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Ali AE, Sharma S, Elebute OA, Ademuyiwa A, Mashavave NZ, Chitnis M, Abib S, Wahid FN. Trauma and sexual abuse in children-Epidemiology, challenges, management strategies and prevention in lower- and middle-income countries. Semin Pediatr Surg 2023; 32:151356. [PMID: 38041908 DOI: 10.1016/j.sempedsurg.2023.151356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
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.
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Affiliation(s)
- Abdelbasit E Ali
- Department of Pediatric Surgery, King Saud Medical City, KSA, Associate Professor of Surgery, Faculty of Medicine, University of Khartoum, Sudan
| | - Shilpa Sharma
- MCh, PhD, ATLS Faculty, ISTPF(UK), FIAPS, MNAMS, FAMS. Professor of Pediatric Surgery, Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Olumide A Elebute
- College of Medicine, University of Lagos and Lagos University Teaching Hospital Idi Araba, Lagos, Nigeria
| | - Adesoji Ademuyiwa
- Department of Surgery, College of Medicine, University of Lagos & Honorary Consultant and Chief Pediatric Surgery Unit, Lagos University Teaching Hospital. Lagos, Nigeria
| | - Noxolo Z Mashavave
- Department of Pediatric Surgery, East London Hospital Complex, Walter Sisulu University, East London, Eastern Cape, South Africa
| | - Milind Chitnis
- Department of Pediatric Surgery, East London Hospital Complex, Walter Sisulu University, East London, Eastern Cape, South Africa
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Apostolopoulou K, Setia V, Pettorini B, Parks C, Ellenbogen J, Dawes W, Mallucci C, Mehta B, Sinha A. Secure windows for child safety: a retrospective study of window falls in children, aiming to raise prevention awareness. Childs Nerv Syst 2023; 39:3195-3205. [PMID: 37093265 PMCID: PMC10124675 DOI: 10.1007/s00381-023-05964-7] [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: 12/13/2022] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The aim of the study is to enhance understanding, raise awareness and inform prevention programmes regarding potential factors that lead to severe paediatric injuries caused by unintentional falls from windows. METHODS This is a retrospective review from a major Trauma Centre, covering the majority of North West England and North Wales and included children under the age of 16 that had sustained falls from windows and were hospitalised between April 2015 and June 2020. RESULTS Overall, 825 patients' records have been reviewed, 39% of which exhibited neurosurgical injuries (322 admissions). The most common cause of injury was falls (42%), out of which 19% was identified as falls from windows which was eventually the core focus of this review (25 patients). The records showed that 72% of the falls were not witnessed by another individual, suggesting that children were being left unattended. Average GCS recorded at presentation was 11.2 and 56% of cases were identified as severe major traumas. With a mean stay of 2.2 days in ICU, 1.6 days in HDU and 6 days in the neurosurgical clinic, average treatment costs per patient were £4,493, £651 and £4,156 respectively. Finally, 52% of patients were identified to require long-term physiotherapy/occupational therapy due to permanent disabilities, 20% long-term antiepileptic treatment for seizures and 44% long-term psychological services input. CONCLUSION This study presents our experience at a major tertiary trauma centre in the UK over a 5-year period, from a paediatric neurosurgical injuries perspective due to fall from windows. We aim to raise awareness and highlight the importance of establishing prevention programmes which would hopefully decrease the incidence of paediatric window falls.
