Adolescent injury deaths and hospitalization in Canada: magnitude and temporal trends (1979-2003)

Epidemiology and factors associated with mortality among pediatric major trauma patients in Nova Scotia: A 17-year retrospective analysis

BACKGROUND

Major traumatic injury in the pediatric population requires further evaluation to improve patient outcomes. Relatively few Canadian studies have investigated pediatric trauma using population-based data. Our objectives were to describe the epidemiology of pediatric major trauma in Nova Scotia and identify factors associated with in-hospital mortality.

METHODS

Retrospective cohort study of pediatric major trauma patients (age <18 years) injured in Nova Scotia over a 17-year period (April 2001-March 2018). Data were collected from the Nova Scotia Trauma Registry. Characteristics were compared between patient subgroups using t-tests, chi-square analyses and Fisher's exact test. Temporal trends were evaluated using the Mann-Kendall test. Incidence and mortality rates were mapped using ArcGIS Pro. A multivariate logistic regression model was created to assess for factors associated with in-hospital mortality.

RESULTS

A total of 1258 injuries were observed over the 17-year study period. The incidence of pediatric major trauma was 41.7 per 100,000 person-years. Most patients were male (819/1258; 65.1 %) and resided in urban areas (764/1258; 60.7 %). Blunt trauma accounted for 86.2 % (1084/1258) of injuries, and motor vehicle collisions were the most common cause (448/1258; 35.6 %). Incidence and mortality rates were highest in the 15-17 year age group, with a trend towards increasing incidence among females (p = 0.011). Mortality was 17.2 % (217/1258) of patients; 10.9 % (137/1258) died pre-hospital. No trends were detected in mortality rates. The regression model showed increased odds of in-hospital mortality for every point increase in the ISS (OR 1.05; 95 % CI 1.02 to 1.09) and for every unit decrease in scene GCS (OR 0.63; 95 % CI 0.56-0.71). Rural patients were 2 times more likely to die in-hospital versus urban patients (OR 2.40; 95 % CI 1.01-5.69), and patients injured at home were 6 times more likely to die compared to those injured in other locations (OR 6.19; 95 % CI 1.01-38.11).

CONCLUSION

Pediatric trauma remains a major public health issue in Canada and beyond. Greater efforts are required to expand our understanding of trauma epidemiology and develop targeted injury prevention strategies, especially for rural inhabitants.

Fatal and non-fatal firearm-related injuries in Canada, 2016-2020: a population-based study using three administrative databases

BACKGROUND

Firearms are a substantial cause of injury-related morbidity and mortality in Canada and globally, though evidence from contexts other than the USA is relatively limited. We examined deaths, hospitalizations and emergency department (ED) visits due to firearm-related injuries in Canada to identify population groups at increased risk of fatal and non-fatal outcomes.

METHODS

We conducted a population-based study using three national administrative databases on deaths, hospitalizations, and ED visits. ICD-10 codes were used to identify firearm-related injuries from January 1, 2016, through December 31, 2020. Fatal and non-fatal firearm injuries were classified as suicide/self-harm, homicide/assault, unintentional, undetermined or legal intervention injuries. We analyzed the data with counts, rates and proportions, stratified by sex, age group, province/territory, and year.

RESULTS

Over the 5-year period, we identified 4005 deaths, 3169 hospitalizations, and 2847 ED visits related to firearm injuries in various jurisdictions in Canada. Males comprised the majority of fatal and non-fatal injury cases. The highest rates of fatal and non-fatal firearm injuries were among 20- to 34-year-olds. The leading cause of fatal firearm injuries was self-harm (72.3%). For non-fatal firearm hospitalizations and ED visits, assault (48.8%) and unintentional injuries (62.8%) were the leading causes of injury. Rates varied by province and territory.

CONCLUSIONS

Our results showed that males comprised the majority of fatal and non-fatal firearm injuries in Canada. The rates of both fatal and non-fatal firearm injuries were highest among the 20- to 34-year-old age group. This comprehensive overview of the epidemiology of firearm injuries in Canada provides baseline data for ongoing surveillance and policy evaluation related to public health interventions.

