Prevention of unintentional injuries in children under five years

The effect of educational programs on parents' knowledge, behavior, and practices regarding aluminum phosphide poisoning and its first-aid measures

BACKGROUND

Aluminum phosphide is an excellent insecticide available as a chalky white or brown tablet. Aluminum phosphide is traded in the Egyptian market as tablets under the brand name celphos. To date, no specific antidotes for aluminum phosphide poisoning have been identified. Management is primarily supportive, to control toxic symptoms and prevent the anticipated consequences. Therefore, educating parents about first aid management is of utmost importance. This study aimed to evaluate the knowledge, behavior, and practices of parents concerning aluminum phosphide poisoning and its first-aid measures.

METHODS

This study used a quasi-experimental research design and was conducted in the inpatient clinical toxicology department ward of Menoufia University Hospital between June 2022 and May 2023. Children (n = 98) who met the inclusion criteria (aged between 0 and 18 years and who experienced accidental or suicidal aluminum phosphide poisoning) were recruited from the inpatient clinical toxicology department ward, intensive care unit in the emergency department, and critical care unit of Menoufia University Hospital. Four questionnaires were used to collect data for this study: (1) sociodemographics, poisoning data, physical examination, and laboratory investigations; (2) knowledge of parents; (3) practice of parents; and (4) behavior response scales.

RESULTS

This study analyzed 98 cases of acute ALP poisoning, predominantly affecting females (67.3%) aged 16-18 years, with most incidents occurring in summer (51.1%) and rural areas (80.6%). Suicidal ingestion accounted for 86.7% of cases, and delays in hospital arrival were noted in 65.3%. Clinical findings included vomiting (76.6%), dyspnea (77.5%), and cardiogenic shock (84.8%). ECG abnormalities were found in 82.7% of patients, and metabolic acidosis was present in 82.3% of patients. An educational program significantly improved the knowledge and first-aid practices of the participants regarding ALP poisoning, highlighting the need for enhanced awareness and intervention strategies.

CONCLUSIONS

Community awareness programs, such as first-aid education initiatives, can positively influence the knowledge, practices, and behaviors of mothers in terms of providing first aid for aluminum phosphide toxicity.

Epidemiological pattern of injuries among road traffic crash victims: the first experience of a large tertiary care hospital in the West Bank of Palestine

BACKGROUND

Road traffic injuries are a global public health challenge. This study was conducted to describe the epidemiological patterns of road traffic injuries in a large tertiary care hospital in the West Bank of Palestine. In addition, associations between the different variables of the victims and the patterns of road traffic injuries were also assessed.

METHODS

This study was conducted in a retrospective cohort observational design between January 2021 and July 2023 at a large tertiary care hospital in Nablus, Palestine. The data were collected from the electronic medical record system of the large tertiary care hospital using a data collection form.

RESULTS

A total of 1,544 victims of traffic road injuries were included in this study. Lower limb (43.0%), neck (41.2), and upper limb (39.8%) injuries were the most common types of road traffic injuries sustained by the victims admitted to the large tertiary care hospital. The victims who were 30 years or older were more likely to sustain back injuries (aOR = 1.71, 95% CI: 1.20-2.45) pelvic injuries (aOR = 1.84, 95% CI: 1.08-3.12), chest injuries (aOR = 1.59, 95% CI: 1.06-2.38), and neck injuries (aOR = 2.54, 95% CI: 1.68-3.82) compared to the victims who were younger than 30 years. The victims who did not use seatbelts were more likely to sustain abdominal injuries (aOR = 1.88, 95% CI: 1.34-2.63) and head injuries (aOR = 1.49, 95% CI: 1.06-2.10) compared to the victims who used seatbelts. The victims who did not have the airbag deployed were more likely (aOR = 1.85, 95% CI: 1.31-2.63) to sustain neck injuries compared to the victims who had the airbag deployed.

CONCLUSION

The epidemiological patterns of road traffic injuries in a large tertiary care hospital in Nablus, Palestine were described and the associations between the different variables of the victims and the patterns of road traffic injuries were assessed. The findings indicated a need to design measures to prevent/minimize these injuries. Future studies are still needed to determine the best measures to avoid/minimize the incidence of serious road traffic injuries.

Developing a framework for community childcare doctors to support community-based parental health education in preventing unintentional injuries among children aged below 6 years: a grounded theory exploration in eastern China

OBJECTIVE

Unintentional injuries are a major threat to children's health. Community-based health management services, which include the prevention of unintentional injuries among children aged 0-6 years, are important basic national public health services. However, deficiencies exist at this stage, such as community childcare doctors not being motivated to provide guidance. Previous studies have explored the impact of the underlying reasons; however, few studies have considered the supporting factors from a social perspective. This study explored the elements supporting community childcare doctors in conducting parental health education and sought to generate a framework capable of providing recommendations.

DESIGN

A qualitative study was conducted to analyse data collected through semistructured interviews and used the grounded theory method.

SETTING

Interviews were conducted at eight health institutions, health management departments, hospital and universities in four regions of eastern China (Shanghai, Zhejiang, Anhui and Liaoning) and recorded on audio. Interviews were conducted face to face or online.

PARTICIPANTS

Key informant interviews were conducted with 39 adults (15 parents of children, 11 direct providers of child healthcare and 13 health department managers or experts). The information obtained through interviews included the current situation and difficulties faced by community childcare doctors providing parental health education, the attitudes and perceptions of parents regarding receiving health education and the degree of service acceptance. The independent transcription of interview results was performed by two coders.

RESULTS

A total of 39 interview transcripts from healthcare service providers, managers and demanders were analysed. Many factors affect the provision of parental health education by community childcare doctors, including the macrodimension and microdimension. Supplier, demander, direct support and indirect support were summarised and reported as both facilitators and barriers to active provision of health services, including 18 subdomains under these four main domains.

