A 10-Year Retrospective Review of Playground-Associated Craniofacial Injuries in the Pediatric Patient Population

This retrospective study utilized the National Electronic Injury Surveillance System (NEISS) database to identify pediatric emergency department (ED) patients with playground-associated craniofacial injuries between January 2012 and December 2021. A total of 25 414 patients were identified. The majority of injuries occurred in preschool and elementary school-age children (90.3%) and patients were more commonly boys (59.3%). Injuries most often involved the head/scalp (52.4%), face (30.4%), and mouth (11.9%). Infant (32.7%) and teen (40.0%) injuries most commonly involved swings, whereas preschool (23.1%) and elementary school (28.1%) injuries were mostly associated with slides and climbers, respectively. Most patients were treated in the ED and discharged to home (96.5%), a small portion required hospitalization (1.6%), and one death was reported. Although the majority of the injuries were relatively minor and resulted in same-day discharges, these injuries can result in serious physical harm, emotional stress, and unexpected financial burdens. Proper education and supervision regarding safe play is important to prevent these injuries.

Kite String (Manjha) Injuries Among Children: Single Center Experience Over Four Years

We reviewed hospital records for kite-string injuries among children over four years (2017-2022). Of 42 affected children, mortality was 9.5%. The mean (SD) Pediatric Trauma Score (PTS) was 8.02 (2.66), with passively involved children facing greater severity [mean (SD) PTS, 5.58 (2.23)]. Kite-string injuries, alarmingly, endanger even bystanders, urging stricter preventive strategies.

Trampoline Injuries in a Statewide Trauma System

INTRODUCTION

It is well known that trampolines can be a particular source of danger, especially in children. We sought to examine the profile of those patients with trampoline injuries. We hypothesized there would be certain injury patterns predicative of trampoline injuries.

METHODS

All patients submitted to Pennsylvania Trauma Outcome Study database from 2016 to 2018 were analyzed. Trampoline injury was determined by ICD-10 activity code. Injury patterns in the form of abbreviated injury scale body regions were examined. Patient demographics and clinical variables were compared between those with trampoline injury vs those without.

RESULTS

There were 107 patients with a trampoline injury. All of these patients were discharged alive and had a blunt mechanism of injury. The most common injury type was injury to the extremities (n=90,[84.1%]) with 54(50.5%) upper extremity injuries and 36(33.6%) lower extremity injuries. Ten (9.35%) patients had injury to the spine and five (4.67%) had head injury. Those with trampoline injuries were significantly younger (13y vs. 48.6y) and more likely to be white or of Hispanic ethnicity. Almost half of the patients injured (49.5%) were under 10 years. Patients with trampoline injuries had significantly lower Injury Severity Scores and significantly higher shock index.

DISCUSSION

The majority of patients with trampoline injuries had injury to an extremity. These results help better understand the demographic, physiologic, and anatomic patterns surrounding trampoline injuries. Current government standards recommend that no child under age six should use a full-sized trampoline; however, based of this study, we advise that this age be increased to ten.

TRAUMATIC RETINAL DETACHMENT CAUSED BY NERF GUN SHOT IN A PEDIATRIC PATIENT

PURPOSE

To present a case of retinal detachment caused by a Nerf-gun shot in a pediatric patient.

METHODS

Single case report.

RESULTS

A 16-year-old white man presented with a nasal visual field deficit and floaters in his left eye for 1 month after being shot with a foam-ball Nerf gun by a friend. Fundus examination revealed a midperipheral retinal dialysis extending from 1 to 4:30 clock hours with a macula-on retinal detachment and superficial proliferative vitreoretinopathy. He underwent successful 25-gauge pars plana vitrectomy with membrane peel, retinectomy, injection of perfluoron, endolaser, and use of 1,000 centistoke silicone oil for tamponade.

CONCLUSION

This is the first reported case of traumatic retinal detachment secondary to a Nerf-gun shot.

Shared electric scooter injuries admitted to Auckland City Hospital: a comparative review one year after their introduction

AIM

E-scooters were introduced to New Zealand in 2018 as a means of city transport. Since their introduction, their use has resulted in high injury rates. No studies have directly compared e-scooters to other forms of transport.

METHOD

The Auckland City Hospital trauma registry was retrospectively searched for patients admitted with an e-scooter injury. A comparison group of patients admitted with an injury secondary to cycling during the same period was collected.

RESULTS

178 patients were identified: 69 with e-scooter injuries and 109 with injuries sustained while cycling. The hospitalisation rate for e-scooter injuries was 326 hospitalisations per million hours. There was a significant difference found in blood ethanol levels (18.6 vs 6.4% positive, p-value=0.01), mechanism of injury (isolated falls: 87 vs 60.6%), time of injury (55.1 vs 40.4% between 5pm-8am) and protective gear use (worn in 10.1 vs 78.9%). No differences were found in injury severity, ICU admissions, length of stay or mortality.

