Trends in moderate to severe paediatric trauma in Central Netherlands

Teens on Wheels and Consequences: A Six-Year Population-Based Study of Bicycle and Moped Injuries

INTRODUCTION

 Road traffic accidents are a major contributor to morbidity and mortality in the pediatric and adolescent population. Among adolescents, bicycles and light motorized two wheelers are popular means of transportation and increase adolescents' autonomy. Most previous studies on injury risk and incidence have pooled different vehicles and age groups together but more distinct data are required to guide policy.

MATERIALS AND METHODS

 We gathered data on all 1,432 children and adolescents (age 7-15) who had been treated for injuries from bicycle(n = 841) or moped/motorized scooter (n = 591) accidents at our study centers during a 6-year period (2008-2013). In addition to clinical data, we reviewed Injury Severity Scores (ISS) and calculated incidence estimates for the population of 15-year-olds in the study area.

RESULTS

 Most bicyclists were injured after a fall (72%), whereas most moped/scooter riders were injured in a collision (51%), most often with a heavier motorized vehicle. Internal injuries, multiple injuries, and severe injuries (ISS >15) were more common among moped/scooter riders than bicyclists (p < 0·001 for all). Moped/scooter riders were more often hospitalized and underwent more operations than bicyclists (p < 0·001 for both). The annual estimated incidence rates of injury were roughly eightfold for 15-year-old moped/scooter riders compared to bicyclists of the same age.

CONCLUSION

 Cycling is in general a safe mode of transportation and rider safety could be further increased with the proper use of helmets. Although no patient deaths occurred in this study population, mopeds and motorized scooters led to significant morbidity.

The burden of hospitalized sports-related injuries in children: an Australian population-based study, 2005-2013

Background

There is concern about recent increase and severity of sports-related injuries in children. Despite the benefits of sports participation, injuries may carry long-term health consequences. We aimed to evaluate the prevalence, characteristics and types of hospitalized sports-related injuries in children.

Methods

Population-based study of all acute sports-related injuries requiring hospitalization in children 5 to 15 years of age in New South Wales (NSW), Australia, 2005–2013. Health information was obtained from the NSW Admitted Patient Data Collection, a census of all hospital admissions from public and private hospitals. Children with a recorded ICD10-AM injury code (S00-T79) and sport-related activity code (U50-U70) were included. Prevalence and trend in injuries by age group, sporting code, body region affected and type of injury were assessed.

Results

There was a total of 20,034 hospitalizations for sports-related injuries (2.7% of all hospitalizations in children aged 5–15 years), involving 21,346 recorded injuries in 19,576 children. The overall population hospitalization period prevalence was 227 per 100,000 children aged 5–15 years in 2005–2013, remaining stable over time (RR 0.99; 95% CI 0.98–1.00). Football codes such as rugby league/union and soccer combined represented nearly two thirds of the total (60%). The most common body regions affected were the forearm (31%) head (15%) and hand injuries (13%). Fractures accounted for 65% of injuries followed by dislocations (10%) and traumatic brain injury (10%). Compared to other age groups, children aged 5–8 years had double the proportion of shoulder (15% vs. 7%) while 13–15 year olds had higher proportion of lower-leg (14% vs. 8%) and knee (6% vs.2%) injuries. One in seven injuries sustained while playing rugby league/union, baseball and hockey were traumatic brain injuries. A total of 444 (2.2%) of children had more than one hospitalization for sports-related injuries.

Conclusion

On average, six children were hospitalized every day for sports-related injuries in the last decade with trends remaining stable. The most common sports involved were football codes, one in three injuries involved the forearm and two thirds were fractures. These findings can be used to inform health policy and sporting governing bodies to target preventive interventions and promote safe sports participation in children.

Electronic supplementary material

The online version of this article (10.1186/s40621-018-0175-6) contains supplementary material, which is available to authorized users.

Epidemiology and Pattern of Traumatic Brain Injury in a Developing Country Regional Trauma Center

Objective

To determine the epidemiological aspects of patients with traumatic brain injury (TBI) in a regional trauma center.

Methods

A cross-sectional study was conducted on patients with TBI during 2013 to 2016 in a single center in Hamedan, central Iran. The distribution and relationships of TBI was assessed with gender, age, type of trauma, traumatic cause, exiting status and Length of Hospitalization (LOH). Data were analyzed by Stata V11 statistical software.