CONCLUSIONS

A theoretical model of parental health education based on community childcare doctors was constructed to explain the factors influencing the implementation of education by community childcare doctors. These include individual and socialised behaviours requiring cooperation among individuals, families, governments, the general public and all workers in the healthcare sector. For demanders, it is essential to evoke their beliefs, and for suppliers, it is necessary to improve their skills and stimulate their motivation, both of which cannot be separated from macrolevel support. This model can be used to guide intervention designs aimed at enhancing the enthusiasm of community childcare doctors and further enhancing parental literacy, ultimately achieving the goal of improving children's health.

Contemporary Approach for Traumatic Dental Injuries in the Primary Dentition

Management of traumatic dental injuries (TDI) is very complex, even under ideal circumstances. Children in the primary dentition have unique needs, and it is important that the diagnosis and treatment choices are offered to parents. The prevalence of TDI in the primary dentition is far greater than for any other age group. Education of parents and caregivers in prevention and emergency management of oral injuries is essential. When injuries occur, the dental professionals must also respond appropriately to establish correct diagnosis of the injuries and assist parents in making decisions for management while communicating realistic expectations for the future. Progress has been made in the diagnosis and management of dental injuries in the primary dentition based on the biological healing response of oral tissues following injury over time. Several factors influence critical decisions that must be made based on basic principles and guidelines to improve successful outcomes for the child. Managing co-operation must be balanced with the benefit of anticipated treatment need. The current evidence challenges previous dental interventions. The IADT guidelines updated the approach to management of TDI in children in the primary dentition. Encouraging a positive attitude to the dental setting early in the life course prepares the child to be a motivated dental attendee throughout their lifetime. This manuscript aimed to outline the critical issues and clinical choices for injuries to the primary dentition and to summarise recent guidance from the International Association of Dental Traumatology (IADT).

Assessment of non-fatal injuries among university students in Hainan: a machine learning approach to exploring key factors

Background

Injuries constitute a significant global public health concern, particularly among individuals aged 0-34. These injuries are affected by various social, psychological, and physiological factors and are no longer viewed merely as accidental occurrences. Existing research has identified multiple risk factors for injuries; however, they often focus on the cases of children or the older adult, neglecting the university students. Machine learning (ML) can provide advanced analytics and is better suited to complex, nonlinear data compared to traditional methods. That said, ML has been underutilized in injury research despite its great potential. To fill this gap, this study applies ML to analyze injury data among university students in Hainan Province. The purpose is to provide insights into developing effective prevention strategies. To explore the relationship between scores on the self-rating anxiety scale and self-rating depression scale and the risk of non-fatal injuries within 1 year, we categorized these scores into two groups using restricted cubic splines.

Methods

Chi-square tests and LASSO regression analysis were employed to filter factors potentially associated with non-fatal injuries. The Synthetic Minority Over-Sampling Technique (SMOTE) was applied to balance the dataset. Subsequent analyses were conducted using random forest, logistic regression, decision tree, and XGBoost models. Each model underwent 10-fold cross-validation to mitigate overfitting, with hyperparameters being optimized to improve performance. SHAP was utilized to identify the primary factors influencing non-fatal injuries.

Results

The Random Forest model has proved effective in this study. It identified three primary risk factors for predicting non-fatal injuries: being male, favorable household financial situation, and stable relationship. Protective factors include reduced internet time and being an only child in the family.

Conclusion

The study highlighted five key factors influencing non-fatal injuries: sex, household financial situation, relationship stability, internet time, and sibling status. In identifying these factors, the Random Forest, Logistic Regression, Decision Tree, and XGBoost models demonstrated varying effectiveness, with the Random Forest model exhibiting superior performance.

A nationwide longitudinal survey of infantile injury and its recurrence in Japan

Injury recurrence in young children is a significant public health concern, as it may indicate an unfavorable home environment. This study evaluates whether infantile injuries increase recurrence during preschool years, contributing to more effective prevention strategies for vulnerable families. The study included 20,191 children from "The Longitudinal Survey of Babies in the 21st Century," a representative sample of infants born in Japan between May 10 and 24, 2010. We conducted a logistic regression analysis to compare injury recurrence risk between children aged 18 months to seven years with and without infantile injury histories. The study revealed that infants with a history of injuries had a higher risk of subsequent hospital visits for injuries during preschool years (crude Odds Ratio (cOR) 1.52, 95% CI, 1.41-1.64, adjusted OR (aOR) 1.48, 95% CI 1.37-1.60). Specific injuries, such as falls (aOR 1.34, 95% CI, 1.26-1.43), pinches (aOR 1.22, 95% CI, 1.15-1.29), drowning (aOR 1.29, 95% CI, 1.19-1.40), ingestion (aOR 1.35, 95% CI, 1.17-1.55), and burns (aOR 1.47, 95% CI, 1.31-1.65), independently increased the risk of future injuries. Our findings highlight the necessity of universal safety measures in the home environment and targeted interventions for families with a history of high-risk injuries.

Rates of fall injuries across three claims databases, 2019

INTRODUCTION

In 2021, among all age groups, falls ranked as the third leading cause of unintentional injury death in the USA. Unlike fatal data, which rely on death certificates as the gold standard, there is not a gold standard for non-fatal data. Non-fatal falls data are often based on insurance claims or administrative billing data. The purpose of our study is to compare three claims databases to estimate rates of unintentional fall-related hospitalisations in 2019, the most recent year of available data across the three sources.

METHODS

Three databases were used to produce incidence rates of fall-related hospitalisations for the year 2019: (1) Merative MarketScan research databases, (2) Centers for Medicare and Medicaid Services (CMS) data and (3) Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample. Inpatient falls were identified using International Classification of Diseases, 10th Revision, Clinical Modification codes. Incidence rates per 100 000 people were then produced across all three datasets by payer type. Unadjusted incidence rate ratios were estimated with corresponding 95% CIs.

RESULTS

There were wide disparities among fall rates between the three datasets by payer type. HCUP had the highest rate of falls among Medicare (1087.6 per 100 000) and commercial enrollees (74.7 per 100 000), while CMS had the highest rates of falls among Medicaid enrollees (148.0 per 100 000).