CONCLUSION

This study demonstrates a concerningly high e-scooter-related hospitalisation rate and suggests e-scooters are currently not as safe as cycling. Strategies to improve e-scooter safety are needed and could include zero tolerance for alcohol, mandatory protective gear, restricted operating times and changes in road laws.

Combining measures of risk exposure with injury incidence estimates to estimate nursery product injury rates

INTRODUCTION

Nursery product hazards have been a frequent topic in the published literature. However, because information on the exposure to nursery product risks has not been generally available, there has been little evaluation of exposure-adjusted injury rates.

METHODS

A national survey of durable nursery product use, by nursery product type, was conducted in 2013. Two measures of risk exposure were developed for each nursery product type: the number used frequently (i.e., used every day or a few times a week) and the total number in use by households, regardless of usage frequency. These data were combined with national estimates of nursery product injuries treated in U.S. hospital emergency departments to determine exposure-adjusted injury rates.

RESULTS

For the 13 nursery products examined, there were an estimated 79.9 million in use; 81.6% were reportedly used frequently. When combined with injury estimates, there were an average of 104.1 injuries per 100,000 frequently used nursery products and 85.0 injuries per 100,000 in use. The exposure-adjusted injury rate rankings for the 13 products, from highest to lowest, varied substantially from rankings based on injury incidence alone. Although the injury rate rankings for the two risk exposure measures were not identical, they were highly correlated.

CONCLUSIONS

The use of exposure-adjusted injury rates provides an enhanced understanding of product-related injury patterns, and can play an important role in program development and evaluation. Estimates of frequently used products may be preferable to products in use as a measure of risk exposure, because such estimates may better reflect intensity of use; both, however, represent valid alternatives that can result in improved program and policy analysis. Practical Applications: Exposure-adjusted injury rates can provide for a more comprehensive evaluation of injury patterns than incidence estimates alone. Analysts should, when possible, take risk exposure into account when evaluating safety programs and policy options.

Motorized scooter injuries in the era of scooter-shares: A review of the national electronic surveillance system

INTRODUCTION

There has been a spike in recent news regarding motorized scooter injuries due to the expansion of scooter sharing companies. Given the paucity of literature on this topic, the purpose of our study was to describe and quantify emergency department encounters associated with motorized scooter related injuries.

METHODS

The National Electronic Injury Surveillance System (NEISS) was queried for motorized scooter related injuries from 2013 to 2017. Patient demographics, diagnosis, injury location, narrative description of incident, and disposition data were collected from emergency department encounters.

RESULTS

There were an estimated 32,400 motorized scooter injuries from 2013 to 2017. The estimated incidence did not change significantly over time with 1.9 cases per 100,000 in 2013 and 2.6 cases per 100,000 in 2017. A 77.0% increase in scooter injuries was noted for millennials from 2016 to 2017. Head injuries were the most common body area injured (27.6%). Fractures or dislocations (25.9%) were the most common diagnosis. The most common site of fracture was the wrist and lower arm (35.4%). There were no deaths. Major orthopaedic injury and concussion were the strongest independent predictors of hospital admission.

CONCLUSIONS

Head injuries were the most commonly injured body part, while fractures or dislocations were the most common diagnosis. These results highlight the importance of using protective equipment while riding motorized scooters, and lay a foundation for future policies requiring helmet use.

Don't take down the monkey bars: Rapid systematic review of playground-related injuries

OBJECTIVE

To synthesize the available evidence on playground-related injuries and to determine the prevalence of these injuries in pediatric populations.

DATA SOURCES

A rapid systematic review was conducted using PubMed, EMBASE, and the Cochrane Library, as well as the gray literature.

STUDY SELECTION

The search was limited to studies published between 2012 and 2016 and identified a total of 858 articles, of which 22 met our inclusion criteria: original quantitative studies published in peer-reviewed journals in the past 5 years, concerning unintentional injuries in playgrounds in children aged 0 to 18 years.

SYNTHESIS

Information was collected on study and injury characteristics, and the proportion of pediatric injuries related to playground activity was determined. Studies were performed in various countries and most were retrospective cohort studies. The prevalence of playground-related injury ranged from 2% to 34% (median 10%). Studies varied in the types of injuries investigated, including head injuries, genitourinary injuries, ocular and dental trauma, and various types of fractures. Most injuries were low severity.

CONCLUSION

Although playgrounds are a common location where pediatric injuries occur, these injuries are relatively low in frequency and severity.

