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Rosendahl K, de Horatio LT, Habre C, Shelmerdine SC, Patsch J, Kvist O, Lein RK, Plut D, Enoksen EJ, Avenarius R, Laborie LB, Augdal TA, Simoni P, van Rijn RR, Offiah AC. The incidence of fractures in children under two years of age: a systematic review. BMC Musculoskelet Disord 2024; 25:528. [PMID: 38982362 PMCID: PMC11232341 DOI: 10.1186/s12891-024-07633-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/27/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Epidemiological research on fractures in children under the age of two is of great importance to help understand differences between accidental and abusive trauma. OBJECTIVE This systematic review aimed to evaluate studies reporting on the incidence of fractures in children under two years of age, excluding birth injuries. Secondary outcome measures included fracture location, mechanisms of injury and fracture characteristics. METHODS A systematic literature review (1946 to February 7th 2024), including prospective and retrospective cohort studies and cross-sectional cohort studies, was performed. Studies including children from other age groups were included if the actual measures for those aged 0-2 years could be extracted. We also included studies restricted to infants. Annual incidence rates of fractures were extracted and reported as the main result. Critical appraisal of was performed using the Appraisal tool for Cross-Sectional Studies. RESULTS Twelve moderate to good quality studies met eligibility criteria, of which seven were based on data from medical records and five were registry studies. Studies investigated different aspects of fractures, making comprehensive synthesis challenging. There was an overall annual fracture incidence rate of 5.3 to 9.5 per 1,000 children from 0-2 years of age; with commonest sites being the radius/ulna (25.2-40.0%), followed by tibia/fibula (17.3-27.6%) and the clavicle (14.6-14.8%) (location based on 3 studies with a total of 407 patients). In infants, the reported incidence ranged between 0.7 to 4.6 per 1,000 (based on 3 studies), with involvement of the clavicle in 22.2% and the distal humerus in 22.2% of cases (based on 1 study). Only a single metaphyseal lesion was reported (proximal humerus of an 11-month-old infant). Fracture mechanisms were detailed in four studies, with fall from chair, bed, table, own height or fall following indoor activities causing 50-60% of fractures. CONCLUSIONS There is a paucity of good quality data on fracture incidence in children under the age of two. Larger, prospective and unbiased studies would be helpful in determining normal pattern of injuries, so that differences from abusive trauma may be better understood.
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Affiliation(s)
- Karen Rosendahl
- Department of Clinical Medicine, UiT the Artic University of Norway, Tromsø, Norway.
- Department of Radiology, University Hospital of North Norway, Pb 100, Tromsø, 9038, Norway.
| | - Laura Tanturri de Horatio
- Department of Clinical Medicine, UiT the Artic University of Norway, Tromsø, Norway
- Department of Radiology, University Hospital of North Norway, Pb 100, Tromsø, 9038, Norway
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Celine Habre
- Pediatric Radiology Unit, Radiology Division, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, England
- Great Ormond Street Hospital for Children, UCL Great Ormond Street Institute of Child Health, London, England
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Bloomsbury, London, England
- Department of Radiology, St. George's Hospital, London, England
| | - Janina Patsch
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Austria
| | - Ola Kvist
- Department of Pediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Regina K Lein
- University Library, Bergen University, Bergen, Norway
| | - Domen Plut
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Edvard J Enoksen
- Department of Clinical Medicine, UiT the Artic University of Norway, Tromsø, Norway
| | - Rien Avenarius
- Department of Clinical Medicine, UiT the Artic University of Norway, Tromsø, Norway
| | - Lene B Laborie
- Section for Paediatric Radiology, Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Thomas A Augdal
- Department of Clinical Medicine, UiT the Artic University of Norway, Tromsø, Norway
- Department of Radiology, University Hospital of North Norway, Pb 100, Tromsø, 9038, Norway
| | - Paolo Simoni
- Department of Radiology, "Reine Fabiola" Children's University Hospital Université Libre de Bruxelles, Brussels, Belgium
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Amaka C Offiah
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, England
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Bustamante A, Zavala A, Iglesias M, Tornero R, Machaca L, De Pawlikowski W. Quality of Life After Lower Leg Reconstruction With the Latissimus Dorsi Free Flap in Pediatric Patients. Ann Plast Surg 2024; 92:418-423. [PMID: 38527349 DOI: 10.1097/sap.0000000000003812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND The latissimus dorsi free flap is a widely used reconstructive technique for complex lower leg defects in the pediatric population due to its reliability and anatomical features. However, the impact of this technique on the postoperative quality of life in children and adolescents, who require appropriate lower extremity function during their developmental period, remains to be analyzed. METHODS Patients who underwent microsurgical lower leg reconstruction using the latissimus dorsi flap were analyzed retrospectively. The quality of life of these patients was assessed prospectively using the Lower Extremity Functional Scale (LEFS) at a minimum of 18 months after surgical reconstruction. RESULTS Sixteen pediatric patients who had severe lower extremity injuries and underwent latissimus dorsi free flap reconstruction met the inclusion criteria. The mean follow-up period was 33.9 months (22-64 months). Two patients experienced postoperative complications: one had partial flap necrosis and surgical site infection, while the other developed a surgical site infection. The LEFS scores ranged from 26 to 80, with a mean score of 64.6. Remarkably, 14 of 16 patients achieved LEFS scores consistent with at least the 10th percentile when compared with normative data. Patients with severe associated fractures presented with the lowest scores. CONCLUSIONS Based on our findings, the latissimus dorsi flap is reaffirmed to be an excellent choice for lower leg reconstruction in the pediatric population. It effectively restores the quality of life in patients who have experienced moderate to severe lower extremity injuries.
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Affiliation(s)
- Atenas Bustamante
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Abraham Zavala
- Department of Plastic and Reconstructive Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Martin Iglesias
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Ray Tornero
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Lucero Machaca
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Wieslawa De Pawlikowski
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
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Pekas D, Telken W, Sahmoun AE, Beal JR. Association Between Race and Usage of Pain Medications in Children With Long Bone Fractures in US Emergency Departments, 2011-2019. Pediatr Emerg Care 2023; 39:393-396. [PMID: 37159330 DOI: 10.1097/pec.0000000000002958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the association between race and analgesic administration for children with long bone fracture (LBF) in US emergency departments. Previous studies have shown conflicting results regarding association between race and analgesic administration for pediatric LBFs. METHODS We conducted a retrospective analysis of pediatric emergency department visits for LBF using the 2011-2019 National Hospital Ambulatory Medical Care Survey-Emergency Department. We investigated the diagnostic workup and analgesic prescription rate among White, Black, and other pediatric emergency department visits for LBF. RESULTS Of the estimated 292 million pediatric visits to US emergency departments from 2011 to 2019, 3.1% were LBFs. Black children were less likely to be seen for a LBF than White or other children (1.8% vs 3.6% and 3.1%, P < 0.001). There was no association between race and subjective pain scale ( P = 0.998), triage severity ( P = 0.980), imaging (x-ray, P = 0.612; computed tomography scan, P = 0.291), or analgesic administration (opioids, P = 0.068; nonsteroidal antiinflammatory drugs/acetaminophen, P = 0.750). Trend analysis showed a significant decrease in opioid administration for pediatric LBF from 2011 to 2019 ( P < 0.001), with 33.0% receiving opioids. CONCLUSIONS There was no association between race and analgesic administration, including opioids, or diagnostic workup in pediatric LBF. In addition, there was a significant downtrend in opioid administration for pediatric LBF from 2011 to 2019.
