33 cases of airsoft gun pellet ocular injuries in Copenhagen, Denmark, 1998-2002

PURPOSE

To evaluate the incidence and ocular effects of blunt trauma due to injury from airsoft gun pellets.

METHODS

We conducted a non-comparative case series based on the files of 33 patients who suffered ocular injury from airsoft guns and were admitted to one university emergency eye clinic in Copenhagen during a 5-year period.

RESULTS

A total of 33 eyes in 33 patients were examined. Thirty male and three female patients were affected. Mean age was 13 years (range 3-49 years). Mean follow-up time was 6.5 days (range 1-540 days). On initial examination, we found: hyphaema (n = 28), corneal abrasion (n = 22), retinal oedema (n = 11), subconjunctival haemorrhage (n = 10), palpebral haemorrhage and/or oedema (n = 9), iris dialysis (n = 7), intraocular pressure (IOP) > 31 mmHg (n = 4), IOP < 9 mmHg (n = 4), vitreous haemorrhage (n = 2) and cataract (n = 1). One patient had brown corneal discoloration due to severe chronic hyphaema that required surgery. The final visual acuity was 1.0 in 20 patients and < or = 0.7 in five patients.

CONCLUSION

The airsoft gun trauma resulted in anterior and posterior segment ocular injuries that required acute medical intervention and for which some patients were hospitalized. Trauma mainly occurred in children and youths. A longterm risk of glaucoma is expected. Eye care professionals and parents as well as manufacturers of airsoft guns should advise participants to wear adequate protection when involved in this activity.

Neighborhood social capital and dental injuries in Brazilian adolescents

OBJECTIVES

Evidence suggests that communities with higher levels of social capital have better health, but this association has not been explored specifically in relation to dental injury. We investigated the association between social capital and dental injury.

METHODS

We conducted a multilevel study assessed individual and neighborhood effects on dental injury of 1302 14- to 15-year-old adolescents in 39 schools of Distrito Federal, Brazil. Children underwent a dental examination and, with their parents, answered a questionnaire about their local environments. Our data analysis used logistic multilevel modeling of students and neighborhood (the latter defined by catchment areas of schools).

RESULTS

The prevalence of dental injury was significantly lower in neighborhoods with higher levels of social capital, especially among boys. After control for individual and neighborhood variables, the adjusted odds ratio for a 1-unit increase in the standardized social capital index was 0.55 (95% confidence interval=0.37, 0.81; P=.002) among boys.

CONCLUSIONS

Social capital may explain inequalities in rates of dental injury, especially among boys.

Trampoline injuries in children

We reviewed the records of children referred to our hospital between April and September 2005 who had been injured whilst trampolining.

Of 88 such children there were 33 boys and 55 girls with a mean age of 8 years 6 months (2 years 4 months to 15 years 9 months). Most of the injuries (53; 60%) occurred when bouncing and 34 (39%) were secondary to falls from the trampoline. The cause of injury was unknown in one child. The injured child was supervised in only 35 cases (40%). In 31 (35%) cases, the injury was related to the presence of others on the trampoline. A total of 36 (40%) children required surgery. Fractures of the upper limbs occurred in 62 cases (70%).

Injuries related to the recreational use of trampolines are a significant cause of childhood injury. Our results suggest strongly that there is a need for clear guidelines on safe and responsible use of domestic trampolines.

Severity of playground fractures: play equipment versus standing height falls

AIM

To compare the severity of fractures from playground equipment falls to the severity of fractures from standing height falls occurring on the playground.

METHODS

This case control study used data on all children presenting to the Hospital for Sick Children (Toronto) from 1995 to 2002 with a fracture due to a playground fall. Cases were children who fell from a height off playground equipment. Controls were children who fell from standing height on a playground. Fractures were major if they required reduction and minor if they did not.

RESULTS

Fractures from equipment falls were 3.91 (95% CI 2.76 to 5.54) times more likely to require reduction than were fractures from standing height falls.

CONCLUSIONS

Major fractures were strongly associated with falls from playground equipment, whereas minor fractures came from both play equipment and standing height falls. Efforts to prevent major fractures should target playground equipment and the impact absorbing surface beneath it.

Heelys injuries in children

INTRODUCTION

Heelys, a type of shoes with stealth wheels, are extremely popular among children in Singapore. The widespread availability of cheap imitations has led to a proliferation of young users. Coupled with a total lack of safety equipment and instructions, these shoes can lead to significant injuries. The purpose of this study was to examine the incidence and type of injuries sustained by children using Heelys.

METHODS

During a seven-month period from February to August 2004, all children treated at the Paediatric Orthopaedic Department of the KK Women's and Children's Hospital, were asked if the injury was sustained while "heeling". All the patients were reviewed by the authors. A total of 37 patients with significant injuries sustained while "heeling" were identified. Their radiographs and clinical charts were reviewed. The patients and/or their parents were also interviewed to obtain additional information.