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Affiliation(s)
| | - Vikrant Setia
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Benedetta Pettorini
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Chris Parks
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jonathan Ellenbogen
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - William Dawes
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Bimal Mehta
- A&E Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Ajay Sinha
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Alamr F, Alzahrani HMA, Alghamdi AMA, Alzhrani ASA, Alzahrani FAA, Alkhediwi LMA, Alghamdi MAA, Alhomrani MAM, Aburaida OM. Prevalence and Risk Factors of Home Accidents Among Children Under Five Years of Age in Al-Baha, Saudi Arabia. Cureus 2023; 15:e46846. [PMID: 37954756 PMCID: PMC10637285 DOI: 10.7759/cureus.46846] [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: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
INTRODUCTION Internationally, home accidents are the main cause of preventable debilities and death among children and young persons. Many times, children survive accidents with physical or mental damage that curtails their activities in the long term. The most commonly reported accidental injuries include head injuries, open wounds, and poisoning. This study aims to assess the prevalence and factors associated with home accidents among children under five years old in the Al-Baha region, Saudi Arabia. METHODS A descriptive cross-sectional study was conducted among the community population in the Al-Baha region, Saudi Arabia, targeting all accessible parents who have children under five years old. A convenience sampling technique was used for sample collection during the period of three months (May 2023 to July 2023), where all accessible parents who fulfilled the inclusion criteria and agreed to participate were invited to fill out the received online study questionnaire. Section 1 covered the participants' demographic data. The second section covered the children's data and the third section included questions about home accident types, frequency, severity, and causes. Results: The findings showed that 205 (58.2%) study parents reported a history of home accidents among their children. As for accident data, about 122 (59.5%) of the injured children were males. The most reported home accidents among children were fall/impact with hard objects (58.2%), burn (30.7%), asphyxia (27.6%), and poisoning (24.4%). Families with more than seven members and those with four or more siblings significantly experienced higher home accidents than others (p<0.001). CONCLUSION In conclusion, the current study showed that home accidents among children under five years of age were mainly falls and burns; they were mainly found among male children and children in families with highly educated mothers and many kids. A majority of the reported cases of home accidents were less severe and the hospitalization rates with complications were very few.
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Affiliation(s)
- Fahad Alamr
- College of Medicine, Al-Baha University, Al-Baha, SAU
| | | | | | | | | | | | | | | | - Omer M Aburaida
- Paediatrics and Child Health, College of Medicine, Al-Baha University, Al-Baha, SAU
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Al Babtain I, Almalki Y, Masud N, Asiri D. Unintentional Injuries Among Young Adolescents at a Level-One Trauma Center in Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e36645. [PMID: 37101997 PMCID: PMC10123526 DOI: 10.7759/cureus.36645] [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: 03/23/2023] [Indexed: 04/28/2023] Open
Abstract
Background Unintentional injuries are the leading preventable cause of mortality across different demographics. This study aims to assess the prevalence, severity, contributing factors, and clinical outcomes of unintentional injuries among adolescent patients. Methods A retrospective study was conducted using the charts of patients admitted with unintentional injuries (motor vehicle accidents (MVA), falls, pedestrian injuries, burns, etc.) to the emergency department (ED) from January 2016 to December 2018 at a level-one trauma center in Riyadh, Saudi Arabia. A total of 721 patients' charts were reviewed, but only 52 patients were consecutively included as per the definition of an adolescent. All variables, including severity and outcome, were assessed. Results The overall prevalence of unintentional injuries was 7.2 per 100 adolescent patients. The most common cause of unintentional injury were MVAs, which were reported in 35 (71%), with head and neck region injuries among 38 (73%) patients. The overall mortality was noted at 10 per 52 (19%) patients. The mean Injury Severity Score (ISS) score was 17.81±12.76. The patients who stayed longer in the ED were not associated with pelvic and lower extremity injuries, with a p-value=0.008. The ISS was the significant predictor of mortality, with an odds ratio (OR) of 1.6, a confidence interval (CI) of 1.02-2.65, and a p-value=0.04. Conclusion MVAs were the main cause of unintentional injuries among adolescents. Future recommendation plans for adolescents should include stricter implementation of road traffic laws to control this early, preventable death among adolescents.
