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Popa Ș, Ciongradi CI, Sârbu I, Bîcă O, Popa IP, Bulgaru-Iliescu D. Traffic Accidents in Children and Adolescents: A Complex Orthopedic and Medico-Legal Approach. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1446. [PMID: 37761407 PMCID: PMC10527870 DOI: 10.3390/children10091446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Traffic accidents involving children and adolescents present complex challenges from both the medico-legal and orthopedic standpoints. Despite the implementation of road traffic safety laws, pediatric road traffic injuries continue to be a significant contributor to mortality rates, physical harm, and hospitalization on a global scale. For children and young people, automobile accidents are considered to be the primary culprit of mortality in developed nations. Even in highly developed nations, trauma is a significant factor in infant mortality. Each age category, from childhood to young adulthood, has its fracture patterns, as their skeletons are considerably different from those of adults. The consequences of traffic accidents extend beyond the immediate physical trauma. The medico-legal aspects surrounding these incidents add another layer of complexity, as legal repercussions may affect the responsible adult or parent, particularly in cases involving child fatalities. To effectively address traffic accidents in children and adolescents, a comprehensive approach is necessary. This approach should involve not only medical professionals but also legal experts and policymakers. Collaboration between orthopedic specialists, medico-legal professionals, law enforcement agencies, and relevant government bodies can facilitate the development and implementation of strategies aimed at prevention, education, the enforcement of traffic laws, and improved infrastructure. By addressing both the medical and legal aspects, it is possible to enhance road safety for children and adolescents, reducing the incidence of injuries and their associated long-term consequences. In this review, we aimed to summarize traffic accidents in children and adolescents from a complex orthopedic and medico-legal approach.
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Affiliation(s)
- Ștefan Popa
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Carmen Iulia Ciongradi
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Ioan Sârbu
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Ovidiu Bîcă
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Irene Paula Popa
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Diana Bulgaru-Iliescu
- 3rd Department of Medical Specialities–Legal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
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Lee JJ, Kim BW, Kong SY, Park GJ, Chai HS, Kim YM, Park HJ, Kim H, Lee SW, Kim SC. Age-specific characteristics of road traffic injuries among children and adolescents in South Korea. TRAFFIC INJURY PREVENTION 2023:1-6. [PMID: 37216479 DOI: 10.1080/15389588.2023.2212308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 05/06/2023] [Accepted: 02/12/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Road traffic injuries (RTIs) are the leading cause of mortality among children and adolescents. This study aimed to identify and compare the age-specific epidemiology, clinical characteristics and factors related to severe RTIs among children and adolescents who had RTIs. METHODS This multicenter cross-sectional study was conducted using data collected between January 2011 and December 2018 in the Emergency Department-based Injury In-depth Surveillance registry in South Korea. A total of 66,632 participants younger than 19 years who presented with RTIs to emergency departments (EDs) were classified under three age groups: preschoolers (age 0-6 years, n = 18,694), elementary school student (age 7-12 years, n = 21,251), and middle and high school student (age 13-18 years, n = 26,687). Data on demographic and injury-related factors were analyzed, and multivariate logistic regression was used to determine the factors related to severe RTIs, which were defined as the Excess Mortality Ratio-based Injury Severity Score ≥16. RESULTS RTIs among children and adolescents were more common in boys (71.0%), during weekdays (39.7%), in the summer (31.1%), and between 12 noon and 6 pm (47.9%). The most common type of road users were passengers (preschoolers, 46.4%) and cyclists (age 7-12 years and age 13-18 years, 50.1% and 36.2%, respectively). The proportion of head injury was highest in the preschoolers group (57.3%). The length of ED stay, Excess Mortality Ratio-adjusted Injury Severity Score, and the proportion of intensive care unit admission increased with age. Nighttime (0-6 am), vulnerable road users (motorcyclists, bicyclists, and pedestrians), and use of emergency medical services were significantly associated with severe injury. CONCLUSIONS The three age groups of patients younger than 19 years with RTIs differed in the types of road user, proportions of injured body regions, and clinical outcomes. In an effort to reduce RTIs to children and adolescents, age-specific focused intervention should be considered. Additionally, the injury severity was found to be associated with nighttime occurrence, vulnerable road users, ED visit through emergency medical services, and nonuse of safety devices across all age group.