Cannabis-impaired driving and Canadian youth

Acute cannabis use results in inattention, delayed information processing, impaired coordination, and slowed reaction time. Driving simulator studies and epidemiologic analyses suggest that cannabis use increases motor vehicle crash risk. How much concern should we have regarding cannabis associated motor vehicle collision risks among younger drivers? This article summarizes why young, inexperienced drivers may be at a particularly high risk of crashing after using cannabis. We describe the epidemiology of cannabis use among younger drivers, why combining cannabis with alcohol causes significant impairment and why cannabis edibles may pose a heightened risk to traffic safety. We provide recommendations for clinicians counselling younger drivers about cannabis use and driving.

An interprovincial comparison of unintentional childhood injury rates in Canada for the period 2006-2012

OBJECTIVES

To perform an interprovincial comparison of unintentional population-based injury hospitalization and death rates for Canadian children ages 0-19 years and compare trends between 2006 and 2012.

METHODS

Annual population-based hospitalization rates per 100,000 from unintentional injuries were calculated for children/youth (< 19 years) using data from the Discharge Abstract Database between 2006 and 2012. Annual mortality rates were analyzed using provincial coronial data. The mean annual change in the rate of hospitalizations due to unintentional injuries was reported for each province.

RESULTS

The average annual rate of hospital admissions for unintentional injuries was 305.10 per 100,000 population between 2006 and 2012, and this decreased by - 11.91 over time (p < 0.01, - 15.85; - 7.77). Saskatchewan had the highest average annual morbidity rate (550.76 per 100,000) from all unintentional causes, and Ontario had the lowest average annual rate (238.89 per 100,000). Saskatchewan had the highest average annual rate for all subcauses except for drowning. Ontario was the only province with an average annual injury morbidity rate that was consistently below the Canadian average. The average annual mortality rate from all unintentional injury was highest in Saskatchewan (17.51 per 100,000) and lowest in Ontario (5.99 per 100,000) when compared to Canada (7.97 per 100,000).

CONCLUSION

Injury prevention policies vary considerably among provinces. Although the unintentional injury hospitalization rate is decreasing over time, some subcauses such as choking/suffocation have shown an increase in certain provinces. Evidence-based childhood injury prevention policies, such as playground equipment safety and four-sided pool fencing among others, should be standardized across Canada.

Prevalence and correlates of suicidal ideation and attempts among children and adolescents

Suicide is a potentially preventable public health issue. It is therefore important to examine its immediate precursors, including suicidal ideation and attempts, to help in the development of future public health interventions. The present study reports the prevalence of suicidal ideation and attempts in the past 12 months in children and adolescents and identifies correlates of such behaviors in a large and diverse sample of middle and high school students. Data were drawn from a representative sample of Ottawa students (n=1922) aged 11-20 years (14.4±1.9 years) from three cycles (2009, 2011 and 2013) of the Ontario Student Drug Use and Health Survey (OSDUHS), a cross-sectional school-based appraisal of students in grades 7-12 across Ontario, Canada. Overall, 10.8% of students exhibited suicidal ideation and 3.0% reported suicide attempts in the past 12 months. The conditional probability of making an attempt was 25.5% among suicide ideators. Multivariable analyses indicated that being a girl and using alcohol and cannabis were positively associated with suicidal ideation, while tobacco was positively associated with suicide attempts. Being a victim of school bullying was significantly associated with reports of suicidal ideation and attempts, whereas school connectedness had protective effects against both suicidal ideation and attempts. These results indicate that suicidal ideation and attempts are related to other risky behaviors. Suicide-prevention efforts should be integrated within broader health-promoting initiatives.

Trends in Emergency Department Visits for Nonfatal Violence-Related Injuries Among Adolescents in the United States, 2009-2013

PURPOSE

Violence-related injuries are a major cause of death and disability among adolescents in the United States. The objective of this study was to examine trends in adolescent violence-related injuries between 2009 and 2013.

METHODS

This study examined data from the National Electronic Injury Surveillance System-All Injury Program for years 2009-2013. Linear regression was used to assess trends in rates of violence-related injuries among adolescents aged between 10 and 19 years.

RESULTS

We found overall rates of nonfatal violence-related injuries among all adolescents did not change significantly across the study years (p = .502). However, self-harm injury rates have significantly increased among female and younger adolescents during the period (p = .001 and .011, respectively).

