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Lee JY, Kim K, Bae K. Contemporary Patterns and Underlying Causes of Vitrectomy in Pediatric and Adolescent Patients: A Nationwide, Population-Based Analysis. Am J Ophthalmol 2024; 261:28-35. [PMID: 38219892 DOI: 10.1016/j.ajo.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/24/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE We determined the incidence, etiology, and longitudinal trends of vitreoretinal diseases necessitating pars plana vitrectomy (PPV) in the pediatric and adolescent population. DESIGN Nationwide, population-based cohort study. METHODS This study utilized data extracted from the Korean National Health Claims database spanning from 2009 to 2020. All pediatric and adolescent patients (under 20 years of age) who underwent PPV across the Korean population were included. The cumulative incidence of PPV was estimated from 2009 to 2020, with 2009 to 2011 as the washout period. The annual trends of PPV incidence, the proportion of each etiology, and comorbidity were estimated based on sex and specific age groups. RESULTS In total, 1913 patients, including 83 infants, 746 pediatric patients, and 1084 adolescents, were newly identified as having undergone PPV surgery. The cumulative incidence of PPV surgery per 100,000 individuals was 21.42 (95% CI, 21.41-21.43). The rate of PPV was 2.4 times higher for males than females, and the rate of trauma as a comorbidity was also higher for males than females (13.1% vs 4.8%). Among males aged 5 years and older, the incidence of PPV nearly halved from 2011 to 2020. Among the primary etiologies, ROP had the highest rate (72%) in infants (under 1 year), while RD was most common (63%) in individuals aged 5 to 19 years. Myopia was present in 30.3% of patients, and atopic dermatitis was present in 31.8% of all patients. CONCLUSION The primary etiologies underlying the need for PPV in the pediatric and adolescent populations vary by sex and age group. The incidence of PPV continues to decline in the adolescent population. Therefore, tailored patient education and age-specific etiological examination are recommended.
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Affiliation(s)
- Ju-Yeun Lee
- From the Department of Ophthalmology (J.Y.L.), Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea; Department of Preventive Medicine (J.Y.L., K.K., K.B.), Seoul National University College of Medicine, Seoul, South Korea; Integrated Major in Innovative Medical Science (J.Y.L.), Seoul National University College of Medicine, Seoul, South Korea
| | - Kyungsik Kim
- Department of Preventive Medicine (J.Y.L., K.K., K.B.), Seoul National University College of Medicine, Seoul, South Korea; Department of Biomedicine Sciences (K.K.), Seoul National University Graduate School, Seoul, South Korea; Cancer Research Institute (K.K.), Seoul National University, Seoul, South Korea
| | - Kunho Bae
- Department of Preventive Medicine (J.Y.L., K.K., K.B.), Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology (K.B.), Seoul National University Hospital, Seoul, South Korea.
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Catchpoole J, Niven C, Möller H, Harrison JE, Ivers R, Craig S, Vallmuur K. External causes of emergency department presentations: A missing piece to understanding unintentional childhood injury in Australia. Emerg Med Australas 2023; 35:927-933. [PMID: 37366326 DOI: 10.1111/1742-6723.14259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/09/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To identify external causes of unintentional childhood injury presenting to Australian EDs. METHODS Six major paediatric hospitals in four Australian states supplied de-identified ED data for 2011-2017 on age, sex, attendance time/date, presenting problem, injury diagnosis, triage category and mode of separation. Three hospitals supplied data on external cause and intent of injury. A machine classifier tool was used to supplement the missing external cause coding in the remaining hospitals to enable the compilation of a standardised dataset for childhood injury causes analysis. RESULTS A total of 486 762 ED presentations for unintentional injury in children aged 0-14 years were analysed. The leading specified cause of ED presentations was low fall (35.0%) followed by struck/collision with an object (13.8%) with little sex difference observed. Males aged 10-14 years had higher rates of motorcycle, pedal cycle and fire/flame-related injury and lower rates of horse-related injury and drug/medicinal substance poisoning compared with females. The leading specified external cause resulting in hospitalisation was low fall (32.2%) followed by struck/collision with an object (11.1%). The injuries with the highest proportion of children being hospitalised were drownings (64.4%), pedestrian (53.4%), motorcycle (52.7%) and horse-related injuries (50.0%). CONCLUSIONS This is the first large-scale study since the 1980s to explore external causes of unintentional childhood injury presenting to Australian paediatric EDs. It demonstrates a hybrid human-machine learning approach to create a standardised database to overcome data deficiencies. The results supplement existing knowledge of hospitalised paediatric injury to better understand the causes of childhood injury by age and sex, which require health service utilisation.