RESULTS

Upper limb injuries were by far the most common. Distal radius fractures and elbow injuries predominated. None of the children used safety gear.

CONCLUSION

"Heeling" can lead to serious injuries despite the relatively low velocity involved. Children and their parents need to be educated on the use of safety gear.

Children's indoor and outdoor play patterns in Ahwaz City: implications for injury prevention

A cross-sectional study in Ahwaz city, Islamic Republic of Iran, described children's indoor and outdoor play patterns. A total of 952 pupils aged 7 and 9 years and 942 parents completed questionnaires. Children's favourite activities were: playing football (22.3%), cycling (13.2%) and watching television (12.3%). This differed from those perceived by the parents who reported watching television (20.3%), playing football (13.3%) and playing in street (11.4%). Children reported their favourite places to play were: street (27.4%), park/playground (18.3%) and home (17.8%). There were significant differences in play patterns by age and sex. The play patterns of older children and boys exposed them to more hazardous situations than younger children and girls.

Roller coaster related fatalities, United States, 1994--2004

OBJECTIVE

To determine the number of fatalities related to roller coasters and examine factors common to multiple incidents.

METHODS

A case was defined as the death of a person, which was associated with a roller coaster in the United States between 15 May 1994 and 14 May 2004. Cases were identified from four

DATA SOURCES

(1) Consumer Product Safety Commission, (2) Lexis-Nexis, (3) Medline, and (4) Safer parks.

RESULTS

Forty people, ranging in age from 7 to 77 years, were killed in 39 separate incidents. Twenty nine (73%) deaths occurred among roller coaster patrons. Eleven fatalities resulted from external causes related to injuries from falls or collisions. Eighteen people died from medical conditions that might have been caused or exacerbated by riding a roller coaster; 15 were the result of intracranial hemorrhages or cardiac problems. Eleven (28%) deaths involved employees; all were caused by injuries.

CONCLUSIONS

Approximately four deaths annually in the United States are associated with roller coasters. Prevention of roller coaster fatalities is dependent on establishing an effective surveillance system for amusement ride injuries, engineering rides to better protect both patrons and employees, improving training and supervision of employees regarding safety precautions, and posting cautionary notices near roller coasters for people with specified medical conditions. Further research is needed on roller coaster related deaths resulting from intracranial hemorrhages and cardiac problems.

Circumstance and outcome of ocular paintball injuries

PURPOSE

To determine the circumstance and outcome of ocular injuries attributable to paintball projectiles.

DESIGN

Retrospective interventional case series.

METHODS

Institutional review board approved retrospective chart review of 19 consecutive eyes with paintball injuries with minimum follow-up of 3 months.

RESULTS

Ten eyes (53%) had final visual acuity of 20/40 or better, while seven (36%) were 20/200 or worse. Ten eyes were injured in paintball games, (two formal and eight informal), while nine (47%) were injured by accidents or assaults not associated with any "game."

CONCLUSIONS

Paintball injuries often cause severe and permanent visual loss. Nearly half of these injuries occur outside a war game setting as accidents or assaults.

Significant Spinal Injury Resulting From Low-Level Accelerations: A Case Series of Roller Coaster Injuries

OBJECTIVES

To describe a cohort of significantly injured roller coaster riders and the likely levels of acceleration at which the injuries occurred, and to compare these data with contemporary efforts to define a lower limit of acceleration below which no significant spinal injury is likely to occur.

DESIGN

A retrospective case series of roller coaster ride-induced significant spinal injuries.

SETTING

Injury incident records and emergency medical service records for the Rattler roller coaster in San Antonio, TX, were evaluated for a 19-month period in 1992 and 1993. Medical records for the more significant injuries were also reviewed and the specific injuries were tabulated, along with the demographics of the cohort.

PARTICIPANTS

There were 932,000 riders of the Rattler roller coaster, estimated to represent between 300,000 and 600,000 individual riders.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Injury incident reports and medical record review.

RESULTS

It is estimated that there were a total of 656 neck and back injuries during the study period, and 39 were considered significant by the study inclusion criteria. Seventy-two percent (28/39) of the injured subjects sustained a cervical disk injury; 71% of these injuries were at C5-6 (15 disk herniations, 5 symptomatic disk bulges) and 54% were at C6-7 (11 disk herniations, 4 symptomatic disk bulges). In the lumbar spine, the most frequent injury was a symptomatic disk bulge (20% of the cohort), followed by vertebral body compression fracture (18%), and L4-5 or L5-S1 disk herniation (13%). Accelerometry testing of passengers and train cars indicated a peak of 4.5 to 5g of vertical or axial acceleration and 1.5g of lateral acceleration over approximately 100ms (0.1s) on both.

