Scald burns in children under 3 years: an analysis of NEISS narratives to inform a scald burn prevention program

Epidemiology of burns in a humanitarian setting: A national study among refugees in Lebanon

INTRODUCTION

Burns represent one of the leading causes of morbidity worldwide and disproportionately impact women, children, and socioeconomically disadvantaged individuals. Syrian refugees who fled conflict to land in overcrowded informal settlements across Lebanon are a particularly vulnerable population. This study aims to assess the etiology and risk factors for burns in this population.

METHODS

This cross-sectional, cluster-based population study adopted the Surgeons Overseas Assessment of Surgical Need (SOSAS) version 3.0 to capture data from refugees residing in informal settlements in multiple regions across Lebanon. The tool was contextualized and used to collect detailed information on burn cases sustained by refugees during the last 12 months prior to data collection. Univariate logistic regression models were performed to assess the relationship between burns and associated risk factors.

RESULTS

From the 1468 households surveyed, a total of 223 households experienced a burn in the last 12 months. Over 63% of burns occurred in children under the age of ten years and almost 57% of burns occurred in females. More than 70% of burns resulted from hot liquid, while 17% were caused by direct heat contact. Over 3/4ths of burns occurred while preparing food (77.4%). Approximately 32% of those burned did not seek healthcare, of which almost 85% noted the cause was mainly due to financial limitations.

CONCLUSION

Burns are a common injury in the Syrian refugee population living in Lebanon. Children and women are particularly impacted, often during cooking. Multi-level interventions are necessary to reduce burn injuries and improve care for those affected by burns. Community kitchens can be used to separate cooking and living environments and get stoves and hot liquids off the floor. Importantly, policies should allow for refugees to receive medical care when necessary without a major financial burden.

Pediatric Craniofacial and Neck Burns

This study aimed to determine the epidemiological features, risk factors, current management trends and prognosis associated with injury severity in paediatric craniofacial and neck burn injuries. In the study conducted between January 2016 and January 2022, the data of 204 paediatric patients with head and neck burns hospitalised in Gazi Yaşargil Training and Research Hospital Burn Centre were scanned from medical records in a hospital computer. Of the total 204 patients, 114 (55.9%) were boys and 90 (44.1%) were girls. The age group most affected by burn trauma was the 1-4 age group at 55.4%. Scald burns were the most common cause in all age groups. Electrical, chemical and sunburns were rare causes. Among the patients, 97 (47.5%) developed acute conjunctivitis due to burns. Among the patients, 91 (44.6%) lived in rural areas and 113 (55.4%) in urban areas. The wound culture results of the patients were 24% positive, and the most common bacteria were Staphylococcus hominis (5.4%) and Staphylococcus aureus (4.9%). During follow-up, neck contracture developed in six (2.94%) patients with neck burns. Four (1.96%) patients died because of sepsis. The mean hospital stay was 5.49 ± 4.14 days. Craniofacial and neck burns in the paediatric population are complex and leave sequelae after burns, often requiring advanced care. Children are at risk for injury by liquid, kitchen and chemical products, which serve as common caustic injury mechanisms.

Understanding the circumstances of paediatric fall injuries: a machine learning analysis of NEISS narratives

OBJECTIVES

Falls are the leading cause of non-fatal injury among young children. The aim of this study was to identify and quantify the circumstances contributing to medically attended paediatric fall injuries among 0-4 years old.

METHODS

Cross-sectional data for falls among kids under 5 years recorded between 2012 and 2016 in the National Electronic Injury Surveillance System was obtained. A sample of 4546 narratives was manually coded for: (1) where the child fell from; (2) what the child fell onto; (3) the activities preceding the fall and (4) how the fall occurred. A natural language processing model was developed and subsequently applied to the remaining uncoded data to yield a set of 91 325 cases coded for what the child fell from, fell onto, the activities preceding the fall, and how the fall occurred. Data were descriptively tabulated by age and disposition.