CONCLUSIONS

This study shows wide variation in fall hospitalisation rates based on the claims data used to estimate rates. This study suggests that database selection is an important consideration when determining incidence of non-fatal falls.

The Diagnosis and Management of Pediatric Blunt Abdominal Trauma-A Comprehensive Review

Blunt abdominal trauma in childhood has always been full of diagnostic and therapeutic challenges that have tested the clinical and radiological skills of pediatric surgeons and radiologists. Despite the guidelines and the studies carried out so far, to this day, there is no absolute consensus on certain points of view. Around the world, a paradigm shift towards non-operative treatment of hemodynamically stable children, with low complication rates, is noticeable. Children with blunt abdominal trauma require a standardized methodology to provide the best possible care with the best possible outcomes. This comprehensive review systematizes knowledge about all aspects of caring for children with blunt abdominal trauma, from pre-hospital to post-hospital care.

Epidemiological analysis of a 10-year retrospective study of pediatric trauma in intensive care

Pediatric trauma plays a crucial role in pediatric mortality, with traffic injuries and falls frequently cited as leading causes of significant injuries among children. A comprehensive investigation, including geographical factors, is essential for developing effective strategies to prevent injuries and alleviate the burden of pediatric trauma. This study involved a retrospective analysis of clinical data from pediatric patients admitted to our hospital's intensive care unit (ICU) due to trauma over a 10-year period. Comprehensive analyses were conducted to elucidate trends, demographics, injury patterns, and risk factors associated with these admissions. This retrospective study included 951 pediatric patients (mean age: 4.79 ± 3.24 years; mean weight: 18.45 ± 9.02 kg; median time to ICU admission post-injury: 10.86 ± 14.95 h). Among these patients, 422 (44.4%) underwent emergency surgery, and 466 (49%) required mechanical ventilation support, with a mean duration of 70.19 ± 146.62 h. The mean duration of ICU stay was 6.24 ± 8.01 days, and the overall mean hospitalization duration was 16.08 ± 15.56 days. The predominant cause of unintentional injury was traffic accidents (47.9%), followed by falls (42.5%) and burns/scalds (5.3%). Most incidents involved children aged 0-6 years (70.7%), with males comprising 60.0% of patients. Injury incidents predominantly occurred between 12 and 6 PM (44.5%) and on non-workdays (37.6%). The most common locations where injuries occurred were roadsides (49%) and rural areas (64.35%). Single-site injuries (58.78%) were more prevalent than multiple-site injuries (41.22%), and head injuries were the most common among single-site injuries (81.57%). At ICU admission, the mean injury severity score was 18.49 ± 8.86. Following active intervention, 871 patients (91.59%) showed improvement, while 80 (8.41%) succumbed to their injuries. Traffic injuries remain the primary cause of pediatric trauma leading to ICU admission, underscoring the importance of using appropriate child restraint systems and protective gear as fundamental preventive measures. The increased incidence of injuries among children aged < 6 years and those residing in rural areas highlights the need for targeted preventive strategies, necessitating tailored interventions and public policy formulations that address these high-risk populations.

Comparison of pediatric poisoning patterns before and during the COVID-19 pandemic in South Korea

OBJECTIVE

To investigate the epidemiological changes in emergency department (ED), including changes in toxic substances and ED outcomes in pediatric and adolescent patients who visited the EDs before and during the COVID-19 pandemic.

METHODS

This cross-sectional observational study used data from the ED-based Injury In-depth Surveillance from 2017 to 2021 in South Korea (SK). The study population comprised patients aged <19 years who visited 23 EDs because of poisoning before and during the COVID-19 outbreak. We divided the study period into pre-COVID-19 (January 2017 to February 2020) and COVID-19 periods (March 2020 to December 2021).

RESULTS

In total, 5862 patients were included in the final analysis, with 3863 and 1999 in the pre-COVID-19 and COVID-19 periods, respectively. The patients' mean age increased from 8.3 ± 7.1 to 11.2 ± 6.9 years between the pre-COVID-19 and COVID-19 periods (P < 0.001), and the number of adolescents (aged 13-18 years) significantly increased during the COVID-19 period (1653 [42.8%] vs. 1252 [62.6%]; P < 0.001). The number of intentional poisoning cases increased from 1332 (34.5%) before COVID-19 to 1174 (58.7%) during COVID-19 (P < 0.001). Specifically, pharmaceutical poisoning significantly increased during the COVID-19 period (2242 [58.0%] vs. 1443 [72.2%]; P < 0.001), with central nervous system (CNS) drug poisoning being the most common type (780 [34.8%] vs. 747 [51.8%]; P < 0.001). Among the intentional poisoning cases, pharmaceutical substance use significantly increased during the COVID-19 period (1207 [90.6%] vs. 1102 [93.9%]; P = 0.007). We used Bayesian structural time series (BSTS) forecasting models to forecast the number of ED visits during COVID-19. The total number of pediatric patients with poisoning decreased during the COVID-19 pandemic. However, when using the BSTS forecasting model, the decrease in the number of patients was not significant. Furthermore, the forecasting models showed no statistically significant increase in the number of intentional pediatric poisoning cases.

CONCLUSIONS

The previous studies suggested a decrease in the total number of patients with poisoning but an increase in intentional poisoning cases during the COVID-19 pandemic. By using similar methods to those of previous studies, our results also reached the same conclusion. However, the BSTS model, which predicts real-world time series patterns, seasonal effects, and cumulative effects, shows no significant change in pediatric poisoning patterns during the COVID-19 pandemic.

