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Singh S, Babl FE, Hearps SJC, Hoch JS, Dalziel K, Cheek JA. Trends of paediatric head injury and acute care costs in Australia. J Paediatr Child Health 2022; 58:274-280. [PMID: 34523175 DOI: 10.1111/jpc.15699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/01/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
AIM Paediatric head injuries (PHI) are the most common cause of trauma-related emergency department (ED) presentations. This study sought to report the incidence of PHI in Australia, examine the temporal trends from 2014 to 2018 and estimate the patient and population-level acute care costs. METHODS Taking a public-sector health-care perspective, we applied direct and indirect hospital costs for PHI-related ED visits and acute admissions. All costs were inflated to 2018 Australian dollars ($). The patient-level analysis was performed with data from 17 841 children <18 years old enrolled in the prospective Australasian Paediatric Head Injury Study. Mechanisms of injury were characterised by the total and average acute care costs. The population-level data of PHI-related ED presentations were obtained from the Independent Hospital Pricing Authority. Age-standardised incidence rates (IR) and incidence rate ratios (IRR) were calculated, and negative binomial regression examined the temporal trend. RESULTS The age-standardised IR for PHI was 2734 per 100 000 population in 2018, with a significant increase over 5 years (IRR 1.13, 95% confidence interval (CI) 1.12-1.14; P < 0.001) and acute care costs of $154 million. Falls occurred in 70% of the study cohort, with average costs per episode of $666 (95% CI: $627-$706), accounting for 47% of acute care costs. Transportation-related injuries occurred in 4.1% of the study cohort, with average costs per episode of $8555 (95% CI: $6193-$10 917), accounting for 35% of acute care costs. CONCLUSION PHI have increased significantly in Australia and are associated with substantial acute care costs. Population-based efforts are required for road safety and injury prevention.
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Affiliation(s)
- Sonia Singh
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California, United States
| | - Franz E Babl
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Jeffrey S Hoch
- Center for Healthcare Policy and Research, University of California at Davis, Sacramento, California, United States.,Division of Health Policy and Management, Department of Public Health Sciences, University of California at Davis, Davis, California, United States
| | - Kim Dalziel
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Centre for Health Policy, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - John A Cheek
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
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Beck B, Teague W, Cameron P, Gabbe BJ. Causes and characteristics of injury in paediatric major trauma and trends over time. Arch Dis Child 2019; 104:256-261. [PMID: 30279158 DOI: 10.1136/archdischild-2018-315565] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate causes, characteristics and temporal trends of paediatric major trauma. DESIGN A retrospective review of paediatric major trauma (<16 years of age) was conducted using data from the population-based Victorian State Trauma Registry from 2006 to 2016. Temporal trends in population-based incidence rates were evaluated using Poisson regression. SETTING Victoria, Australia. RESULTS Of the 1511 paediatric major trauma patients, most were male (68%), had sustained blunt trauma (87%) and had injuries resulting from unintentional events (91%). Motor vehicle collisions (15%), struck by/collisions with an object or person (14%) and low falls (13%) were the leading mechanisms of injury. Compared with those aged 1-15 years, a greater proportion of non-accidental injury events were observed in infants (<1 year) (32%). For all patients, isolated head injury (29%), other/multitrauma (27%) and head and other injuries (24%) were the most prevalent injury groups. The incidence of paediatric major trauma did not change over the study period (incidence rate ratio (IRR)=0.97; 95% CI 0.92 to 1.02; p=0.27), which was consistent in all age groups. There was a 3% per year decline in the incidence of transport events (IRR=0.97; 95% CI 0.94 to 0.99; p=0.005), but no change in the incidence of falls of any type (IRR=1.01; 95% CI 0.97 to 1.04; p=0.70) or other events (IRR=1.00; 95% CI 0.97 to 1.02; p=0.79). The overall in-hospital mortality rate was 7.2%. CONCLUSIONS This study demonstrated no change in the incidence of paediatric major trauma over an 11-year period. Given the potential lifelong impacts of serious injury in children, additional investment and coordination of injury prevention activities are required.
