Children at play: the death and injury pattern in New South Wales, Australia, July 1990-June 1994

Causes and consequences of injuries in children in Western Australia

Objective

To identify the common causes and consequences of pediatric injury-related admission to an Australian children’s hospital.

Methods

A retrospective study was conducted at a pediatric teaching hospital. Patients < 18 years of age hospitalized between March 1, 2007 and April 30, 2007 were included. Patient medical records were reviewed if an admission diagnosis was injury related. Data collected included date of birth, gender, date of admission, date of discharge, diagnosis, procedure, and causes and outcomes of the injury.

Results

A total of 184 patients were admitted as a result of injury during the study period. Of these, one neonate, six infants, 38 toddlers, 111 children, and 28 teenagers were included in this study. The most common cause of injury-related hospital admission was a fall (n = 109, 59%). Other causes of injury included crushing (8%, n = 15), the spilling of fluids (5.4%, n = 10), and bites (4.3%, n = 8). The most common consequence of an injury for children (43/111, 38.7%) and teenagers (12/28, 43%) was bone fracture. However, head injuries were the most common injury in toddlers (11/38, 29%), infants (5/6, 83.3%), and neonates (1/1, 100%). The radius and/or ulna (36/63, 57%) were the most common bones fractured. The majority (32/37, 86.5%) of patients who suffered head injuries were diagnosed as having a minor injury.

Conclusion

The main cause of injury-related admission to the hospital for children was a fall, with the most common consequences being fractures and head injuries.

Risks for, and causes of, injuries to the hand and forearm: a study in children 0 to 6 years old

Ninety-six children aged 0-6 years with unintentional hand injuries were referred to the Department of Hand Surgery between 2002 and 2003. Either parents, medical staff, or both, completed a questionnaire (response rate 79/96; 82%) about the circumstances of the injury. The incidence of injuries referred for treatment was 33.4/10,000 people/year. Seventy-five percent (59/79) of all injuries occurred at home, and only 8% (6/79) in a day-care centre. The risk was highest between 4 p.m. and 8 p.m. (incidence rate ratio 5.17, 95% confidence interval 2.12 to 17.7) and in 6 year old children (IRR 4.89, 95% CI 1.58 to 37.68). Adults were present when 66/79 children (84%) were injured. Most injuries occurred during play (39/79; 49%). Stuck in front doors (23/79; 29%) (closed by a child) was common. There was no increase in incidence in children with a foreign background (IRR 1.19, 95% CI 0.64 to 2.28). Advice about prevention will be distributed to parents to encourage safer environments in homes.

The epidemiology and cost of falls requiring hospitalisation in children in Western Australia: a study using linked administrative data

OBJECTIVE

The aim of this study was to examine the epidemiology and health system cost of children's falls resulting in hospitalisation in 2003 in Western Australia.

METHODS

The Injury Cost Database was used to identify children who were admitted to hospital with a falls related injury. Adjusted incidence rate ratios (IRR) of hospitalisation were modelled using Poisson regression. In-patient hospital costs were assigned using the published DRG costs for Western Australia. These costs were then extrapolated to health system costs based on previously published relative proportions.

RESULTS

When adjusted for other covariates in the model males had a 53% higher incidence of falls requiring hospitalisation compared with females. Aboriginal children had a 36% higher incidence compared with their non-Aboriginal counterparts, and the incidence of falls reduced with increasing age. The total cost of in-patient hospitalisation associated with children's falls in Western Australia was A$4,554,000 with an average cost of A$1876 per case. In children aged 0-4 years and 10-14 years the highest cost resulted from falls on the flat (slips and trips). However, in children aged 5-9 years injuries resulting from falls from playground equipment resulted in both the highest cost group (A$539,000) and the highest cost per case (A$1917). The total cost to the health system of children's falls in Western Australia in 2003 were estimated to be A$21.5 million, with the total cost to the community estimated at A$108.5 million.

CONCLUSION

Children's falls impose a considerable burden and cost to both the health care system and the community. This study has provided information on where the burden of risk and the majority of costs lie, namely males, Aboriginal children and for children aged 5-9 years, unlike their younger and older peers, playground equipment.