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Affiliation(s)
- Devon Pekas
- From the University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
| | - Wyatt Telken
- From the University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
| | - Abe E Sahmoun
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - James R Beal
- Department of Family and Community Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
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Chakraborty S, Salama K, Lee LH. Tibia Fractures in Children: A Single-Centre 11-Year Retrospective Study for Evaluating the Management and Outcomes in an Acute General Orthopaedic Hospital. Cureus 2023; 15:e36462. [PMID: 37090408 PMCID: PMC10117001 DOI: 10.7759/cureus.36462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction Tibia fractures are children's most typical lower limb fractures affecting their general and mental well-being. This study aims to evaluate the management and outcomes of displaced tibia fractures. Methods A retrospective study was conducted to review children up to 16 years of age with displaced tibia shaft fractures who received treatment in our department from January 2011 to December 2021. Fractures managed in the operating theatre and patients who completed follow-up until fracture healing were included in the study. Treatment procedures were assessed, and outcome was measured by hospital stays, complications and revision procedure incidences. Results The study included 74 patients (75 fractures, including one re-fracture). The patient's ages ranged from 2 to 16 years (median age: 11 years). Seven patients sustained open fractures (Gustilo I, II). Tibia diaphysis was the most common site of involvement. A total of 43 patients were treated by manipulation under anaesthesia and cast. Surgical fixation was directly proportional to increasing age (p<0.05). Overall, 74% of patients were treated by fixation when age was >10 years. Three patients needed conversion of casting to surgical fixation. One patient had re-fracture following a secondary injury after six months of initial tibia shaft fracture treated by casting. Five patients had complications, including delayed union, pin site and surgical site infections. Antibiotics were adequate to manage infections except in one patient who needed debridement. The average hospital stay was three days. The median number of follow-up X-rays was 4. The planned removal of all flexible nails, and the circular frame was done between 2 and 15 months, except for one that had delayed union. All the patients underwent clinical and radiological union at the end of the follow-up. Conclusion The treatment plan was dependent on the individual need of the patient and the fracture pattern. Children older than 10 years were more likely to undergo surgical fixation. The majority of fractures were treated by manipulation and cast in operating theatres. Better logistic support in the emergency department could reduce the burden on the operating theatre.
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Affiliation(s)
| | - Karim Salama
- Trauma and Orthopaedics, Sunderland Royal Hospital, Sunderland, GBR
| | - Ling Hong Lee
- Trauma and Orthopaedics, Sunderland Royal Hospital, Sunderland, GBR
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Walker LC, Hamad F, Wilson C, O'Connor D, Richards SW, Southgate JJ. Types, management and complications in paediatric distal radial fractures sustained during COVID-19 lockdown. J Hand Surg Eur Vol 2022; 47:605-609. [PMID: 35073763 DOI: 10.1177/17531934221074307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In response to the coronavirus pandemic the British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guidelines advised treating distal radial fractures non-operatively where possible. A cohort was studied retrospectively to assess whether the COVID pandemic lockdown within the UK altered types, the management and complications of paediatric distal radial fractures. The cohort studied comprised of 194 paediatric distal radial fractures in the pre-COVID cohort and 101 fractures in the COVID cohort. There was no significant differences in the type of fractures in the two cohorts. Significantly more high energy injuries were sustained among the COVID cohort than the pre-COVID (p < 0.001). The COVID cohort had significantly more patients managed in cast (p < 0.001) and significantly more managed with K-wire fixation (p = 0.049). The COVID cohort had significantly more complications (p = 0.016) at minimum 10-month follow-up. The results suggest that treatment of paediatric distal radial fractures during lockdown was too conservative and subsequent complications may put additional strain on orthopaedic services.Level of evidence: IV.
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Affiliation(s)
- Lucy C Walker
- Department of Trauma and Orthopaedics, University Hospitals Dorset, Poole, UK
| | - Farouk Hamad
- Department of Trauma and Orthopaedics, University Hospitals Dorset, Poole, UK
| | - Christopher Wilson
- Department of Trauma and Orthopaedics, University Hospitals Dorset, Poole, UK
| | - David O'Connor
- Department of Trauma and Orthopaedics, University Hospitals Dorset, Poole, UK
| | - Simon W Richards
- Department of Trauma and Orthopaedics, University Hospitals Dorset, Poole, UK
| | - Jeremy J Southgate
- Department of Trauma and Orthopaedics, University Hospitals Dorset, Poole, UK
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Koris J, Deo S. Parental acceptability of pediatric forearm manipulations in a UK district hospital emergency department. J Child Orthop 2022; 16:98-103. [PMID: 35620126 PMCID: PMC9127884 DOI: 10.1177/18632521221084176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/07/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Pediatric forearm fractures are a common presentation to Accident and Emergency departments. Standard treatment for the majority of these is manipulation under sedation within the department, followed by cast application. Concerns have been raised about the acceptability of such interventions, and reluctance to perform these procedures has led to increased admissions and manipulations performed under general anesthetic. METHODS A prospective case series of all pediatric patients with forearm fractures who underwent a manipulation under sedation in the Accident and Emergency department was collected over 12 months. All parents were invited to complete an acceptability questionnaire, adapted from the Swedish Pyramid Questionnaire for Treatment, based on their experiences. RESULTS A total of 77 patients were included and their parents were asked to complete a Swedish Pyramid Questionnaire of Treatment. Forty-four parents (55%) agreed to fill out the questionnaire. Patient demographics and fracture characteristics were compared between the group that responded and those that did not, with no significant differences. Average level of satisfaction was 9.4/10 (range = 7-10). 98% of respondents were satisfied with the level of analgesia provided, but only 86% with the timeliness of administration. CONCLUSION This parent-focused evaluation of treatment confirms high levels of parental satisfaction with the management of pediatric forearm fractures in Accident and Emergency, with regard to care, analgesia, and information. It provides insights about parental concern relating to the injury and their anxiety as information useful to further improving care, a template for assessing quality improvement and should be considered as part of further studies in this field. LEVEL OF EVIDENCE Level IV case series.
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Affiliation(s)
| | - S Deo
- S Deo, Trauma and Orthopaedic Consultant, Great Western Hospital, Marlborough Road, Swindon SN3 6BB, UK.
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Fallatah SM, Daghriri YA, Afifi AA, Alghamdi FA, Zein AF. A Rare Case of Femoral Neck Fracture in a Six-Year-Old Girl. Cureus 2021; 13:e17373. [PMID: 34584783 PMCID: PMC8457261 DOI: 10.7759/cureus.17373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 12/02/2022] Open
Abstract
Proximal femur fractures are rare pediatric injuries associated with high energy trauma as well as polytrauma. Injuries during childhood can cause a significant disability in some cases. The four Delbet classifications of femur fractures are frequently used as prognostic for potential avascular necrosis. Necessary treatment is urgent and needs to be tailored to the fracture type and patient age. This case report presents the detailed history, examination, and treatment of a six-year-old girl with an uncommon site of pediatric fracture at the femoral neck combined with an ipselateral displaced talus fracture due to a fall from the second floor. Talus fracture was missed and discovered in operation room; however, both fractures are highly associated with avascular necrosis and post-traumatic arthritis. The patient was followed for two years on regular basis after the initial operation with a normal gait, full range of motion, and no active complain.