Childhood trampoline injuries

INTRODUCTION

With the increasing use of recreational trampolines, more injuries are seen in emergency depart-ments (ED). Little is known about the relationship between adherence to safety precautions and injuries. This retro-spective study aims to describe the types of injuries and the precautions taken when using trampolines, and to investigate the relationship between injuries and safety precautions.

METHODS

We reviewed patient lists and the medical records of children younger than 18 years who were treated between 1 April and 30 September 2014 at the ED of Hospital Unit West, Denmark. Demographic data and type of injury were recorded. Patients or guardians were contacted for a structured telephone interview to describe the safety precautions they had taken before the injury occurred. A total of 113 patients were identified, and 100 patients were included in the phone interviews. A total of 13 patients were excluded due to incorrect/missing phone numbers or lack of a Danish home address.

RESULTS

6% of all children treated in the ED had trampoline-related injuries. A total of 58 (51.3%) patients had fracture injuries, and 55 (48.7%) patients had non-fracture injuries. 4% had complied with all five recommended safety precautions.

CONCLUSIONS

This study describes types of injuries and safety precautions related to trampoline use. 6% of all children in the ED had an injury related to trampoline use. 4% complied with all five recommended safety precautions.

FUNDING

none.

TRIAL REGISTRATION

not relevant.

[Laryngeal traumas in children caused by trampoline accidents]

Laryngeal trauma is rare in children due to the anatomical placement and the trauma mechanisms required for injury. Recently the trampoline has become frequent in Danish households leading to more high-energy laryngeal traumas. This case report is about two incidents occurring within a year. The first patient had a laryngeal fracture despite minimum objective findings. The second patient had a compromised airway and needed acute intubation, although she only presented with light hoarseness. We strive to underline the severity of laryngeal trauma in children and briefly discuss the correct handling of these cases.

Pediatric Trampoline-Related Injuries in a Nationwide Registry in South Korea, 2011 to 2016

PURPOSE

Trampoline-related injuries are steadily increasing. To our knowledge, there have been very few studies on trampoline injuries in Asia. The purpose of this study is to report the characteristics of pediatric trampoline injuries in Korea.

MATERIALS AND METHODS

We conducted a nationwide retrospective cohort study. Data were collected from prospective nationwide databases (Emergency Department-based Injury In-depth Surveillance databases of the Korea Centers for Disease Control and Prevention) for patients who visited emergency departments (EDs) after injuries during 2011-2016.

RESULTS

Of 263712 patients between 0 and 17 years of age, 2799 patients with trampoline injuries visited EDs. The median age of the patients was 5 years (interquartile range, 3-8 years), and 63% of the patients were under 6 years old. Of the patients, 1526 (54.2%) were male. Seventy-six percent of injuries occurred at trampoline parks. Trampoline injuries and trampoline park injuries have increased steadily, while ages at injury have gradually decreased year by year (p<0.001). Injury locations included the lower extremity (47%), head and face (24%), and upper extremity (24%). A fracture was sustained by 886 (31.7%) patients. The distal humerus and proximal tibia were the most common fracture sites (34% and 23%, respectively). Fractures occurred more commonly in trampoline parks than in homes (33.7% vs. 21.1%, p<0.001).

CONCLUSION

In Korea, pediatric trampoline injuries and trampoline park injuries have tended to increase, while ages at injury have tended to decrease. Policies to prevent trampoline injuries are needed.

Trampolines: What's the Harm?

Trampolines hold the promise of fun and enjoyment for many children, but they are associated with a significant number of orthopedic and other injuries. Injuries vary from minor to severe, and the most common are extremity injuries. Although most injuries are associated with residential (ie, backyard) trampolines, a growing number of injuries now occur in trampoline parks. Adult supervision has not been effective for prevention. Emerging data on trampoline park-related injuries indicate that caution should be exercised in these settings as well. [Pediatr Ann. 2018;47(10):e385-e387.].

Distinct features of trampoline-related orthopedic injuries in children aged under 6 years

INTRODUCTION

Concern has been growing about trampoline-related injuries among young children. Several published policy statements have repeatedly recommended that children younger than 6 years should not use trampolines. However, few studies have investigated the injuries caused by trampoline-related accidents among young children. This study aimed to identify the distinct features of trampoline-related orthopedic injuries in children younger than 6 years.

METHODS

We retrospectively reviewed the medical records of pediatric patients aged between 0 and 16 years who visited our regional emergency center due to trampoline-related orthopedic injuries between 2012 and 2015. Patients were divided into two groups: a preschool group (younger than 6 years) and a school group (older than 6 years). We compared the features of the injuries in the two groups.