RESULTS

Children most often fell from the bed accounting for one-third (33%) of fall injuries in infants, 13% in toddlers and 12% in preschoolers. Children were more likely to be hospitalised if they fell from another person (7.4% vs 2.6% for all other sources; p<0.01). After adjusting for age, the odds of a child being hospitalised following a fall from another person were 2.1 times higher than falling from other surfaces (95% CI 1.6 to 2.7).

CONCLUSIONS

The prevalence of injuries due to falling off the bed, and the elevated risk of serious injury from falling from another person highlights the need for more robust and effective communication to caregivers on fall injury prevention.

The cost burden of hospital-treated tap water scald burns in the United States

OBJECTIVE

We aimed to determine the cost burden and epidemiology of hospital-treated, tap water scald burns in the United States to inform consideration of policy proposals to require thermostatic mixing valves with all new water heaters.

METHODS

A retrospective, cross-sectional study was performed using the 2016-2018 National Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS) from the Healthcare Cost and Utilisation Project (HCUP). We queried the samples to examine the prevalence, cost, and epidemiology of hospital-treated, tap water scald burns.

RESULTS

The NIS and NEDS identified 52 088 (weighted) emergency department (ED) visits, 7270 (weighted) hospitalisations and 110 hospital-based deaths attributable to tap water scald burns in 2016-2018. The average cost for each encounter was $572 per ED visit and $28 431 per hospitalisation. In aggregate, the direct healthcare cost of these initial encounters was $206.69 million for inpatient (IP) visits and $29.79 million for ED visits. Medicare paid $109.54 million of these costs and Medicaid paid $18.3 million. Multiple body surfaces were involved in 35.4% of IP visits and 16.1% of ED visits.

CONCLUSIONS

NIS and NEDS are valuable tools to examine the cost burden and epidemiology of hospital-treated, tap water scald burns. The high injuries, deaths, and overall cost of these scald burns suggest policy proposals are needed to require the use of thermostatic mixing valves.The additional detail provided by using the International Classification of Diseases (ICD)-10 External Cause of Morbidity Code allows for a better understanding of the size and scope of tap water scald injuries than was possible with ICD-9.

Lower Risk of Burn Injury in Children and Adolescents with Autism Spectrum Disorder: A Nationwide Population-Based Study

Little research has examined burn injury in the pediatric population with autism spectrum disorder (ASD). We used data from Taiwan's National Health Insurance Research Database to identify 15,844 participants aged <18 years with ASD and 130,860 participants without ASD. Our results revealed that the hazard ratios differed across three age ranges. The ASD group had a lower risk of burn injury than the non-ASD group when they were less than 6 years of age, a higher risk from 6 years to 12 years of age, and no difference when they were older than 12 years of age. More research is required to study the characteristics and causes of burn injury in the pediatric population with ASD.

Comparison of accidental pediatric scald burns in a tertiary care center: hot cauldron burns versus accidental spill burns

Background: Scald burns result from exposure to high-temperature fluids and are more common in the pediatric age group. They occur mainly by two mechanisms: (i) spill and (ii) immersion (hot cauldron) burns. These two patterns differ in clinical characteristics and outcomes. Scalds cause significant morbidity and mortality in children. The objective of this study was to compare accidental spill burns and hot cauldron burns in a hospital setting. Methods: An analytical cross-sectional study was conducted by reviewing the secondary data of scald cases admitted during the years 2019 and 2020 in a burn-dedicated tertiary care center. Total population sampling was adopted. Data analysis was done partly using SPSS, version-23, and Stata-15. Mann Whitney U-test and Chi-square/Fisher's exact test were done appropriately to find associations between different variables. Binary regression analysis was performed taking mortality events as the outcome of interest. Results: Out of 108 scald cases, 43 (39.8%) had hot cauldron burns and 65 (60.2%) had accidental spill burns. Overall mortality was 16 (14.8%), out of which hot cauldron burns and accidental spill burns comprised 12 (75.0%) and 4 (25.0%), respectively. Binary logistic regression analysis showed the type of scald, age, and Baux score found to be associated with mortality. Every one-year increment in age had a 29% lower odds of occurrence of mortality event (adjusted odds ratio [OR], 0.71; 95% confidence interval [CI], 0.50-0.99, p=0.042). Likewise, every one-point increment in Baux score was associated with 19% higher odds of mortality (adjusted OR, 1.190; 95% CI, 1.08-1.32; p<0.001). Conclusions: Accidental spill burn was more common but mortality was significantly higher for hot cauldron burns. The risk of mortality was significantly higher in burn events occurring outside the house, and burns involving back, buttocks, perineum, and lower extremities.