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Affiliation(s)
| | | | - Amgad A Afifi
- Orthopedic Surgery, King Salman Armed Forces Hospital, Tabuk, SAU
| | | | - Ayman F Zein
- Orthopedic Surgery, King Salman Armed Forces Hospital, Tabuk, SAU
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Mamoowala N, Johnson NA, Dias JJ. Trends in paediatric distal radius fractures: an eight-year review from a large UK trauma unit. Ann R Coll Surg Engl 2019; 101:297-303. [PMID: 30855170 PMCID: PMC6432966 DOI: 10.1308/rcsann.2019.0023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This observational study investigated the incidence of distal radius fractures in children, to determine whether the rate is rising, the effect of seasonal variation on incidence and whether fracture type and rate of surgical intervention has changed, to help in determining costs for secondary care and to aid resource allocation. MATERIALS AND METHODS All paediatric patients(n = 6529) who sustained a distal radius fracture over an eight-year period (2007-2014) were identified. Poisson regression modelling was used to identify change in trends. RESULTS There was no change in distal radius fracture incidence, rate of surgical intervention (P = 0.36) or fracture type (P = 0.70). Overall incidence was 337 fractures per 100,000 patient/years. The highest fracture incidence was seen in older school boys (708 per 100,000 patient/years, P < 0.005). Overall fracture rate was lower in winter (P < 0.005). Incidence is highest in summer and the main variation is related to season. DISCUSSION These data can help to predict accurately the number of children presenting to the emergency department with wrist fractures depending on the time of year.
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Affiliation(s)
- N Mamoowala
- Department of Trauma and Orthopaedics, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - NA Johnson
- Department of Trauma and Orthopaedics, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - JJ Dias
- Department of Trauma and Orthopaedics, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
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Koga H, Omori G, Koga Y, Tanifuji O, Mochizuki T, Endo N. Increasing incidence of fracture and its sex difference in school children: 20 year longitudinal study based on school health statistic in Japan. J Orthop Sci 2018; 23:151-155. [PMID: 28947242 DOI: 10.1016/j.jos.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/05/2017] [Accepted: 09/06/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Studies on the epidemiology of pediatric fractures have been scarce in recent years although fractures are very common in childhood. Boys have a higher incidence of fractures than girls. Currently, societal trends have seemed to influence the difference in activity patterns between boys and girls, but the sex difference regarding longitudinal changes in fracture incidence is not well known. METHODS We analyzed the school accident report in Niigata city, Japan and compared the incidence of fractures in elementary and junior high school students and the sex-related risk ratio between two 9-year periods separated by 20 years from their start and end points (1999-2007 and 1979-1987). RESULTS The study included 383,273 students from 1999 to 2007 and 561,109 students from 1979 to 1987. Comparing these periods, the fracture incidence increased significantly by 2.4 times in boys vs 2.1 times in girls from elementary school and by 2.2 times in boys vs 2.9 times in girls from junior high school (all p < 0.001). The sex-related risk ratio of boys to girls increased significantly from 1.47 to 1.64 in elementary school students. In contrast, it decreased significantly from 3.29 to 2.52 in junior high school students and the change was markedly significant because of the drastic increase in fracture incidence in junior high school girls. CONCLUSIONS The reasons proposed for the increase in schoolchildren's fractures were an improvement in diagnosis owing to social background and increased participation in sports activities despite the general decline in children's physical fitness and exercise ability. In junior high school girls, in particular, there was an increase in fracture risk due to increased participation in sports activities.
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Affiliation(s)
- Hiroshi Koga
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Go Omori
- Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Japan.
| | | | - Osamu Tanifuji
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Tomoharu Mochizuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Naoto Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Nugraha HK, Adiantono A. EPIDEMIOLOGY OF FRACTURES AND DISLOCATIONS IN CHILDREN. FOLIA MEDICA INDONESIANA 2017. [DOI: 10.20473/fmi.v53i1.5494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Fracture is quite a common occurrence in the age group of children, with a fairly wide variety of epidemiology throughout the world, hence it could be considered as a major health problem. A retrospective study of all pediatric fractures presenting to Dr. Soegiri General Hospital Lamongan, Indonesiain 2015 was undertaken. It showed that 79.5% of children’s fractures occurred in males and that 86.76% presented as a single fracture, whileelbow dislocation is the most prevalent dislocation in this study.Analysis of pediatric fractures shows that there is a trimodal distribution of single fracture with age, withdistal radius/ulna fracture as the most prevalent single fracture.The commonest cause of single fracture are road traffic accident, and the majority involve the upper limb. Those suggested that there should be more concern about road safety program in Indonesia.
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Sims-Gould J, Race D, Hamilton L, MacDonald H, Mulpuri K, McKay H. 'I fell off and landed badly': Children's experiences of forearm fracture and injury prevention. J Child Health Care 2016; 20:98-108. [PMID: 25326540 PMCID: PMC5059151 DOI: 10.1177/1367493514551311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Forearm fractures are one of the most common injuries sustained by children. Our descriptive study addressed, from the perspective of a child, the following research objectives: (1) to describe their fracture experience and (2) to describe how fractures might be prevented. Photovoice is a unique research strategy by which people create and discuss photographs. This technique has been used to elicit the perspectives of those whose voices are often 'not heard' in research, like children. Participants were recruited from a larger three-year prospective trial and included 10 boys (12.3 ± 1.6 years) and 7 girls (11.3 ± 1.6 years). We asked participants to take pictures to explain where their injury occurred (place), what they were doing at the time (context) and how the fracture had happened (mechanism). We also used semi-structured interview techniques. The following key themes emerged from our interviews: (1) the built environment as a key factor that 'caused' their fracture, (2) the fracture experienced as a journey not an event and (3) strategies to prevent fractures. A simple clinical step to potentially reduce subsequent fractures will be for clinicians to have a brief conversation with their young patients and to listen to the child's personal preventive strategies.
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Affiliation(s)
- Joanie Sims-Gould
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Douglas Race
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Heather MacDonald
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Kishore Mulpuri
- Department of Orthopaedic Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Heather McKay
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Joeris A, Lutz N, Wicki B, Slongo T, Audigé L. An epidemiological evaluation of pediatric long bone fractures - a retrospective cohort study of 2716 patients from two Swiss tertiary pediatric hospitals. BMC Pediatr 2014; 14:314. [PMID: 25528249 PMCID: PMC4302599 DOI: 10.1186/s12887-014-0314-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 12/11/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Children and adolescents are at high risk of sustaining fractures during growth. Therefore, epidemiological assessment is crucial for fracture prevention. The AO Comprehensive Injury Automatic Classifier (AO COIAC) was used to evaluate epidemiological data of pediatric long bone fractures in a large cohort. METHODS Data from children and adolescents with long bone fractures sustained between 2009 and 2011, treated at either of two tertiary pediatric surgery hospitals in Switzerland, were retrospectively collected. Fractures were classified according to the AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). RESULTS For a total of 2716 patients (60% boys), 2807 accidents with 2840 long bone fractures (59% radius/ulna; 21% humerus; 15% tibia/fibula; 5% femur) were documented. Children's mean age (SD) was 8.2 (4.0) years (6% infants; 26% preschool children; 40% school children; 28% adolescents). Adolescent boys sustained more fractures than girls (p < 0.001). The leading cause of fractures was falls (27%), followed by accidents occurring during leisure activities (25%), at home (14%), on playgrounds (11%), and traffic (11%) and school accidents (8%). There was boy predominance for all accident types except for playground and at home accidents. The distribution of accident types differed according to age classes (p < 0.001). Twenty-six percent of patients were classed as overweight or obese - higher than data published by the WHO for the corresponding ages - with a higher proportion of overweight and obese boys than in the Swiss population (p < 0.0001). CONCLUSION Overall, differences in the fracture distribution were sex and age related. Overweight and obese patients seemed to be at increased risk of sustaining fractures. Our data give valuable input into future development of prevention strategies. The AO PCCF proved to be useful in epidemiological reporting and analysis of pediatric long bone fractures.