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Affiliation(s)
| | - Yara Almalki
- General Surgery, King Abdulaziz Medical City Riyadh, Riyadh , SAU
| | - Nazish Masud
- Biostatistics, Epidemiology and Environmental Health Sciences, Georgia Southern University, Statesboro, USA
| | - Deemah Asiri
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Vieira Abib SDC. The importance of pediatric trauma prevention: The work of Criança Segura - Safe Kids Brazil. J Pediatr Surg 2023; 58:198-203. [PMID: 36376125 DOI: 10.1016/j.jpedsurg.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/11/2022] [Indexed: 11/15/2022]
Abstract
Trauma is the leading cause of death in children and adolescents less than 14 years of age worldwide. Although there have been advances regarding treatment in the last decades, it is still complex to assemble well-trained teams and proper hospitals to care for traumatized children. The most effective vaccine and the less expensive tool to deal with such a burden is prevention. The aim of the Non-Governmental Organization (NGO) Criança Segura - Safe Kids Brazil is to work with child and adolescent trauma prevention through three pillars: mobilization, communication, and public policy. Nationwide actions, campaigns, education material, events, research, and proposing laws resulted in a 53% decrease of trauma deaths in Brazil in a 20-year period. The strategy contributes to build the culture of prevention in Brazil with the involvement of every sector of society. Childhood trauma prevention is effective in decreasing trauma deaths. Criança Segura is now part of Children's Villages, an international organization that will be able to multiply the model through different countries. LEVELS OF EVIDENCE: Review article.
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Marcondes P, Rosas GH, González MEL, Queiroz AAAD, Marques PS. Poly(vinyl alcohol)/poly(glycerol) dendrimer hydrogel mediated green synthesis of silver nanoparticles. POLIMEROS 2022. [DOI: 10.1590/0104-1428.20220025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Botelho F, Truche P, Mooney DP, Caddell L, Zimmerman K, Roa L, Alonso N, Bowder A, Drumond D, Abib SDCV. Pediatric trauma primary survey performance among surgical and non-surgical pediatric providers in a Brazilian trauma center. Trauma Surg Acute Care Open 2020; 5:e000451. [PMID: 32724859 PMCID: PMC7375395 DOI: 10.1136/tsaco-2020-000451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/05/2020] [Accepted: 06/13/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Trauma is the leading cause of death and disability among Brazilian children and adolescents. Trauma protocols such as those developed by the Advanced Trauma Life Support course are widely taught, but few studies have assessed the degree to which the use of protocolized trauma assessment improves outcomes. This study aims to quantify the adherence of trauma assessment protocols among different types of frontline trauma providers. METHODS A prospective observational study of pediatric trauma care in one of the busiest Latin American trauma centers was conducted during 6 months. Trauma primary survey assessments were observed and adherence to each step of a standardized primary assessment protocol was recorded. Adherence to the assessment protocol was compared among different types of providers, the time of presentation and severity of injury. The relationship between protocol adherence and clinical outcomes including mortality, length of hospital stay, admission to pediatric intensive care unit, use of blood components, mechanical ventilation and number of imaging exams performed in the first 24 hours were also assessed. RESULTS Emergency department evaluations of 64 patients out of 274 pediatric admissions were observed over a period of 6 months. 50% of the primary assessments were performed by general surgeons, 34.4% by residents in general surgery and 15.6% by pediatricians. There was an average adherence rate of 34.1% to the trauma protocol. Adherence among each specific step included airway: 17.2%; breathing: 59.4%; circulation: 95.3%; disability: 28.8%; exposure: 18.8%. No differences between specialties were observed. Patients with a more thorough primary assessment underwent fewer CT scans (receiver operating characteristic curve area: 0.661; p=0.027). CONCLUSIONS Our study demonstrates that trauma assessment protocol adherence among trauma providers is low. Thorough initial assessment reduced the use of CT scans suggesting that standardized pediatric trauma assessments may be a way to reduce unnecessary radiological imaging among children. LEVEL OF EVIDENCE IV. STUDY TYPE Pediatric and global trauma.