Results

In general, 9426 patients with TBI were enrolled in analyses. The mean ± SD age of patients was 29.70 (± 21.46) years. Multivariate logistic regression indicated that being male [OR: 1.29; 95% CI (2.92-4.73), P ≤0.001], 41-50 to 71-80 and 90+ years old' age groups (1.32<OR<3.12, 0.029<p≤0.001), having surgery [OR: 5.58; 95% CI (4.89-6.37), p≤0.001], and different types of trauma (p≤0.001) were significantly related to LOH. Moreover, odds ratio of mortality was 1.52 times greater in males than females (p≤0.001). As the age increases, the odds ratio of mortality was also rising. However, having surgery [OR: 3.72; 95% CI (2.92-4.73), p≤0.001], LOH >5 days [OR: 2.01; 95% CI (1.60-2.52), p≤0.001] and different types of trauma were significantly related to mortality.

Conclusion

TBI is one of the main causes of mortality and LOH of the young population. By providing preventive measures and a traumatic care system, the burden of trauma can be greatly reduced, the implementation of the trauma care system in Hamedan province is a necessity.

Regional Deprivation and Non-Cancer Related Computed Tomography Use in Pediatric Patients in Germany: Cross-Sectional Analysis of Cohort Data

BACKGROUND

Conflicting findings were observed in recent studies assessing the association between patients' area-level socio-economic status and the received number of computed tomography (CT) examinations in children. The aim was to investigate the association between area-level socio-economic status and variation in CT examination practice for pediatric patients in Germany.

METHODS

Data from Radiology Information Systems for children aged 0 to < 15 years without cancer who had at least one CT examination between 2001 and 2010 were extracted in 20 hospitals across Germany. The small-area German Index of Multiple Deprivation (GIMD) was used to assess regional deprivation. The GIMD scores were classified into least, medium and most deprived areas and linked with the patient's last known postal code. A multinomial logistic regression model was used to assess the association between patients' CT numbers and regional deprivation adjusting for age, sex, and location of residence (urban/rural).

RESULTS

A total of 37,810 pediatric patients received 59,571 CT scans during the study period. 27,287 (72%) children received only one CT, while n = 885 (2.3%) received six or more. Increasing numbers of CT examinations in non-cancer patients were significantly associated with higher regional deprivation, which increased, although CI overlap, for higher CT categories: '2-3 CT' odds ratio (OR) = 1.45, 95%CI: 1.40-1.50; '4-5 CT' OR = 1.48, 95%CI: 1.38-1.59; '6+CT' OR = 1.54, 95%CI: 1.41-1.69. In addition, male sex, higher age categories, and specific body regions were positively associated with increased numbers of CT examinations.

CONCLUSION

We observed a positive association between regional deprivation and CT numbers in non-cancer pediatric patients. Limitations of the ecological approach and the lack of differentiation of CT details have to be acknowledged. More information on CT indications is necessary for a full assessment of this finding. In addition, further work on ways to assess socio-economic status more accurately may be required.

What is the Relationship between Risky Outdoor Play and Health in Children? A Systematic Review

Risky outdoor play has been associated with promoting children’s health and development, but also with injury and death. Risky outdoor play has diminished over time, concurrent with increasing concerns regarding child safety and emphasis on injury prevention. We sought to conduct a systematic review to examine the relationship between risky outdoor play and health in children, in order to inform the debate regarding its benefits and harms. We identified and evaluated 21 relevant papers for quality using the GRADE framework. Included articles addressed the effect on health indicators and behaviours from three types of risky play, as well as risky play supportive environments. The systematic review revealed overall positive effects of risky outdoor play on a variety of health indicators and behaviours, most commonly physical activity, but also social health and behaviours, injuries, and aggression. The review indicated the need for additional “good quality” studies; however, we note that even in the face of the generally exclusionary systematic review process, our findings support the promotion of risky outdoor play for healthy child development. These positive results with the marked reduction in risky outdoor play opportunities in recent generations indicate the need to encourage action to support children’s risky outdoor play opportunities. Policy and practice precedents and recommendations for action are discussed.