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Abstract
BACKGROUND Bone fractures in children represent a source of significant disability and morbidity. Are children with autistic spectrum disorder (ASD) at an altered risk of fractures compared with typically developing children? METHODS Using the General Practice Research Database, the authors assessed the prevalence of fractures in boys with ASD diagnosed between 2 and 8 years. A cross-sectional design was used to compare the prevalence of fractures among children with ASD and age-matched controls, conditional logistic regression to explore the relative risk of having a fracture in association with diagnosed ASD. RESULTS The study population comprised 3,219 boys with a first-time diagnosis of ASD and 12,265 matched controls. ASD was associated with a significantly decreased risk of developing a fracture at any time in childhood (odds ratio [OR], 0.68, 95% confidence interval [CI], 0.59-0.77, p < .0001). The relative risk estimates were lower for the time period after ASD diagnosis (OR, 0.56, 95% CI, 0.48-0.66, p < .0001) but were not different for the time period before ASD diagnosis (OR, 0.96, 95% CI, 0.78-1.18, p = .6866). Adjusting for use of different drugs did not change the estimates. CONCLUSION The relative risk of experiencing a fracture at any time in childhood is lower for boys with ASD compared with healthy boys.
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Abstract
The relationship between body composition and skeletal metabolism has received growing recognition. Low body weight is an established risk factor for fracture. The effect of obesity on skeletal health is less well defined. Extensive studies in patients with anorexia nervosa and obesity have illuminated many of the underlying biologic mechanisms by which body composition modulates bone mass. This review examines the relationship between body composition and bone mass through data from recent research studies throughout the weight spectrum ranging from anorexia nervosa to obesity.
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Affiliation(s)
- Alexander Faje
- BUL 457, Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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15
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Kraus T, Švehlík M, Singer G, Schalamon J, Zwick E, Linhart W. The epidemiology of knee injuries in children and adolescents. Arch Orthop Trauma Surg 2012; 132:773-9. [PMID: 22358221 DOI: 10.1007/s00402-012-1480-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Injuries in childhood and adolescence are frequent and the knee is one of the most common sites of injuries. This study aimed to analyze the epidemiology, gender distribution, age, and circumstances of knee injuries in childhood at a Level I Trauma Center in Austria. METHODS All pediatric and adolescent trauma patients who presented in a 2-year period were recorded. Children managed with knee injuries were selected prospectively. Patients were divided into five age groups: infants (younger than 1 year); pre-school aged children (1-6 years); pre-pubertal school-aged children (7-10 years); early adolescent patients (11-14 years); and late adolescent patients (15-18 years). Five diagnosis-related groups were formed: extraarticular soft tissue injuries, intraarticular soft tissue injuries, patella disorders, fractures, and overload injuries. RESULTS The study included 23,832 patients up to the age of 18 years, who presented with 1,199 knee injuries. There was a male predominance (m:f = 58,6%:41.4%). Boys had a lower mean age at presentation (11.9 years) as girls (12.3 years). The most common accident sites were outdoors (34.8%) and sports facilities (32.8%). Leading injury mechanisms were falls on level surfaces (58.1%) and traffic accidents (13.4%). The number of knee injuries and its severity increased with age. Knee injuries did not occur in infants. In general, extraarticular soft-tissue injuries were most common and fractures were rare. CONCLUSION Knee injuries in children and adolescents are rare and extraarticular soft-tissue injury is the most frequent type of knee trauma. The number of knee injuries and its severity increases with age with a male predominance. Sports facilities and traffic injuries are important scenes of knee trauma. Mechanisms and patterns evaluated in this study can serve as the basis for knee-injury prevention efforts in children and adolescents and may be used for necessary precautions. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- T Kraus
- Department of Pediatric Orthopedics, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria.
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16
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Polinder S, Haagsma JA, Toet H, van Beeck EF. Epidemiological burden of minor, major and fatal trauma in a national injury pyramid. Br J Surg 2012; 99 Suppl 1:114-21. [PMID: 22441864 DOI: 10.1002/bjs.7708] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The impact of trauma on population health is underestimated because comprehensive overviews of the entire severity spectrum of injuries are scarce. The aim of this study was to measure the total health impact of fatal and non-fatal unintentional injury in the Netherlands. METHODS Epidemiological data for the four levels of the injury pyramid (general practitioner (GP) registry, emergency department (ED) registers, hospital discharge and mortality data) were obtained for the whole country. For all levels, the incidence and years of life lost (YLL) owing to premature death, years lived with disability (YLD) and disability-adjusted life-years (DALYs) were calculated. RESULTS Unintentional injury resulted in 67 547 YLL and 161 775 YLD respectively, amounting to 229 322 DALYs (14.1 per 1000 inhabitants). Home and leisure, and traffic injuries caused most DALYs. Minor injury (GP and ED treatment) contributed 37.3 per cent (85 504 DALYs; 5.2 per 1000) to the total burden of injury, whereas injuries requiring hospital admission contributed 33.3 per cent (76 271 DALYs; 4.7 per 1000) and fatalities contributed 29.5 per cent (67 547 DALYs; 4.1 per 1000). Men aged 15-65 years had the greatest burden of injury, resulting in a share of 39.6 per cent for total DALYs owing to unintentional injury. The highest individual burden resulted from death (19 DALYs per patient). CONCLUSION Trauma causes a major burden to society. For priority setting in public health and the identification of opportunities for prevention it is important that burden-of-injury estimates cover the entire spectrum of injuries, ranging from minor injury to death.
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Affiliation(s)
- S Polinder
- Department of Public Health, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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17
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Evaluation of Fractures in Children and Adolescents in a Level I Trauma Center in Austria. ACTA ACUST UNITED AC 2011; 71:E19-25. [DOI: 10.1097/ta.0b013e3181f8a903] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Smithson J, Garside R, Pearson M. Barriers to, and facilitators of, the prevention of unintentional injury in children in the home: a systematic review and synthesis of qualitative research. Inj Prev 2010; 17:119-26. [PMID: 21097943 PMCID: PMC3184217 DOI: 10.1136/ip.2010.026989] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background This review considers barriers to, and facilitators of, success for interventions to reduce unintentional injury to children in the home through supply and/or installation of home safety equipment, and looks at risk assessments. Methods A systematic review of qualitative research. Bibliographic databases were searched for studies on interventions to reduce unintentional child injury in the home, or on related attitudes and behaviours. Studies were quality appraised, findings extracted, and a conceptual framework was developed to assess factors affecting the success of interventions. Results Nine peer-reviewed journal articles were included. Barriers and facilitators were highlighted at organisational, environmental and personal levels. Effective provision of safety equipment involves ongoing support with installation and maintenance. Take up and success of interventions depends on adjusting interventions according to practical limitations and parents' cultural expectations. A particular barrier was parents' inability to modify rented or shared accommodation. Conclusions The review highlights ways in which health inequalities affect the take up and success of home safety interventions, and how health workers can use this knowledge to facilitate future interventions.
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Affiliation(s)
- Janet Smithson
- College of Life and Environmental Sciences, University of Exeter, Washington Singer Laboratories, Exeter, UK.