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Affiliation(s)
- Jung Ju Lee
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Byung Woo Kim
- Department of Paramedic Science, Korea National University of Transportation, Jeungpyeong-gun, Chungcheongbuk-do, Republic of Korea
| | - So Yeon Kong
- Strategic Research, Laerdal Medical, Stavanger, Norway
| | - Gwan-Jin Park
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Chungbuk National University, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Hyun-Seok Chai
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Chungbuk National University, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Young Min Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Chungbuk National University, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Ho-Jin Park
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Hoon Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Chungbuk National University, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Suk-Woo Lee
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Chungbuk National University, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Sang-Chul Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Chungbuk National University, Cheongju-si, Chungcheongbuk-do, Republic of Korea
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Xu Y, Chen M, Yang R, Wumaierjiang M, Huang S. Global, Regional, and National Burden of Road Injuries from 1990 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16479. [PMID: 36554366 PMCID: PMC9779128 DOI: 10.3390/ijerph192416479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Understanding occurrence can help formulate effective preventative laws and regulations. However, the most recent global burden and road injuries (RIs) trends have not been reported. This study reports the burden of RIs globally from 1990 to 2019. (2) Methods: RIs data were downloaded from the Global Burden of Disease 2019. Incidence, deaths, and disability-adjusted life years (DALYs) described the trend and burden of RIs. We calculated age-standardized rates (ASRs) and estimated annual percentage change (EAPC) for the above indexes to evaluate the temporal trend of RIs. We evaluated the social-demographic index (SDI) with epidemiological RI parameters and reported proportions of age-standardized rates due to RI. (3) Results: In 2019, the global incidence of RIs reached 103.2 million. The EAPC of RI incidence increased, whereas deaths and DALYs decreased. Age-standardized incident rate (ASIR) was highest in low-middle SDI regions, age-standardized death rate (ASDR) was high in middle SDI regions, and age-standardized DALYs increased in low SDI regions. The highest accident rates were found in those aged 20-24 years old. Cyclist injuries were the leading RIs (34%), though pedestrian and motor vehicle accidents were the leading cause of death (37.4%, 37.6%) and DALYs (35.7%, 32.3%), respectively. (4) Conclusions: Over the past 30 years, RIs incidence increased annually, though death and DALY rates decreased. RIs places a considerable burden on public health in low SDI countries. Data should be used to develop and implement effective measures to reduce the burden of RIs.
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Affiliation(s)
- Yifan Xu
- Department of Orthopedics, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710049, China
| | - Meikai Chen
- Department of Intensive Care Unit, The Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing 210093, China
| | - Ruitong Yang
- Department of Orthopedics, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710049, China
| | - Muhemaiti Wumaierjiang
- Department of Orthopedics, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710049, China
| | - Shengli Huang
- Department of Orthopedics, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710049, China
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Merali HS, Campbell SC, Inada H, Vecino-Ortiz AI, Bachani AM. 10 city analysis of child passenger helmet use. Injury 2022; 53:2478-2484. [PMID: 35400488 DOI: 10.1016/j.injury.2022.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Road traffic injuries are the leading cause of death in children over age five. Most of these deaths occur in low- and middle-income countries. Vulnerable road users, such as motorcyclists and their passengers, are at higher risk. Helmets have significantly decreased morbidity and mortality for motorcyclists; however, they are often unused. The second phase of the Bloomberg Philanthropies Initiative for Global Road Safety was launched in 2015 to improve road safety in 10 cities. This study focuses on child passenger helmet use data from that study to understand the prevalence of helmet use and factors that are associated with helmet use. METHODS The 10 cities selected were Accra, Addis Ababa, Bandung, Bangkok, Bogota, Fortaleza, Ho Chi Minh City, Mumbai, Sao Paulo, and Shanghai. Eight rounds of roadside observational data were collected from February 2015 to April 2019. Observers noted correct child motorcycle passenger helmet use and other site observations including weather patterns, traffic volume, and road surface conditions. A multivariable Poisson regression model was used to examine correct helmet use trends over time. A multivariable logistic regression model was fitted for correct child passenger helmet use in all cities controlling for weather, observation time, number of passengers, and driver's correct helmet use. RESULTS This dataset contained 99,846 motorcycle child passenger observations across the 10 cities. The highest prevalence of correct child passenger helmet use was in Sao Paulo at 97.33%. Six cities had under 25% correct helmet use for child passengers. Examining helmet use over time, only five cities had a significant increase, four cities had no change, and Ho Chi Minh City demonstrated a decrease. In the multivariable regression model, child passengers had higher odds of wearing helmets in adverse weather conditions, early mornings, if the driver wore a helmet, and if there were fewer passengers. CONCLUSIONS The prevalence of correct child passenger helmet utilization shows large variation globally and is concerningly low overall. Enhanced enforcement in combination with media campaigns may have contributed to increasing helmet use prevalence over time. Further research is needed to understand reasons for low child passenger helmet use in most cities.
