Child injury in Brisbane South 1985-91: implications for future injury surveillance

Evaluation of a mobile safety center's impact on pediatric home safety knowledge and device use

Background

A Mobile Safety Center (MSC) is designed to remove financial accessibility barriers to home safety by providing education and safety devices within local communities. The objective of this study was to evaluate the impact of an MSC on pediatric home safety knowledge and device use.

Methods

We conducted a prospective home safety interventional study. Parents and grandparents with children at home were recruited at community events attended by the MSC. Participants completed a pre-test survey assessing demographics and current home safety knowledge, practices, and device use. Participants then attended the MSC’s short home safety educational program. Afterwards, participants completed a knowledge reassessment post-test and were offered free safety devices: a smoke detector, a gun lock, and a childproofing kit comprising outlet covers, doorknob covers, and cabinet latches. We administered two follow-up surveys four weeks and six months after visiting the MSC. Descriptive statistics, Friedman tests, Wilcoxon Sum-Rank tests, and Pearson Chi-Square were used to assess respondent demographic characteristics and changes in home safety knowledge, practices, and device use.

Results

We recruited 50 participants, of whom 29 (58%) completed follow-up 1, 30 (60%) completed follow-up 2, and 26 (52%) completed both. Participants who completed both follow-ups increased total correct answers to safety knowledge questions between the pre-test and post-test (p = 0.005), pre-test and follow-up 1 (p = 0.003), and pre-test and follow-up 2 (p = 0.012) with no significant changes between the post-test, follow-up 1, and follow-up 2. Of the respondents who reported accepting safety products, outlet covers were used most frequently, followed by the smoke detector, doorknob covers, cabinet latches, and the gun lock.

Conclusions

The MSC may be an effective means of increasing home safety among families with children, as participation in the MSC’s home safety educational program significantly increased home safety knowledge and spurred home safety device use. Implementation of MSCs could potentially reduce childhood injury rates within communities through promotion of home safety.

Epidemiological risk analysis of home injuries in Italy (1999-2006)

Home injuries are an important public health issue in both developed and developing countries. This study focused on the Italian epidemiological framework between 1999 and 2006, using a nation-representative sample provided by the National Institute of Statistics. Every year, about 3,000,000 Italian residents reported at least one home injury, with an overall annual rate of 5.2/100 (95% CI 5.1–5.4); 3.2/100 (3.0–3.4) for males and 7.2/100 (6.9–7.4) for females. Poisson regression models were used for different age-specific populations (children, young/adults and older people), to evaluate the effects of socio-demographic, health/income satisfaction and housing variables. For children, non-applicable variables (including smoking and health satisfaction) were taken as those of the head of family, while housework time was taken the family mean time. Evidence of decreasing time trend in risk of home injury was found only among young/adults (p < 0.01). The following were risk factors: female gender (adjusted relative risk—RR 2.0 for older people and RR 1.9 for young/adults, p < 0.01); one additional hour of work at home (RR 1.009, p < 0.01 for young/adults and RR 1.016, p = 0.01 for children); smoking (RR 1.3, p < 0.01 for young/adults and p = 0.02 for children); health dissatisfaction (RR 1.3, p = 0.05 for children, RR 1.6 for young/adults and RR 1.7 for older people, p < 0.01); income dissatisfaction (RR 1.2, p < 0.01 for young/adults ); living alone (RR 1.5, p < 0.01 for young/adults and RR 1.2, p < 0.02 for the older people); having a garden (RR 1.1, p < 0.01 for young/adults ). Awareness of the need for safety at home could be boosted by information campaigns on the risk, and its social cost could be reduced by specific prevention schemes. Developing tools for assessing the risk at home and for removing the main hazards would be useful for both informative and prevention interventions.