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19
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Abstract
Intentional and non intentional injury is a major global public health concern. Traditionally, injuries have been regarded as random, unavoidable 'accidents'. However, within the last few decades a better understanding of the nature of injuries has changed these old attitudes, and today both unintentional and intentional injuries are viewed as largely preventable events. Burn injuries are of special importance in the field of injury prevention. On average, 82 people die in Ireland each year from fire and burns. However, burn injuries have known causes and can be prevented and controlled. In order to prevent burn injuries it is important to understand the aetiology and epidemiology of burn injuries. The aim of this 3 part series of articles is to provide an overview of burn injury care where this first article focuses on current epidemiology, aetiology and burn injury prevention strategies.
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Alexandrescu R, O'Brien SJ, Lecky FE. A review of injury epidemiology in the UK and Europe: some methodological considerations in constructing rates. BMC Public Health 2009; 9:226. [PMID: 19591670 PMCID: PMC2720963 DOI: 10.1186/1471-2458-9-226] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Accepted: 07/10/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Serious injuries have been stated as a public health priority in the UK. However, there appears to be a lack of information on population-based rates of serious injury (as defined by a recognised taxonomy of injury severity) at national level from either official statistics or research papers. We aim to address this through a search and review of literature primarily focused within the UK and Europe. METHODS The review summarizes research papers on the subject of population based injury epidemiology published from 1970 to 2008. We examined critically methodological approaches in measuring injury incident rates including data sources, description of the injury pyramid, matching numerator and denominator populations as well as the relationship between injury and socioeconomic status. RESULTS National representative rates come from research papers using official statistics sources, often focusing on mortality data alone. Few studies present data from the perspective of an injury pyramid or using a standardized measure of injury severity, i.e. Injury Severity Score (ISS). The population movement that may result in a possible numerator - denominator mismatch has been acknowledged in five research studies and in official statistics. The epidemiological profile shows over the past decades in UK and Europe a decrease in injury death rates. No major trauma population based rates are available within well defined populations across UK over recent time periods. Both fatal and non-fatal injury rates occurred more frequently in males than females with higher rates in males up to 65 years, then in females over 65 years. Road traffic crashes and falls are predominant injury mechanisms. Whereas a straightforward inverse association between injury death rates and socio-economic status has been observed, the evidence of socioeconomic inequalities in non-fatal injuries rates has not been wholly consistent. CONCLUSION New methodological approaches should be developed to deal with the study design inconsistencies and the knowledge gaps identified across this review. Trauma registries contain injury data from hospitals within larger regions and code injury by Abbreviated Injury Scale enabling information on severity; these may be reliable data sources to improve understanding of injury epidemiology.
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Affiliation(s)
- Roxana Alexandrescu
- Trauma Audit and Research Network, Clinical Science Building, Hope Hospital, University of Manchester, Manchester, UK.
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22
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Rennie L, Court-Brown CM, Mok JYQ, Beattie TF. The epidemiology of fractures in children. Injury 2007; 38:913-22. [PMID: 17628559 DOI: 10.1016/j.injury.2007.01.036] [Citation(s) in RCA: 301] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 01/27/2007] [Accepted: 01/29/2007] [Indexed: 02/02/2023]
Abstract
A retrospective study of all paediatric fractures presenting to hospital in Edinburgh, Scotland in 2000 was undertaken. It showed that the incidence of fractures was 20.2/1000/year and that 61% of children's fractures occurred in males. Analysis of paediatric fractures shows that there are six basic fracture distribution curves with six fractures showing a bimodal distribution but most having a unimodal distribution affecting younger or older children. The incidence of fractures increases with age with falls from below bed height (<1m) being the commonest cause of fracture. The majority of fractures in children involve the upper limb. Lower limb fractures are mainly caused by twisting injuries and road traffic accidents. The incidence of fractures in cyclists and pedestrians remains relatively high whereas the incidence in vehicle occupants is low suggesting that road safety programs have been successful. Similar programs should be instituted for young cyclists. The importance of accident prevention programmes in the home is also highlighted.
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Affiliation(s)
- Louise Rennie
- Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, United Kingdom
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23
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Nilsen P. Evaluation of community-based injury prevention programmes: methodological issues and challenges. Int J Inj Contr Saf Promot 2006; 12:143-56. [PMID: 16335432 DOI: 10.1080/17457300512331339175] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The evaluation of comprehensive community-based injury prevention programmes is complex and poses many methodological challenges. There is little consensus in contemporary literature about the most appropriate methods of evaluating these programmes. This study employed a systematic literature review to examine evaluations of 16 community-based injury prevention programmes with regard to key methodological issues and challenges. Three aspects of the evaluated programmes were analysed: assessed elements (context, structure, process, impact, and outcome); study design; and methodological issues addressed. The results showed that context, structure and process assessments were the most neglected aspects of the evaluation studies. The programmes were typically described with minimal discussion of how the context may have influenced the effectiveness. The process (activities) was described rather than evaluated against appropriate standards of comparisons. Impact evaluations adhered more closely to documented guidelines, but half of the evaluations did not include impact variables. Outcome evaluations focused on injury incidence. Most evaluations employed some qualitative methods, but the vast majority of methods used were quantitative. This study indicated that the quasi-experimental study design has become an accepted norm for the evaluation of community-based injury prevention programmes. Most of the evaluations contained explicit details of the methodology used and of the choices related to the methodology. While threats to internal validity were identified in most studies, problems related to external validity and construct validity were largely overlooked by the evaluators.
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Affiliation(s)
- Per Nilsen
- Linköping University, Department of Health and Society IHS, Division of Social Medicine and Public Health Science, SE-58183 Linköping, Sweden.
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Kendrick D, Mulvaney C, Burton P, Watson M. Relationships between child, family and neighbourhood characteristics and childhood injury: a cohort study. Soc Sci Med 2006; 61:1905-15. [PMID: 15927334 DOI: 10.1016/j.socscimed.2005.04.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2004] [Indexed: 11/25/2022]
Abstract
There has been little research into the role of neighbourhood effects in childhood injury. We report results from a cohort study, comprising 1717 families (2357 children aged 0-7 years) registered at 47 general practices in Nottingham, UK. Multi-level Poisson regression examined relationships between electoral ward (neighbourhood), family and child characteristics and medically attended injury rates. Primary care attendance rates were higher for children in rented accommodation and those aged 2-3 years. An n-shaped relationship was found between geographical access to services and the primary care attendance rate. Accident and Emergency (A&E) department attendance rates were higher amongst boys, children in rented accommodation, with a teenage mother, aged 2-5 years and living in wards with a higher number of parks and play areas. They were lower for children whose families had a smoke alarm. Hospital admission rates were higher amongst children living in more deprived wards and wards with higher violent crime rates. They were lower in children whose families had smoke alarms, stair gates and stored sharp objects safely. Primary care and A&E attendance rates varied significantly between families. Variation between wards in the A&E attendance rate was explained by family characteristics. We conclude that characteristics of wards, families and children are associated with medically attended childhood injury rates. This study did not find a neighbourhood effect for A&E attendances that could not be explained by family level characteristics. Studies with greater power and a measure of injury severity independent of health service utilisation are needed to explore the relationship between neighbourhood effects and more severe injuries. The greater variation in injury rates vary between families than between neighbourhoods suggests reducing inequalities in injury rates may be achieved more effectively by focussing prevention at families rather than neighbourhoods, but in practice interventions at both levels are likely to be necessary.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, Floor 13, Tower Building, University Park, Nottingham NG7 2RD, UK.
