Traumatic Brain Injuries Associated With Consumer Products at Home Among US Children Younger Than 5 Years of Age

Product-related injury morbidity among Americans aged 0-19 years, 2001-2020

INTRODUCTION

This study examined changes in product-related injury morbidity among under-20 Americans between 2001 and 2020.

METHOD

Product-related injury morbidity data came from the National Electronic Injury Surveillance System (NEISS). Using age-standardized morbidity rates, the authors performed Joinpoint regression models to identify time periods with significant changes between 2001 and 2020 and quantified the annual magnitude of morbidity changes with annual percent changes (APCs) in rates and 95 % confidence intervals (CIs).

RESULTS

Age-standardized product-related injury morbidity declined consistently among under-20 Americans from 2001 to 2020 (from 7449.3 to 4023.5 per 100,000 persons; APC = -1.5 %, 95 % CI: -2.3 %, -0.7 %), with the most striking morbidity drop in 2019-2020 (-1576.8 per 100,000 persons). Sports and recreation equipment and home were the most common product and location, respectively, for nonfatal pediatric product-related injuries. Large morbidity differences and varying spectrum by product and by occurring location existed across sex and age groups.

CONCLUSIONS

Product-related injury morbidity declined significantly among under-20 Americans between 2001 and 2020, but large variations remained across sex and age groups.

PRACTICAL APPLICATIONS

Further research is recommended to understand causal factors contributing to the observed decrease in product-related injury morbidity over the past 20 years and to understand product-related injury morbidity disparities across sex and age groups. Understanding of causal factors could lead to implementation of additional interventions to reduce product-related injury among children and adolescents.

What and who should we focus in pediatric injury prevention - An analysis of critical pediatric trauma in a major trauma center in Hong Kong

BACKGROUND

Understanding trauma epidemiology is essential in formulating region-specific strategies for injury prevention. Our study aimed to evaluate the characteristics and clinical outcomes of critical pediatric trauma requiring intensive care in Hong Kong.

METHODS

A retrospective analysis was performed on pediatric patients who were injured and admitted to the pediatric intensive care unit (PICU), Queen Elizabeth Hospital, Hong Kong between 2014 and 2018. Clinical features of patients who sustained injuries before and after 2 years old were compared.

RESULTS

141 patients were admitted to the PICU due to trauma during the study period. Most patients sustained injuries due to fall (48.2%) or road traffic injuries (34.0%), with the latter more common in older patients. Two (1.4%) patients died due to the trauma. The majority (95.0%) of the survivors had good recovery assessed by Glasgow Outcome Scale. Patients younger than 2 years old were mostly injured at home due to fall while left unattended. Children in this age group were more likely to receive interventions, including mechanical ventilation (OR 2.61; 95% CI 1.15-5.95), anti-epileptic medications (OR 2.61; 95% CI 1.17-5.83), blood transfusion (OR 5.37; 95% CI 2.29-12.60) and inotropic support (OR 4.08; 95% CI 1.31-12.70), and require longer hospitalization (PICU stay 2.5 vs. 1.5 days, p = 0.011; hospital stay 10.9 vs. 6.9 days, p = 0.012).

CONCLUSION

Fall injuries and road traffic injuries were common etiologies of critical pediatric trauma in Hong Kong. Patients younger than 2 years old had worse clinical outcomes. Parental education on home safety and importance of close supervision should be emphasized in this age group.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The Diagnostic Value of Neuron-Specific Enolase in Children with Mild Blunt Trauma Requiring Cranial CT Scan

BACKGROUND

The present study was conducted to investigate the relationship between serum levels of enolase and pathological findings obtained from CT scans of the brain in children with mild blunt brain trauma and help with a more accurate diagnosis of brain injuries.

METHODS

The present observational study was conducted on children presenting with head traumas to the emergency department (ED) of Golestan Hospital in Ahvaz, Iran in 2016. A venous blood sample was immediately taken by the ward nurse from all the eligible patients within 6 hrs of the incident after obtaining their information, performing initial examinations and their initial stabilization. Laboratory serum levels and the corresponding interpretations of CT scans of the brain were collected, recorded and then evaluated and analyzed.

RESULTS

A total of 62 children with mild blunt brain trauma were included in the study. A significant difference was observed between the positive CT scan group (2.7±9.74 µg/L) and the negative group (4.23±1.33 µg/L) in terms of serum levels of enolase (P<0.0001). The area under the receiver operating characteristic (ROC) curve was 0.992 for serum levels of enolase in diagnosing brain lesions caused by mild head traumas. Moreover, with a cut-off point of 6.97 µg/L, brain lesions could be detected with a sensitivity of 93.55% and a specificity of 100%.

CONCLUSION

Serum levels of enolase were found to be higher in patients with brain injuries. This highly accurate diagnostic biomarker can be recommended for estimating the presence of brain lesions associated with mild head traumas in infants.

Prevention of Concussion

Concussion is a common pediatric problem, and the best point of intervention would be to prevent a concussion from occurring. Unfortunately, information in this area has inconsistent support for the various methods that have been attempted. In infants, concussions are typically related to safety hazards in the environment and attempts to make the environment safer have resulted in decreased injuries over time. Toddlers also face environmental hazards that are slightly different in light of their increased mobility. School-aged children and adolescents primarily sustain concussions in the course of participation in organized contact sports. Although much research has been devoted to protective equipment, there is not a clearly effective piece of equipment that prevents concussions. Some effect has been demonstrated with changes in rules and policy that limit or eliminate certain kinds of dangerous contact. Research is still being performed to adequately evaluate methods that are already being used, as well as to find new methods in the future that may help protect today's children from concussions.