Understanding Parental Adherence to Early Childhood Domestic Injury Prevention: A Cross-Cultural Test of the Integrated Behavior-Change Model

Unintentional injuries pose a significant risk to children in early years globally. In particular, toddlers and preschoolers are vulnerable to injuries that occur at home. Despite the availability of preventive measures that can greatly reduce the risks of domestic injuries, some caregivers (e.g., parents) of children in early childhood may not fully implement these safety measures due to poor behavioral adherence or low awareness of the risk of domestic injury. Therefore, it is crucial to understand how caregivers in different cultural contexts approach injury prevention in the home environment. In this multi-cultural study, we investigated the motivational and belief processes underlying childhood domestic injury prevention among a total of 2059 primary caregivers (parents/guardians) of infant and toddlers (aged 2 to 6 years) across four societies, Australia (AU; N = 500), the United States (US; N = 500), Singapore (SG; N = 507), and Hong Kong (HK; N = 552), by applying the integrated model of self-determination theory (SDT) and theory of planned behavior (TPB). Our results support the key tenets of the integrated model and demonstrated cultural invariance model pathways across the four societies studied. In particular, the positive relationships among psychological need support, autonomous motivation, socio-cognitive beliefs, intention, and behavior adherence remained constant across societies. With a multi-cultural sample, this study provides valuable insights into the similarities and differences in motivation and beliefs surrounding childhood domestic injury prevention across these four societies.

Individual, environmental and demographic factors may play a role in the prognosis of fatal and non-fatal paediatric drowning

AIM

Drowning is a leading cause of unintentional death. Ongoing efforts are dedicated to preventing these tragic incidents. Our aim was to evaluate whether demographic, environmental and epidemiological characteristics of drowned children influence their prognosis.

METHODS

Single-centre retrospective study spanning 12 years. Each patient's record included: age, sex, place of residence, presence of siblings, season of incident, location of event, associated trauma, loss of consciousness, need for cardiopulmonary resuscitation, intubation, admission to intensive care unit, length of stay and mortality.

RESULTS

We enrolled 60 patients, with a mean age of 5.9 ± 3.4 years; 63.5% were male. Children who did not reside near the sea were significantly older than those who did (p = 0.01) and faced a higher risk of experiencing sea-related drowning (p = 0.05). No patients died. Loss of consciousness and need for cardiopulmonary resuscitation were recorded in 30 and 19 patients respectively. Seven patients sustained trauma. Only one patient requiring intubation. Pool-related drowning were associated with a higher incidence of needing cardiopulmonary resuscitation (p = 0.02). The need for cardiopulmonary resuscitation (p = 0.05) and the occurrence of trauma (p = 0.02) were identified as risk factors for a longer hospitalisation.

CONCLUSION

Prevention and early initiation of cardiopulmonary resuscitation are essential for achieving a favourable prognosis. Identifying demographic and environmental risk factors may help identify other effective preventive measures.

Readiness of Omani Families to Prevent Accidental Injuries at Home in Children Younger than Six Years Old

Objectives

We sought to assess the attitude of Omani families toward accidental injuries among children (aged < 6 years) and evaluate the safety measures and available preventive measures to reduce child injuries at home.

Methods

We conducted a cross-sectional survey examining the self-reported attitudes of Omani parents about accidental injuries (poisoning, falls, burns, and drowning) at home among children younger than six and house safety measures. A total of 220 parents of children aged < 6 years, admitted to a tertiary healthcare teaching hospital, were invited to participate over a period of six months (May to November 2018). Analysis of 178 participant data was performed using SPSS, as 44 of the answered questionnaires had missing data, or were related to children over the age of six.

Results

Only 16.9% of the Omani families had a history of a child injury in the year before the study. Males were more injured (61.0%) and 66.0% were younger than three years at the time of injury. A door to control access to stairs was available for 53.8% of the families. In 42.5% and 16.0% of the houses, children could access electrical sockets and wires, respectively. Fire alarms and extinguishers were not available in 90.8% and 82.1% of houses, respectively. Those who did not store medications and chemicals in safe places out of reach of children accounted for 56.7% and 63.3% of families, respectively.

Conclusions

Many of the studied families are not providing an adequate safe environment for children in their houses. Therefore, actions should be taken to increase awareness about accidental injuries prevention within homes and to implement actions so that a safe home environment can be enjoyed by children.

Trauma Demographics and Injury Prevention

Traumatic injury is a leading cause of death in the United States. Risk of traumatic injury varies by sex, age, geography, and race/ethnicity. Understanding the nuances of risk for a particular population is essential in designing, implementing, and evaluating injury prevention initiatives.

Association between obtaining injury prevention information and maternal and child health services during COVID-19

BACKGROUND

Coronavirus disease 2019 disrupted the delivery of public maternal and child health services to caregivers of preschool children, leading to decreased opportunities for injury prevention education. We aim to 1) explore the timing, content, and methods of providing injury prevention information desired by pregnant women and mothers and 2) identify mothers who experienced difficulty in obtaining injury prevention information owing to reduced maternal and child health services.

METHODS

From March 24 to 29, 2022, we conducted a population-based cross-sectional study and web-based survey. Of the registered monitors of the internet research company Rakuten Insight, 675 mothers raising their first child aged 0-2 during the COVID-19 period (February 2020 to March 2022) were included in the analysis.

RESULTS

Over half of the mothers wanted injury prevention information throughout their pregnancy. They preferred receiving information through traditional face-to-face services provided by local governments, such as antenatal classes or checkups. However, 34.1% of mothers said they did not obtain the information they needed; this was particularly true of unemployed mothers, had children aged 0-1, and had children with illnesses requiring hospital visits.

CONCLUSIONS

Mothers who could not obtain injury prevention information were originally disadvantaged mothers concerning access to information. The decrease in maternal and child health services may have widened this information gap. These findings can inform recommendations for caregivers, particularly those susceptible to information gaps during emergencies, and offer insights into future injury prevention education strategies.