Home injuries in Italy: patterns of injury and the most exposed people

Home injuries are a significant public health problem in developed and developing countries. To support future policies for reducing their occurrence and controlling their consequences, this study investigated the home injuries situation in Italy in 1999, using a nation-representative sample. The weighted correspondence analysis showed four different patterns of injury and seven profiles of the people most exposed to them. As results of this study falls were followed by bumps and cuts requiring specialist assistance then burns. Women were the most exposed to burn and fall risks and men to the risk of cuts and bumps. Among the elderly and children, falls and bumps leading to fractures, wounds or other consequences were frequent. The risks were highest for people with a lower level of education. Bumps and cuts were prevalent among unmarried and with the highest education level subjects. These injury risks were higher for young males. Cuts in adults doing do-it-yourself jobs had the worst consequences, while domestic work cuts generally did not need medical treatment. Burns occurred almost exclusively in the kitchen (90%) and did not need specialist assistance. Because home injuries are largely preventable, an efficient public health policy could promote and disseminate home safety culture.

Socio-economic distribution of environmental risk factors for childhood injury

OBJECTIVE

Childhood injury remains the single most important cause of mortality in children aged between 1-14 years in many countries. It has been proposed that lower socio-economic status (SES) and poorer housing contribute to potential hazards in the home environment. This study sought to establish whether the prevalence of observed hazards in and around the home was differentially distributed by SES, in order to identify opportunities for injury prevention.

METHODS

This study was a cross-sectional, random sample survey of primary school children from 32 schools in Brisbane. Interviews and house audits were conducted between July 2000 and April 2003 to collect information on SES (income, employment and education) and previously identified household hazards.

RESULTS

There was evidence of a relationship between prevalence of household environmental hazards and household SES; however, the magnitude and direction of this relationship appeared to be hazard-specific. Household income was related to play equipment characteristics, with higher SES groups being more likely to be exposed to risk. All three SES indicators were associated with differences in the home safety characteristics, with the lower SES groups more likely to be exposed to risk.

CONCLUSION

The differential distribution of environmental risk factors by SES of household may help explain the SES differential in the burden of injury and provides opportunities for focusing efforts to address the problem.

Information sources accessed by parents following childhood poisoning

OBJECTIVE

To ascertain the sources of information accessed by parents/caregivers following an incident of child poison ingestion, prior to their presentation to an ED.

METHODS

A questionnaire based survey of the parents/caregivers of children presenting to the Mater Children's Hospital Emergency Department with poisoning from March to October 2001.

RESULTS

A total of 121 parents/caregivers were surveyed. In 117 cases (97%), information was sought prior to presentation. The Poisons Information Centre (PIC) was the initial source of information in 39 cases (32%), the ED in 25 cases (21%) and the family doctor (by telephone or consultation) in 21 cases (17%). Poisons Information Centres, emergency departments and family doctors were the sole sources of information for 18%, 15% and 12% of cases, respectively. For 46% of cases multiple sources of information were accessed, and overall, in 57 cases (47%) the Poisons Information Centre was accessed, the ED in 38 cases (31%) and the family doctor in 34 cases (28%).

CONCLUSIONS

Poisons Information Centres are under-utilized as the first point of contact after childhood poisoning but in nearly all cases of poison ingestion that presented to the ED, information was sought prior to presentation and in most cases this was from direct contact with a health professional.

The potential of emergency department injury surveillance data: an illustration using descriptive analysis of data in 0-4 year olds from the Bath injury surveillance system

OBJECTIVES

To illustrate the potential of injury surveillance data from an emergency department surveillance system.

SETTING

Bath clinical area.

METHODS

Data for children (0-4 years old) resident in Bath city in UK were recoded and analysed.

RESULTS

There were a total of 3144 attendances and 2300 unintentional injuries - equivalent to an attendance rate of 131/1000. There were 91 thermal injuries and 162 poisoning/ingestions. Descriptive information is presented on the circumstances and consequences.