Comparison of accidental pediatric scald burns in a tertiary care center: hot cauldron burns versus accidental spill burns

Background: Scald burns result from exposure to high-temperature fluids and are more common in the pediatric age group. They occur mainly by two mechanisms: (i) spill and (ii) immersion (hot cauldron) burns. These two patterns differ in clinical characteristics and outcomes. Scalds cause significant morbidity and mortality in children. The objective of this study was to compare accidental spill burns and hot cauldron burns in a hospital setting. Methods: An analytical cross-sectional study was conducted by reviewing the secondary data of scald cases admitted during the years 2019 and 2020 in a burn-dedicated tertiary care center. Total population sampling was adopted. Data analysis was done partly using SPSS, version-23, and Stata-15. Mann Whitney U-test and Chi-square/Fisher's exact test were done appropriately to find associations between different variables. Regression analysis was performed taking mortality events as the outcome of interest. Results: Out of 108 scald cases, 43 (39.8%) had hot cauldron burns and 65 (60.2%) had accidental spill burns. Overall mortality was 16 (14.8%), out of which hot cauldron burns and accidental spill burns comprised 12 (75.0%) and 4 (25.0%), respectively. Multinomial logistic regression analysis showed the type of scald, age, and Baux score found to be associated with mortality. Every one-year increment in age had a 29% lower odds of occurrence of mortality event (adjusted odds ratio [OR], 0.71; 95% confidence interval [CI], 0.50-0.99, p=0.042). Likewise, every one-point increment in Baux score was associated with 19% higher odds of mortality (adjusted OR, 1.190; 95% CI, 1.08-1.32; p<0.001). Conclusions: Accidental spill burns were more common but mortality was significantly higher for hot cauldron burns. The majority of burn injuries occurred inside the kitchen emphasizing appropriate parental precautions. The risk of mortality was significantly higher in burn events occurring outside the house, and burns involving back, buttocks, perineum, and lower extremities.

Pediatric Hand Burns Requiring Emergency Care in the United States

PURPOSE

Hand and finger burns represent a relatively common occurrence in children, and serious injuries may require surgical intervention to prevent long-term disability. This study examines the epidemiological characteristics of pediatric patients presenting for emergency care of hand and finger burns within the United States (US).

METHODS

We report a cross-sectional study of patients reported to the National Electronic Injury Surveillance System (NEISS) from January 1, 2010 to December 31, 2019. Patients were included in our study if they were younger than 18 years old and evaluated for an isolated hand or finger burn. United States census data from the same period were utilized for determining epidemiological estimates of injury incidence.

RESULTS

During the 10-year study period, an estimated 300,245 pediatric hand and finger burns were treated in 778,497,380 person-years: an incidence rate of 38.6 burns per 100,000 person years. Most treated burns occurred in the 1- to 2-year age group (28.3%) with an approximate 50% reduction in incidence for each 1-year age stratum until stabilizing at 6 years. Most burns occurred in white children (58%), but Black children had a higher incidence than white children when corrected for US population (45.15 burns versus 21.45 burns per 100,000 person-years). The most common etiology was a stove or oven (1595/10420; 15%).

CONCLUSIONS

Pediatric hand and finger burns occurred most frequently in young children from the oven and/or stove. We urge that parents be assertively counseled about potential burn risks to their young children's hands and fingers, especially once they reach ambulatory age.

Head and Neck Injury Patterns among American Football Players

IMPORTANCE

American football is a popular high-impact sport, leading to 2.7 million injuries in the United States annually. Recent evidence in football-related neurological damage has spurred national interest in player-safety. Football players injure their head and neck in up to 26% of total injuries. Variation in injury patterns between age groups and correlated hospitalizations for football-related head and neck injury has yet to be characterized.