The bidirectional relationship between head injuries and conduct problems: longitudinal modelling of a population-based birth cohort study

Childhood head injuries and conduct problems increase the risk of aggression and criminality and are well-known correlates. However, the direction and timing of their association and the role of their demographic risk factors remain unclear. This study investigates the bidirectional links between both from 3 to 17 years while revealing common and unique demographic risks. A total of 8,603 participants (50.2% female; 83% White ethnicity) from the Millennium Cohort Study were analysed at 6 timepoints from age 3 to 17. Conduct problems were parent-reported for ages 3 to 17 using the Strengths and Difficulties Questionnaire (SDQ) and head injuries at ages 3 to 14. A cross-lagged path model estimated the longitudinal bidirectional effects between the two whilst salient demographic risks were modelled cumulatively at three ecological levels (child, mother, and household). Conduct problems at age 5 promoted head injuries between 5 and 7 (Z = 0.07; SE = 0.03; 95% CI, 0.02-0.13), and head injuries at ages 7 to 11 promoted conduct problems at age 14 (ß = .0.06; SE = .0.03; 95% CI, 0.01-0.12). Head injuries were associated with direct child-level risk at age 3, whereas conduct problems were associated with direct risks from all ecological levels until 17 years. The findings suggest a sensitive period at 5-11 years for the bidirectional relationship shared between head injuries and conduct problems. They suggest that demographic risks for increased head injuries play an earlier role than they do for conduct problems. Both findings have implications for intervention timing.

Trauma and sexual abuse in children-Epidemiology, challenges, management strategies and prevention in lower- and middle-income countries

Trauma is rising as a cause of morbidity and mortality in lower- and middle-income countries (LMIC). This article describes the Epidemiology, Challenges, Management strategies and prevention of pediatric trauma in lower- and middle-income countries. The top five etiologies for non-intentional injuries leading to death are falls, road traffic injuries, burns, drowning and poisoning. The mortality rate in LMICs is twice that of High-Income Countries (HICs) irrespective of injury severity adjustment. The reasons for inadequate care include lack of facilities, transportation problems, lack of prehospital care, lack of resources and trained manpower to handle pediatric trauma. To overcome these challenges, attention to protocolized care and treatment adaptation based on resource availability is critical. Training in management of trauma helps to reduce the mortality and morbidity in pediatric polytrauma cases. There is also a need for more collaborative research to develop preventative measures to childhood trauma.

Pediatric Neurocritical Care: Maximizing Neurodevelopmental Outcomes Through Specialty Care

The field of pediatric neurocritical care (PNCC) has expanded and evolved over the last three decades. As mortality from pediatric critical care illness has declined, morbidity from neurodevelopmental disorders has expanded. PNCC clinicians have adopted a multidisciplinary approach to rapidly identify neurological injury, implement neuroprotective therapies, minimize secondary neurological insults, and establish transitions of care, all with the goal of improving neurocognitive outcomes for their patients. Although there are many aspects of PNCC and adult neurocritical care (NCC) medicine that are similar, elemental difference between adult and pediatric medicine has contributed to a divergent evolution of the respective fields. The low incidence of pediatric critical care illness, the heterogeneity of neurological insults, and the limited availability of resources all shape the need for a PNCC clinical care model that is distinct from the established paradigm adopted by the adult neurocritical care community at large. Considerations of neurodevelopment are fundamental in pediatrics. When neurological injury occurs in a child, the neurodevelopmental stage at the time of insult alters the impact of the neurological disease. Developmental variables contribute to a range of outcomes for seemingly similar injuries. Despite the relative infancy of the field of PNCC, early reports have shown that implementation of a specialized PNCC service elevates the quality and safety of care, promotes education and communication, and improves outcomes for children with acute neurological injuries. The multidisciplinary approach of PNCC clinicians and researchers also promotes a culture that emphasizes the importance of quality improvement and education initiatives, as well as development of and adherence to evidence-based guidelines and family-focused care models.

Epidemiological and clinical features of paediatric inpatients for scars: A retrospective study

OBJECTIVES

To describe the epidemiological and clinical features of paediatric scar inpatients and then to facilitate therapeutic schedule for children with scars.

METHODS

In this cross-sectional study, data of patients admitted for scar treatment in 1064 tertiary hospitals from 2013 to 2018 were extracted through the Hospital Quality Monitoring System (HQMS) database. Demographic and clinical features of children with scars were analysed statistically and highlighted compared with those of adults and the elderly scar cases.

RESULTS

In this study, 53,741 paediatric scar cases, accounting for 30.29% of all hospitalized for scar, were analysed. Compared to adults and the elderly, children with scars were mainly males (62.27% vs 50.98% vs 49.85%, P < 0.001) and were vulnerable to scalds (37.10%) and operative intervention (34.11%). Although the scalp/face/neck was the most common affected location, the proportion of scars involving upper limbs (27.88% vs 21.69% vs 7.28%, P < 0.001), lower limbs (15.14% vs 10.28% vs 6.56%, P < 0.001) and perineum (4.59% vs 3.13% vs 2.65%, P < 0.001) was higher in children than that in other two groups. Scar contracture was the most common complications in children (45.27%). Nearly 66% of paediatric scar cases received surgical treatment during hospitalization, among whom release of lesion was the most frequent operation (56.35%). The proportion of keloids was relatively lower in child cases than in other two groups (6.20% vs 14.48% vs 18.15%, P < 0.001). Additionally, the median LOS in child cases was 9 (5-15) days, slightly exceeding that in adult/elderly cases.

CONCLUSIONS

Scars were common inducing factors of hospitalization and contributed greatly to the disease burden of children. More attention should be paid to those who are males, burn survivors, or skin-injured at extremities and perineum to improve therapeutic strategies and prognoses for paediatric scar patients.

Unintentional injuries in children in the south of Iran, 2004-2019: a trend analysis of mortality rates

INTRODUCTION

Injury is one of the main causes of death and disability in the world. This study was designed to determine the trend of mortality rate and years of life lost (YLLs) due to unintentional injuries in children in southern Iran.

METHOD

In this cross-sectional study, we extracted all death reports due to unintentional injuries based on age, gender and the year of death based on International Classification of Diseases (ICD-10)from the Electronic Death Registration System. The YLL analysis due to premature death related to unintentional injuries was executed by the 2015 YLL template from the WHO using the Excel V.2016 software. To examine the trend of crude mortality rate and YLL rates for different years, joinpoint regression was used based on the log-linear model.