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Affiliation(s)
- Ben Beck
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Warwick Teague
- Trauma Service, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Farr Institute, Swansea University Medical School, Swansea University, Swansea, UK
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Liu S, Zhou H, Ma J, Wang C, Chen Z, Chen S, Yang Y, Liu X, Peng J, Duan L, Deng X. Knowledge, attitudes, and behaviors related to child safety restraint in citizens of Shenzhen Municipality, China, and the associations between these factors. TRAFFIC INJURY PREVENTION 2018; 19:42-48. [PMID: 28534715 DOI: 10.1080/15389588.2017.1329534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 05/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE A child safety restraint (CSR) is an effective measure to reduce the risk of child injury from traffic collisions. This study aims to explore knowledge, attitudes, and behaviors regarding CSRs in a Chinese population. METHODS A cross-sectional survey regarding CSR use was conducted from April to May 2014 in Shenzhen municipality. Respondents were parents who had at least one child 0 to 6 years of age and owned a car. These parents provided a self-report of demographic characteristics as well as information about their knowledge, attitudes, and behaviors toward CSR use. RESULTS Most respondents had a fair level of knowledge about CSRs, with higher mean knowledge scores demonstrated among the respondents who were male, had an advanced degree, had a higher income, owned an expensive car, had an older child, drove frequently with children, and routinely drove greater distances with children. In addition, most respondents had a more positive attitude toward CSR use, with a higher mean attitude score among those who had an advanced degree, owned an expensive car, drove frequently with children, and routinely drove greater distances with children. However, some myths regarding CSR use also existed (e.g., parents can effectively protect their children in a car collision by holding them, they are not required to purchase the CSR for child safety if there is no mandatory provision by law, among others). Among 3,768 respondents who had at least one child and a car, 27.8% (1,047) had a CSR and 22.9% (864) used the CSR. A logistic regression model showed the likelihood of CSR ownership to be higher if respondents drove frequently or greater distances and was dependent on both the education level of the respondents and the age of the children. The frequency of CSR use increased as the age of children decreased (P = .0274). Respondents who owned a CSR and those who frequently used CSRs had higher mean knowledge and mean attitude scores. CONCLUSIONS This observational study found that although the majority of respondents had fair levels of knowledge and positive attitudes, they had lower rates of CSR ownership and use. Therefore, efforts at developing opportunities to expand public awareness of CSR use should be made to improve child passenger safety practices and eliminate child injury caused by traffic collisions.
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Affiliation(s)
- Shengyuan Liu
- a Department of Chronic Non-communicable Disease Control and Prevention , Shenzhen Nanshan Center for Chronic Disease Control , Shenzhen, Guangdong , China
| | - Haibin Zhou
- b Department of Chronic Non-communicable Disease Control and Prevention , Shenzhen Center for Chronic Disease Control , Shenzhen, Guangdong , China
| | - Jianping Ma
- a Department of Chronic Non-communicable Disease Control and Prevention , Shenzhen Nanshan Center for Chronic Disease Control , Shenzhen, Guangdong , China
| | - Changyi Wang
- a Department of Chronic Non-communicable Disease Control and Prevention , Shenzhen Nanshan Center for Chronic Disease Control , Shenzhen, Guangdong , China
| | - Zhongwei Chen
- a Department of Chronic Non-communicable Disease Control and Prevention , Shenzhen Nanshan Center for Chronic Disease Control , Shenzhen, Guangdong , China
| | - Sihan Chen
- a Department of Chronic Non-communicable Disease Control and Prevention , Shenzhen Nanshan Center for Chronic Disease Control , Shenzhen, Guangdong , China
| | - Yingzhou Yang
- b Department of Chronic Non-communicable Disease Control and Prevention , Shenzhen Center for Chronic Disease Control , Shenzhen, Guangdong , China
| | - Xiaoli Liu
- b Department of Chronic Non-communicable Disease Control and Prevention , Shenzhen Center for Chronic Disease Control , Shenzhen, Guangdong , China
| | - Ji Peng
- b Department of Chronic Non-communicable Disease Control and Prevention , Shenzhen Center for Chronic Disease Control , Shenzhen, Guangdong , China
| | - Leilei Duan
- c National Center for Chronic Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention , Beijing , China
| | - Xiao Deng
- c National Center for Chronic Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention , Beijing , China