RESULTS

Among 208 patients, 108 (52%) were male and 100 (48%) were female. The mean age was 5.4 years. The preschool group accounted for 66%. There were no seasonal variations. Fractures were sustained in 96 patients (46%). The anatomical locations of injuries differed significantly between the two age groups. Proximal tibia fractures were more frequent in the preschool group than the school group (34% and 6%, respectively). Distal tibia fractures were more prevalent in the school group than the preschool group (44% vs. 13%, respectively). Surgical treatment was needed more frequently in the school group (p = 0.035, hazard ratio 2.52, 95% confidence interval: 1.03-6.17). Most of the injuries (82%) occurred at trampoline parks.

CONCLUSIONS

The anatomical locations of trampoline-related orthopedic injuries differed significantly between age groups. Fractures were more common around the knee in younger children and the ankle in older children.

The effect of trampoline parks on presentations to the Christchurch Emergency Department

AIMS

To analyse trampoline-related injuries suffered after the opening of two new trampoline parks in Christchurch.

METHODS

Data was collected from three 90-day periods. All trampoline-related injuries were collected from electronic documentation and coding. Those injured after both arenas opened were contacted and a semi-structured interview performed.

RESULTS

In the 90 days after both parks opened there were 602 claims for trampoline-related injuries with 106 hospital presentations (55% male). This was a significant increase (p<0.01) from one year earlier (333 claims, 37 hospital presentations) and the 90 days prior to their opening (201 claims, 15 hospital presentations). Most injuries affected an older group of children, aged between 10-14 years (26%, n=28), compared to the other two periods (p<0.01). There was also a greater proportion of lower-limb injuries (52%, n=55) compared to the other two periods (p<0.01). Thirty-six required hospital admission, with 29 operations and an average length of stay of 2.11 days. One trampoline park allowed two or more people to use the same trampoline at the same time, and had over twice as many presentations (33%, n=35) than the other trampoline park (14%, n=15).

CONCLUSIONS

Christchurch saw a significant increase in trampoline-related injuries after the opening of two new parks. These injuries involved an older group of children, affected predominantly the lower limbs and were more severe than those reported from the use of domestic trampolines. Consistent with past research, the trampoline park allowing multiple users had a higher proportion of presentations and more injuries requiring operative intervention.

Trampoline-associated injuries are more common in children in spring

AIMS

Trampoline use is a popular pastime amongst children in New Zealand, and has many advantages for child development. However, recent reports claim that trampoline-associated injuries are still highly prevalent. In order to help prevent these injuries in the future, this study aims to provide more up-to-date epidemiological information in children, with emphasis on the time of year that injuries most commonly occur.

METHODS

A retrospective review was carried out utilising a prospective maintained trauma database. The database was searched electronically for injuries involving trampolines in children aged 0-15 years. Patient demographics and information regarding month of injury, injury type and management were extracted.

RESULTS

There were 344 admissions to hospital for trampoline-related injuries between June 2000 and January 2015. Injuries were uncommon in winter, but rose in spring and summer. Fracture of the radius and/or ulna was the most common injury (34.0%), followed by humeral fracture (32.0%).

CONCLUSION

The peak incidence of trampoline-related injuries occurred around the beginning of spring daylight savings time each year. This could therefore prove an opportune time to remind children and parents about trampoline safety at the same time as daylight savings reminders.

Inflatable bouncer-related injuries to children: increasing phenomenon in pediatric emergency department, 2002-2013

A sharp uptrend in emergency department (ED) visits for injuries associated with inflatable bouncers (IBs) has been observed recently. The aim of this study is to describe the epidemiology and features of injuries resulting from the use of IBs at an Italian pediatric ED. We collected data of 521 children from GIPSE (regional software for management of admission at ED) in the period of 2002-2013. The injuries were slightly more frequent in males than females (52.4 vs 47.6 %). Preschooler children were the most commonly injured (45.7 %). The occurrence of injuries increased by year (eight cases in 2002 and 90 cases in 2013), and a seasonal variability was reported (207 cases in the period of April-June). The most common body region injured was the upper extremity (52.4 %). Children with fractures were 126 times more likely to have injured the upper extremity rather than other body regions compared with patients with no fracture (p < 0.05). Humerus and radius/ulna fractures occurred most commonly in preschooler children (p < 0.05). Fractures were 43 times more likely to be hospitalized than children with no fracture (p < 0.05).

CONCLUSION

Injuries associated with IBs increased over time. Preschooler children were most injured, and this means there is insufficient adherence to existing recommendations concerning an age limit.