RESULTS

During the 16-year study period (2004-2019), 6590 deaths due to unintentional injuries in children aged 0-19 years have occurred. The total YLLs due to unintentional injuries were 138 482 in males and 53 168 in females. The three main causes of YLLs in our study were transportation injuries (67.37%), drowning (7.19%) and burns (6.70%). According to the joinpoint regression analysis, the 16-year trend of YLL rate due to premature mortality was decreasing; the annual per cent change was -5.2% (95% CI -6.5% to -3.9%, p<0.001) for males and -4.3% (95% CI -5.7% to -3.0%, p<0.001) for females.

CONCLUSION

Based on the findings of this study, the trend of mortality and YLL rate has been decreasing. Road traffic injuries were the most frequent injuries and the most common cause of death. Mortality rates fell by half. To improve child survival, injuries must now be recognised as a major child health problem, and to prevent deaths from injuries in children, early and preventive measures should be taken into account.

Improving outcome after paediatric concussion: challenges and possibilities

The term concussion has permeated mainstream media and household vocabulary mainly due to awareness regarding the risks of concussion in professional contact sports, yet it occurs across a variety of settings and ages. Concussion is prevalent in infants, preschoolers, children, and adolescents, and is a common presentation or reason for referral to primary care providers, emergency departments, and specialised trauma clinics. Its broad range of symptoms and sequelae vary according to multiple individual, environmental, and clinical factors and can lead to health and economic burden. More than 20 years of research into risk factors and consequences of paediatric concussion has revealed as many questions as answers, and scientific work and clinical cases continue to expose its complexity and heterogeneity. In this Review, we present empirical evidence for improving outcome after paediatric concussion. We consider work pertaining to both sports and other injury mechanisms to provide a perspective that should be viewed as complementary to publications focused specifically on sports concussion. Contemporary challenges in prevention, diagnosis, prognosis, and intervention are discussed alongside pathways and future directions for improving outcome.

Mobile Apps Aimed at Preventing and Handling Unintentional Injuries in Children Aged <7 Years: Systematic Review

BACKGROUND

Despite various global health crises, the prevention and handling of unintentional childhood injuries remains an important public health objective. Although several systematic reviews have examined the effectiveness of different child injury prevention measures, these reviews did not address the evaluation of mobile communication intervention tools. Whether and how mobile apps were evaluated provides information on the extent to which communication theories, models, and evidence-based knowledge were considered. Previous studies have shown that the effectiveness of mobile apps increases when theories and evidence are considered during their development.

OBJECTIVE

This systematic review aimed to identify research on mobile apps dealing with the prevention and handling of unintentional injuries in children and examine the theoretical and methodological approaches thereof. In addition, this review analyzed the different needs of various target groups of the mobile apps described in the articles.

METHODS

In total, 8 electronic databases, ranging from interdisciplinary to medical and technical as well as social sciences databases, were searched for original research articles or brief reports in peer-reviewed journals or conference proceedings. Moreover, this review encompassed a systematic scan of articles published in the BMJ journal Injury Prevention. These steps were followed by a snowball search based on the literature references in the articles identified through the initial screening. The articles had to be written in English or German, published between 2008 and 2021, and evaluate mobile apps dealing with the prevention and handling of unintentional child injuries. The identified 5 studies were analyzed by 5 independent researchers using an inductive approach. Furthermore, the quality of the studies was assessed using the Mixed Methods Appraisal Tool.

RESULTS

A total of 5 articles were included and assessed with regard to overall quality of theoretical and methodological foundations, assessed variables, the focal app's architecture, and the needs of the study participants. The overall study quality was moderate, although part of this classification was due to a lack of details reported in the studies. Each study examined 1 mobile app aimed at parents and other caregivers. Each study assessed at least 1 usability- or user experience-related variable, whereas the needs of the included study participants were detailed in only 20% (1/5) of the cases. However, none of the studies referred to theories such as the Technology Acceptance Model during the development of the apps.

CONCLUSIONS

The future development and evaluation of apps dealing with the prevention and handling of child injuries should combine insights into existing models on user experience and usability with established theories on mobile information behavior. This theory-based approach will increase the validity of such evaluation studies.

Unintentional injury deaths among children under five in Hunan Province, China, 2015-2020

Injury is the most common cause of preventable morbidity and death among children under five. This study aimed to describe the epidemiological characteristics of injury-related mortality rates in children under five and to provide evidence for future preventive strategies. Data were obtained from the Under Five Child Mortality Surveillance System in Hunan Province, China, 2015-2020. Injury-related mortality rates with 95% confidence intervals (CI) were calculated by year, residence, gender, age, and major injury subtype (drowning, suffocation, traffic injuries, falls, and poisoning). And crude odds ratios (ORs) were calculated to examine the association of epidemiological characteristics with injury-related deaths. The Under Five Child Mortality Surveillance System registered 4,286,087 live births, and a total of 22,686 under-five deaths occurred, including 7586 (which accounted for 33.44% of all under-five deaths) injury-related deaths. The injury-related under-five mortality rate was 1.77‰ (95% CI 1.73-1.81). Injury-related deaths were mainly attributed to drowning (2962 cases, 39.05%), suffocation (2300 cases, 30.32%), traffic injuries (1200 cases, 15.82%), falls (627 cases, 8.27%), and poisoning (156 cases, 2.06%). The mortality rates due to drowning, suffocation, traffic injuries, falls, and poisoning were 0.69‰ (95% CI 0.67,0.72), 0.54‰ (95% CI 0.51,0.56), 0.28‰ (95% CI 0.26,0.30), 0.15‰ (95% CI 0.13,0.16), and 0.04‰ (95% CI 0.03,0.04), respectively. From 2015 and 2020, the injury-related mortality rates were 1.78‰, 1.77‰, 1.60‰, 1.78‰, 1.80‰, and 1.98‰, respectively, and showed an upward trend (χ²_trend = 7.08, P = 0.01). The injury-related mortality rates were lower in children aged 0-11 months than in those aged 12-59 months (0.52‰ vs. 1.25‰, OR = 0.41, 95% CI 0.39-0.44), lower in urban than rural areas (1.57‰ vs. 1.88‰, OR = 0.84, 95% CI 0.80-0.88), and higher in males than females (2.05‰ vs . 1.45‰, OR = 1.42, 95% CI 1.35-1.49). The number of injury-related deaths decreased with children's age. Injury-related deaths happened more frequently in cold weather (around February). Almost half (49.79%) of injury-related deaths occurred at home. Most (69.01%) children did not receive treatment after suffering an injury until they died, and most (60.98%) injury-related deaths did not receive treatment because it was too late to get to the hospital. The injury-related mortality rate was relatively high, and we have described its epidemiological characteristics. Several mechanisms have been proposed to explain these phenomena. Our study is of great significance for under-five child injury intervention programs to reduce injury-related deaths.

