are common occurrences, and affect worldwide approximately 20% to 30% of permanent dentition, often with serious aesthetic, functional, psychological, and economic consequences. With such a high frequency of injuries, prevention becomes a primary goal. A prevention approach relies on the identification of etiologic factors, and on giving rise to measures aimed at avoiding those factors or at reducing their impact. This article reviews the etiology and preventive strategy regarding dental injuries, and examines the role and manufacture of appliances, especially mouthguards, in preventive dentistry.