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Affiliation(s)
- Hasan S Merali
- Department of Pediatrics, McMaster Children's Hospital, Master University, 1280 Main St W., Hamilton, ON, Canada L8S 4K1; Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8132, Baltimore, MD 21205, United States.
| | - Sachalee C Campbell
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8132, Baltimore, MD 21205, United States.
| | - Haruhiko Inada
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8132, Baltimore, MD 21205, United States.
| | - Andres I Vecino-Ortiz
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8132, Baltimore, MD 21205, United States
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8132, Baltimore, MD 21205, United States.
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Rezapour M, Ksaibati K. Modeling crashes involving children, finite mixture cumulative link mixed model. Int J Inj Contr Saf Promot 2021; 28:494-502. [PMID: 34407738 DOI: 10.1080/17457300.2021.1964088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Despite the efforts in the literature review on the traffic safety of children, the majority of past studies mainly focused only on the child's seatbelt status, or its position while ignoring other underlying factors that might contribute to the severity of those crashes. Inclusion of ther factors is especially important for a mountainous state like Wyoming with one of the highest rates of children's traffic fatality in the country. Thus, this study is conducted to fill the gap by identifying important factors contributing to the severity of crashes involving children. Here child is defined as any passengers under 9 years old. A first step in identifying factors to the severity of crashes involving children is implementing a reliable statistical method that could account for heterogeneity across various observations. So, in this study, to account for the heterogeneity in the dataset, the standard cumulative link model (CLM) was extended to the random effect model, while instead of assigning the subjective attribute for random effect, an objective hierarchy through the finite mixture modeling (FMM) was used. The FMM was employed in the context of the CLM to prevent the loss of information due to disaggregation of the dataset into the homogeneous datasets. The comparison results highlighted that the random effect model by the objective hierarchy would result in a significant improvement in the model fit compared with the standard cumulative link model. The results highlighted factors such as safety equipment in use, type of collision, and various drivers' characteristics and actions such as belting condition, alcohol and drug involvement are some of the factors contributing to the severity of child crashes. As expected, the main findings of our results highlighted that various drivers' actions and behaviors are the main causes that children would undergo a higher severity level in crashes. An extensive discussion regarding the implications of the results and the implemented statistical method were given in the context of the manuscript.
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Cimino S, Marzilli E, Erriu M, Carbone P, Casini E, Cerniglia L. Motor Vehicle Collisions during Adolescence: The Role of Alexithymic Traits and Defense Strategies. Behav Sci (Basel) 2021; 11:bs11060079. [PMID: 34063788 PMCID: PMC8223781 DOI: 10.3390/bs11060079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/01/2021] [Accepted: 05/18/2021] [Indexed: 12/18/2022] Open
Abstract
International literature has shown that adolescents represent the population most at risk of fatal and nonfatal motor vehicle collisions (MVCs). Adolescents’ alexithymic traits and significant use of immature defense strategies have been seen to play a key role. This study aimed to investigate the possible mediation role played by defense strategies use in the relationship between alexithymia and MVCs. Our sample consisted of 297 adolescents divided into four subgroups, based on the number of visits to the emergency department due to an MVC. We assessed adolescents’ alexithymic traits and defense strategies use through self-report instruments. Results showed that males reported a higher rate of MVCs than females. Higher rates of MVCs are associated with more alexithymic traits and maladaptive defense strategies use. Adolescents’ Acting Out and Omnipotence use significantly mediated the relationship between alexithymia and MVCs. Our findings suggest the recidivism of MVCs as an attempt to cope with emotional difficulties, with important clinical implications.
