Surveillance of pediatric injury hospitalizations in Southern California

Diversity of Spectrum and Management of Animal-Inflicted Injuries in the Pediatric Age Group: A Prospective Study from a Pediatric Surgery Department Catering Primarily to the Rural Population

Introduction:

Animal-inflicted injuries continue to be a major health problem worldwide. In developing countries, the outcome of such injuries, especially in children may be poor.

Aim:

The study aimed to evaluate the diversity of spectrum and management of animal-inflicted injuries in the pediatric age group.

Materials and Methods:

This was a prospective study on animal-inflicted injuries in children between 1 to 15 years of age over a period of 12 months. Data on various parameters such as age and sex, animal species involved, provoked/unprovoked, mechanism of injury, time of injury, prehospital care, injury-arrival interval, pattern and type of injury, trauma score, body region injured, treatment given and complications were collected and analyzed.

Results:

Fifty-two children with animal-inflicted injuries were included, constituting <1% of all trauma cases seen during the study period (male:female = 2:1). The mean age of the cohort was 9.65 years. Domestic animals were responsible in 41 children (78.84%) and wild animals in 11 children (21.16%). Dog bite was the most common (57.69%). Penetrating injury was observed in 40 (76.9%) and blunt injury was observed in 12 (23.1%). The musculoskeletal system was the most common organ-system injured affecting 36 children (69.23%). Thirty-five children (67.3%) after minor treatment were discharged. Seventeen children (32.7%) required admission. Thirty-four children (65.38%) underwent surgical procedures. Wound debridement was the most common procedure performed. Wound infection was observed in 20 children (38.46%) and was significantly higher (P < 0.01) in delayed presenters. The length of hospital stay for the admitted children ranged from 3 to 28 days.

Conclusion:

Animal-inflicted injuries are rare in children and have a wide spectrum of presentation. Severe injuries require extensive resuscitation and expert surgical care. Mild injuries can be managed conservatively with the use of proper dressings, antibiotics, and analgesics.

Epidemiological trends of pediatric trauma: A single-center study of 791 patients

AIM

To assess the various epidemiological parameters that influence the causation of trauma as well as the consequent morbidity and mortality in the pediatric age group.

MATERIALS AND METHODS

A prospective study of 791 patients of less than 12 years age, was carried out over a period of 1 year (August 2009 to July 2010), and pediatric trauma trends, with regards to the following parameters were assessed: Age group, sex, mode of trauma, type of injury, place where the trauma occurred and the overall mortality as well as mortality.

RESULTS

Overall trauma was most common in the school-going age group (6-12 years), with male children outnumbering females in the ratio of 1.9:1. It was observed that orthopedic injuries were the most frequent (37.8%) type of injuries, whereas fall from height (39.4%), road traffic accident (27.8%) and burns (15.2%) were the next most common modes of trauma. Home was found out to be the place where maximum trauma occurred (51.8%). Maximum injuries happened unintentionally (98.4%). Overall mortality was found out to be 6.4% (n = 51).

CONCLUSIONS

By knowing the epidemiology of pediatric trauma, we conclude that majority of pediatric injuries are preventable and pediatric epidemiological trends differ from those in adults. Therefore, preventive strategies should be made in pediatric patients on the basis of these epidemiological trends.

Lower rates of emergency department injury visits among Latino children in the USA: no association with health insurance

BACKGROUND AND OBJECTIVE

Latino children have lower rates of injury visits to emergency departments (EDs) than non-Latino white and African American children. This study tests the hypothesis that this difference reflects health insurance status.

DESIGN

Secondary analysis. Patients/

SETTING

Children under 19 years of age visiting EDs in the USA, sampled in the National Hospital Ambulatory Medical Care Survey of EDs (NHAMCS-ED) from 1997 to 2001.

MAIN OUTCOME MEASURES

Rates of ED injury visits; ED injury visit rates by race/ethnicity stratified by health insurance and adjusted for other covariates; subtypes of injury visits; and procedures and hospital admissions by race/ethnicity.