OBJECTIVE

Our aim is to evaluate injury patterns among American-football related head and neck trauma.

METHODS

A retrospective cohort study of patients with football-related head and neck injury in the National Electronic Injury Surveillance System (NEISS).

RESULTS

Nearly 100 000 ED visits for football-related head and neck injuries occur annually. Males comprised 95% of patients, with a median age of 13. The head comprised 70% of injuries followed by the face (13%). The most common diagnoses were concussions (39%), internal organ injury (26%), and lacerations (11%). Pediatric patients were more likely to sustain concussions while adults experienced more lacerations (P < .05%). Fractures and nerve damage were rare injuries but caused a disproportionate share of hospitalizations.

CONCLUSION

Pediatric males are most likely to present for emergency care from football-related injury to the head and neck. Evaluating physicians can anticipate concussions, internal organ injury, and lacerations among presenting patients. Concussions, facial fractures, and nerve damage are injuries most likely to lead to hospitalization.

Nonfatal Pediatric Injuries Associated With Consumer Products and Sports and Recreational Activities in the United States

OBJECTIVE

The aim of this study was to investigate the epidemiology of nonfatal consumer product- and sports and recreational activity-related injuries among US children.

METHODS

National Electronic Injury Surveillance System data regarding children younger than 18 years who were treated in US emergency departments (EDs) for nonfatal consumer product- or sports and recreational activity-related injuries were analyzed.

RESULTS

From 1990 through 2012, an estimated 121,489,024 (95% confidence interval, 104,226,323-138,751,726) children younger than 18 years were treated in US EDs for nonfatal injuries meeting study criteria, yielding an average of 5,282,131 children annually, or 74.12 injuries per 1000 children. During 1990 to 2005, the overall annual injury rate decreased by 14.0% (P < 0.001), followed by an increase of 7.3% (P = 0.157) during 2005 to 2012. The concussion/closed head injury rate increased by 199.3% (P < 0.001) from 1996 to 2012. Injury rates were highest among children 0 to 4 years old and lowest among children 5 to 9 years old. Sports and recreational activities accounted for 46.5% of all injuries. Falls (40.2%) and "struck-by" (22.6%) were the leading mechanisms of injury, and 62.3% of all injuries were among boys. Injuries often occurred to the head/neck (37.8%) or upper extremities (31.9%), were frequently diagnosed as lacerations (29.0%) or soft tissue injuries (21.0%), and 2.7% were admitted to the hospital.

CONCLUSIONS

On average, a child was treated in a US ED for a nonfatal consumer product- or sports and recreational activity-related injury every 6 seconds. Although injury rates decreased early in the study period, there was a nonsignificant increasing trend from 2005 to 2012. Multilevel injury prevention efforts are recommended.

Sparking the Debate: Facial Injury Patterns from Fireworks

The objective of this article is to estimate the incidence, injury patterns, and demographics of patients presenting to emergency departments (EDs) for facial injury sustained from fireworks. This was an analysis of a nationwide database. The National Electronic Injury Surveillance System (NEISS) was evaluated for facial injuries from fireworks from 2013 to 2017. Relevant entries were examined for incidence, patient characteristics, location of injury, and type of injury. There were 509 NEISS entries, extrapolating to an estimated 19,816 ED visits for head and neck injuries due to fireworks from 2013 to 2017. The number of visits per year due to fireworks has been relatively stable over the past 5 years with an average of 3,963 cases per year. Greater than 90% of injuries occurred in July. Males comprised the majority of patients (67%), with the median age of 16 years. Most common sites of injury were the eyeballs (41%), followed by midface including eyelids, periorbita, and nose (31%), ears (12%), and only minor incidence of oral injuries (2%). After burns, contusions were the second most common injury from fireworks, followed by lacerations and foreign body injuries. The majority of firework injuries occurred in teenagers, reinforcing the importance of greater safety regulations and age limits for purchasing fireworks. Nearly half the incidents were eye injuries, necessitating greater public education in protective eyewear and mandating their use during festive holidays. Furthermore, injury patterns reported in this analysis may serve as a valuable adjunct for enhancing clinical history taking and physical examination to look for concurrent injuries.