WHAT IS KNOWN

• Along with the skyrocketing popularity of IBs among children, the number of children presenting to ED with injuries from these plays has also been increasing at an alarming rate; • The European literature about this phenomenon is scarce and no specific legislations exist for safety of these devises in European Union (EU). What is New: • This is the first study in EU that examines trends for pediatric inflatable bouncer-related injuries at ED over an 11-year period. • Although American Academy of Pediatrics recommends restrictions of attendance to IBs under 6 years old, injuries and fractures continue to occur more frequently under this age.

ROLLER COASTER RETINOPATHY: CASE REPORT OF SYMPTOMATIC BILATERAL INTRARETINAL HEMORRHAGES AFTER SHAKING INJURY IN AN OTHERWISE HEALTHY ADULT

PURPOSE

Traumatic head injuries not involving the eye have been known to cause retinal injury through multiple mechanisms. Abusive head trauma remains the prototypical example. We propose to demonstrate the first case of bilateral multiple retinal hemorrhages in a young healthy adult related to riding multiple theme park roller coasters.

METHODS

The patient was evaluated with a complete ophthalmic examination including dilated extended ophthalmoscopy, fluorescein angiography, optical coherence tomography, and fundus photography.

RESULTS

The patient was found to have a bilateral symptomatic macular retinopathy characterized by multiple intraretinal hemorrhages. Given the lack of other systemic findings and negative medical workup, her signs and symptoms were thought to be attributed to the same day attendance of a theme park and riding of multiple roller coasters.

CONCLUSION

Theme park roller coasters, as well as other attractions, may affect the eye at the vitreoretinal interface. This type of acceleration-deceleration injury should be considered in the differential of an adolescent or adult patient with retinal hemorrhage in the absence of other pathologic processes to explain clinical findings.

Ocular Paintball Injuries

Background: One of the most alarming ocular injury trends in recent years has been the proliferation of paintball guns and the proportional increase in the number of ocular eye injuries caused by paintballs.

OBJECTIVES

To describe five cases of paintball eye injuries that resulted in loss of functional vision in four of them.

METHODS

We conducted a retrospective review of the clinical course in five patients with paintball eye injuries treated in the ophthalmology departments of two medical centers.

RESULTS

Five young males were evaluated for paintball injuries caused by blunt trauma. There was one case of full-thickness laceration (globe rupture). Four patients required one to five surgical interventions: three of these involved the removal of traumatic cataract including two eyes with significant zonular dehiscence treated by lens capsule conservation using anchoring devices, one retinal surgery and two glaucoma filtration surgeries. However, final visual outcome was not favorable due to irreversible retinal damage.

CONCLUSIONS

Paintball trauma often results in significant ocular injury and loss of functional vision despite successful surgical intervention. Most injuries occur in under-supervised settings and are easily preventable. Improved safety measures, strict regulation enforcement and appropriate public education could prevent such serious damage.

Accidental ingestion of magnetic spheres in children

Magnetic foreign body ingestion can have a very serious sequale if multiple or combined with another metal object inside the abdomen. We report 2 cases of ingestion of rare-earth magnets with a very different consequences. This adds to the world's literature on this topic.

Paintball-related ocular trauma: Paintball or Painball?

BACKGROUND

The aim of this study is to describe the type and severity of paintball-related ocular trauma and to determine the necessary precautions to minimize the risk of ocular injury regardless of whether adequate eye protection was used.

MATERIAL AND METHODS

A retrospective chart review identified patients treated for paintball-related ocular trauma at the Ataturk University Medical Hospital from June 2010 through March 2013. A descriptive analysis of data was performed.

RESULTS

Ten patients with paintball-related ocular trauma were identified. At the time of their first examination, 7 of these patients had visual acuity (VA) of 20/200 or worse. One patient had a final VA of no light perception and 4 patients had a final VA of 20/200 or worse. Hyphema was noted in 7 patients, traumatic cataract in 2, iridodialysis in 2, retinal detachment in 3, and secondary glaucoma in 1. Six patients required surgery. Although all victims have used eye protection during the game, all patients were injured after they thought the game was over and had taken off their helmets or eye-protective devices.

CONCLUSIONS

Paintball-related accidents result in serious ocular trauma and most of the patients require surgery. These injuries result in severe loss of VA in some patients. Uninterrupted use of proper eye protection whenever a player is in the game field, even after they believe the game has ended, may reduce the incidence of severe ocular trauma in paintball players.

Trampoline related injuries in children: risk factors and radiographic findings

BACKGROUND

Backyard trampolines are immensely popular among children, but are associated with an increase of trampoline-related injuries. The aim of this study was to evaluate radiographs of children with trampoline related injuries and to determine the risk factors.