Pediatric falls ages 0-4: understanding demographics, mechanisms, and injury severities

Background

Pediatric unintentional falls are the leading cause of injury-related emergency visits for children < 5 years old. The purpose of this study was to identify population characteristics, injury mechanisms, and injury severities and patterns among children < 5 years to better inform age-appropriate falls prevention strategies.

Methods

This retrospective database study used trauma registry data from the lead pediatric trauma system in Georgia. Data were analyzed for all patients < 5 years with an international classification of disease, 9th revision, clinical modification (ICD-9 CM) external cause of injury code (E-code) for unintentional falls between 1/1/2013 and 12/31/2015. Age (months) was compared across categories of demographic variables, injury mechanisms, and emergency department (ED) disposition using Kruskal-Wallis ANOVA and the Mann Whitney U test. The relationships between demographic variables, mechanism of injury (MOI), and Injury Severity Score (ISS) were evaluated using multinomial logistic regression.

Results

Inclusion criteria were met by 1086 patients (median age = 28 months; 59.7% male; 53.8% White; 49.1% <  1 m fall height). Younger children, < 1-year-old, primarily fell from caregiver’s arms, bed, or furniture, while older children sustained more falls from furniture and playgrounds. Children who fell from playground equipment were older (median = 49 months, p < 0.01) than those who fell from the bed (median = 10 months), stairs (median = 18 months), or furniture (median = 19 months). Children < 1 year had the highest proportion of head injuries including skull fracture (63.1%) and intracranial hemorrhage (65.5%), 2-year-old children had the highest proportion of femur fractures (32.9%), and 4-year-old children had the highest proportion of humerus fractures (41.0%). Medicaid patients were younger (median = 24.5 months, p < 0.01) than private payer (median = 34 months). Black patients were younger (median = 20.5 months, p < 0.001) than White patients (median = 29 months). Results from multinomial logistic regression models suggest that as age increases, odds of a severe ISS (16–25) decreased (OR = 0.95, CI = 0.93–0.97).

Conclusions

Pediatric unintentional falls are a significant burden of injury for children < 5 years. Future work will use these risk and injury profiles to inform current safety recommendations and develop evidence-based interventions for parents/caregivers and pediatric providers.

Electronic supplementary material

The online version of this article (10.1186/s40621-018-0147-x) contains supplementary material, which is available to authorized users.

The epidemiology of inpatient pediatric trauma in United States hospitals 2000 to 2011

BACKGROUND

This study provides important updates to the epidemiology of pediatric trauma in the United States.

METHODS

Age-specific epidemiologic analysis of the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample, representing 2.4 million pediatric traumatic injury discharges in the US from 2000 to 2011. We present yearly data with overlying loess smoothing lines, proportions of common injuries and surgical procedures, and survey-adjusted logistic regression analysis.

RESULTS

From 2000 to 2011 there was a 21.7% decline in US pediatric trauma injury inpatient discharges from 273.2 to 213.7 admissions per 100,000. Inpatient case-fatality decreased 5.5% from 1.26% (95% CI 1.05-1.47) to 1.19% (95% CI 1.01-1.38). Severe injuries accounted for 26.5% (se=0.11) of all discharges in 2000 increasing to 31.3% (se=0.13) in 2011. The most common injury mechanism across all age groups was motor vehicle crashes (MVCs), followed by assaults (15-19years), sports (10-14), falls (5-9) and burns (<5). The total injury-related, inflation-adjusted cost was $21.7 billion, increasing 56% during the study period.

CONCLUSIONS

The overall rate of inpatient pediatric injury discharges across the United States has been declining. While injury severity is increasing in hospitalized patients, case-fatality rates are decreasing. MVCs remain a common source of all pediatric trauma.

LEVELS OF EVIDENCE

Level III.

Nursery Product-Related Injuries Treated in United States Emergency Departments

OBJECTIVE

The goal of this study was to determine the epidemiology of injuries associated with nursery products among young children treated in US emergency departments.

METHODS

Data from the National Electronic Injury Surveillance System were retrospectively analyzed for patients aged <3 years who sustained an injury associated with a nursery product from 1991 through 2011.

RESULTS

An estimated 1 391 844 (95% confidence interval, 1 169 489-1 614 199) nursery product-related injuries among children aged <3 years were treated in US emergency departments during the 21-year study period, averaging 56.29 injuries per 10 000 children. The annual injury rate decreased significantly by 33.9% from 1991 to 2003, followed by a significant increase of 23.7% from 2003 to 2011. The decrease was driven by a significant decline in baby walker/jumper/exerciser-related injuries; the increase was driven by a significant increase in concussions and closed head injuries. Nursery product-related injuries were most commonly associated with baby carriers (19.5%), cribs/mattresses (18.6%), strollers/carriages (16.5%), or baby walkers/jumpers/exercisers (16.2%). The most common mechanism of injury was a self-precipitated fall (80.0%), and the most frequently injured body region was the head or neck (47.1%).

CONCLUSIONS

Although successful injury prevention efforts with baby walkers led to a decline in nursery product-related injuries from 1991 to 2003, the number and rate of these injuries have been increasing since 2003. Greater efforts are warranted to prevent injuries associated with other nursery products, especially baby carriers, cribs, and strollers. Prevention of falls and concussions/closed head injuries associated with nursery products also deserves special attention.