CONCLUSIONS

Our results indicate that the overall intentional injury rates in adolescents have been stable; however, rates of self-injury have significantly increased in younger adolescents and females. Future research should focus on exploring causes of increases in self-harm injuries in these subpopulations.

Patterns of youth injury: a comparison across the northern territories and other parts of Canada

BACKGROUND

Injury is the leading cause of death for young people in Canada. For those living in the northern territories (Yukon, Nunavut, and the Northwest Territories), injury represents an even greater problem, with higher rates of injury for people of all ages in northern areas compared with the rest of Canada; however, no such comparative studies have focussed specifically on non-fatal injury in youth.

OBJECTIVES

To profile and examine injuries and their potential causes among youth in the northern territories as compared with other parts of Canada.

DESIGN

Cross-sectional data from the 2009/2010 Health Behaviour in School-aged Children survey (youth aged 11-15 years) were examined for the Canadian northern territories and the provinces (n=26,078). Individual survey records were linked to community-level data to profile injuries and then study possible determinants via multilevel regression modelling.

RESULTS

The prevalence of injury reported by youth was similar in northern populations and other parts of Canada. There were some minimal differences by injury type: northern youth experienced a greater percentage of neighbourhood (p<0.001) and fighting (p=0.02) injuries; youth in the Canadian provinces had a greater proportion of sport-related injuries (p=0.01). Among northern youth, female sex (RR=0.87, 95% CI 0.81-0.94), average (RR=0.88, 95% CI 0.80-0.97) or above-average affluence (RR=0.84, 95% CI 0.76-0.91), not being drunk in the past 12 months (RR=0.77, 95% CI 0.69-0.85), not riding an all-terrain vehicle (RR=0.81, 95% CI 0.68-0.97) and not having permanent road access (RR=0.89, 95% CI 0.80-0.98) were protective against injury; sport participation increased risk (RR=1.45, 95% CI 1.33-1.59).

CONCLUSIONS

Patterns of injury were similar across youth from the North and other parts of Canada. Given previous research, this was unexpected. When implementing injury prevention initiatives, individual and community-level risk factors are essential to understand; however, specific positive safety assets that might exist in different community contexts must also be considered.

Injury risk in British Columbia, Canada, 1986 to 2009: are Aboriginal children and youth over-represented?

Background

Children and youth worldwide are at high risk of injury resulting in morbidity, disability or mortality. Disparities in risk exist between and within countries, and by sex and ethnicity. Our aim is to contribute data on disparities of injury rates for Aboriginal children and youth compared with those of the general population in British Columbia (BC), Canada, by examining risks for the two populations, utilizing provincial administrative data over a 24-year period.

Methods

Hospital discharge records from the provincial health care database for children and youth were used to identify injury for the years 1986 to 2009. Within the total BC population, the Aboriginal population was identified. Crude rates and standardized relative risks (SRR) of hospitalization were calculated, by year and category of injury type and external cause, and compared to the total BC population for males and females under age 25 years.

Results

Over the 24-year period, substantive decreases were found in hospitalization injury risks for children and youth in both Aboriginal and total populations, for both sexes, and for most categories and types of injuries. Risk in overall injury dropped by 69% for the Aboriginal population and by 66% for the total BC population, yet in every year, the Aboriginal population had a higher risk than the total BC population. There were over 70% declines in risks among females of intentionally inflicted injury by another, among both the Aboriginal and total BC populations. Risk of injury caused by transport vehicles has decreased by an overwhelming 83% and 72% for the Aboriginal male population and for the total BC male population, respectively.

Conclusions

The over 70% declines in risks for females of intentionally inflicted injury by another, among both the Aboriginal and total BC populations is excellent news. Risk of injury caused by transport vehicles for males decreased overwhelmingly for both populations. Disparities in rates between the Aboriginal population and total BC population remain because of similarity in the proportional reductions among the two populations. Since the Aboriginal population started at a much higher risk, in absolute terms, the gap between the two populations is shrinking.

Youth health care utilization in Nova Scotia: what is the role of age, sex and socio-economic status?