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25
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Carter Y. Preventing accidental injuries in children: champions needed in primary care. Br J Gen Pract 2005; 55:579-80. [PMID: 16105363 PMCID: PMC1463222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
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Potter BK, Manuel D, Speechley KN, Gutmanis IA, Campbell MK, Koval JJ. Is there value in using physician billing claims along with other administrative health care data to document the burden of adolescent injury? An exploratory investigation with comparison to self-reports in Ontario, Canada. BMC Health Serv Res 2005; 5:15. [PMID: 15720709 PMCID: PMC554767 DOI: 10.1186/1472-6963-5-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2004] [Accepted: 02/18/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Administrative health care databases may be particularly useful for injury surveillance, given that they are population-based, readily available, and relatively complete. Surveillance based on administrative data, though, is often restricted to injuries that result in hospitalization. Adding physician billing data to administrative data-based surveillance efforts may improve comprehensiveness, but the feasibility of such an approach has rarely been examined. It is also not clear how injury surveillance information obtained using administrative health care databases compares with that obtained using self-report surveys. This study explored the value of using physician billing data along with hospitalization data for the surveillance of adolescent injuries in Ontario, Canada. We aimed i) to document the burden of adolescent injury using administrative health care data, focusing on the relative contribution of physician billing information; and ii) to explore data quality issues by directly comparing adolescent injuries identified in administrative and self-report data. METHODS The sample included adolescents aged 12 to 19 years who participated in the 1996-1997 cross-sectional Ontario Health Survey, and whose survey responses were linked to administrative health care datasets (N = 2067). Descriptive analysis was used to document the burden of injuries as a proportion of all physician care by gender and location of care, and to examine the distribution of both administratively-defined and self-reported activity-limiting injuries according to demographic characteristics. Administratively-defined and self-reported injuries were also directly compared at the individual level. RESULTS Approximately 10% of physician care for the sample was identified as injury-related. While 18.8% of adolescents had self-reported injury in the previous year, 25.0% had documented administratively-defined injury. The distribution of injuries according to demographic characteristics was similar across data sources, but congruence was low at the individual level. Possible reasons for discrepancies between the data sources included recall errors in the survey data and errors in the physician billing data algorithm. CONCLUSION If further validated, physician billing data could be used along with hospital inpatient data to make an important and unique contribution to adolescent injury surveillance. The limitations inherent in different datasets highlight the need to continue rely on multiple information sources for complete injury surveillance information.
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Affiliation(s)
- Beth K Potter
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Douglas Manuel
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Department of Public Health Sciences, University of Toronto, Toronto, Canada
| | - Kathy N Speechley
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada
- Children's Health Research Institute, London, Canada
- Department of Paediatrics, University of Western Ontario, London, Canada
| | - Iris A Gutmanis
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada
- Southwest Region Health Information Partnership, London, Canada
| | - M Karen Campbell
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada
- Children's Health Research Institute, London, Canada
- Department of Paediatrics, University of Western Ontario, London, Canada
- Department of Obstetrics and Gynecology, University of Western Ontario, London, Canada
| | - John J Koval
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada
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Ferrando J, Rodríguez-Sanz M, Borrell C, Martínez V, Plasència A. Individual and contextual effects in injury morbidity in Barcelona (Spain). ACCIDENT; ANALYSIS AND PREVENTION 2005; 37:85-92. [PMID: 15607279 DOI: 10.1016/j.aap.2004.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Revised: 05/10/2004] [Accepted: 05/18/2004] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To determine the relationship between socioeconomic level (measured through individual educational level and material deprivation in the areas of residence) and injury morbidity in different age groups and in males as well as in females. DESIGN Cross-sectional survey. SETTING Barcelona (Spain). METHODS The study population included all cases over the age of 19 who, as a result of an injury (motor vehicles injuries, falls, hits and cuts), were admitted to the emergency departments of the six main hospitals of the city during the years 1990-1991. Age- and sex-specific morbidity rates were calculated for each educational level and each cause of injury. The contextual variable included was the proportion of unemployment in each neighbourhood. Multilevel Poisson regression models were fitted. RESULTS Morbidity rates were higher in males, in young people and for lower educational levels. Results from the multilevel models show that, at contextual level, neighbourhoods with more unemployment present a higher risk of injuries. At individual level, after adjusting for contextual variables, the risk of sustaining injuries was higher among young men and women for all injury causes except falls among women where the risk was higher in the elderly; among both men and women, the risk of sustaining injury was higher in the population with lower educational level (RR = 1.79, 95% CI = 1.73-1.86 in men; RR = 2.12, 95% CI = 2.04-2.21 in women). This trend was also observed separately for traffic injuries, falls, hits and cuts. CONCLUSION Our results provide information about individual and contextual social inequalities in injury morbidity, the highest risks of injury occur in individuals of lower educational level and who reside in the more private neighbourhoods. These results underscore the need to implement injury prevention strategies not only at the individual level, but also to tailor them to the socioeconomic position of the population.
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Affiliation(s)
- Josep Ferrando
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, Barcelona 08023, Spain
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Dunning J, Batchelor J, Stratford-Smith P, Teece S, Browne J, Sharpin C, Mackway-Jones K. A meta-analysis of variables that predict significant intracranial injury in minor head trauma. Arch Dis Child 2004; 89:653-9. [PMID: 15210499 PMCID: PMC1719991 DOI: 10.1136/adc.2003.027722] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Previous studies have presented conflicting results regarding the predictive effect of various clinical symptoms, signs, and plain imaging for intracranial pathology in children with minor head injury. AIMS To perform a meta-analysis of the literature in order to assess the significance of these factors and intracranial haemorrhage (ICH) in the paediatric population. METHODS The literature was searched using Medline, Embase, Experts, and the grey literature. Reference lists of major guidelines were crosschecked. Control or nested case-control studies of children with head injury who had skull radiography, recording of common symptoms and signs, and head computed tomography (CT) were selected. OUTCOME VARIABLE CT presence or absence of ICH. RESULTS Sixteen papers were identified as satisfying criteria for inclusion in the meta-analysis, although not every paper contained data on every correlate. Available evidence gave pooled patient numbers from 1136 to 22 420. Skull fracture gave a relative risk ratio of 6.13 (95% CI 3.35 to 11.2), headache 1.02 (95% CI 0.62 to 1.69), vomiting 0.88 (95% CI 0.67 to 1.15), focal neurology 9.43 (2.89 to 30.8), seizures 2.82 (95% CI 0.89 to 9.00), LOC 2.23 (95% CI 1.20 to 4.16), and Glasgow Coma Scale (GCS) <15 of 5.51 (95% CI 1.59 to 19.0). CONCLUSIONS There was a statistically significant correlation between intracranial haemorrhage and skull fracture, focal neurology, loss of consciousness, and GCS abnormality. Headache and vomiting were not found to be predictive and there was great variability in the predictive ability of seizures. More information is required about the current predictor variables so that more refined guidelines can be developed. Further research is currently underway by three large study groups.
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Affiliation(s)
- J Dunning
- Emergency Medicine Research Group (EmeRGe), Manchester Royal Infirmary, UK.
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Brownscombe J, Simpson N, Lenton S, Davis R, Barby T. The potential of emergency department injury surveillance data: an illustration using descriptive analysis of data in 0-4 year olds from the Bath injury surveillance system. Child Care Health Dev 2004; 30:161-6. [PMID: 14961868 DOI: 10.1111/j.1365-2214.2003.00402.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To illustrate the potential of injury surveillance data from an emergency department surveillance system. SETTING Bath clinical area. METHODS Data for children (0-4 years old) resident in Bath city in UK were recoded and analysed. RESULTS There were a total of 3144 attendances and 2300 unintentional injuries - equivalent to an attendance rate of 131/1000. There were 91 thermal injuries and 162 poisoning/ingestions. Descriptive information is presented on the circumstances and consequences. CONCLUSION The majority of unintentional injuries in 0-4 year olds occur in the home, which is a modifiable environment. Detailed information around the circumstances available from the Bath injury surveillance system allows better focus for prevention messages and priority setting.