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Pan S, Du W, Jiang F, Bilston L, Brown J, Shen X. Restraint use and seating position among child car passengers: an observational study in Shanghai. ACCIDENT; ANALYSIS AND PREVENTION 2011; 43:2195-2199. [PMID: 21819852 DOI: 10.1016/j.aap.2011.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 05/17/2011] [Accepted: 06/22/2011] [Indexed: 05/31/2023]
Abstract
Child passenger restraint practices in China are poorly characterized and few direct observational studies have been performed. This study aims to describe child passenger restraint use and to investigate factors influencing the restraint practices. A cross-sectional observational study was conducted at toll-gates in Shanghai during an 11-day period in June in 2009. A pro-forma observation checklist was used to collect data related to restraint use by child passengers aged ≤ 12 years, restraint use by drivers, and the number of child passengers traveling in passenger cars registered in Shanghai. Adjusted risk ratios (RR) comparing those children who were properly rear seated with those in other positions (front seat, on adult's lap) and any restraint use with no restraint use were evaluated using multivariate binomial regression with robust variance estimation. Among 967 children observed, 44.1% of children were in suboptimal seating positions (i.e., 12.2% in the front seat and 31.9% in adult laps) and 93.9% were unrestrained. Children aged ≤ 4 years (RR: 0.35, 95% Confidence Interval: 0.28-0.44), and those who were the only child in a car (RR: 0.84, 95% confidence interval: 0.74-0.96) had a lower likelihood of being properly rear seated. Children traveling with unrestrained drivers (RR: 0.09, 95% confidence interval: 0.01-0.60) were less likely to be restrained. This study demonstrates low restraint use and common suboptimal seating positions for child passengers in China and relates these to driver restraint use. These findings support the need for targeted programs to improve child restraint practices in China.
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Affiliation(s)
- Shuming Pan
- Emergency Department, Xinhua Hospital, and Faculty of Medicine, Shanghai Jiaotong University, China; Shanghai Paediatric Research Institute, Shanghai Key Laboratory of Children's Environmental Health, China
| | - Wei Du
- Neuroscience Research Australia, University of New South Wales, Australia; Institute of Population Research, Peking University, China; The George Institute for International Health, Faculty of Medicine, University of Sydney, Australia
| | - Fan Jiang
- Shanghai Paediatric Research Institute, Shanghai Key Laboratory of Children's Environmental Health, China; Department of Developmental and Behavioural Paediatrics, Shanghai Children's Medical Centre, China
| | - Lynne Bilston
- Neuroscience Research Australia, University of New South Wales, Australia; Prince of Wales Clinical School, University of New South Wales, Australia
| | - Julie Brown
- Neuroscience Research Australia, University of New South Wales, Australia; School of Medical Sciences, University of New South Wales, Australia
| | - Xiaoming Shen
- Shanghai Paediatric Research Institute, Shanghai Key Laboratory of Children's Environmental Health, China.
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Du W, Finch CF, Hayen A, Bilston L, Brown J, Hatfield J. Relative benefits of population-level interventions targeting restraint-use in child car passengers. Pediatrics 2010; 125:304-12. [PMID: 20064863 DOI: 10.1542/peds.2009-1171] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Because public health resources for injury prevention are limited, methods for comparing competing strategies are needed. We aimed to estimate potential injury reductions for 4 population-level interventions that target restraint practices for child car passengers aged 0 to 12 years. METHODS Population-attributable risk fraction (PARF) is a population-level estimate of excess risk from exposure to a risk factor. PARFs were calculated for each intervention scenario by using published age-specific mortality/injury relative-risk estimates; restraint practices among injured child car passengers from police-collected data; and observational data for correctness of restraint use in New South Wales, Australia. PARF reductions were estimated for population uptakes of 25%, 50%, and 75%. RESULTS Assuming a 50% population uptake, (1) promoting age-appropriate restraint use could prevent additional fatalities (5.1%, infants; 3.4%, 1- to 6-year-olds) and nonfatal injuries (3.2%, infants; 16.2%, 1- to 6-year-olds) compared with promoting any restraint use; (2) further encouraging correct age-appropriate restraint use could also prevent additional fatalities (9.1%, infants; 14.3%, 1- to 6-year-olds) and nonfatal injuries (9.2%, infants; 10.7%, 1- to 6-year-olds); and (3) for children aged 7 to 12 years, promoting correct use of restraints could prevent an additional 3.4% fatalities and 3.1% nonfatal injuries compared with promoting any restraint use. CONCLUSIONS Interventions that target child passenger-restraint practices offer population-level benefits in terms of reduction in fatalities and injuries. These tangible benefits call for action internationally, not only to promote restraint use but correct age-appropriate restraint use for child car passengers.
