Injuries among Amish children: opportunities for prevention

Distribution of Hay-Hole Covers Prevents Injuries from Falls Through Hay Holes

Hay-holes are openings on the second floor of barns used to drop feed to ground level. Hay-hole falls (HHFs) are a unique problem among Anabaptist communities, especially for children. To follow-up on our previous study that created the Anabaptist Youth Trauma Prevention Consortium with distribution of 231 hay-hole covers in South Central Pennsylvania, we compared a five-year period before cover distribution with the 5-year period after. Data were stratified by phase: Before Cover Implementation (BC): 1/2011-12/2016, After Cover Implementation (AC): 1/2017-12/2021. 49 patients met inclusion criteria. There was a 47% decrease in the number of HHF from the BC phase to the AC phase, suggesting that cover distribution has significantly impacted HHF incidence. Further investigation is needed to elucidate the long-term impact of cover distribution and to guide future interventions, such as another round of cover distribution or improvements in the design of these covers for long-term use.

Infrastructure and Injury Prevention in Cycling

The focus of this article centers on bicycle injury prevention and related infrastructure. The article discusses the current epidemiology of cycling injuries, and known prevention strategies, specifically individual recommended practices related to helmet use in both adult and pediatric populations. The article also discusses different ways in which the environment plays a role in protecting cyclists from injuries, and what environmental changes have been adopted to reduce the likelihood for cycling injuries.

An Overview of Amish Mortalities at a Level I Trauma Center

BACKGROUND

The Amish population is a unique subset of patients that may require a specialized approach due to their lifestyle differences compared to the general population. With this reasoning, Amish mortalities may differ from typical trauma mortality patterns. We sought to provide an overview of Amish mortalities and hypothesized that there would be differences in injury patterns between mortalities and survivors.

METHODS

All Amish trauma patients who presented and were captured by the trauma registry at our Level I trauma center over 20 years (1/2000-2004/2020) were analyzed. A retrospective chart review was subsequently performed. Patients who died were of interest to this study. Demographic and clinical variables were analyzed for the mortalities. Mortalities were then compared to Amish patients who survived.

RESULTS

There were 1827 Amish trauma patients during the study period and, of these, 32 (1.75%) were mortalities. The top 3 mechanisms of injury leading to mortality were falls (34.4%), pedestrian struck (21.9%), and farming accidents (15.6%). Pediatric (age ≤ 14y) (25%) and geriatric (age ≥ 65y) (28.1%) had the highest percentage of mortalities. Mortalities in the Amish population were significantly older (mean age: 39 years vs 27 years, P = .003) and had significantly higher ISS (mean ISS: 29 vs 10, P < .001) compared to Amish patients who survived.

DISCUSSION

The majority of mortalities occurred in the pediatric and geriatric age groups and were falls. Further intervention and outreach in the Amish population should be done to highlight this particular cause of mortality.

LEVEL OF EVIDENCE

Level III, epidemiological.

Identifying barriers and considerations for cochlear implantation in Amish children

OBJECTIVE

To determine if barriers to cochlear implantation (CI) exist with respect to Amish children and to describe unique considerations associated with CI and subsequent otologic care in the Amish population.

METHODS

Out of all patients who underwent CI at a tertiary care pediatric hospital from 2008 to 2019, Amish children were age-matched to the remainder of the cohort to compare demographics and care-related metrics including etiology of hearing loss, age at time of initial hearing-related appointment and at CI, total number of pre- and post-operative audiologic and otologic appointments, and post-operative complications. Social considerations that may pose barriers to care were collected for descriptive analysis.

RESULTS

Since 2008, 232 children underwent CI, of which 8 implants were performed on Amish children. Six (75%) Amish children underwent newborn hearing screening and 3(38%) were found to have syndromic etiology for hearing loss. While Amish patients had a lower number of both audiologic (15 vs 33.5, p<.001) and otologic (4.5 vs 8.5, p=.028) appointments when compared to age-matched controls, median age at the time of implantation for the whole sample was not different between groups (2.5 vs 2.0 years, p=.211). From a social standpoint, limitations in transportation, telephone communication, and ability to recharge processor batteries must be considered in the Amish population.

CONCLUSION

Amish children undergoing CI face unique barriers to care including transportation and technologic limitations, leading to overall fewer hearing-related appointments when compared to an age-matched cohort. Understanding societal differences is important to facilitate optimal care for Amish children with hearing loss.