CONCLUSIONS

The results of this study suggest that there is no established minimum threshold of significant spine injury. The greatest explanation for injury from traumatic loading of the spine is individual susceptibility to injury, an unpredictable variable.

Scooter injuries in children in a midwestern metropolitan area

OBJECTIVES

We describe the use of nonmotorized scooters and utilization of safety equipment in a Midwestern suburb.

METHODS

Schoolchildren in second to sixth grades of a local school district completed a survey distributed by school nurses and teachers in spring 2001, including topics of scooter ownership, riding patterns, and utilization of safety gear.

RESULTS

Three thousand eighty-seven surveys were distributed, with a 74.4% response rate; 93.2% of children had ridden a scooter, and 71.4% owned a scooter. Children rode in many locations, with 93% riding on the sidewalk, 86.5% in the driveway, 35.5% in a parking lot, and 20% in the street. Of those owning scooters, 91.2% reported owning a helmet, 61.2% kneepads, 59.4% elbow pads, 43.8% wrist guards, and 35.5% riding gloves. Among those owning scooters, 54.6% reported wearing helmets while using their scooter, whereas 10% or less wore riding gloves, kneepads, elbow pads, or wrist guards. Helmet use decreased as grade increased; 50.7% of all second graders reported wearing helmets, compared with 22.7% of sixth graders (P < 0.001). Of those owning scooters, 32.2% reported being injured while riding their scooter. Of those injured, 54% reported wearing helmets.

CONCLUSIONS

Many children ride scooters and own safety gear; however, few children wear their safety equipment when riding their scooter. Children wear helmets less frequently as they age. Physicians should continue to educate patients and their parents as to potential injuries on scooters and encourage the use of safety gear, especially helmets, when riding scooters.

Fatal blunt trauma of the larynx in a child

We report an autopsy case of an 11-year-old girl who suffered mechanical asphyxia from falling off the metal bars in the playground. This autopsy case is interesting because of the atypical trauma and lesions. To our knowledge there has been no similiar published case reports in the forensic literature. The young age of the victim, the setting and the pattern of the injuries are rare in a fall at playground by a child.

Do wrist guards have the potential to protect against wrist injuries in bicycling, micro scooter riding, and monkey bar play?

OBJECTIVE

To test the potential of wrist guards to prevent wrist injury in recreational activities that require good grip strength and hand dexterity.

METHODS

Forty eight children aged 5-8 years from one Melbourne school volunteered for tests chosen or devised following a review of the literature on the effects of orthoses use and hand function.

RESULTS

Wrist guard wearing significantly degraded grip strength, bicycle steering, and performance on a monkey bar. Micro scooter steering was not significantly affected by their use.

CONCLUSION

Wrist guards designed for skating are not recommended for bicycle riding and playing on climbing apparatus, and their suitability for scooter riding requires further investigation.

Micro-scooter induced dental trauma: a case report

There has been a remarkable increase in the popularity of micro-scooters over the past few years. This has brought with it an astonishing rise in the number of associated injuries. Highlighted here is a case report which outlines the dental injuries associated with the use of a micro-scooter.

Out on a limb: risk factors for arm fracture in playground equipment falls

OBJECTIVES

To investigate and quantify fall height, surface depth, and surface impact attenuation as risk factors for arm fracture in children who fall from playground equipment.

DESIGN

Unmatched case control study.

SETTING

Five case hospitals and 78 randomly selected control schools.

PARTICIPANTS

Children aged less than 13 years in Victoria, Australia who fell from school playground equipment and landed on their arm. Cases sustained an upper limb fracture and controls had minor or no injury. A total of 402 cases and 283 controls were included.

INTERVENTIONS

Children were interviewed in the playground as soon as possible after their fall.

MAIN OUTCOME MEASURES

Falls were recreated on site using two validated impact test devices: a headform (measuring peak G and HIC) and a novel anthropometric arm load dummy. Equipment and fall heights, as well as surface depth and substrate were measured.

RESULTS

Arm fracture risk was greatest for critical equipment heights above 1.5 m (OR 2.39, 95% CI 1.49 to 3.84, p<0.01), and critical fall heights above 1.0 m (OR 2.96, 95% CI 1.71 to 5.15, p<0.01). Peak headform deceleration below 100G was protective (OR 0.67, 95% CI 0.45 to 0.99, p = 0.04). Compliance with 20 cm surface depth recommendation was poor for both cases and controls.

CONCLUSIONS

Arm fracture-specific criteria should be considered for future standards. These include surface and height conditions where critical headform deceleration is less than 100G. Consideration should also be given to reducing maximum equipment height to 1.5 m. Improved surface depth compliance and, in particular, guidelines for surface maintenance are required.