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Affiliation(s)
- Jesani Catchpoole
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Catherine Niven
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Holger Möller
- School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia
- Injury Division, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - James E Harrison
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Rebecca Ivers
- School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Simon Craig
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Paediatric Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Kirsten Vallmuur
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Metro North Health, Brisbane, Queensland, Australia
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Yao Y, Ma L, Chen L. Characteristics of injury mechanisms in children and differences between urban and rural areas in central China. Eur J Trauma Emerg Surg 2023; 49:2459-2466. [PMID: 37410133 DOI: 10.1007/s00068-023-02320-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Some studies lack detailed analyses of the differences and characteristics of pediatric injury mechanisms between urban and rural areas. OBJECTIVE We aim to understand the characteristics, trends, and mortality rates of injury mechanisms in children in urban and rural areas in central China. RESULTS In a study involving 15,807 pediatric trauma patients, it was observed that boys constituted the majority (65.4%) and those aged ≤ 3 years were the most prevalent (28.62%). Falls (39.8%), burns (23.2%), and traffic accidents (21.1%) were identified as the top three injury mechanisms. The head (29.0%) and limbs (35.7%) were found to be the most susceptible to injury. Additionally, children between the ages of 1-3 years exhibited a higher likelihood of sustaining burn injuries compared to other age groups. The main causes of burn injury were hydrothermal burns (90.3%), flame burns (4.9%), chemical burns (3.5%), and electronic burns (1.3%). In urban areas, the major injury mechanisms were falls (40.9%), traffic accidents (22.4%), burns (20.9%), and poison (7.1%), whereas, in rural areas, they were falls (39.5%), burns (23.8%), traffic accidents (20.8%), and penetration (7.0%). Over the past decade, the overall incidences of pediatric trauma have been decreasing. In the past year, the number of injured children was the highest in July, and the overall mortality rate due to trauma was 0.8%. CONCLUSION Our findings revealed that in different age groups, the injury mechanisms are different in urban and rural areas. Burns are the second leading cause of trauma in children. A decrease in pediatric trauma over the past 10 years indicates targeted measures and preventive intervention may effectively prevent pediatric trauma.
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Affiliation(s)
- Yuanying Yao
- Department of Medical Record Management, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Lijuan Ma
- Department of Medical Record Management, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Lei Chen
- Department of Burn and Plastic Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China.
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Herren A, Palmer CS, Landolt MA, Lehner M, Neuhaus TJ, Simma L. Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1377. [PMID: 37628376 PMCID: PMC10453385 DOI: 10.3390/children10081377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Trauma is one of the most common causes of death in childhood, but data on severely injured Swiss children are absent from existing national registries. Our aim was to analyze trauma activations and the profiles of critically injured children at a tertiary, non-academic Swiss pediatric emergency department (PED). In the absence of a national pediatric trauma database, this information may help to guide the design of infrastructure, processes within organizations, training, and policies. METHODS A retrospective analysis of pediatric trauma patients in a prospective resuscitation database over a 2-year period. Critically injured trauma patients under the age of 16 years were included. Patients were described with established triage and injury severity scales. Statistical evaluation included logistic regression analysis. RESULTS A total of 82 patients matched one or more of the study inclusion criteria. The most frequent age group was 12-15 years, and 27% were female. Trauma team activation (TTA) occurred with 49 patients (59.8%). Falls were the most frequent mechanism of injury, both overall and for major trauma. Road-traffic-related injuries had the highest relative risk of major trauma. In the multivariate analysis, patients receiving medicalized transport were more likely to trigger a TTA, but there was no association between TTA and age, gender, or Injury Severity Score (ISS). Nineteen patients (23.2%) sustained major trauma with an ISS > 15. Injuries of Abbreviated Injury Scale severity 3 or greater were most frequent to the head, followed by abdomen, chest, and extremities. The overall mortality rate in the cohort was 2.4%. Conclusions: Major trauma presentations only comprise a small proportion of the total patient load in the PED, and trauma team activation does not correlate with injury severity. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED. Our findings indicate that high priority should be given to training in the management of severely injured children in the PED. The leading major trauma mechanisms were preventable, which should prompt further efforts in injury prevention.
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Affiliation(s)
- Anouk Herren
- Department of Pediatrics, Children’s Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
- Department of Pediatrics, University’s Children Hospital Zurich, University of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
| | - Cameron S. Palmer
- Trauma Service, The Royal Children’s Hospital, Melbourne, VIC 3052, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Markus A. Landolt
- Department of Psychosomatics and Psychiatry and Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Binzmuehlestrasse 14, CH-8050 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, CH-8032 Zurich, Switzerland
| | - Markus Lehner
- Department of Pediatric Surgery, Children’s Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
| | - Thomas J. Neuhaus
- Department of Pediatrics, Children’s Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
| | - Leopold Simma
- Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, CH-8032 Zurich, Switzerland
- Emergency Department, Children’s Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
- Emergency Department, University’s Children Hospital Zurich, University of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
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Schuetze K, Pankratz C, Schütze S, Zieger J, Gebhard F, Cintean R. Road Traffic Accidents, Climbing Frames, or Trampolines: What Harms Children in the 2020s? Cureus 2023; 15:e35781. [PMID: 37025721 PMCID: PMC10072073 DOI: 10.7759/cureus.35781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 03/07/2023] Open
Abstract
Background In the modern Western world, activities and the daily routine of children have changed over time. Detailed analyses of the mechanisms of injuries and current fracture patterns in children are rare. The aim of the study was to elicit and investigate the most dangerous leisure and sporting activities leading to fractures in children today. Materials and methods This is a retrospective study focusing on children that were treated in a level-one trauma center in Germany between 2015 and 2020. All children who were 14 years of age or younger and suffered a traumatic injury treated in our emergency department were included in this study. From the database, mechanisms of injury, type of injury, age, and gender were analyzed. Results The study included 12508 patients, including 7302 males and 5206 females. Among the 10 most common mechanisms of injury were collisions (8.6%), falls (7.7%), injuries while playing (6.1%) or while running or walking (5.9%), soccer (5.9%), bicycle accidents (3.8%), and trampoline falls (3.4%). Road traffic accidents involving passengers or pedestrians caused 3.3% of the injuries but were the most common cause of death. The most common mechanisms of injury causing a fracture were falls, playing soccer, and bicycle accidents. Sorting the mechanisms of injury by the percentage that caused a fracture, the most dangerous activities were falling from heights above 2 meters, skiing and snowboarding, climbing and bouldering, skateboarding, and horseback riding. In the five-year study period, four out of six children died due to road traffic accidents. Conclusion Injured children must be provided with the best quality of care 24/7 in orthopedic trauma departments and have to be kept as a focus in the training of orthopedic trauma surgeons. Road traffic accidents are still the main cause of death in children, but they are overall less common. Falls and sports activities are the most likely to cause a fracture.