RESULTS

Injuries accounted for >56 million, or 40.5%, of total ED visits among pediatric patients. Injury visits occurred at lower rates for Latino children (9.9 per 100 person years) than non-Latino white and African American children (16.2 and 18.3, respectively), although total ED visit rates were similar. Regardless of health insurance status, Latino children had lower rates of injury visits than non-Latino white and African American children. Latino children had lower rates of the three major subtypes of injury visits (sports, accidental falls, struck by/between objects). Latino children had similar rates of procedures and hospital admissions to non-Latino white children.

CONCLUSIONS

Irrespective of their insurance status, Latino children have lower rates of ED injury visits in the USA than non-Latino white children. Possible reasons for this difference include different healthcare seeking behavior or different injury patterns by race/ethnicity, but not differences in health insurance status or barriers to accessing ED care.

Trauma-related hospitalizations among urban adolescents in New Zealand: priorities for prevention

PURPOSE

To: (a) determine the magnitude, characteristics, and in-patient costs of injury among hospitalized urban adolescents in New Zealand (NZ); (b) identify regional priorities for injury prevention and investigative research; and (c) compare the study findings with published data from other industrialized countries.

METHODS

The 1989-1993 files of the NZ Hospital Discharge Database were accessed to identify and analyze trauma-related admissions of adolescents residing in NZ's largest metropolitan region.

RESULTS

The estimated 9569 hospitalizations for injury accounted for one-fourth of all adolescent admissions in the region, a mean annual hospitalization rate of 1292/100,000 population and a minimum annual cost of NZ $5.8 million for in-patient care. Males and indigenous Maori youth had comparatively higher rates of hospitalizations for most major causes of injury. Falls, pedal cyclist injury, cuts, and piercing injuries were leading causes of hospitalization for trauma in early adolescence. Admission rates for motorcylist and other motor vehicle occupant trauma and self-inflicted injury increased substantially among older adolescents. Sport and recreational activities comprised at least one-sixth of injury admissions.

CONCLUSIONS

The overall rates of injury resulting in hospitalization among Auckland adolescents were comparable to those reported from Australia and France, but higher than those from the United States, Canada, and Israel. By identifying priority issues and high-risk groups, this study provides a foundation for regional injury control initiatives. It also demonstrates the utility and limitations of E-coded hospital discharge registries in defining the burden of serious nonfatal trauma.

Comparing pediatric intentional injury surveillance data with data from publicly available sources: consequences for a public health response to violence

OBJECTIVE

A hospital based intentional injury surveillance system for youth (aged 3-18) was compared with other publicly available sources of information on youth violence. The comparison addressed whether locally conducted surveillance provides data that are sufficiently more complete, detailed, and timely that clinicians and public health practitioners interested in youth violence prevention would find surveillance worth conducting.

SETTING

The Boston Emergency Department Surveillance (BEDS) project was conducted at Boston Medical Center and the Children's Hospital, Boston.

METHOD

MEDLINE and other databases were searched for data sources that report separate data for youth and data on intentional injury. Sources that met these criteria (one national and three local) were then compared with BEDS data. Comparisons were made in the following categories: age, gender, victim-offender relationship, injury circumstance, geographic location, weapon rates, and violent injury rates.

RESULTS

Of 14 sources dealing with violence, only four met inclusion criteria. Each source provided useful breakdowns for age and gender; however, only the BEDS data were able to demonstrate that 32.6% of intentional injuries occurred among youth aged 12 and under. Comparison data sources provided less detail regarding the victim-offender relationship, injury circumstance, and weapon use. Comparison of violent injury rates showed the difficulties for practitioners estimating intentional injury from sources based on arrest data, crime victim data, or weapon related injury.

CONCLUSIONS

Comparison suggests that surveillance is more complete, detailed, and timely than publicly available sources of data. Clinicians and public health practitioners should consider developing similar systems.