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Affiliation(s)
- Silvia Cimino
- Department of Dynamic and Clinical Psychology, University of Rome, Sapienza, 00186 Rome, Italy; (S.C.); (E.M.); (M.E.); (P.C.); (E.C.)
| | - Eleonora Marzilli
- Department of Dynamic and Clinical Psychology, University of Rome, Sapienza, 00186 Rome, Italy; (S.C.); (E.M.); (M.E.); (P.C.); (E.C.)
| | - Michela Erriu
- Department of Dynamic and Clinical Psychology, University of Rome, Sapienza, 00186 Rome, Italy; (S.C.); (E.M.); (M.E.); (P.C.); (E.C.)
| | - Paola Carbone
- Department of Dynamic and Clinical Psychology, University of Rome, Sapienza, 00186 Rome, Italy; (S.C.); (E.M.); (M.E.); (P.C.); (E.C.)
| | - Elisa Casini
- Department of Dynamic and Clinical Psychology, University of Rome, Sapienza, 00186 Rome, Italy; (S.C.); (E.M.); (M.E.); (P.C.); (E.C.)
| | - Luca Cerniglia
- Faculty of Psychology, International Telematic University Uninettuno, 00186 Rome, Italy
- Correspondence: ; Tel.: +39-066-920-761
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Ding H, Sze NN, Li H, Guo Y. Roles of infrastructure and land use in bicycle crash exposure and frequency: A case study using Greater London bike sharing data. ACCIDENT; ANALYSIS AND PREVENTION 2020; 144:105652. [PMID: 32559657 DOI: 10.1016/j.aap.2020.105652] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/06/2020] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
Cycling is increasingly promoted as a sustainable transport mode. However, bicyclists are more vulnerable to fatality and severe injury in road crashes, compared to vehicle occupants. It is necessary to identify the contributory factors to crashes and injuries involving bicyclists. For the prediction of motor vehicle crashes, comprehensive traffic count data, i.e. AADT and vehicle kilometer traveled (VKT), are commonly available to proxy the exposure. However, extensive bicycle count data are usually not available. In this study, revealed bicycle trip data of a public bicycle rental system in the Greater London is used to proxy the bicycle crash exposure. Random parameter negative binomial models are developed to measure the relationship between possible risk factors and bicycle crash frequency at the zonal level, based on the crash data in the Greater London in 2012-2013. Results indicate that model taking the bicycle use time as the exposure measure is superior to the other counterparts with the lowest AIC (Akaike information criterion) and BIC (Bayesian information criterion). Bicycle crash frequency is positively correlated to road density, commercial area, proportion of elderly, male and white race, and median household income. Additionally, separate bicycle crash prediction models are developed for different seasons. Effects of the presence of Cycle Superhighway and proportion of green area on bicycle crash frequency can vary across seasons. Findings of this study are indicative to the development of bicycle infrastructures, traffic management and control, and education and enforcement strategies that can enhance the safety awareness of bicyclists and reduce their crash risk in the long run.
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Affiliation(s)
- Hongliang Ding
- Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - N N Sze
- Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - Haojie Li
- School of Transportation, Southeast University, China; Jiangsu Key Laboratory of Urban ITS, China; Jiangsu Province Collaborative Innovation Center of Modern Urban Traffic Technologies, China.
| | - Yanyong Guo
- School of Transportation, Southeast University, China; Jiangsu Key Laboratory of Urban ITS, China; Jiangsu Province Collaborative Innovation Center of Modern Urban Traffic Technologies, China.