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Affiliation(s)
- Wei Du
- the George Institute for International Health, University of Sydney, PO Box M201, Missenden Road, New South Wales 2050, Australia.
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Anderson RWG, Hutchinson TP. Optimising product advice based on age when design criteria are based on weight: child restraints in vehicles. ERGONOMICS 2009; 52:312-324. [PMID: 18937110 DOI: 10.1080/00140130802327110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The motivation for this paper is the high rate of inappropriate child restraint selection in cars that is apparent in published surveys of child restraint use and how the public health messages promoting child restraints might respond. Advice has increasingly been given solely according to the child's weight, while many parents do not know the weight of their children. A common objection to promoting restraint use based on the age of the child is the imprecision of such advice, given the variation in the size of children, but the magnitude of the misclassification such advice would produce has never been estimated. This paper presents a method for estimating the misclassification of children by weight, when advice is posed in terms of age, and applies it to detailed child growth data published by the Centers for Disease Control and Prevention. In Australia, guidelines instructing all parents to promote their children from an infant restraint to a forward-facing child seat at 6 months, and then to a belt-positioning booster at 4 years, would mean that 5% of all children under the age of 6 years would be using a restraint not suited to their weight. Coordination of aged-based advice and the weight ranges chosen for the Australian Standard on child restraints could reduce this level of misclassification to less than 1%. The general method developed may also be applied to other aspects of restraint design that are more directly relevant to good restraint fit.
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Affiliation(s)
- R W G Anderson
- Centre for Automotive Safety Research, University of Adelaide, Australia.
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Zurynski YA, Bilston L, Elliott EJ. Booster seat use by children aged 4-11 years: evidence of the need to revise current Australasian standards to accommodate overweight children. Med J Aust 2008; 189:183. [PMID: 18673118 DOI: 10.5694/j.1326-5377.2008.tb01972.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 04/02/2008] [Indexed: 11/17/2022]
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Desapriya E, Fujiwara T, Scime G, Babul S, Pike I. Compulsory child restraint seat law and motor vehicle child occupant deaths and injuries in Japan 1994–2005. Int J Inj Contr Saf Promot 2008; 15:93-7. [DOI: 10.1080/17457300802080602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fitzharris MP, Charlton J, Bohensky M, Koppel S, Fildes B. Booster seat use by children aged 4-11 years: evidence of the need to revise current Australasian standards to accommodate overweight children. Med J Aust 2008; 188:328-31. [PMID: 18341454 DOI: 10.5694/j.1326-5377.2008.tb01647.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 10/31/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the relationship between child weight and vehicle booster seat usage in the context of current Australasian booster seat standards. DESIGN, SETTING AND PARTICIPANTS Questionnaire survey conducted between February and April 2005. A convenience sample of parents with children aged 4-11 years in New South Wales and Victoria completed a questionnaire, reporting on the height and weight of their children and the nature of restraint devices used in the family vehicle. MAIN OUTCOME MEASURES Proportion of children meeting standard-specified weight and height criteria who are not restrained in booster seats; proportion of children who meet the specified height criteria but whose weight exceeds the specified weight. RESULTS 699 of 3959 questionnaires were returned (response rate, 18%), of which seven lacked essential details. The remaining 692 responses provided information on 1500 children. Of these children, 633 aged 4-11 years fell within the recommended height range for using booster seats, but only 29% were typically restrained in booster seats, the majority (70%) being restrained in normal seatbelts. A key finding was that 37% of the children who met the recommended height criteria exceeded the maximum weight for booster seats stipulated by the current Australasian safety standard. CONCLUSION In view of increasing rates of overweight and obesity in children, it is important to reassess current Australasian standards for child restraints in vehicles. A concerted parental education campaign is also needed to raise awareness of which restraint types are appropriate for children of various heights and weights.
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Affiliation(s)
- Michael P Fitzharris
- Critical Care and Trauma, The George Institute for International Health, Sydney, NSW, Australia.
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