Strangulation injuries in children

In this article we present a case of fatal strangulation with playground equipment in a 4-year-old child and a review of the literature. Playground injuries are a major cause of injury in children but fatalities are rare. However, strangulation is the cause of death in more than 50% of all playground fatalities. Neurological damage and death are caused by airway obstruction and venous congestion leading to hypoxia, acidosis, brain congestion and brain cell death. Airway injury in survivors is an exception and spinal cord injury has not been found in survivors. The mortality rate in strangulation is high. In cardiac arrest survival is unlikely and full neurological recovery has never been reported. However, all resuscitative efforts should be undertaken in patients with a residual circulation because neurologically intact survival is possible even in deeply comatose patients.

Language barriers and paediatric burns: Does education make a difference?

A focused first aid education campaign was conducted in Sydney in 1996 for parents of children from Non-English speaking backgrounds (NESB) to improve their knowledge of correct burns first aid treatment (BFAT). This study sought to determine the correlation, if any, between the reported beneficial results of this education campaign and the subsequent severity of burns in children. A retrospective review of all patients admitted to the state Burns Unit at The Children's Hospital at Westmead (CHW) over a 7-year period from January 1995 to December 2001 was performed. Number of patients, language spoken at home (English, Chinese, Arabic, Vietnamese or Other) and the rate of burns requiring skin grafting was assessed. A total of 1,283 patients were admitted over 7 years. Skin grafting was required in 544 (42%). NESB children required grafting in up to 88% of cases prior to the first aid education campaign, reducing to a minimum of 37% at 1 year and 65% at 5 years following the campaign. This compared to 40 and 36%, respectively, for English speaking children. While the initial decrease in grafting requirements may reflect an effective education campaign, the subsequent rise suggests the need for reinforcement.

Are current playground safety standards adequate for preventing arm fractures?

OBJECTIVE

To assess compliance with current standards of playgrounds where children have sustained a fall-related arm fracture.

DESIGN, SETTING AND PARTICIPANTS

Between October 2000 and December 2002, a consecutive prospective series of 402 children aged under 13 years who fell from playground equipment and sustained an arm fracture was identified by emergency department staff in five Victorian hospitals. Trained field testers measured playground equipment height, surface type and depth, and surface impact attenuation factors to determine compliance with safety standards.

MAIN OUTCOME MEASURES

Playground compliance with current Australian safety standards.

RESULTS

Ninety-eight percent of playgrounds had a recommended type of surface material. The mean surface depth was 11.1 cm (SD, 5.0 cm) and the mean equipment height was 2.04 m (SD, 0.43 m). Although over 85% of playgrounds complied with recommended maximum equipment height and surface impact attenuation characteristics, only 4.7% complied with recommended surface depth.

CONCLUSION

Playgrounds where children have sustained an arm fracture generally comply with all important safety recommendations except surface depth. Playground fall-related arm fracture requires specific countermeasures for prevention, distinct from head injury prevention guidelines.

Unintentional residential child injury surveillance in Hong Kong

OBJECTIVES

To provide an overall pattern of morbidity in unintentional residential childhood injuries (URCI) in Hong Kong.

METHODOLOGY

A cross-sectional telephone survey of caregivers of children aged under 16-years and adolescents suffering from URCI and admitted to three selected local Accident and Emergency Departments.

RESULTS

Falls, cuts and scalds were the most common external causes of URCI observed, while boys predominated in the sample population. Most of the observed URCI were of moderate to mild severity. Children of new immigrant mothers were more likely to receive first aid immediately after the incidents. Parents were aware of potentially injurious behaviour and intervened on occasion, but most resorted to verbal warnings only.

CONCLUSIONS

Prevalence of falls among observed URCI offers evidence in support of the hypothesis that the high population density in Hong Kong plays an integral role in understanding mechanisms of morbidity. Parents show concern about URCI but often lack substantial action that modifies injury risk. Considering the local injury differentials, an active prevention effort such as behavioural intervention and education for parents may be useful.

Injuries experienced by infant children: a population-based epidemiological analysis

OBJECTIVE

Injuries to infant children are an important health concern, yet there are few population-based analyses from which to develop prevention initiatives. This study describes the external causes, natures, and disposition from an emergency department of infants with injuries for a geographically distinct population in Eastern Ontario.