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Injury Patterns and Severity of Motorcycle Crash Injuries Among Hospitalized Children and Adolescents in Darab, Iran in 2016: A cross-Sectional Study. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2020. [DOI: 10.52547/pcnm.10.3.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kılınç E, Gür K. Behaviours of adolescents towards safety measures at school and in traffic and their health beliefs for injuries. Int J Nurs Pract 2020; 26:e12861. [DOI: 10.1111/ijn.12861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 02/26/2020] [Accepted: 05/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Eda Kılınç
- Faculty of Health Sciences, Public Health Nursing Department Pamukkale University Denizli Turkey
| | - Kamer Gür
- Faculty of Health Sciences, Public Health Nursing Department Marmara University Istanbul Turkey
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A Retrospective Records-Based Cohort of 1,082 Pediatric Forensic Cases Presenting to the Emergency Department. J Emerg Nurs 2020; 46:373-383. [DOI: 10.1016/j.jen.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 11/15/2022]
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Useche S, Alonso F, Montoro L, Garrigós L. More aware, more protected: a cross-sectional study on road safety skills predicting the use of passive safety elements among Spanish teenagers. BMJ Open 2019; 9:e035007. [PMID: 31772115 PMCID: PMC6887036 DOI: 10.1136/bmjopen-2019-035007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study had two objectives: first, to test the effects of sociodemographic variables, and the effects of three key road safety skills (knowledge-risk perception-attitudes) on the use of passive safety elements (PSEs) among teenagers; and second, to assess the differential impact of the study variables on PSEs use from a gender-based perspective. SETTING AND PARTICIPANTS This cross-sectional study was framed in the paradigm of primary care, and it involved students from several educational centres in Spain. A sample of 827 Spanish teenagers (52.4% females and 47.6% males) with a mean age of M=14.41-7 (12-19) years was used. RESULTS Through SEM modelling, we found that the use of PSEs is largely explained by psychosocial variables through the mediation of three road safety skills: risk perception (β=0.103***), rule knowledge (β=0.095*) and attitudes towards road safety (β=0.186***). Furthermore, multigroup analyses showed that, although most variables explain the use of PSEs among teenagers in a similar way, key gender-based differences exist in this regard. CONCLUSIONS Road safety skills have a significant effect on the use of PSEs among Spanish teenagers, and gender explains some differences in the mechanisms which predict them. Also, in the study we discuss the need for strengthening school-based interventions aimed at helping this vulnerable group of road users acquire and develop positive behavioural competences.
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Affiliation(s)
- Sergio Useche
- DATS (Development and Advising in Traffic Safety) Research Group - INTRAS (Research Institute on Traffic and Road Safety), Universitat de Valencia, Valencia, Valencian Community, Spain
| | - Francisco Alonso
- DATS (Development and Advising in Traffic Safety) Research Group - INTRAS (Research Institute on Traffic and Road Safety), Universitat de Valencia, Valencia, Valencian Community, Spain
| | - Luis Montoro
- FACTHUM.Lab (Human Factor and Road Safety) Research Group - INTRAS (Research Institute on Traffic and Road Safety), University of Valencia, Valencia, Valencian Community, Spain
| | - Leandro Garrigós
- Generalitat Valenciana (Government of the Valencian Community), Valencia, Valencian Community, Spain
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Wu J, Wang Q, Zheng YZ, Zhang CY, Wang L, Huo F. [Causes and clinical features of children with traumatic brain injury: a retrospective analysis of 126 cases]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:317-322. [PMID: 31014421 PMCID: PMC7389213 DOI: 10.7499/j.issn.1008-8830.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/01/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the causes and clinical features of children with traumatic brain injury (TBI) who need hospitalization or emergency observation. METHODS A retrospective analysis was performed for the clinical data of 126 children with TBI who were admitted to the emergency department from January 1, 2014 to August 31, 2016, including causes of injury and clinical features. RESULTS Of the 126 children, there were 95 boys and 31 girls, with a mean age of 2.8 years (range 0.8-5.5 years). The children aged <1 year accounted for 38.1% (48/126), and 26 children died. The two most common types of TBI were epidural hematoma (54.0%) and subarachnoid hemorrhage (50.8%). Of the 126 children, 83 (65.9%) had a Glasgow Coma Scale score of ≤8 within 24 hours after admission. There were different causes of TBI and places where TBI occurred in different age groups. The two leading causes of TBI were falls (51.6%) and road traffic injuries (42.9%). Compared with those in the other age groups, the children in the age <1 year group were most likely to experience injury due to falls (46%; P=0.023). Thirty-five percent of all TBI due to road traffic injuries occurred in the children aged 3-6 years (P<0.001). Most TBI cases occurred at home (47.6%) or on roads/streets (45.2%). Among those who experienced TBI at home, the children aged <1 year accounted for the highest proportion of 48% (P=0.002), and 53% of the patients aged 3-6 years experienced TBI on roads/streets. The most common cause of death in children with TBI was road traffic injury, which accounted for 69%. Among those who died, the children aged <1 year accounted for the highest proportion (62%). CONCLUSIONS There are different causes of TBI and places where TBI occurs in different age groups. Among children with TBI, the children aged <1 year account for the highest proportion and have the highest number of deaths, with falls at home as the most common cause of TBI. Children aged 3-6 years tend to suffer TBI due to road traffic injury. Road traffic injury is the leading cause of death.