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Veeser J, Barkmann C, Schumacher L, Zindler A, Schön G, Barthel D. Post-traumatic stress disorder in refugee minors in an outpatient care center: prevalence and associated factors. Eur Child Adolesc Psychiatry 2023; 32:419-426. [PMID: 34524524 DOI: 10.1007/s00787-021-01866-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
Due to their likelihood for experiencing a number of traumatic events, refugee minors have an increased risk of developing post-traumatic stress disorder (PTSD). However, the prevalence of PTSD in refugee children varies widely between studies, and it remains somewhat unclear what factors increase children's risk of PTSD. This study aimed to assess the prevalence of PTSD in a clinical outpatient sample of refugee minors, and to evaluate the association of different risk factors with a PTSD diagnosis. N = 417 refugee minors were recruited from an outpatient clinical center in Hamburg, Germany. The median age was 15.4 years and 74.6% of the minors were male. As part of the standard diagnostic process, their social history and a potential PTSD diagnosis using the Module K of the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) was assessed. The predictive value of age, gender, number of interpersonal traumatic events, un-/accompanied status, presence of family member in the host country, flight duration, residence status, and time since arrival in the host country were investigated using logistic regression analysis. The prevalence of PTSD among the young refugee patients was 61.6%. Significant predictors of a PTSD diagnosis were number of interpersonal traumatic life events, age, residence status, and time since arrival in the host country. The prediction model explained 33.8% of variance of the outcome with the number of interpersonal traumatic events having the largest contribution (20.8%). The high prevalence of PTSD among refugee minors in outpatient care emphasizes the need to establish appropriate care structures and train specialists in the treatment of PTSD.
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Affiliation(s)
- Jakob Veeser
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
- Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
| | - Lea Schumacher
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Areej Zindler
- Outpatient Center GmbH, Refugee Outpatient Clinic, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Dana Barthel
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
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Sweet AAR, de Bruin IGJ, Peek J, IJpma FFA, van Baal MCPM, Leenen LPH, Houwert RM. Epidemiology and outcomes of traumatic chest injuries in children: a nationwide study in the Netherlands. Eur J Pediatr 2023; 182:1887-1896. [PMID: 36807757 PMCID: PMC10167109 DOI: 10.1007/s00431-023-04828-1] [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: 08/04/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 02/21/2023]
Abstract
UNLABELLED Thoracic injuries are infrequent among children, but still represent one of the leading causes of pediatric mortality. Studies on pediatric chest trauma are dated, and little is known of outcomes in different age categories. This study aims to provide an overview of the incidence, injury patterns, and in-hospital outcomes of children with chest injuries. A nationwide retrospective cohort study was performed on children with chest injuries, using data from the Dutch Trauma Registry. All patients admitted to a Dutch hospital between January 2015 and December 2019, with an abbreviated injury scale score of the thorax between 2 and 6, or at least one rib fracture, were included. Incidence rates of chest injuries were calculated with demographic data from the Dutch Population Register. Injury patterns and in-hospital outcomes were assessed in children in four different age groups. A total of 66,751 children were admitted to a hospital in the Netherlands after a trauma between January 2015 and December 2019, of whom 733 (1.1%) sustained chest injuries accounting for an incidence rate of 4.9 per 100,000 person-years. The median age was 10.9 (interquartile range (IQR) 5.7-14.2) years and 62.6% were male. In a quarter of all children, the mechanisms were not further specified or unknown. Most prevalent injuries were lung contusions (40.5%) and rib fractures (27.6%). The median hospital length of stay was 3 (IQR 2-8) days, with 43.4% being admitted to the intensive care unit. The 30-day mortality rate was 6.8%. CONCLUSION Pediatric chest trauma still results in substantial adverse outcomes, such as disability and mortality. Lung contusions may be inflicted without fracturing the ribs. This contrasting injury pattern compared to adults underlines the importance of evaluating children with chest injuries with additional caution. WHAT IS KNOWN • Chest injuries are rare among children, but represent one of the leading causes of pediatric mortality. • Children show distinct injury patterns in which pulmonary contusions are more prevalent than rib fractures. WHAT IS NEW • The proportion of chest injuries among pediatric trauma patients is currently lower than reported in previous literature, but still leads to substantial adverse outcomes, such as disabilities and death. • The incidence of rib fractures gradually increases with age and in particular around puberty when ossification of the ribs becomes completed. The incidence of rib fractures among infants is remarkably high, which is strongly suggestive for nonaccidental trauma.