METHODS

Epidemiologic analysis of emergency-based surveillance data (1994-2000) for infants (<12 months old) from the Kingston sites of the Canadian Hospitals Injury Reporting and Prevention Program.

RESULTS

A total of 990 cases of injury to infants were identified, of which 217 (21.9%) required significant medical intervention. Leading causes of injury were falls (605/990; 61.1%), ingestion injuries (65/990; 6.6%), and burns (56/990; 5.7%). Common types of falls experienced were: from furniture (229/605; 37.9%), being dropped (92/605; 15.2%), in car seats (73/605; 12.1%), down stairs (63/605; 10.4%), or in a child walker (42/605; 6.9%). The observed patterns of injury changed according to the ages of the children. Vignettes are used to illustrate recurrent injury patterns (falls, physical vulnerability, burns and ingestions, equipment injuries).

CONCLUSION

The results indicate the relative importance of several external causes of injury and how these vary by age group. This population-based information is also useful in establishing rational priorities for prevention, and the targeting of interventions toward responsible authorities.

A neglected risky behavior among children and adolescents: underage driving and injury in New South Wales, Australia

PROBLEM

Among different causes of injury, roads and traffic-related incidents contributed most to all child deaths. The majority of childhood and adolescent traffic-related deaths are young people killed as pedestrians or bicyclists. Underage driving is a particular risky behavior much neglected. This study aimed to describe some characteristics related to motor-vehicle crashes and crash-related injury in which the vehicle was driven by a young person who was under the legal age of obtaining a learner license in New South Wales, Australia.

METHODS

Data used in this study were made available from the Roads and Traffic Authority of NSW for the period between 1996 and 2000. Crash information was collected and reported by NSW police at the scene of these motor-vehicle crash incidents.

RESULTS

There were 526 crashes involving an underage driver recorded within the study period. The majority (79.5%) of these underage drivers were males with slightly more than half (58.0%) aged 15 years, and nearly 30% aged 14 years. Among these, 83.6% involved the driver of the vehicle being killed or injured. Among the injured or killed passengers, 128 (73.6%) were nonadult passengers under the age of 18 years. Seventy of these crashes occurred while the car was in pursuit by police. The adjusted relative risk of injury to at least one occupant in the vehicle should a crash occur for female underage drivers was two times (OR=2.01, 95% CI=1.27-3.20) as compared to male underage drivers.

DISCUSSION

Underage driving poses a serious problem in terms of crash outcomes. Experimental driving and late-night outings for adolescents should be discouraged. Well-designed studies are required to further investigate the relationship between underage driving and on road risk-taking behavior among licensed adolescents.

IMPACT ON INDUSTRY

Data obtained from this study indicate that adults, particularly parents, should discourage underage adolescents from experimenting driving and should actively cultivate a positive attitude toward driving.

Horse-related injuries in children

OBJECTIVES

To identify the frequency, spectrum and outcome of horse-related injuries in children.

DESIGN AND SETTING

Retrospective case series of horse-related injuries in children admitted to the Children's Hospital at Westmead (CHW) from January 1988 to December 1999, the John Hunter Children's Hospital (JHCH) from January 1991 to December 1997 and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry from January 1988 to December 1999.

MAIN OUTCOME MEASURES

Circumstances of injury; helmet use; adult supervision; type and number of injuries identified.

RESULTS

232 children were admitted with horse-related trauma, 97 to the CHW over 12 years and 135 to JHCH over seven years, with one death at each hospital. There were six deaths reported to the NPTD Registry over 12 years. The median age was 11 years (range, 1-17). Girls accounted for 65% of those injured and 75% of children were injured while riding. Falls caused the injury in 76.3% of cases. Head and upper-limb trauma accounted for 216 of the injuries (73%). Five out of six children with severe head injuries died. In the CHW group, helmet use was documented in only 24 riders (38%) and adult supervision in 22 (22.9%).

CONCLUSIONS

Horse-related trauma accounts for a considerable number of deaths and injuries in children in NSW. The use of a Standards-approved helmet for riding or horse-related activities might have decreased the severity of head injuries.