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Affiliation(s)
- Fabio Botelho
- Cirurgia Pediatrica, Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paul Truche
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - David P Mooney
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Luke Caddell
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathrin Zimmerman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Nivaldo Alonso
- Cirurgia Plastica, Universidade de São Paulo, São Paulo, Brazil
| | - Alexis Bowder
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
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Bardón Cancho EJ, Arribas Sánchez C, Rivas García A, Lorente Romero J, Vázquez López P, Marañón Pardillo R. Management and serious risk factors associated with unintentional injuries in paediatric emergencies in Spain. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Al Rumhi A, Al Awisi H, Al Buwaiqi M, Al Rabaani S. Home Accidents among Children:
A Retrospective Study at a Tertiary Care Center in Oman. Oman Med J 2020; 35:e85. [PMID: 32042466 PMCID: PMC6975254 DOI: 10.5001/omj.2020.03] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/23/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We sought to identify the prevalence, commonest causes, and severity of home accident injuries and their effects on children who present to the emergency department (ED) of a university-tertiary hospital in Oman. METHODS We conducted a retrospective study among children aged ≤ 18 years old who presented with home accidents to the ED between January and June 2017. A checklist for data collection was designed to include demographic data, causes and effects of home accidents, and treatment outcomes. The data was retrieved from the hospital electronic patient records. RESULTS A total of 1333 children presented to the ED over six months as a result of unintentional home accidents, giving a prevalence of 7.7% from all children who visited the ED. There was a significant male to female ratio of 1.7:1. The most prevalent causes for home accidents were 'falls' in 716 (53.7%) children, followed by 'struck by/against-animate/inanimate mechanical force' in 201 (15.1%) children. 'Poisoning' was the third major cause in 117 (8.8%) children. Severity scale showed that around 36.0% of children suffered from severe injuries and 5.4% were admitted to the hospital. CONCLUSIONS Despite this study being a single-center study in Oman, it indicates a high prevalence and severity of unintentional home accidents among children. The study findings suggest the need for implementing strategies to raise public awareness of child safety at home and to improve the preparedness of healthcare providers in ED to deal with such accidents.
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Affiliation(s)
- Alya Al Rumhi
- Nursing Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Huda Al Awisi
- Nursing Department, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Salim Al Rabaani
- Nursing Department, Sultan Qaboos University Hospital, Muscat, Oman
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Bardón Cancho EJ, Arribas Sánchez C, Rivas García A, Lorente Romero J, Vázquez López P, Marañón Pardillo R. [Management and serious risk factors associated with unintentional injuries in paediatric emergencies in Spain]. An Pediatr (Barc) 2019; 92:132-140. [PMID: 31266733 DOI: 10.1016/j.anpedi.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Thirty-eight million patients with injuries are treated in Emergency Departments every year, 90% of them being in the form of unintentional injuries (UIs). There are currently no global records of its management in Spain, or the risk factors that may be associated with them. The objective of this study is to describe the management of UIs in Spanish paediatric emergency departments, and to analyse factors related to the presence of serious injuries. MATERIAL AND METHODS A sub-study of a prospective multicentre observational study conducted over 12months in 11hospitals of the Spanish Paediatric Emergency Research Group (RiSEUP-SPERG), including children from 0 to 16years of age consulting for UIs. Epidemiological data, circumstances of the injury, and data on emergency care and discharge destination were recorded on the 13th day of each month. RESULTS A total of 10,175 episodes were recorded, of which 1,941 were UIs (19.1%), including 1,673, of which 257 (15.4%) were severe. The most frequent complementary test was simple radiography (60.0%), and the most frequent procedure was limb immobilisation (38.6%). A significant relationship was found between presenting with a severe UI and age >5 years (OR2.24; 95%CI: 1.61-3.16), history of fracture (OR2.05; 95%CI: 1.22-3.43), or sports activity as a mechanism of injury (OR1.76; 95%CI: 1.29-2.38), among others. CONCLUSION In Spain, most UIs are not serious. X-rays and immobilisation of extremities are the most frequently performed tests and procedures. Severe UIs were associated with individual factors, such as age >5years or history of fracture, and with sports activity as a mechanism associated with severity. It is vital to implement measures to improve the prevention of these injuries and to support the training of caregivers through educational programmes.
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Affiliation(s)
- Eduardo J Bardón Cancho
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Cristina Arribas Sánchez
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Arístides Rivas García
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Jorge Lorente Romero
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Paula Vázquez López
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Rafael Marañón Pardillo
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
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