Pediatric Trauma in The Netherlands: Incidence, Mechanism of Injury and In-Hospital Mortality

BACKGROUND

In the Netherlands, there are no specialized or certified pediatric trauma centers, especially for severely injured children. National and regional agreements on centralization of pediatric trauma care are scarce. This study aims to describe the incidence, injury mechanism and in-hospital mortality of pediatric trauma in the Netherlands, as a prelude to the further organization of pediatric trauma care.

METHODS

A retrospective cohort analysis of data from the Dutch National Trauma Registry in 2009-2018, concerning all children (0-16 years) hospitalized due to injury in the Netherlands.

RESULTS

The annual number of admitted injured children increased from 8666 in 2009 to 13,367 in 2018. Domestic accidents were the most common cause of non-fatal injury (67.9%), especially in children aged 0-5 years (89.2%). Severe injury (injury severity score ≥  16) accounted for 2.5% and 74% of these patients were treated in level-1 trauma centers. In both deceased and surviving patients with severe injuries, head injuries were the most common (72.1% and 64.3%, respectively). In-hospital mortality after severe injury was 8.2%. Road-traffic accidents (RTAs) were the leading cause of death (46.5%).

CONCLUSIONS

Domestic accidents are the most common cause of injury, especially in younger children, whereas RTAs are the lead cause of fatal injury. Severe pediatric trauma in the Netherlands is predominantly managed in level-1 trauma centers, where a multidisciplinary team of experts is available. Improving the numbers of severely injured patients primarily brought to level-1 trauma centers may help to further reduce mortality.

Pediatric Poisonings Associated With Ingestion of Marijuana Products

BACKGROUND

Rapid changes in marijuana legislation have resulted in a wider array of products containing tetrahydrocannabinol (THC) to be legally manufactured and sold, such as edibles in the form of gummy candies and cookies. These products may be enticing to young children who mistake them for typical snack foods.

OBJECTIVE

Our aim was to describe emergency department (ED) visits due to unintentional ingestion of cannabis products among children aged birth to 11 years old in the United States.

METHODS

Using the 2019-2020 National Electronic Injury Surveillance System, U.S. ED records for poisoning events related to ingestion of THC were examined. Descriptive epidemiologic analyses were conducted to provide national estimates of the pediatric visits.

RESULTS

An estimated 1245 pediatric patient visits related to unintentional marijuana poisoning occurred. Most poisonings involved edible marijuana products and most patients were admitted to the hospital.

CONCLUSIONS

Cannabis edibles present a challenge with regard to prevention of poisonings among the pediatric population. Legislation or company policies pertaining to packaging and manufacturing are needed to limit the attraction of toddlers and young children, as well reliance on parents and caregivers for safe storage of the products. Continued and expanded public health education campaigns are warranted.

A cohort of pediatric injury patients from a hospital-based trauma registry in Northern Tanzania

Introduction

Pediatric injuries in low- and middle-income countries are a leading cause of morbidity and mortality worldwide. Implementing hospital-based trauma registries can reduce the knowledge gap in both hospital care and patient outcomes and lead to quality improvement initiatives. The goal of this study was to create a pediatric trauma registry to provide insight into the epidemiology, outcomes, and factors associated with poor outcomes in injured children.

Methods

This was a prospective observational study in which a pediatric trauma registry was implemented at a large zonal referral hospital in Northern Tanzania. Data included demographics, hospital-based care, and outcomes including morbidity and mortality. Data were input into REDCap© and analyzed using ANOVA and Chi-squared tests in SAS(Version 9.4)©.

Results

365 patients were enrolled in the registry from November 2020 to October 2021. The majority were males (n=240, 65.8%). Most were children 0-5 years (41.7%, n=152), 34.5% (n=126) were 6-11 years, and 23.8% (n=87) were 12-17 years. The leading causes of pediatric injuries were falls (n=137, 37.5%) and road traffic injuries (n=125, 34.5%). The mortality rate was 8.2% (n=30). Of the in-hospital deaths, 43.3% were children with burn injuries who also had a higher odds of mortality than children with other injuries (OR 8.72, p<0.001). The factors associated with in-hospital mortality and morbidity were vital sign abnormalities, burn severity, abnormal Glasgow Coma Score, and ICU admission.

Conclusion

The mortality rate of injured children in our cohort was high, especially in children with burn injuries. In order to reduce morbidity and mortality, interventions should be prioritized that focus on pediatric injured patients that present with abnormal vital signs, altered mental status, and severe burns. These findings highlight the need for health system capacity building to improve outcomes of pediatric injury patients in Northern Tanzania.

Burns in Israel: Etiologic, Demographic, and Clinical trends—A 9-Year Updated Comprehensive Study, 2004–2010 versus 2011–2019

Based on the Israeli National Trauma Registry (INTR) data, this study reports etiological, demographic, and clinical trends and includes all admissions to burn and trauma centers across Israel from 2011 to 2019 and compares these with 2004 to 2010 rates. From 2011 to 2019, 5,710 patients were admitted to burn centers across Israel. Children aged 0 to 1 years (25.9%), non-Jews (40.7%), and males (67.2%) remain the main groups of the burn casualties. Most of the casualties sustained 1 to 9% total body surface area (TBSA) burns with various depths. Scalds were less fatal than fire/flame-related casualties (<1 vs. 11.5%). Fewer surgical procedures were conducted for burns under 9% TBSA compared with greater TBSA. The percentage of TBSA and burn depth were found to be the most significant predictor of mortality among all age groups (>200 times increased risk with full-thickness burns >30% TBSA burn) and correlated with prolonged length of stay (>7 days).