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Affiliation(s)
- Jie Wu
- Department of Emergency, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
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Tan RMR, Dong C, Shen GQ, Feng JXY, Piragasam R, Tyebally A, Chong SL. Parental knowledge and beliefs on the use of child car restraints in Singapore: a qualitative study. Singapore Med J 2019; 61:102-107. [PMID: 30773603 DOI: 10.11622/smedj.2019023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Road traffic injuries and fatalities represent a significant public health problem. In Singapore, compliance with appropriate child car restraints (CCRs) is poor. We aimed to understand parental knowledge, beliefs and barriers regarding the use of CCRs. METHODS In this qualitative study, we conducted five focus group discussions with parents who drive with their children in private cars. Participants were recruited using the KK Women's and Children's Hospital's social media page. Guiding questions were derived by consensus following literature review and adaptation to the Singapore context, exploring parental perceptions of CCR use. Focus group interviews were then transcribed and analysed. RESULTS 33 participants were recruited, with an age range of 28‒46 (mean age 35.5) years. They had a total of 46 children with ages ranging from 2.5 months to 14 years (mean age 4.2 years). Three key themes were identified: parental knowledge regarding CCRs, barriers to CCR use, and suggestions to increase CCR compliance. Barriers to compliance included lack of knowledge, difficult child behaviour and cultural norms. A multipronged approach was proposed to increase CCR use, including educating the public, reinforcing positive behaviour, legal enforcement as a deterrent to non-compliance, increasing CCR installation services, providing CCRs for taxi users and offering financial incentives. CONCLUSION Non-compliance to CCR use is multidimensional, including multiple potentially modifiable factors. This study could inform ongoing collaborative injury prevention efforts among healthcare professionals, industry partners and the traffic police, using public education and outreach to reduce the burden of road traffic injuries.
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Affiliation(s)
- Ronald Ming Ren Tan
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Chaoyan Dong
- Department of Education, Sengkang General Hospital, Singapore
| | - Germac Qiaoyue Shen
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
| | - Jasmine Xun Yi Feng
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
| | - Rupini Piragasam
- KK Research Centre, KK Women's and Children's Hospital, Singapore
| | - Arif Tyebally
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
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Beckwith K, James V, Kalaiselvan K, Ganapathy S. Bicycle injuries among the paediatric population at an emergency department in Singapore. Singapore Med J 2019; 60:343-346. [PMID: 30644526 DOI: 10.11622/smedj.2019009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Bicycles injuries are the leading cause of emergency department visits among all recreational activities and have been established as a significant worldwide public health burden. The purpose of this retrospective study was to describe the epidemiology and patterns of paediatric bicycle-related injuries in Singapore. METHODS This was a single-centre retrospective study based on data collected from a trauma registry between 2011 and 2016. RESULTS A total of 760 patients presented to the emergency department during this period, of whom 68.2% were male and 39.7% were aged 10-16 years. 50.1% of the patients were Chinese and 25.9% were Malay. The cyclist was the person most commonly injured (65.7%) during the bicycle accident. From 2011 to 2015, the number of bicycle injuries showed a persistent upward trend. Superficial injuries such as abrasions and bruises were the most common injuries sustained (46.1%), followed by fractures. The majority of the patients were discharged from the emergency department. There were no bicycle accident deaths recorded during the study period. CONCLUSION Our study demonstrated an increasing number of bicycle injuries among paediatric cyclists in the local setting. Parents, teachers, coaches and other caregivers should be educated regarding the need to use protective equipment and to seek medical care promptly in the case of trauma resulting from bicycle injuries.