CONCLUSION

The majority of unintentional injuries in 0-4 year olds occur in the home, which is a modifiable environment. Detailed information around the circumstances available from the Bath injury surveillance system allows better focus for prevention messages and priority setting.

Childhood poisoning in Queensland: an analysis of presentation and admission rates

OBJECTIVE

To determine the presentation rates for paediatric poisoning by ingestion and the determinants of hospital admission.

METHODOLOGY

Cross-sectional survey using an injury surveillance database from emergency departments in South Brisbane, Mackay and Mt Isa, Queensland, from January 1998 to December 1999. There were 1516 children aged 0-14 years who presented following ingestional poisoning.

RESULTS

The presentation rates for poisoning were 690, 40 and 67 per 100000 population aged 0-4, 5-9 and 10-14 years, respectively. The admission rates to hospital for poisoning were 144, 14 and 22 per 100000 population aged 0-4, 5-9 and 10-14 years, respectively. Although presentation rates for poisoning were higher in the rural centres the admission rates were disproportionately high for the 0-4 years age group. The agents most frequently ingested were paracetamol, Dimetapp, rodenticides and essential oils.

CONCLUSION

There is a need to design and implement interventions aimed at reducing poison exposures and unnecessary hospital admissions in the 0-4 years age group.

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

OBJECTIVES

To describe and to understand the pattern of play-related deaths and injury (excluding organized sports) among children in New South Wales (NSW), Australia.

METHODOLOGY

This study utilized a state-wide prospective surveillance data collection of paediatric traumatic deaths and injuries at the Royal Alexandra Hospital for Children. Deaths and injury cases were selected from the NSW Trauma Death Registry and Childsafe NSW database. Information including basic demographics, the surrounding circumstances of death and injury incidents, and the required treatment was collected.

RESULTS

There were 30 play-related deaths and 92 drownings over the 4-year period. The male to female ratio was about 2:1. Excluding drowning, which has been reported elsewhere, and sports, the leading causes of play-related deaths were burns (eight) and asphyxiation (eight). An average of 6444 presentations to the emergency departments per year were recorded with sex ratio and age distribution pattern similar to the deaths. The home was the most common place (55.5%) of play-related injury, specifically the living and sleeping area. Falls, both under and above 1 metre, were the most common causes of injury (50.9%). The leading mechanism was cuts and lacerations (21.2%). Nearly one-third (32.7%) of all injuries were to the head, with face, cheek, forehead and scalp as the most common injured body part. Significant associations between place of injury, injured body parts and age were observed.

CONCLUSIONS

Play-related injury is common among children, and in some cases causes severe injury and death. To tackle the problem of play-related deaths and injuries, a holistic approach is suggested. This includes the provision of a safe environment, supervision by parents, education of children and detailed data collection.

Injury surveillance in an accident and emergency department: a year in the life of CHIRPP

BACKGROUND

The design of childhood injury prevention programmes is hindered by a dearth of valid and reliable information on injury frequency, cause, and outcome. A number of local injury surveillance systems have been developed to address this issue. One example is CHIRPP (Canadian Hospitals Injury Reporting and Prevention Program), which has been imported into the accident and emergency department at the Royal Hospital for Sick Children, Glasgow. This paper examines a year of CHIRPP data.

METHODS

A CHIRPP questionnaire was completed for 7940 children presenting in 1996 to the accident and emergency department with an injury or poisoning. The first part of the questionnaire was completed by the parent or accompanying adult, the second part by the clinician. These data were computerised and analysed using SPSSPC for Windows.

RESULTS

Injuries commonly occurred in the child's own home, particularly in children aged 0-4 years. These children commonly presented with bruising, ingestions, and foreign bodies. With increasing age, higher proportions of children presented with injuries occurring outside the home. These were most commonly fractures, sprains, strains, and inflammation/oedema. Seasonal variations were evident, with presentations peaking in the summer.