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Affiliation(s)
- Arthur A R Sweet
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Ivar G J de Bruin
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jesse Peek
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank F A IJpma
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Mark C P M van Baal
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roderick M Houwert
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Möller H, Niven C, Catchpoole J, Ivers R, Harrison J, Vallmuur K. Bandaids are not the fix: Examining the patterns of injury-related emergency department presentations in Australian children. Emerg Med Australas 2023; 35:112-119. [PMID: 36126966 PMCID: PMC10087466 DOI: 10.1111/1742-6723.14087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To provide an epidemiological understanding of the types of injuries treated in ED in Australian children, describe the impact of these injuries in volume and severity, and assess the patterns by demographic and temporal factors. METHODS ED data from six major paediatric hospitals in four Australian states over the period 2011-2017 were analysed to identify childhood injury patterns by nature of injury and body region, as well as sex, age group and temporal factors. RESULTS A total of 486 762 ED presentations for injury in children aged 0-14 years were analysed. The most common injuries for all age groups were fractures of the upper extremities. Leading injury diagnosis groups varied by age groups and sex. Overall, children aged 1-2 years had the highest number of ED presentations for injury, and from birth more males than females presented to ED with injuries with the highest absolute sex difference observed for 10- to 14-year-olds. Seventeen percent of children who presented to ED were admitted to hospital with the leading type of hospitalised injury being fractures. Little monthly variation in ED presentations was observed, except for higher presentations for drowning in summer months, and for most injury types, ED presentations were higher during weekends and daytime. CONCLUSIONS This is the first large-scale quantification of paediatric injury-related ED presentation patterns in Australia since the conclusion of the National Injury Surveillance and Prevention Program about 30 years ago. It provides valuable information to inform paediatric ED resourcing decisions as well as important evidence for injury prevention practitioners.
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Affiliation(s)
- Holger Möller
- School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Catherine Niven
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jesani Catchpoole
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Rebecca Ivers
- School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - James Harrison
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Kirsten Vallmuur
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Queensland, Australia
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Disadvantaged by More Than Distance: A Systematic Literature Review of Injury in Rural Australia. SAFETY 2022. [DOI: 10.3390/safety8030066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rural populations experience injury-related mortality and morbidity rates 1.5 times greater than metropolitan residents. Motivated by a call for stronger epidemiological evidence around rural injuries to inform prevention, a systematic review of peer-reviewed literature published between January 2010 and March 2021 was undertaken to explore the epidemiology of rural injury and associated risk factors in Australia. A subsequent aim was to explore definitions of rurality used in injury prevention studies. There were 151 papers included in the review, utilizing 23 unique definitions to describe rurality. People living in rural areas were more likely to be injured, for injuries to be more severe, and for injuries to have greater resulting morbidity than people in metropolitan areas. The increase in severity reflects the mechanism of rural injury, with rural injury events more likely to involve a higher energy exchange. Risk-taking behavior and alcohol consumption were significant risk factors for rural injury, along with rural cluster demographics such as age, sex, high socio-economic disadvantage, and health-related comorbidities. As injury in rural populations is multifactorial and nonhomogeneous, a wide variety of evidence-based strategies are needed. This requires funding, political leadership for policy formation and development, and implementation of evidence-based prevention interventions.
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Hashimoto A, Kawaguchi H, Hashimoto H. Contribution of the Technical Efficiency of Public Health Programs to National Trends and Regional Disparities in Unintentional Childhood Injury in Japan. Front Public Health 2022; 10:913875. [PMID: 35903376 PMCID: PMC9315066 DOI: 10.3389/fpubh.2022.913875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/21/2022] [Indexed: 12/03/2022] Open
Abstract
To achieve the Sustainable Development Goals, strengthening investments in health service inputs has been widely emphasized, but less attention has been paid to tackling variation in the technical efficiency of services. In this study, we estimated the technical efficiency of local public health programs for the prevention of unintentional childhood injury and explored its contribution to national trend changes and regional health disparities in Japan. Efficiency scores were estimated based on the Cobb-Douglas and translog production functions using a true fixed effects model in a stochastic frontier analysis to account for unobserved time-invariant heterogeneity across prefectures. Using public data sources, we compiled panel data from 2001 to 2017 for all 47 prefectures in Japan. We treated disability-adjusted life years (DALYs) as the output, coverage rates of public health programs as inputs, and caregivers' capacity and environmental factors as constraints. To investigate the contribution of efficiency to trend changes and disparities in output, we calculated the predicted DALYs with several measures of inefficiency scores (2001 average, yearly average, and prefecture-year-specific estimates). In the translog model, mean efficiency increased from 0.62 in 2001 to 0.85 in 2017. The efficiency gaps among prefectures narrowed until 2007 and then remained constant until 2017. Holding inefficiency score constant, inputs and constraints contributed to improvements in average DALYs and widened regional gaps. Improved efficiency over the years further contributed to improvements in average DALYs. Efficiency improvement in low-output regions and stagnated improvement in high-output regions offset the trend of widening regional health disparities. Similar results were obtained with the Cobb-Douglas model. Our results demonstrated that assessing the inputs, constraints, output, and technical efficiency of public health programs could provide policy leverage relevant to region-specific conditions and performance to achieve health promotion and equity.