A state-wide analysis of pediatric scald burns by tap water, 2016-2018

INTRODUCTION

Unsafe tap water temperatures (>120 °F) are a risk factor for pediatric burns, which may disproportionally impact low-income, urban communities. We sought to estimate the incidence and demographic characteristics of tap water burns and their association with housing characteristics.

METHODS

We performed a secondary data analysis to summarize emergency department discharge records from 2016 to 2018 involving children <18 years with an ICD-10-CM code for tap water burn (X11), and town-level housing data from the American Community Survey. Unpaired student's t-test and spearman's correlation analysis were performed for comparative analyses.

RESULTS

A total of 146 tap water burn visits were identified, representing an incidence of 2 per 10,000 ED visits. The majority of cases were male, non-Hispanic White, of public insurance type, and from an urban CT town. The median age was 3 years, with 58% of cases <5 years. Towns with at least one tap water burn had a significantly higher average percentage of multi-family unit and renter housing as compared to towns with no tap water burns (p < 0.0001).

CONCLUSIONS

Our results identified a significant number of tap water burns in children. Primary prevention efforts targeting education or regulation of water temperatures may work to reduce burns in underserved areas.

Craniofacial and neck burns in the pediatric population

INTRODUCTION

Burn injuries can present with catastrophic physical and psychiatric harm with extensive, long-term sequelae. The pediatric population may especially be at-risk given this population's early neurocognitive and behavioral state of development. Innovations in treatment modalities and the development of evidence-based guidelines have helped mitigate burn morbidity and mortality in the pediatric population. Unfortunately, a surprising dearth of literature identifies risk-factors, epidemiological data, injury mechanisms, and prognostic factors within the pediatric population in the setting of craniofacial burns.

METHODS

An analysis of emergency department visits under the National Electronic Injury Surveillance System was conducted for the most recent 5-year period available (2014-2018). Available information includes demographical data, such as age and sex, mechanism of injury, visit circumstances, as well as visit disposition. Additionally, details surrounding the injury, including type of burn and anatomical location of injury, were compared.

RESULTS

After a review of results, a total of 2599 patients were included for analysis. Our study shows that infants and young children are at increased risk for grave injury 27.3% and 13% of infants and toddlers transferred or admitted, respectively, p < 0.05). 59.8% of infant burns in particular were caused by liquid or kitchen products, while 44.5% of burns in toddlers were caused by chemical products (p < 0.05 for both). Conversely, adolescents are at greater risk of burns in the setting of occupational and hobby-based activities (20.4% of adolescent burns).

CONCLUSIONS

Craniofacial burns in the pediatric population may present with complex pathology and sometimes necessitate advanced care. Presentations and prognoses are different dependent upon age and injury mechanism. These findings may serve as important framework in the establishment of guidelines for medical and legislative reform.

Preventing injuries must be a priority to prevent disease in the twenty-first century

Injuries continue to be the leading cause of morbidity and mortality for children, adolescents, and young adults aged 1-24 years in industrialized countries in the twenty-first century. In this age group, injuries cause more fatalities than all other causes combined in the United States (U.S.). Importantly, many of these injuries are preventable. Annually in the U.S. there are >9 million emergency department visits for injuries and >16,000 deaths in children and adolescents aged 0-19 years. Among injury mechanisms, motor vehicle crashes, firearm suicide, and firearm homicide remain the leading mechanisms of injury-related death. More recently, poisoning has become a rapidly rising cause of both intentional and unintentional death in teenagers and young adults aged 15-24 years. For young children aged 1-5 years, water submersion injuries are the leading cause of death. Sports and home-related injuries are important mechanisms of nonfatal injuries. Preventing injuries, which potentially cause lifelong morbidity, as well as preventing injury deaths, must be a priority. A multi-pronged approach using legislation, advancing safety technology, improving the built environment, anticipatory guidance by clinical providers, and education of caregivers will be necessary to decrease and prevent injuries in the twenty-first century.