OBJECTIVE

Youth have distinct health care needs that are not always met within a framework designed for children or adults. In Canada, little attention has been given to how youth utilize health care services and limited data are available. The aim of this study was to identify whether age, sex, socio-economic status (SES) and geographic location were significant mediators of youth health care utilization in Nova Scotia.

METHODS

The NSYOUTHS database comprises health care utilization information for all youth aged 12 to 24 years, resident in Nova Scotia between 1997 and 2007. We calculated health care utilization rates by provider, stratified by sex, age, SES, urban/rural residence and year. Negative binomial regression was used to model the variation in health care utilization by sex, SES and urban/rural location.

RESULTS

Health care utilization declined over time and varied by age. Females were more frequent users of services. Youth from lower SES areas had fewer family physician contacts but more outpatient, emergency and inpatient contacts compared to those from higher SES areas. Rural residents had fewer family physician and emergency contacts but more outpatient contacts than youth from urban areas. Ten percent of the youth were responsible for 32% of all health care contacts, whereas 11% had no health care contacts.

CONCLUSION

Specific subgroups, including youth from rural areas and of lower SES, utilize health care services differently than other youth. The challenge is to provide health care that is responsive to the needs of this heterogeneous population. Meeting this challenge requires accurate information on youth health care utilization.

Traumatic and other non-natural childhood deaths in Manitoba, Canada: a retrospective autopsy analysis (1989-2010)

OBJECTIVE

The goals of analyzing all non-natural childhood deaths in Manitoba for the 22-year period (1989-2010) are to highlight preventable causes of death and to document temporal trends that might be influenced by changes in society.

METHODS

The 1989 to 2010 pediatric autopsy database at the Winnipeg Health Sciences Centre and records from the Office of the Chief Medical Examiner were searched for all non-natural deaths ≤ 18 years age. All files were reviewed in detail. Data collected included demographic characteristics, manner of death, details of cause and circumstances leading to death, and survival time after the event.

RESULTS

For the 22-year period, the total number of non-natural childhood deaths after which autopsy was performed in Manitoba was 581 for males and 409 for females in a population of approximately 1.23 million (2010 estimate). This represents 22.1% of the total childhood deaths in Manitoba during the study period. A higher proportion of children living in rural and northern communities died from non-natural causes. Of all accidents, which peaked in 1999, road traffic incidents accounted for the majority. Of suicides, which peaked in 2005, hanging in the 15-18 year group accounted for almost all cases. Of homicides, child abuse deaths at <3 years age was the most frequent cause. For all causes, most individuals were dead at the scene or died shortly thereafter.

CONCLUSIONS

Most non-natural childhood deaths in Manitoba might be avoidable through education about prevention strategies and by correction of social inequities. Improved transportation to hospital from remote locations would likely have little impact on survival.

Injuries among adolescents in the United Arab Emirates

This study examines the profile of injuries among adolescents in the United Arab Emirates (UAE) and identifies related factors associated with injury. A cross-sectional study design determined incidence of injury for a sample of 6363 adolescents. Data collected information on injury in the past 12 months, socio-demographic, behavioural and sensory data. Logistic regression modelling was used to examine predictors of physical injury for the past 12 months. Among participants, 18% experienced injury; the three top causes include accidental falls (38%), being struck by an object or person (18%), and motor vehicle injuries (MVI) (13%). The majority of injuries took place at the participant's home and surrounding area. Identified risk factors that are amenable for prevention include smoking behaviour, exposure to smoking, physical activity profile, family income, and speeding behaviour. Our findings highlight the need for public health policies and education programmes that reduce injury among the UAE adolescent population.

Suicide among children and adolescents in Canada: trends and sex differences, 1980-2008

BACKGROUND

Suicide is the second leading cause of death for young Canadians (10-19 years of age)--a disturbing trend that has shown little improvement in recent years. Our objective was to examine suicide trends among Canadian children and adolescents.

METHODS

We conducted a retrospective analysis of standardized suicide rates using Statistics Canada mortality data for the period spanning from 1980 to 2008. We analyzed the data by sex and by suicide method over time for two age groups: 10-14 year olds (children) and 15-19 year olds (adolescents). We quantified annual trends by calculating the average annual percent change (AAPC).