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Affiliation(s)
- Ayumi Hashimoto
- Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Hideki Hashimoto
- Department of Health and Social Behavior, School of Public Health, University of Tokyo, Tokyo, Japan
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The prevalence of non-accidental trauma among children with polytrauma: A nationwide level-I trauma centre study. J Forensic Leg Med 2022; 90:102386. [DOI: 10.1016/j.jflm.2022.102386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/31/2022] [Accepted: 06/02/2022] [Indexed: 11/19/2022]
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Singh S, Babl FE, Hearps SJC, Hoch JS, Dalziel K, Cheek JA. Trends of paediatric head injury and acute care costs in Australia. J Paediatr Child Health 2022; 58:274-280. [PMID: 34523175 DOI: 10.1111/jpc.15699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/01/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
AIM Paediatric head injuries (PHI) are the most common cause of trauma-related emergency department (ED) presentations. This study sought to report the incidence of PHI in Australia, examine the temporal trends from 2014 to 2018 and estimate the patient and population-level acute care costs. METHODS Taking a public-sector health-care perspective, we applied direct and indirect hospital costs for PHI-related ED visits and acute admissions. All costs were inflated to 2018 Australian dollars ($). The patient-level analysis was performed with data from 17 841 children <18 years old enrolled in the prospective Australasian Paediatric Head Injury Study. Mechanisms of injury were characterised by the total and average acute care costs. The population-level data of PHI-related ED presentations were obtained from the Independent Hospital Pricing Authority. Age-standardised incidence rates (IR) and incidence rate ratios (IRR) were calculated, and negative binomial regression examined the temporal trend. RESULTS The age-standardised IR for PHI was 2734 per 100 000 population in 2018, with a significant increase over 5 years (IRR 1.13, 95% confidence interval (CI) 1.12-1.14; P < 0.001) and acute care costs of $154 million. Falls occurred in 70% of the study cohort, with average costs per episode of $666 (95% CI: $627-$706), accounting for 47% of acute care costs. Transportation-related injuries occurred in 4.1% of the study cohort, with average costs per episode of $8555 (95% CI: $6193-$10 917), accounting for 35% of acute care costs. CONCLUSION PHI have increased significantly in Australia and are associated with substantial acute care costs. Population-based efforts are required for road safety and injury prevention.
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Affiliation(s)
- Sonia Singh
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California, United States
| | - Franz E Babl
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Jeffrey S Hoch
- Center for Healthcare Policy and Research, University of California at Davis, Sacramento, California, United States.,Division of Health Policy and Management, Department of Public Health Sciences, University of California at Davis, Davis, California, United States
| | - Kim Dalziel
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Centre for Health Policy, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - John A Cheek
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
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The Socioeconomic Characteristics of Childhood Injuries in Regional Victoria, Australia: What the Missing Data Tells Us. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137005. [PMID: 34209051 PMCID: PMC8296858 DOI: 10.3390/ijerph18137005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/16/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022]
Abstract
Background: Injury is the leading cause of death among those between 1–16 years of age in Australia. Studies have found that injury rates increase with socioeconomic disadvantage. Rural Urgent Care Centres (UCC) represent a key point of entry into the Victorian healthcare system for people living in smaller rural communities, often categorised as lower socio-economic groups. Emergency presentation data from UCCs is not routinely collated in government datasets. This study seeks to compare socioeconomic characteristics of children aged 0–14 attending a UCC to those who attend a 24-h Emergency Departments with an injury-related emergency presentation. This will inform gaps in our current understanding of the links between socioeconomic status and childhood injury in regional Victoria. Methods: A network of rural hospitals in South West Victoria, Australia provide ongoing detailed de-identified emergency presentation data as part of the Rural Acute Hospital Data Register (RAHDaR). Data from nine of these facilities was extracted and analysed for children (aged 0–14 years) with any principal injury-related diagnosis presenting between 1 February 2017 and 31 January 2020. Results: There were 10,137 injury-related emergency presentations of children aged between 0–14 years to a participating hospital. The relationship between socioeconomic status and injury was confirmed, with overall higher rates of child injury presentations from those residing in areas of Disadvantage. A large proportion (74.3%) of the children attending rural UCCs were also Disadvantaged. Contrary to previous research, the rate of injury amongst children from urban areas was significantly higher than their more rural counterparts. Conclusions: Findings support the notion that injury in Victoria differs according to socioeconomic status and suggest that targeted interventions for the reduction of injury should consider socioeconomic as well as geographical differences in the design of their programs.
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14
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Long E, Williams A, Babl FE, Kinmonth A, Tse WC, Palmer CS, Crighton G, Savoia H, Teague WJ, Nystrup KB. Changes in emergency department blood product use for major paediatric trauma following the implementation of a major haemorrhage protocol. Emerg Med Australas 2021; 33:966-974. [PMID: 33811442 DOI: 10.1111/1742-6723.13773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/05/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Fixed ratio blood product administration may improve outcomes in trauma patients with massive blood loss. The present study aimed to describe the impact of a major haemorrhage protocol (MHP) on the ratio of blood products administered for paediatric major trauma. METHODS Retrospective observational study in a state-designated paediatric major trauma centre in Melbourne, Australia. Children with major trauma who received blood products in the ED were identified from a hospital trauma registry. Blood product ratios before, during and after implementation of a hospital MHP were compared in consecutive 2 year blocks. RESULTS Over a 6 year period, 767 major trauma patients were identified, of whom 47 received blood products in the ED and were included in the analysis; 14 pre-MHP implementation, 24 during-MHP implementation and nine post-MHP implementation. No patients received blood products at a ratio of 1:1:1 for red blood cells:fresh frozen plasma:platelets, respectively, during any time period. In this cohort of predominantly blunt trauma, blood products were infrequently administered in the ED because of the low prevalence of massive blood loss. Coagulopathy and hypofibrinogenaemia were commonly observed, nearly half of included patients were managed operatively and one quarter did not survive their injuries. CONCLUSION The implementation of a MHP did not change the ratio of blood product administration in this cohort of patients because of the infrequency of massive blood loss. Future studies may focus on the impact of treating coagulopathy and hypofibrinogenaemia on patient-centred outcomes.