METHODS

Between 2003 and 2009, 286 children under the age of 16 with backyard trampoline injuries were included in the study. The number of injuries increased from 13 patients in 2003 to 86 in 2009. The median age of the 286 patients was 7 years (range: 1-15 years). Totally 140 (49%) patients were males, and 146 (51%) females. Medical records and all available diagnostic imaging were reviewed. A questionnaire was sent to the parents to evaluate the circumstances of each injury, the type of trampoline, the protection equipment and the experience of the children using the trampoline. The study was approved by the Institutional Ethics Committee of the University Hospital of Bern.

RESULTS

The questionnaires and radiographs of the 104 patients were available for evaluation. A fracture was sustained in 51 of the 104 patients. More than 75% of all patients sustaining injuries and in 90% of patients with fractures were jumping on the trampoline with other children at the time of the accident. The most common fractures were supracondylar humeral fractures (29%) and forearm fractures (25%). Fractures of the proximal tibia occurred especially in younger children between 2-5 years of age.

CONCLUSIONS

Children younger than 5 years old are at risk for specific proximal tibia fractures ("Trampoline Fracture"). A child jumping simultaneously with other children has a higher risk of suffering from a fracture.

Intestinal fistula after magnets ingestion

Accidental ingestion of magnetic foreign bodies has become more common due to increased availability of objects and toys with magnetic elements. The majority of them traverse the gastrointestinal system spontaneously without complication. However, ingestion of multiple magnets may require surgical resolution. The case of an 18-month girl who developed an intestinal fistula after ingestion of two magnets is reported.

Traumatic injuries in the primary teeth of 4- to 6-year-old school children in gulbarga city, India. A prevalence study

AIMS

The aims of the study were: to assess the prevalence of traumatic injuries to the teeth of 4- to 6-year-old children living in Gulbarga City, India, to determine prevalence of such dental traumatic injuries at the ages of 4, 5, and 6 years and to compare the prevalence of these injuries between male and female children.

METHODS

A cross-sectional survey was performed. It consisted of a clinical examination of upper and lower deciduous anterior teeth by one examiner and an interview using a questionnaire with a sample of 1500 children aged 4 to 6 years who attended kindergarten and primary schools in Gulbarga city. Garcia-Godoy's (1981) classification was used to classify the traumatic injuries. Intra-examiner consistency was assessed by kappa values on tooth-by-tooth basis. The chisquare test was used to analyse any gender and age differences.

RESULTS

The prevalence of traumatic dental injuries was 76.13%, of which crown fracture with enamel involvement of teeth was the most prevalent, followed by crown fracture with both enamel and dentine involvement. Significant and highly significant differences were found between boys and girls for discoloration of teeth (P<0.05), crown fracture involving enamel (P<0.001) and crown fracture involving both enamel and dentine (P<0.001). The prevalence of traumatic dental injuries in the 5-year-old children was higher than that in the 4- and 6-year-olds. The commonest cause of injury was due to a fall (60%) and in 40% of cases of traumatic injury, they occurred in a field/playground.

CONCLUSIONS

The prevalence of traumatic injuries to the anterior teeth of the 4- to 6-year-olds who took part in this study was very high. There is a need to run educational programmes to increase parents' awareness of the risks of dental trauma.

[Near fatal attraction of ingested magnets]

We report a case of intestinal perforation in a 20 month old girl following the ingestion of 2 small magnets. Ingestion of multiple magnets constitutes a unique problem. Magnets in adjacent intestinal loops may forcefully attract each other and produce pressure necrosis of the bowel wall, leading to perforation, fistula formation or intestinal obstruction. Therefore, these children should be observed carefully. Early surgical intervention should be considered when clinical symptoms develop, especially when, on sequential abdominal radiographs, there is no change in the magnets' location. Since toys with small magnets are ubiquitous, efforts should be made to increase parents' awareness on the one hand, and to alert toy manufacturers on the other hand.

Fatal subcutaneous emphysema by manja: a deadly string

'Manja' is an abrasive string which is gummed, coloured and coated with powdered glass used in fighter kites in Afghanistan, Bangladesh, Chile, India, Nepal, Pakistan, etc. Subcutaneous emphysema occurs when gas or air is present in the subcutaneous layer of the skin either because of blunt and penetrating trauma, chest surgeries or by necrotising skin infections such as gangrene. Here, we present a case of subcutaneous emphysema owing to a cut-throat injury by 'manja', which is rare and has not been reported to date to the best of our knowledge.