RESULTS

We found an average annual decrease of 1.0% (95% confidence interval [CI] -1.5 to -0.4) in the suicide rate for children and adolescents, but stratification by age and sex showed significant variation. We saw an increase in suicide by suffocation among female children (AAPC = 8.1%, 95% CI 6.0 to 10.4) and adolescents (AAPC = 8.0%, 95% CI 6.2 to 9.8). In addition, we noted a decrease in suicides involving poisoning and firearms during the study period.

INTERPRETATION

Our results show that suicide rates in Canada are increasing among female children and adolescents and decreasing among male children and adolescents. Limiting access to lethal means has some potential to mitigate risk. However, suffocation, which has become the predominant method for committing suicide for these age groups, is not amenable to this type of primary prevention.

Cause of death among Ghanaian adolescents in Accra using autopsy data

BACKGROUND

There is limited data on adolescent mortality particularly from developing countries with unreliable death registration systems. This calls for the use of other sources of data to ascertain cause of adolescent mortality. The objective of this study was to describe the causes of death among Ghanaian adolescents 10 to 19 years in Accra, Ghana utilizing data from autopsies conducted in Korle Bu Teaching Hospital (KBTH).

FINDINGS

Out of the 14,034 autopsies carried out from 2001 to 2003 in KBTH, 7% were among adolescents. Of the 882 deaths among adolescents analyzed, 402 (45.6%) were females. There were 365 (41.4%) deaths from communicable disease, pregnancy related conditions and nutritional disorders. Non-communicable diseases accounted for 362 (41%) cases and the rest were attributable to injuries and external causes of morbidity and mortality. Intestinal infectious diseases and lower respiratory tract infections were the most common communicable causes of death collectively accounting for 20.5% of total deaths. Death from blood diseases was the largest (8.5%) among the non-communicable conditions followed by neoplasms (7%). Males were more susceptible to injuries than females (χ2 = 13.45, p = .000). At least five out of ten specific causes of death were as a result of infections with pneumonia and typhoid being the most common. Sickle cell disease was among the top three specific causes of death. Among the females, 27 deaths (6.7%) were pregnancy related with most of them being as a result of abortion.

CONCLUSIONS

The autopsy data from the Korle-Bu Teaching Hospital can serve as a useful source of information on adolescent mortality. Both communicable and non-communicable diseases accounted for most deaths highlighting the need for health care providers to avoid complacency in their management of adolescents presenting with these diseases.

Youth injuries in British Columbia: type, settings, treatment and costs, 2003-2007

In this study, the types and costs of unintentional injuries among adolescents transitioning to adulthood are examined to provide age-appropriate prevention strategies. The data were collected in 2003, 2005 and 2007, in which a total of 273 (41%), 228 (39%) and 176 (33%) youths, respectively, reported to be having at least one serious injury. The leading types of injuries were sprains/strains, broken bones and bruises. Most injuries occurred while playing sports, falling/tripping, biking or rollerblading, mainly in recreation centres (>12-15%), schools (<27-9%), and workplaces (>2-14.5%). Most injuries were treated at emergency departments, walk-in clinics and health professional's offices (68-84%). Prevention included: doing nothing; being more careful; giving up the activity and rarely, rehabilitation or physiotherapy. The total direct cost of treatment was $471,498, (Canadian) at a mean direct cost of $775 per injury. Improved sports training and educational strategies targeted at subgroups of adolescents are needed to reduce the human and economic burden of injury.

Injury-related mortality among adolescents: findings from a teaching hospital's post mortem data

Background

Injuries are noted to be an important cause of death among adolescents. There is however limited data on the injury related deaths among adolescents in Ghana.

Findings

Using data from post-mortem records derived from the Department of Pathology of the Korle-Bu Teaching Hospital (KBTH), Accra Ghana from 2001 to 2003, the causes of injury related deaths among adolescents 10 to 19 years were analyzed by gender and age groups 10 to 14 and 15 to 19 years. There were 151 injury-related deaths constituting 17% of the autopsies performed among adolescents in the study period. The male-to-female ratio was 2.1:1. Drowning was the most common cause of death (37%) in the study population. This was followed by road traffic accidents (RTA) (33%). Over 70% of the RTA victims were pedestrians knocked downed by a vehicle. Deaths from electrocution, poisoning, burns, stab/gunshot, hanging and other miscellaneous causes (example blast injury, traumatic injury from falling debris, fall from height) made up the remaining 30% of the injury related mortality. Among males and in both age categories, drowning was the leading cause of death. In females, the highest mortality was from road traffic accidents accounting for almost half (49%) of the deaths; significantly more than that occurring in males (25%, p = .004).