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Affiliation(s)
- Kristy Beckwith
- Formerly NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vigil James
- Children's Emergency, KK Women's and Children's Hospital, Singapore
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Kim T, Jung KY, Kim K, Yoon H, Hwang SY, Shin TG, Sim MS, Jo IJ, Cha WC. Protective effects of helmets on bicycle-related injuries in elderly individuals. Inj Prev 2018; 25:407-413. [PMID: 30291153 DOI: 10.1136/injuryprev-2018-042942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/25/2018] [Accepted: 09/01/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The increasing frequency of bicycle-related injuries is due to the growing elderly population and their increasing physical activity. This study aimed to compare the protective effects of helmets on bicycle-related injuries in elderly individuals compared with those in younger adults. METHODS Data from the Korean emergency department-based Injury In-depth Surveillance database from eight emergency departments during 2011-2016 were retrospectively analysed. The subjects sustained injuries while riding bicycles. Cases with unknown clinical outcomes were excluded. Covariates included mechanism, place and time of injury. The primary outcome was traumatic brain injury (TBI) incidence, and the secondary outcomes were in-hospital mortality and severe trauma. The effects of helmets on these outcomes were analysed and differences in effects were determined using logistic regression analysis. Subsequently, the differences in the effects of helmets use between age groups were examined by using interaction analysis RESULTS: Of 7181 adults, 1253 were aged >65 years. The injury incidents showed a bimodal pattern with peaks around ages 20 and 50 years. Meanwhile, the helmet-wearing rate showed a unimodal pattern with its peak at age 35-40 years; it decreased consistently with age. By multivariate analysis, helmet-wearing was associated with a reduced TBI incidence (OR 0.76; 95% CI 0.57 to 0.99) and severe trauma (OR 0.78; 95% CI 0.65 to 0.93). The effects of helmets increased in elderly individuals (TBI (p=0.022) and severe trauma (p=0.024)). CONCLUSION The protective effects of helmets on bicycle-related injuries are greater for elderly individuals, thus reducing TBI incidence.
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Affiliation(s)
- Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwang Yul Jung
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyunga Kim
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Chong SL, Khan UR, Santhanam I, Seo JS, Wang Q, Jamaluddin SF, Hoang Trong QA, Chew SY, Ong MEH. A retrospective review of paediatric head injuries in Asia - a Pan Asian Trauma Outcomes Study (PATOS) collaboration. BMJ Open 2017; 7:e015759. [PMID: 28821516 PMCID: PMC5724214 DOI: 10.1136/bmjopen-2016-015759] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE We aim to examine the mechanisms of head-injured children presenting to participating centres in the Pan Asian Trauma Outcomes Study (PATOS) and to evaluate the association between mechanism of injury and severe outcomes. DESIGN AND SETTING We performed a retrospective review of medical records among emergency departments (EDs) of eight PATOS centres, from September 2014 - August 2015. PARTICIPANTS We included children <16 years old who presented within 24 hours of head injury and were admitted for observation or required a computed tomography (CT) of the brain from the ED. We excluded children with known coagulopathies, neurological co-morbidities or prior neurosurgery. We reviewed the mechanism, intent, location and object involved in each injury, and the patients' physical findings on presentation. OUTCOMES Primary outcomes were death, endotracheal intubation or neurosurgical intervention. Secondary outcomes included hospital and ED length of stay. RESULTS 1438 children were analysed. 953 children (66.3%) were male and the median age was 5.0 years (IQR 1.0-10.0). Falls predominated especially among children younger than 2 years (82.9%), while road traffic injuries were more likely to occur among children 2 years and above compared with younger children (25.8% vs 11.1%). Centres from upper and lower middle-income countries were more likely to receive head injured children from road traffic collisions compared with those from high-income countries (51.4% and 40.9%, vs 10.9%, p<0.0001) and attended to a greater proportion of children with severe outcomes (58.2% and 28.4%, vs 3.6%, p<0.0001). After adjusting for age, gender, intent of injury and gross national income, traffic injuries (adjusted OR 2.183, 95% CI 1.448 to 3.293) were associated with severe outcomes, as compared with falls. CONCLUSIONS Among children with head injuries, traffic injuries are independently associated with death, endotracheal intubation and neurosurgery. This collaboration among Asian centres holds potential for future prospective childhood injury surveillance.
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Affiliation(s)
- Shu-Ling Chong
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Indumathy Santhanam
- Department of Pediatric Emergency Medicine, Institute of Child Health and Hospital for Children, Madras Medical College, Chennai, Tamilnadu, India
| | - Jun Seok Seo
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, School of Medicine, Dongguk University, Seoul, Republic of Korea
| | - Quan Wang
- Department of Emergency Medicine, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | | | | | - Su Yah Chew
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Khoo Teck Puat-National Children’s Medical Institute,, National University Health System, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
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