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Affiliation(s)
- J Brownscombe
- Australasian College for Emergency Medicine, Melbourne, Australia
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Lalloo R, Sheiham A, Nazroo JY. Behavioural characteristics and accidents: findings from the Health Survey for England, 1997. ACCIDENT; ANALYSIS AND PREVENTION 2003; 35:661-667. [PMID: 12850066 DOI: 10.1016/s0001-4575(02)00044-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This study analysed the relationship between major and minor accidents, and major accidents involving a moving vehicle, and behavioural and emotional factors in children, aged 4-15 years, using the Strengths and Difficulties Questionnaire (SDQ), and adjusting for demographic, socio-economic and family type factors. Data from a large representative national sample of about 6000 children were analysed using simple and multiple logistic regression. The analysis shows that the prevalence of SDQ scales, such as hyperactivity and conduct disorder were significantly higher in boys, lower social classes and step- and single-parent families. After adjusting for the demographic, socio-economic and family type factors, children who scored borderline or high for hyperactivity were almost two times more likely to report having major accidents. Children who scored high for hyperactivity and emotional symptoms were one and a half times more likely to report having minor accidents. For major accidents involving moving vehicles, the relationships with the behavioural and emotional factors were generally stronger than for major accidents in general. Hyperactivity, in particular, was significantly associated with the occurrence of major and minor accidents, and major accidents involving moving vehicles. The behavioural risk factors were significantly more common in the lower social classes, families receiving benefits and step- and single-parent families.
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Affiliation(s)
- R Lalloo
- Department of Epidemiology and Public Health, Royal Free and University College London Medical School, 1-19 Torrington Place, London WC1E 6BT, UK.
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Cryer C, Langley JD, Stephenson SCR, Jarvis SN, Edwards P. Measure for measure: the quest for valid indicators of non-fatal injury incidence. Public Health 2002; 116:257-62. [PMID: 12209400 DOI: 10.1038/sj.ph.1900878] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2002] [Indexed: 11/09/2022]
Abstract
In this edition of Public Health, McClure and colleagues report on research that considered the criterion validity of indicators based on serious long bone fracture and length of stay in hospital. They found that neither were sensitive or specific indicators for serious injury as defined by an Injury Severity Score (ISS) of 16 or more. They contend that their study findings ' em leader strongly support a return to a measure similar in intent to that encapsulated in the original UK Green Paper em leader '. We contend that their analysis does not provide any empirical evidence to support their view that there should be a return to the Green Paper: Our Healthier Nation indicator. Furthermore, we consider the analyses that they carry out to validate both the Saving Lives: Our Healthier Nation and the serious long bone fracture indicators are flawed. We agree that national (or state) indicators are very influential. They encourage preventive action and resource use aimed at producing favourable changes to these indicators. However, each of the four non-fatal indicators considered in their analysis have problems. Formal validation of existing indicators is necessary and the following aspects of validity should be addressed: face; criterion; consistency; and completeness and accuracy of the source date. Taking into account the current national data systems in England, possible options for one or more national non-fatal unintentional injury indicators have been proposed in our paper. Furthermore, the International Collaborative Effort on Injury Statistics (ICE) Injury Indicators Group is about to embark on the development of a strategic framework for the development of valid indicators of non-fatal injury occurrence.
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Affiliation(s)
- C Cryer
- Centre for Health Services Studies, University of Kent, Tunbridge Wells, UK.
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Hippisley-Cox J, Groom L, Kendrick D, Coupland C, Webber E, Savelyich B. Cross sectional survey of socioeconomic variations in severity and mechanism of childhood injuries in Trent 1992-7. BMJ 2002; 324:1132. [PMID: 12003886 PMCID: PMC107914 DOI: 10.1136/bmj.324.7346.1132] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the relation between morbidity from injury and deprivation for different levels of injury severity and for different injury mechanisms for children aged 0-14 years. DESIGN Cross sectional survey of routinely collected hospital admission data for injury 1992-7. SETTING 862 electoral wards in Trent Region. SUBJECTS 21 587 injury related hospital admissions for children aged 0-4 years and 35 042 admissions for children aged 5-14. MAIN OUTCOME MEASURES Rate ratios for hospital admission for all injuries, all injuries involving long bone fracture, and all injuries involving long bone fracture requiring an operation; rate ratios for hospital admission for six types of injury mechanism divided by quintiles of the electoral wards' Townsend scores for deprivation. Rate ratios calculated by Poisson regression, with adjustment for distance from nearest hospital admitting patients with injuries, rurality, ethnicity, and percentage of males in each electoral ward. RESULTS Both total number of admissions for injury and admissions for injuries of higher severity increased with increasing socioeconomic deprivation. These gradients were more marked for 0-4 year old children than 5-14 year olds. In terms of injury mechanisms, the steepest socioeconomic gradients (where the rate for the fifth of electoral wards with the highest deprivation scores was > or =3 times that of the fifth with the lowest scores) were for pedestrian injuries (adjusted rate ratio 3.65 (95% confidence interval 2.94 to 4.54)), burns and scalds (adjusted rate ratio 3.49 (2.81 to 4.34)), and poisoning (adjusted rate ratio 2.98 (2.65 to 3.34)). CONCLUSION There are steep socioeconomic gradients for injury morbidity including the most common mechanisms of injury. This has implications for targeting injury prevention interventions and resources.
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Affiliation(s)
- Julia Hippisley-Cox
- Division of General Practice, Tower Building University Park, Nottingham NG7 2RD.
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Sturms LM, van der Sluis CK, Groothoff JW, ten Duis Henk J, Esima WH. Characteristics of injured children attending the emergency department: patients potentially in need of rehabilitation. Clin Rehabil 2002; 16:46-54. [PMID: 11837525 DOI: 10.1191/0269215502cr466oa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To provide an epidemiological overview of the characteristics of injured children and to compare hospitalized and nonhospitalized injured children to identify predictors of hospitalization and, with that, possible predictors of disablement. DESIGN Retrospective analysis of data obtained from a computerized trauma registration system and medical records. SETTING Department of Traumatology, University Hospital Groningen, the Netherlands. SUBJECTS Children (0-19 years) injured in 1996 and 1997 (n = 5,057). RESULTS The majority of children were injured in home and leisure accidents (53%) and sustained minor injuries. Only 55 (1%) children were severely injured (Injury Severity Score (ISS) > or = 16). Overall, 512 (10%) patients required hospitalization, 19 children were referred to a rehabilitation centre, and 24 children died due to their injuries. The majority of these patients were injured in traffic. Compared with the group of nonhospitalized patients, the group of hospitalized patients consisted of more males and traffic victims, were more severely injured and sustained more head/neck, spine, and thorax and abdomen injuries. Nonhospitalized patients incurred proportionally more upper and lower extremity injuries. The ISS, the body region of most severe injury, and injury cause (traffic accidents) were significant predictors of hospitalization. CONCLUSIONS Young traffic victims, severely injured children in terms of high ISS scores, and children with injuries affecting the head/neck/face or thorax/abdomen carry the highest risk of hospitalization.
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Affiliation(s)
- Leontien M Sturms
- Department of Rehabilitation Medicine, University Hospital Groningen and Northern Centre for Healthcare Research, University of Groningen, The Netherlands.