Conclusions

Findings from Korle-Bu Teaching Hospital post-mortem data on adolescents show that drowning and road traffic accidents are the leading causes of injury-related mortality. Appropriate injury reducing interventions are needed to facilitate a decrease in these preventable deaths.

Global patterns of mortality in young people: a systematic analysis of population health data

BACKGROUND

Pronounced changes in patterns of health take place in adolescence and young adulthood, but the effects on mortality patterns worldwide have not been reported. We analysed worldwide rates and patterns of mortality between early adolescence and young adulthood.

METHODS

We obtained data from the 2004 Global Burden of Disease Study, and used all-cause mortality estimates developed for the 2006 World Health Report, with adjustments for revisions in death from HIV/AIDS and from war and natural disasters. Data for cause of death were derived from national vital registration when available; for other countries we used sample registration data, verbal autopsy, and disease surveillance data to model causes of death. Worldwide rates and patterns of mortality were investigated by WHO region, income status, and cause in age-groups of 10-14 years, 15-19 years, and 20-24 years.

FINDINGS

2.6 million deaths occurred in people aged 10-24 years in 2004. 2.56 million (97%) of these deaths were in low-income and middle-income countries, and almost two thirds (1.67 million) were in sub-Saharan Africa and southeast Asia. Pronounced rises in mortality rates were recorded from early adolescence (10-14 years) to young adulthood (20-24 years), but reasons varied by region and sex. Maternal conditions were a leading cause of female deaths at 15%. HIV/AIDS and tuberculosis contributed to 11% of deaths. Traffic accidents were the largest cause and accounted for 14% of male and 5% of female deaths. Other prominent causes included violence (12% of male deaths) and suicide (6% of all deaths).

INTERPRETATION

Present global priorities for adolescent health policy, which focus on HIV/AIDS and maternal mortality, are an important but insufficient response to prevent mortality in an age-group in which more than two in five deaths are due to intentional and unintentional injuries.

FUNDING

WHO and National Health and Medical Research Council.

A review of injury epidemiology in the UK and Europe: some methodological considerations in constructing rates

BACKGROUND

Serious injuries have been stated as a public health priority in the UK. However, there appears to be a lack of information on population-based rates of serious injury (as defined by a recognised taxonomy of injury severity) at national level from either official statistics or research papers. We aim to address this through a search and review of literature primarily focused within the UK and Europe.

METHODS

The review summarizes research papers on the subject of population based injury epidemiology published from 1970 to 2008. We examined critically methodological approaches in measuring injury incident rates including data sources, description of the injury pyramid, matching numerator and denominator populations as well as the relationship between injury and socioeconomic status.

RESULTS

National representative rates come from research papers using official statistics sources, often focusing on mortality data alone. Few studies present data from the perspective of an injury pyramid or using a standardized measure of injury severity, i.e. Injury Severity Score (ISS). The population movement that may result in a possible numerator - denominator mismatch has been acknowledged in five research studies and in official statistics. The epidemiological profile shows over the past decades in UK and Europe a decrease in injury death rates. No major trauma population based rates are available within well defined populations across UK over recent time periods. Both fatal and non-fatal injury rates occurred more frequently in males than females with higher rates in males up to 65 years, then in females over 65 years. Road traffic crashes and falls are predominant injury mechanisms. Whereas a straightforward inverse association between injury death rates and socio-economic status has been observed, the evidence of socioeconomic inequalities in non-fatal injuries rates has not been wholly consistent.

CONCLUSION

New methodological approaches should be developed to deal with the study design inconsistencies and the knowledge gaps identified across this review. Trauma registries contain injury data from hospitals within larger regions and code injury by Abbreviated Injury Scale enabling information on severity; these may be reliable data sources to improve understanding of injury epidemiology.