Accidents due to falls from roof slabs

CONTEXT AND OBJECTIVE Falls from the roof slabs of houses are accidents of high potential severity that occur in large Brazilian cities and often affect children and adolescents. The aims of this study were to characterize the factors that predispose towards this type of fall involving children and adolescents, quantify the severity of associated lesions and suggest preventive measures. DESIGN AND SETTING Descriptive observational prospective longitudinal study in two hospitals in the metropolitan region of São Paulo. METHODS Data were collected from 29 cases of falls from roof slabs involving children and adolescents between October 2008 and October 2009. RESULTS Cases involving males were more prevalent, accounting for 84%. The predominant age group was schoolchildren (7 to 12 years old; 44%). Leisure activities were most frequently being practiced on the roof slab at the time of the fall (86%), and flying a kite was the most prevalent game (37.9%). In 72% of the cases, the children were unaccompanied by an adult responsible for them. Severe conditions such as multiple trauma and traumatic brain injuries resulted from 79% of the accidents. CONCLUSION Falls from roof slabs are accidents of high potential severity, and preventive measures aimed towards informing parents and guardians about the dangers and risk factors associated with this type of accident are needed, along with physical protective measures, such as low walls around the slab and gates with locks to restrict free access to these places.

Trampoline safety in childhood and adolescence

Despite previous recommendations from the American Academy of Pediatrics discouraging home use of trampolines, recreational use of trampolines in the home setting continues to be a popular activity among children and adolescents. This policy statement is an update to previous statements, reflecting the current literature on prevalence, patterns, and mechanisms of trampoline-related injuries. Most trampoline injuries occur with multiple simultaneous users on the mat. Cervical spine injuries often occur with falls off the trampoline or with attempts at somersaults or flips. Studies on the efficacy of trampoline safety measures are reviewed, and although there is a paucity of data, current implementation of safety measures have not appeared to mitigate risk substantially. Therefore, the home use of trampolines is strongly discouraged. The role of trampoline as a competitive sport and in structured training settings is reviewed, and recommendations for enhancing safety in these environments are made.

[Mathematical simulation of mild brain injury in children heading soccer balls]

BACKGROUND

Heading professional soccer balls can generate mild traumatic brain injury in children. The long-term consequences could include difficulty in solving problems and deficits in memory and language.

AIM

To assess the impact of a professional adult soccer ball on a child's head, using the finite element method and dynamic effects to predict brain damage.

MATERIAL AND METHODS

The minimum conditions of an adult game were considered: the ball speed was 6 m/s and the diffuse blow was 345 and 369 Newtons (N), on the forehead and top of the head, respectively. A head was modeled in order to know the stresses, strains and displacements generated by the impacts. The extent of the alteration was determined by comparing the strength of brain tissue, with predictions of computed stresses. The geometric characteristics of the head were transferred from medical images. The input data of the materials of a child's head was obtained from the literature.

RESULTS

In the case of heading with the forehead, mathematical simulation showed frontal lobe alterations, with brain stresses between 0.064 and 0.059 N/mm(2). When the heading was with the upper head zone, the brain alterations were in the parietal lobe, with stresses between 0.089 and 0.067 N/mm(2). In the cerebral spinal fluid the pressure was 3.61 to 3.24 N/mm(2).

CONCLUSIONS

The mathematical simulations reveal evidence of brain alterations caused by a child heading adult soccer balls. The model presented is an economical and quick tool that can help predict brain damage. It demonstrates the ability of the cerebral spinal fluid (CSF) to absorb shock loads.

Pattern of ocular trauma

This prospective observational study was conducted in the department of Ophthalmology Mymensingh Medical College Hospital during the period of November, 2009 to October, 2010. Two hundred & fifty (250) patients of both sexes and all ages with ocular trauma were selected randomly for this study. A detailed history of patients, duration of trauma, relation of trauma with work, visual status prior to injury, any surgery prior to injury & patients were alcoholic or not were taken. Male patients were 190(76%) and female patients were 60(24%). Majority of patients were 11-20 years group (39.2%). Most of patients (40%) attended into hospital within 60 hours of ocular trauma. Accidental occupational trauma were more common (51.2%) and assault injury were less common (12.8%). Greater number of ocular trauma was caused by sharp objects (59.2%) and less number of ocular trauma was caused by chemical injuries (2.4%). Open globe injuries were more common (62%) than closed globe injury (38%). Visual acuity on admission between 6/60 to PL comprises highest number (64%) and also on discharge between 6/60 to PL comprises highest number of cases (50%). Most of the patients came from poor socioeconomic group (60%).

Toys in the upper aerodigestive tract: evidence on their risk as emerging from the ESFBI study

OBJECTIVE

Foreign body inhalation/aspiration or ingestion is a relatively common event in young children and, despite many efforts made in several Countries to reach acceptable safety levels for products devoted to children, small toys or toy parts are frequently mentioned among risky foreign bodies. The aim of the present study is to characterize the risk of complications and prolonged hospitalization due to toys inhalation/aspiration or ingestion according to age and gender of patients, FB characteristics and FB location, circumstances of the accident, as emerging from the ESFBI study.