Children Younger Than 18 Years Treated for Nonfatal Burns in US Emergency Departments

This study investigated children <18 years old treated for burns in United States (US) emergency departments from 1990 to 2014 using data from the National Electronic Injury Surveillance System. There were 2 548 971 children treated for burns during the study period, averaging 101 959 annually. The number and rate of burns decreased by 30.0% and 38.9%, respectively, (both P < .001) during the study. Most patients (58.4%) were boys, 64.0% were <6 years old, and 7.4% were admitted to the hospital. Thermal burns accounted for 60.2% of injuries. The hand/fingers were most commonly injured (37.1%), followed by head/neck (19.6%). The most common specified mechanism of injury was grabbing/touching (18.4%), followed by spilling/splashing (16.4%). Although the number of children treated for burns has decreased, it remains an important source of pediatric injury, demonstrating the need to increase prevention efforts, especially among young children. This is the first study to use a nationally representative sample to investigate burn mechanisms.

Primary Care Opportunities to Prevent Unintentional Home Injuries: A Focus on Children and Older Adults

Unintentional injuries are a persistent public health problem in the United States. A new health care landscape has the potential to create a clinical environment that fosters greater involvement by health care providers in injury prevention. The aim of this article is to provide evidence supporting the need for engagement by primary care providers in unintentional home injury prevention along with examples of how this could be accomplished. We know a great deal about what population groups are at risk for certain types of injuries. We also know that many injuries can be prevented through policies, programs, and resources that ensure safe environments and promote safe behaviors. For example, the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative comprises clinical decision support tools and educational materials for health care providers. Two effective interventions that have demonstrated a reduction in falls among children are the redesign of baby walkers (engineering) and the mandated use of window guards (enforcement). Primary care clinicians can play a key role in promoting their patient's safety. Taken collectively, a focused attention on preventing unintentional home injuries by primary care providers can contribute to the reduction of injuries and result in optimal health for all.

Health education intervention promoting infant safe sleep in paediatric primary care: randomised controlled trial

BACKGROUND

Few randomised controlled trials (RCTs) have been conducted to improve infant sleep practices. There is limited research on how best to integrate safe sleep information into routine paediatric anticipatory guidance delivered at well child visits (WCVs). This protocol paper describes the design of the Safe Start Study, which aims to evaluate the impact of safe sleep interventions on parents' knowledge, beliefs and behaviours related to creating and maintaining a safe sleep environment for their infants.

METHODS

Safe Start is a three-group RCT comparing a safe sleep health education intervention delivered as part of the 2-week WCV, an attention-matched control group that receives a scald burn prevention intervention, and a standard of care group. A baseline survey is completed at the 2-week WCV; follow-up surveys and observations are completed in the home at 2-4 weeks and 2-3 months. Participants include mother-baby dyads attending a large urban paediatric primary care practice and their paediatricians. Primary outcomes are self-reported behaviours (baby sleeps alone, on back, in crib and in a smoke-free environment), observations of the sleep environment, paediatricians' anticipatory guidance counselling about safe sleep and participants' reported exposure to an existing city-wide safe sleep campaign.

DISCUSSION

Providing a theory-driven and evidenced-based safe sleep intervention is both a research and a clinical practice priority. This study will advance the application of educational and environmental interventions in the primary care setting to improve the safety of infant sleep environments in high-risk families.

TRIAL REGISTRATION NUMBER

NCT03070639; Pre-results.

Soccer-Related Facial Trauma: A Nationwide Perspective

PURPOSE

Soccer participation continues to increase among all ages in the US. Our objective was to analyze trends in soccer-related facial injury epidemiology, demographics, and mechanisms of injury.

MATERIALS AND METHODS

The National Electronic Injury Surveillance System was evaluated for soccer-related facial injuries from 2010 through 2014. Results for product code "soccer" were filtered for injures to the face. Number of injuries was extrapolated, and data were analyzed for age, sex, specific injury diagnoses, locations, and mechanisms.