CONCLUSIONS

There are several limitations to the current CHIRPP system in Glasgow: it is not population based, only injuries presented to the accident and emergency department are included, and injury severity is not recorded. Nevertheless, CHIRPP is a valuable source of information on patterns of childhood injury. It offers local professionals a comprehensive dataset that may be used to develop, implement, and evaluate child injury prevention activities.

Traumatic brain injury in children in Denmark: a national 15-year study

Demographic trends are reported concerning three types of traumatic brain injury (concussions, cranial fractures, and intracranial contusions/haemorrhages) among children in Denmark of ages up to and including 14 years, for a fifteen year period from 1979 through 1993. The data were derived from a national computer-based hospitalization register and include 49,594 children, of whom 60% were boys and 89% had suffered a concussion. Virtually all injuries were the result of accidents. A major finding was that there has been a general decline in the incidence of traumatic brain injuries, especially for boys from 5 to 14 years old, suggesting a degree of success in preventive measures, particularly regarding road safety. The incidence of fatal cases of intracranial contusions/haemorrhages approximately halved over the 15 year period. However, as a proportion of all diagnosed cases, mortality from intracranial contusions/haemorrhages remained fairly constant at about 22%, perhaps because there have been no markedly successful innovations in acute care. Among children surviving a intracranial contusions/haemorrhages, rather considerable numbers were found to have been awarded disability pension at ages under 30.

Council playgrounds in New South Wales: compliance with safety guidelines

Despite initiatives to improve the safety of play environments, playground-related injuries continue to be a major public health problem. Efforts to address playground safety in New South Wales were consolidated during 1994 through the Kidsafe Playground Safety Project. In stage 1 of the project (described here), 240 council playgrounds were assessed to determine the extent to which playground equipment complied with safety guidelines. On-site inspection of the selected playgrounds provided data on 862 separate pieces of playground equipment. Of the 723 pieces requiring undersurfacing, less than half (45.4 per cent) had the recommended type of undersurfacing while only 42 of those pieces had undersurfacing to the recommended depth. However, when the fall height of equipment was considered in addition to the undersurfacing guidelines, only 13 (1.8 per cent) of the 723 pieces of equipment simultaneously satisfied all of the safety guidelines. Regrettably, none of the 240 council playgrounds assessed complied fully with the key safety guidelines. The results underscore the need for a collaborative effort on the part of local government, Kidsafe and health promotion and regional public health units to ensure that council playgrounds in New South Wales comply with recommended safety guidelines.

Children and bicycles: what is really happening? Studies of fatal and non-fatal bicycle injury

OBJECTIVES

The objectives of the study were to ascertain the causes of accidents, injuries, and deaths in children who ride bicycles. Fatality and injury rates were also studied in order to compare with other studies.

METHODS

Two studies of children were undertaken in children aged less than 15 years. In the first (retrospective fatality study), children who died as a result of a bicycle incident during the period 1981-92 were reviewed. In the second (prospective injury study) data were obtained prospectively between April 1991 and June 1992 about children who were injured while riding a bicycle and treated at a public hospital in Brisbane.

RESULTS

Study 1: fatality rates for boys were twice those for girls. The rate was highest for boys of 14 years in the metropolitan area at 6.23/100,000. All deaths involved vehicles, and the majority involved head injury or multiple injuries including head injury. Study 2: similar numbers of children were injured at onroad and off-road locations. Faculty riding was described by the rider or caregiver as the cause in 62.5% of cases. The most common time of injury was between 3 and 6 pm on both school and non-school days. Only 5.5% of all incidents involved a moving vehicle.

CONCLUSIONS

Bicycle riding by children is a common cause of injury, particularly for boys. Equal numbers of injuries occurred on the road as at other locations. Faulty riding caused most accidents. Injury prevention for bicycle riders should involve not only compulsory wearing of helmets, but should also include education and training about safe riding habits, separation of motorised vehicles from bicycles, modified helmet design to incorporate facial protection, and improved handlebar design.