Epidemiology of unintentional injury in children admitted to ICU in China mainland: a multi-center cross-sectional study

BACKGROUND

To investigate the epidemiology of unintentional injury in children admitted to Intensive Care Unit (ICU) in China mainland.

METHODS

A total of 39 hospitals in 19 provinces contributed to the 1-day point prevalence study of serious unintentional injury in children aged 0-16 years admitted to ICU.

RESULTS

A total of 1,017 patients from the 39 participating ICUs on the study day were included. Among them, 56 pediatric patients were identified to be suffered from unintentional injury from 18 participating ICUs, accounting for 5.5% (56/1,017) of all the ICU patients. The percentage of boys was more than twice the percentage of girls. Most patients had an age of less than 6 years old (n=42, 75%). The leading cause of unintentional injury was fall (n=17, 30.4%). The patterns of unintentional injury in children were age-related. There were no urban-rural differences in our cohort. The injury happened on 12:00-18:00 PM in 27 cases (48.2%), and 28 patients (50%) had injuries happened at working day. 35 patients (62.5%) received primary treatment at local hospitals. Thirty-five patients (62.5%) needed resuscitation in the emergency department, 15 patients (26.8%) still needed resuscitation in ICU. These 56 children suffered from a total of 106 lesions corresponding to 1.89 lesions per patient. Respiratory failure was most commonly seen (n=18, 32.1%). There was no death in our cohort during the study. After effective treatment during their ICU stay, 45 (80.4%) patients showed improvement, with Glasgow Coma Scale (GCS), Pediatric Trauma Score (PTS) and Pediatric Risk of Mortality III (PRISM III) score significantly better than those before treatment (P<0.05).

CONCLUSIONS

Higher injury rates among children under 6 years old of age illustrate the need for preventive measures, especially programs and public policies targeting this high-risk group.

Pediatric trauma burden in Tanzania: analysis of prospective registry data from thirteen health facilities

Background

Trauma is among the leading causes of morbidity and mortality among pediatric and adolescent populations worldwide, with over ninety percent of childhood injuries occurring in low-income and middle-income countries. Lack of region-specific data on pediatric injuries is among the major challenges limiting the ability of health systems to implement interventions to prevent injuries and improve outcomes. We aim to characterize the burden of pediatric health injuries, initial healthcare interventions and outcomes seen in thirteen diverse healthcare facilities in Tanzania.

Methods

This was a prospective cohort study of children aged up to 18 years presenting to emergency units (EUs) of thirteen multi-level health facilities in Tanzania from 1^st October 2019 to 30^th September 2020. We describe injury patterns, mechanisms and early interventions performed at the emergency units of these health facilities.

Results

Among 18,553 trauma patients seen in all thirteen-health facilities, 4368 (23.5%) were children, of whom 2894 (66.7%) were male. The overall median age was 8 years (Interquartile range 4–12 years). Fall 1592 (36.5%) and road traffic crash (RTC) 840 (19.2%) were the top mechanisms of injury. Most patients 3748 (85.8%) arrived at EU directly from the injury site, using motorized (two or three) wheeled vehicles 2401 (55%). At EU, 651 (14.9%) were triaged as an emergency category. Multiple superficial injuries (14.4%), fracture of forearm (11.7%) and open wounds (11.1%) were the top EU diagnoses, while 223 (5.2%) had intracranial injuries. Children aged 0–4 years had the highest proportion (16.3%) of burn injuries. Being referred and being triaged as an emergency category were associated with high likelihood of serious injuries with adjusted odds ratio (AOR) 4.18 (95%CI 3.07–5.68) and 2.11 (95%CI 1.75–2.56), respectively. 1095 (25.1%) of patients were admitted to inpatient care, 14 (0.3%) taken to operation theatre, and 25 (0.6%) died in the EU.

Conclusions

In these multilevel health facilities in Tanzania, pediatric injuries accounted for nearly one-quarter of all injuries. Over half of injuries occurred at home. Fall from height was the leading mechanism of injury, followed by RTC. Most patients sustained fractures of extremities. Future studies of pediatric injuries should focus on evaluating various preventive strategies that can be instituted at home to reduce the incidence and associated impact of such injuries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40621-022-00369-7.

Unintentional injuries of children and adolescents treated in emergency medical services: A cross-sectional study

Background/Aim: Unintentional injuries among children and adolescents have become a common issue in public healthcare. The study objective was to analyse the characteristics and identify predictors associated with unintentional injuries in children and adolescents treated in emergency medical services (EMS) in the Republic of Srpska, Bosnia and Herzegovina. Methods: A cross-section study with retrospective analysis of WebMedic e-database from 14 EMS, in the period between January 2018 and December 2020 was conducted. Research included patients with unintentional injuries, aged ≤ 19 years, of both sexes. For comparison between groups, Chi-squared and multivariate logistic regression were used in risk factor analysis. Results: A total of 1,856 cases were identified, most injuries resulted from falls (46.7 %) and traffic injuries (26.9 %). Boys were significantly more affected by injuries than girls (p < 0.001). Falls were the major cause for reporting to EMS among age groups of children (0-9 years) and adolescents (10-14 years), whereas injuries in traffic were dominant in adolescents aged 15 to 19. The most common injuries were head injuries (35.7 %). Risk factors of unintentional injuries were age (p < 0.001), sex (p = 0.046), weekday (p = 0.016), winter (p = 0.014), body region (head, abdomen, lower and upper limbs (p < 0.001), thorax (p = 0.009)). Conclusions: There were significant differences in characteristics of unintentional injuries according to age and sex. Chances for occurrence of unintentional injuries among children increased with their age, especially for boys. These differences might indicate areas where preventive measures should be undertaken.