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Affiliation(s)
- Elliot Long
- Department of Emergency Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Integrated Critical Care, Department of Medicine and Radiology, Melbourne Medical School, Melbourne, Victoria, Australia
| | - Amanda Williams
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Franz E Babl
- Department of Emergency Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Integrated Critical Care, Department of Medicine and Radiology, Melbourne Medical School, Melbourne, Victoria, Australia
| | - Anne Kinmonth
- Department of Haematology, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Wai Chung Tse
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Cameron S Palmer
- Trauma Service, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gemma Crighton
- Department of Haematology, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Helen Savoia
- Department of Haematology, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Warwick J Teague
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Trauma Service, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Kristin Brønnum Nystrup
- Paediatric Intensive Care Unit, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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15
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The effect of national public health measures on the characteristics of trauma presentations to a busy paediatric emergency service in Ireland: a longitudinal observational study. Ir J Med Sci 2021; 191:589-595. [PMID: 33743160 PMCID: PMC7980126 DOI: 10.1007/s11845-021-02593-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/07/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND The SARS-CoV-2 pandemic and government-enforced restrictions have impacted medical practices. AIMS The aim of our study was to investigate the impact SARS-CoV-2 and public health restrictions had on trauma presentations to a regional paediatric emergency service. METHODS We carried out a multisite retrospective longitudinal study of all paediatric ED attendances from 2018 including 13 March to 7 June 2020. This aligned with the initial government-enforced public health phases: delay phase, mitigation phase and reopening phase 1. RESULTS There were 7975 total regional attendances during government-enforced restrictions. This represents 17.5% and 15.6% reductions in site attendances when compared with the two previous years. Regional attendances reduced by 52.5% in 2020 compared with 2018 and 50.9% compared with 2019. Following an initial reduction in injury attendances at the beginning of the 'lockdown' (p = 0.076), the number of injuries consistently grew as weeks progressed (p < 0.05), reaching a peak of 44.6% of all attendances. As restrictions eased, the most common location where injuries occurred moved to areas outside the home (p < 0.000). There was a significant change in injury type, final disposition and device-associated injury (p < 0.05). Wheeled recreational devices were associated with over 20% of all injuries by reopening phase 1. CONCLUSIONS This study reveals that total attendances and total injuries reduced during initial phases of the lockdown. This was followed by a significant increase in injury presentations, which reached a peak of 44.6% of all attendances. We identified potential modifiable characteristics of paediatric trauma which can be addressed by future public health strategies.
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16
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Dahl HM, Andelic N, Løvstad M, Holthe IL, Hestnes M, Diseth TH, Myhre MC. Epidemiology of traumatic brain injury in children 15 years and younger in South-Eastern Norway in 2015-16. Implications for prevention and follow-up needs. Eur J Paediatr Neurol 2021; 31:70-77. [PMID: 33647532 DOI: 10.1016/j.ejpn.2021.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This retrospective study aimed to describe the volume, severity, and injury mechanism of all hospital-admitted pediatric traumatic brain injury (pTBI) at Oslo University Hospital (OUH), emphasizing consequences for prevention and factors indicating a need for follow-up programs. METHOD Data were extracted from the OUH Trauma registry on 176 children, 0-15 years old, admitted to OUH in 2015 and 2016 with a pTBI diagnosis. The dataset contains demographic data, injury mechanism, type, and severity (Glasgow coma scale, GCS; abbreviated injury scale, AIS; injury severity score, ISS), ICD-10 diagnosis codes, level of treatment, and destination of discharge. RESULTS 79.5% had mild, 9% moderate, and 11.4% severe TBI. The incidence of hospital-treated pTBI in Oslo was 29 per 100,000 per year. The boy: girl ratio was 1.9:1, but in the young teenage group (14-15 years), the ratio was 1:1. Intracranial injury (ICI) identified on CT/MRI was associated with extended hospital stays, with a median of 6 days compared to 1 day for patients without ICI. 27% of the patients assessed as mild TBI at admission had ICI. Children below eight years of age had a higher incidence of moderate and severe ICI from trauma (53% v.s. 28% in children ≥ eight years). CONCLUSION The injury characteristics of hospital-treated pTBI are in line with other European countries, but we find the boy-girl ratio different as young teenage girls seem to be catching up with the boys. ICI and length of stay should be considered when deciding which patients need follow-up and rehabilitation.
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Affiliation(s)
- Hilde Margrete Dahl
- Dept. of Clinical Neurosciences for Children, Section for Child Neurology, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
| | - Nada Andelic
- Dept. of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Norway.
| | - Marianne Løvstad
- Dept. of Psychology, Faculty of Social Sciences, University of Oslo, Norway; Dept. of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway.
| | - Ingvil Laberg Holthe
- Dept. of Psychology, Faculty of Social Sciences, University of Oslo, Norway; Dept. of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway.
| | - Morten Hestnes
- Division of Emergencies and Critical Care, Department of Research and Development,Oslo University Hospital, Norway; Oslo University Hospital Trauma Registry, Oslo University Hospital, Oslo, Norway.
| | - Trond H Diseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Dept. of Clinical Neurosciences for Children, Section for Psychosomatics and CL-child Psychiatry,Oslo University Hospital, Norway.
| | - Mia Cathrine Myhre
- Norwegian Centre for Violence and Traumatic Stress Studies, Nydalen, Oslo, Norway; Dept. of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway.