METHODS

A retrospective study in major hospitals of 19 European Countries was realized on children aged 0-14 having inhaled/aspired or ingested a toy, with regard to the characteristics of the child and the FB (shape, volume, consistency), the FB location, the hospitalization's details and the occurrence of complications.

RESULTS

In the years 2000-2003 a total of 2094 FB injuries occurred in children aged 0-14 years. Among them 121 (5.8%) were due to toys (mainly parts of toys) and 95 (4.5%) occurred in the lower/upper aero-digestive tract. 58 children needed hospitalization. The first determinant of a damage requiring hospitalization is the rigid consistence of the object. Almost 27% of toys related injuries happened under adults' supervision.

CONCLUSIONS

Despite the adoption of preventive strategies, including products modification by manufacturers, has resulted in a decrease of children's mortality rate for choking in the last decades, our results seem to testify that preventive strategies imposing a regulation of industrial production, even if fundamental, are not sufficient and need to be integrated with other preventive intervention addressed to improve parents ability to be conscious of FB injuries and attentive toward a proper surveillance of children.

Product quality risk perceptions and decisions: contaminated pet food and lead-painted toys

In the context of the recent recalls of contaminated pet food and lead-painted toys in the United States, we examine patterns of risk perceptions and decisions when facing consumer product-caused quality risks. Two approaches were used to explore risk perceptions of the product recalls. In the first approach, we elicited judged probabilities and found that people appear to have greatly overestimated the actual risks for both product scenarios. In the second approach, we applied the psychometric paradigm to examine risk perception dimensions concerning these two specific products through factor analysis. There was a similar risk perception pattern for both products: they are seen as unknown risks and are relatively not dread risks. This pattern was also similar to what prior research found for lead paint. Further, we studied people's potential actions to deal with the recalls of these two products. Several factors were found to be significant predictors of respondents' cautious actions for both product scenarios. Policy considerations regarding product quality risks are discussed. For example, risk communicators could reframe information messages to prompt people to consider total risks packed together from different causes, even when the risk message has been initiated due to a specific recall event.

Common things are common: a case series of oral foreign bodies in paediatric patients

Reports of foreign bodies in the oral cavity are few in number. Three cases of children of varying ages, presenting with oral foreign bodies, and their subsequent diagnosis and management, are described. The importance of considering foreign bodies, as part of a differential diagnosis in paediatric patients, where aetiology is uncertain and clinical appearance is unusual, is highlighted.

Preventing injuries on horizontal ladders and track rides

OBJECTIVES

This study examined the type of injury, fall heights and measures of impact attenuation of surfaces on which children fell from horizontal ladders and track rides.

METHOD

All injured children who presented to two children's hospitals and received medical attention following a fall from a horizontal ladder or track ride in a public school or park during 1996--1997 were interviewed and the playground visited.

RESULTS

The number of children who fell from horizontal ladders and track rides and presented to hospitals with injury was 118. Of those children, 105 were injured when they hit the ground and data were available on 102 of those playground undersurfaces. Fractures to the arm or wrist were the most common injury. The median height fallen by children was 1930 mm, 73% of injuries were from falls greater than 1800mm. In 41% of sites, the surface was deficient in impact absorbing properties for the height of the equipment. Fractures were no more likely on loose surfaces than other surfaces, such as rubber matting (p = 0.556) but more prevalent on compliant than non-compliant surfaces. Relative to falls occurring on noncompliant surfaces, the odds of a fracture occurring on a compliant surface was 2.67 (95% CI 0.88-8.14).

CONCLUSIONS

Modification of the height of horizontal ladders and track rides to 1800mm is preferable to removal of such equipment. The prevalence of fractures on compliant surfaces suggests that the threshold of 200g or 1000 head injury criteria (HIC) needs to be revisited, or additional test criteria added to take account of change in momentum that is not presently accounted for with either g-max on HIC calculations.

Preventive strategies for traumatic dental injuries

Traumatic dental and maxillofacial injuries are common occurrences, and affect worldwide approximately 20% to 30% of permanent dentition, often with serious aesthetic, functional, psychological, and economic consequences. With such a high frequency of injuries, prevention becomes a primary goal. A prevention approach relies on the identification of etiologic factors, and on giving rise to measures aimed at avoiding those factors or at reducing their impact. This article reviews the etiology and preventive strategy regarding dental injuries, and examines the role and manufacture of appliances, especially mouthguards, in preventive dentistry.