RESULTS

In all, 2054 soccer-related facial trauma entries were analyzed. During this time, the number of injures remained relatively stable. Lacerations were the most common diagnosis (44.2%), followed by contusions and fractures. The most common sites of fracture were the nose (75.1%). Of fractures with a reported mechanism of injury, the most common was head-to-head collisions (39.0%). Patients <19 years accounted for 66.9% of injuries, and athletes over 18 years old had a higher risk of fractures.

CONCLUSIONS

The incidence of soccer-related facial trauma has remained stable, but the severity of such injuries remain a danger. Facial protection in soccer is virtually absent, and our findings reinforce the need to educate athletes, families, and physicians on injury awareness and prevention.

Assessing the completeness of coded and narrative data from the Victorian Emergency Minimum Dataset using injuries sustained during fitness activities as a case study

BACKGROUND

Injury surveillance systems support the ongoing systematic collection, analysis and interpretation of health information vital to the prevention, planning and evaluation of injury prevention strategies. One key measure of the success of such systems is their reliability. Data completeness is a major component of system reliability, and is an indicator of a system's data quality. The Victorian Emergency Minimum Dataset (VEMD) is a state-wide record of injury presentations to emergency departments in Victoria, Australia. For each case, it provides information on the injury cause, place of occurrence, activity at time of injury, body region affected and nature of injury, as well as a free-text narrative of the injury event. The aim of this study was to assess the completeness of data in the VEMD using injuries sustained in fitness facilities as a case study.

METHODS

Analysis of VEMD coded parent injury variables (nature of injury, injured body region, cause of injury, place where injury occurred, activity at time of injury) and detailed narratives were reviewed for completeness over the ten-year period July 2003 to June 2012, inclusive. Narratives were text analysed manually to determine which items of injury information they contained and compared to the parent injury variables.

RESULTS

There were 2936 identified cases related to injuries sustained during fitness activities. Two percent of cases had all coded injury variables unspecified. Overall, 95.8 % of narratives had at least one piece of injury information missing. The nature of injury and body region variables were coded in 92.6 and 96.6 % of cases, yet were only mentioned in 27.1 and 75.4 % of narratives, respectively. The cause variable was allocated a specified code in 47.7 % of cases and was mentioned in 45.9 % of narratives. The cause was missing in both in 42.8 % of cases. In approximately half of all cases, the activity and place were specified in both the coded injury variable and narrative; they were missing in both in 7.4 and 13.6 % of cases, respectively.

CONCLUSIONS

The reliability of the VEMD as an injury surveillance system, varied depending on the injury variable being examined.

Children with burns referred for child abuse evaluation: Burn characteristics and co-existent injuries

Intentional burns represent a serious form of physical abuse that must be identified to protect children from further harm. This study is a retrospectively planned secondary analysis of the Examining Siblings To Recognize Abuse (ExSTRA) network data. Our objective was to describe the characteristics of burns injuries in children referred to Child Abuse Pediatricians (CAPs) in relation to the perceived likelihood of abuse. We furthermore compare the extent of diagnostic investigations undertaken in children referred to CAPs for burn injuries with those referred for other reasons. Within this dataset, 7% (215/2890) of children had burns. Children with burns were older than children with other injuries (median age 20 months vs. 10 months). Physical abuse was perceived as likely in 40.9% (88) and unlikely in 59.1% (127). Scalds accounted for 52.6% (113) and contact burns for 27.6% (60). Several characteristics of the history and burn injury were associated with a significantly higher perceived likelihood of abuse, including children with reported inflicted injury, absent or inadequate explanation, hot water as agent, immersion scald, a bilateral/symmetric burn pattern, total body surface area ≥10%, full thickness burns, and co-existent injuries. The rates of diagnostic testing were significantly lower in children with burns than other injuries, yet the yield of skeletal survey and hepatic transaminases testing were comparable between the two groups. This would imply that children referred to CAPs for burns warrant the same level of comprehensive investigations as those referred for other reasons.