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17
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Rossetto A, Morgan AJ, Hart LM, Kelly CM, Jorm AF. Frequency and quality of first aid offered by older adolescents: a cluster randomised crossover trial of school-based first aid courses. PeerJ 2020; 8:e9782. [PMID: 32874786 PMCID: PMC7439956 DOI: 10.7717/peerj.9782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/30/2020] [Indexed: 11/23/2022] Open
Abstract
Background Research indicates that school-based first aid programmes appear to improve students’ knowledge and skills. However, evidence for their effectiveness is limited by a lack of rigorously designed studies. This research used a cluster randomised crossover trial to assess the effects of two different types of first aid training on the frequency and appropriateness of older adolescents’ first aid behaviours towards their peers 12 months after training. Methods Schools eligible to participate were government funded and able to accommodate first aid training and survey time for two consecutive Year 10 student cohorts. Four Australian public schools were matched in two pairs and randomly assigned to receive either physical first aid (PFA) or teen mental health first aid (tMHFA) training for their Year 10 student cohort (mean age 16 years). In the second year, the new Year 10 cohort received the other intervention. Four cohorts were randomised to receive PFA and four were randomised to receive tMHFA. Online surveys were administered at baseline and 12 months after training, measuring whether students had encountered a peer needing PFA, whether they had provided PFA, what actions they performed and, if applicable, why they had been unable to help the person. Only research staff analysing the data could be blinded to measurement occasion, school identity and condition. Results Four cohorts received PFA and four received tMHFA. The results indicated that there were no differences between groups regarding the frequency of appropriate first aid actions performed 12 months after training. The most common types of PFA provided to a peer were sending for help and wound care. Students most commonly mentioned someone else attending to their peer or lacking skills or experience as reasons for not performing PFA actions. Conclusions More research that examines first aid behaviours using rigorous, longitudinal study designs is needed to establish the effectiveness of school-based first aid training for older adolescents.
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Affiliation(s)
- Alyssia Rossetto
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Mental Health First Aid Australia, Melbourne, VIC, Australia
| | - Amy J Morgan
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Laura M Hart
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Claire M Kelly
- Mental Health First Aid Australia, Melbourne, VIC, Australia
| | - Anthony F Jorm
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Mental Health First Aid Australia, Melbourne, VIC, Australia
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18
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Peck B, Terry DR, Kloot K. Understanding childhood injuries in rural areas: Using Rural Acute Hospital Data Register to address previous data deficiencies. Emerg Med Australas 2020; 32:646-649. [PMID: 32633097 DOI: 10.1111/1742-6723.13565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The state of childhood injury in rural areas of Victoria is poorly understood. Currently only data on those children transferred from smaller hospital settings to larger settings appear in existing government datasets, significantly underestimating the characteristics of injury. METHODS Detailed emergency presentation data (Victorian Emergency Minimum Dataset [VEMD] and non-VEMD) that makes up the Rural Acute Hospital Data Register database was collected and compared among children (aged 0-14 years) who have a principal diagnosis of injury. RESULTS Of the 8647 episodes of care identified for injured children aged 0-14 years, 3257 children were managed initially at smaller hospitals that do not report episode data to existing datasets. CONCLUSIONS The Rural Acute Hospital Data Register database captures the presentations at low-resource sites and highlights as much as a 35% deficit in the data that is currently available to inform injury prevention and safety initiatives in Victoria.
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Affiliation(s)
- Blake Peck
- School of Health, Federation University Australia, Ballarat, Victoria, Australia
| | - Daniel R Terry
- School of Health, Federation University Australia, Ballarat, Victoria, Australia
| | - Kate Kloot
- Centre for Rural Emergency Medicine, Deakin University, Warrnambool, Victoria, Australia
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19
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Delayed presentation of traumatic hepatic pseudoaneurysm in a child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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20
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Parent perspectives and psychosocial needs 2 years following child critical injury: A qualitative inquiry. Injury 2020; 51:1203-1209. [PMID: 31983421 DOI: 10.1016/j.injury.2020.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION To provide effective care and promote wellbeing and positive outcomes for parents and families following paediatric critical injury there is a need to understand parent experiences and psychosocial support needs. This study explores parent experiences two years following their child's critical injury. METHODS This multi-centre study used an interpretive qualitative design. Parent participants were recruited from four paediatric hospitals in Australia. Semi-structured interviews were audio recorded and transcribed verbatim. Qualitative data were thematically analysed and managed using NVivo 11. RESULTS Twenty-two parents participated. Three themes were identified through analysis: Recovering from child injury; Managing the emotional impact of child injury; Being resilient and finding ways to adapt. CONCLUSIONS A long-term dedicated trauma family support role is required to ensure continuity of care, integration of support and early targeted intervention to prevent long-term adverse outcomes for critically injured children and their families. Early and ongoing psychosocial intervention would help strengthen parental adaptation and address families' psychosocial support needs following child injury.
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21
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Lesko K, Deasy C. Low falls causing major injury: a retrospective study. Ir J Med Sci 2020; 189:1435-1443. [PMID: 32185749 DOI: 10.1007/s11845-020-02212-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Falling from a height of under 2 m (low fall) is the most common mechanism of injury causing major trauma in Ireland. This presentation encompasses a wide patient cohort, from paediatric sport injuries to elderly falls. AIMS Our aim is to characterise major trauma resulting from a low fall, and its various sub-populations, to identify preventative strategies and care pathways to improve outcomes for patients. METHODS The Trauma Audit and Research Network (TARN) which is used to provide Major Trauma Audit was used to retrospectively identify patients presenting to the Cork University Hospital Emergency Department with trauma resulting from a low fall from January 2015 to June 2018. RESULTS The database returned 1066 qualifying cases (49.3% of cases in the time period), with a mean age of 67.3 years (SD = 21) and a median age of 71.3 years (IQR = 23); 44% were male. 'Mechanical falls' accounted for n = 513 (48%) of low-fall injuries, followed by 'stationary falls' n = 265 (25%). Injuries occurred most often at home n = 515 (48%), followed by public places n = 208 (19.5%). The most severely injured body region was the limbs n = 526 (49.3%), followed by the head n = 253 (23.7%). A number of patients with Glasgow Outcome Scores of 4 (moderate disability) and 5 (good recovery) were n = 488 (45.8%) and n = 390 (36.6%). CONCLUSIONS Low falls occur in patients over 55 years of age; many do not return to independent living. Wait times to initial assessment, length of hospital stay and mortality increase with age. Mechanical falls at home are the most common cause of low-fall major trauma.