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Why the Government was right to change the ‘Our Healthier Nation’ accidental injury target. Public Health 2000. [DOI: 10.1038/sj.ph.1900649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lyons RA, Sellstrom E, Delahunty AM, Loeb M, Varilo S. Incidence and cause of fractures in European districts. Arch Dis Child 2000; 82:452-5. [PMID: 10833175 PMCID: PMC1718346 DOI: 10.1136/adc.82.6.452] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To compare fracture rates in European districts. SETTING Geographically defined areas of Wales (Swansea and Neath Port Talbot), Norway (Harstad, Trondheim, Stavanger, and Drammen), Sweden (Jamtlands), and Finland (Porvoo). METHODS Surveillance of fractures at emergency departments and hospitals and linkage with population data. Comparison of age adjusted and crude rates. Calculation of confidence intervals for ratios. RESULTS A total of 4113 fractures occurred in 167 560 children during 1996. Fracture rates in south Wales (36 per 1000) were substantially higher than in Scandinavian districts (which were similar). Limiting analysis to the most severe injuries to correct for the possibility of ascertainment bias reduced some of the excess rate in Wales: the Welsh:Scandinavian fracture ratio was 1.82 (95% confidence interval: 1.64 to 2.03). CONCLUSIONS Fracture rates in Welsh children are substantially higher than in Scandinavian children.
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Affiliation(s)
- R A Lyons
- Collaboration in Accident Prevention and Injury Control, Welsh Combined Centres for Public Health, University of Wales College of Medicine, Wales, UK.
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Ohn TT, Miller MG, Sparks G. Better evidence must be collected on childhood injuries. BMJ (CLINICAL RESEARCH ED.) 1999; 319:1432-3. [PMID: 10574875 PMCID: PMC1117156 DOI: 10.1136/bmj.319.7222.1432b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Laing GJ, Logan S. Patterns of unintentional injury in childhood and their relation to socio-economic factors. Public Health 1999; 113:291-4. [PMID: 10637521 DOI: 10.1016/s0033-3506(99)00182-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the rate of childhood injury resulting in attendance at Accident and Emergency Departments, to describe the types of accidents and injuries seen and to relate these to socio-economic indices for ward of residence. METHODS Data were collected from Accident and Emergency records, on every fifth day for a year, for children 0-14 y, who attended following unintentional injury and were resident within the study area. RESULTS 1147 children fulfilled the inclusion criteria. The annual rate of attendance was 138.2 per 1000. There was a higher rate of attendance in boys than in girls in all age groups and the gender difference was particularly marked for severe injuries. Social deprivation, measured by Townsend score, of ward of residence was a powerful predictor of risk of attendance; accounting for 33% of the variance between wards. CONCLUSION Unintentional injury results in high rates of attendance at Accident and Emergency Departments although the rates in this community were substantially lower than those reported from elsewhere in the United Kingdom. Risk of injury was strongly related to social disadvantage. District based data collection can be used to facilitate the development of priorities and a locally applicable safety agenda for children.
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Reading R, Langford IH, Haynes R, Lovett A. Accidents to preschool children: comparing family and neighbourhood risk factors. Soc Sci Med 1999; 48:321-30. [PMID: 10077280 DOI: 10.1016/s0277-9536(98)00311-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Accidental injury in young children is more common among poorer families and in deprived areas but little is known about how these factors interact. This paper describes a study to measure the contribution of individual family factors and area characteristics in determining risk of accidental injury among preschool children. We conducted a population based study of preschool accident and emergency attendances over two years in and around the city of Norwich, UK. Information on individual families was extracted from the district child health information system while "social areas" were constructed from adjacent census enumeration districts with homogeneous social and demographic characteristics. Statistical analysis was by multilevel modelling. Accidental injury rates were much higher in deprived urban neighbourhoods than in affluent areas but the multilevel analysis showed that, for all accidents, much of the variation in rates was accounted for by factors at the individual level i.e. male sex, young maternal age, number of elder siblings and distance from hospital, with a smaller, but independent, influence of living in a deprived neighbourhood. The model for more severe injuries was similar except single parenthood was now significant at the level of individuals and the effect of area deprivation was stronger. We conclude that preschool accidental injuries are influenced by factors operating at both the level of individual families and between areas. This evidence suggests that both social policy changes to improve child care among unsupported young families and targeting accident prevention measures at a local level towards deprived neighbourhoods would reduce accidents.
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Affiliation(s)
- R Reading
- School of Health Policy and Practice, UK.
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Abstract
OBJECTIVES The study's objective was to examine incidence of fractures and associated activity restriction among children aged 0-12 years. DESIGN Injuries were prospectively recorded over the four year period from 1992-95 in a cohort of children aged 0-12 years, representing 193,540 children years. Information about length and extent of activity restriction was collected from parents by a mailed questionnaire for a subsample of 192 children with a fracture. RESULTS A total of 2477 fractures occurred in the study population (128 per 10,000 children annually). The incidence increased linearly with age, by 14 cases per 10,000 children year for each year of age. Boys and girls showed similar patterns of fracture occurrence. There was a significant difference in length of activity restrictions for different types of fractures. The mean and 95% confidence interval (CI) of activity restricted days for leg fractures were 26 (95% CI 7 to 45) days, for arm fractures, 14 (95% CI 8 to 20) days, and for other fractures, 5 (95% CI 1 to 8) days. Arm fractures represented 66% of the cases and 62% of the activity restricted days; leg fractures 19% of cases and 33% of all activity restricted days; and other fractures 16% of the cases but only 5% of the activity restricted days in this population. CONCLUSION The incidence of fractures increases in childhood. Different types of fractures among children cause different amounts of activity restriction.
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Affiliation(s)
- B Kopjar
- Department of Population Health Sciences, National Institute of Public Health, Oslo, Norway.
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O'Byrne AM, Edwards P, Jarvis S, Shabde N. Using radiology records to improve epidemiological information in paediatric fractures: a feasibility study. Public Health 1998; 112:243-7. [PMID: 9724948 DOI: 10.1016/s0033-3506(98)00240-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/1998] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To assess the feasibility of using routine computerised radiology records for community injury surveillance data using fractures in the child population as an example. DESIGN Radiology and in-patient computerised files were accessed to extract information concerning type of fracture, age, sex, and home address. Diagnostic coding of radiological report was carried out using the ICD-9 classification. Children were assigned to local authority wards using home postcodes derived from home addresses. Ward fracture rates were calculated using 1991 census data. The association between ward fracture rates and deprivation was explored using Townsend scores. SETTING North Tyneside General Hospital. SUBJECTS Children age 10-14 y receiving care as in-patients or out-patients for long-bone fractures. RESULTS Between April 1991 and March 1996 a total of 497 long-bone fractures were identified. Fractures in boys exceeded those in girls by a ratio of 2:1. The most common fracture identified was of the radius and ulna. There was no evidence of an ecological association between long-bone fracture rates in children aged 10-14 y and social deprivation. CONCLUSIONS Computerised radiological records may be used to improve epidemiological information concerning fractures. However, at present, considerable time and effort is required to access the information, to identify and to classify, long-bone fractures. Such data could be used to assist in the audit of clinical care and long-term outcomes, and to inform effective local planning and evaluation of injury prevention initiatives.
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Affiliation(s)
- A M O'Byrne
- North Tyneside General Hospital, North Tyneside Health Care NHS Trust, North Shields, Tyne
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Jarvis S. Risk taking disease. Inj Prev 1996; 2:182-4. [PMID: 9346087 PMCID: PMC1067699 DOI: 10.1136/ip.2.3.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- S Jarvis
- University of Newcastle upon Tyne, UK
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