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Affiliation(s)
- Kathryn Lesko
- School of Medicine, University College Cork, Cork, Ireland.
| | - Conor Deasy
- School of Medicine, University College Cork, Cork, Ireland
- Cork University Hospital, Cork, Ireland
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22
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Identifying Homogeneous Patterns of Injury in Paediatric Trauma Patients to Improve Risk-Adjusted Models of Mortality and Functional Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030892. [PMID: 32023934 PMCID: PMC7037699 DOI: 10.3390/ijerph17030892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/20/2020] [Accepted: 01/27/2020] [Indexed: 11/16/2022]
Abstract
Injury is a leading cause of morbidity and mortality in the paediatric population and exhibits complex injury patterns. This study aimed to identify homogeneous groups of paediatric major trauma patients based on their profile of injury for use in mortality and functional outcomes risk-adjusted models. Data were extracted from the population-based Victorian State Trauma Registry for patients aged 0–15 years, injured 2006–2016. Four Latent Class Analysis (LCA) models with/without covariates of age/sex tested up to six possible latent classes. Five risk-adjusted models of in-hospital mortality and 6-month functional outcomes incorporated a combination of Injury Severity Score (ISS), New ISS (NISS), and LCA classes. LCA models replicated the best log-likelihood and entropy > 0.8 for all models (N = 1281). Four latent injury classes were identified: isolated head; isolated abdominal organ; multi-trauma injuries, and other injuries. The best models, in terms of goodness of fit statistics and model diagnostics, included the LCA classes and NISS. The identification of isolated head, isolated abdominal, multi-trauma and other injuries as key latent paediatric injury classes highlights areas for emphasis in planning prevention initiatives and paediatric trauma system development. Future risk-adjusted paediatric injury models that include these injury classes with the NISS when evaluating mortality and functional outcomes is recommended.
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23
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Roberts Z, Collins JA, James D, Bouamra O, Young M, Lyttle MD, Roland D, Mullen S. Epidemiology of adolescent trauma in England: a review of TARN data 2008–2017. Emerg Med J 2019; 37:25-30. [DOI: 10.1136/emermed-2018-208329] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 11/04/2022]
Abstract
ObjectivesTrauma contributes significantly to adolescent morbidity and mortality. We aimed to ascertain the epidemiology of adolescent trauma to inform prevention strategies.MethodsData were abstracted from TARN (Trauma Audit Research Network) from English sites over a 10-year period (2008–2017). Adolescents were defined as 10–24 completed years. Descriptive statistical analysis was used in this study.ResultsThere were 40 680 recorded cases of adolescent trauma. The majority were male (77.3%) and aged 16–24 years old (80.5%). There was a 2.6-fold increase during the study time frame (p<0.0001) in the total annual number of cases reported to TARN. To account for increasing hospital participation, the unit trauma cases per hospital per year was used, noting an increasing trend (p=0.048). Road traffic collision (RTC) was the leading cause of adolescent trauma (50.3%). Pedestrians (41.2%) and cyclists (32.6%) were more prevalent in the 10–15 year group, while drivers (22.9%) and passengers (17.8%) predominated in the 16–24 year group. Intentional injury was reported in 20.7% (alleged assault in 17.2% and suspected self-harm in 3.5%). This was more prevalent in the 16–24 year group. The proportion of trauma reported due to violence has increased with stabbings increasing from 6.9% in 2008 to 10.2% in 2017 (p<0.0001). Evidence of alcohol or drug use was recorded in 20.1% of cases. There was an increase in the number treated in major trauma centres (45.7% 2008 vs 63.5% 2017, p<0.0001). Trauma was more likely to occur between 08:00 and 00:00, at weekends and between April and October. Overall mortality rate was 4.1%. Those with a known psychiatric diagnosis had a higher mortality (6.3% vs 4.4%, p<0.001).ConclusionsRTCs and intentional injuries are leading aetiologies. Healthcare professionals and policy-makers need to prioritise national preventative public health measures and early interventions to reduce the incidence of trauma in this vulnerable age group.
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Effects of Fall Training Program on Automatization of Safe Motor Responses During Backwards Falls in School-Age Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214078. [PMID: 31652771 PMCID: PMC6862607 DOI: 10.3390/ijerph16214078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/14/2019] [Accepted: 10/18/2019] [Indexed: 11/17/2022]
Abstract
A significant number of children suffer injuries from falls. The current measures of prevention and education regarding falls are not sufficient, as falling is still the main cause of injury at this age. This study aimed to evaluate the risk of injury during a backward fall and assess the effect of the Safe Fall training program on this risk. 457 primary school children between the ages of 6 and 12 (mean age of 9) were enrolled in a 6-week randomized intervention. The program was carried out during physical education classes and consisted of an intervention group that followed the Safe Fall training program and a control group that was given equilibrium exercises. The risk of injury was assessed before and after the implementation using the Information Scale on Safe Ways of Falling observation scale, evaluating the responses of five different body parts (head, hip, knees, upper limbs and back). Students’ natural response to falls was associated with a high risk of injury in more than 90% of the cases. The implementation of the Safe Fall program resulted in a considerable decrease in this risk, with percentages lowered to levels between 8.7% and 18.3%.
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