The objective of this study was to describe a population of children admitted to a tertiary care pediatric hospital with severe trauma to identify key areas for injury prevention research, and programming.
Retrospective chart review conducted on all children 0-17 years admitted to the Children's Hospital of Eastern Ontario (CHEO) between April 1, 1996, and March 31, 2000, following acute trauma. Each record was reviewed and assigned an ISS using the AIS 1990 revision. All cases with an ISS > 11 were included in the study.
There were 2610 trauma cases admitted to CHEO over the study period. Of these, 237 (9.1%) had severe trauma (ISS > 11). Sixty-two percent were male. Twenty-nine percent were between the ages of 10 and 14 years, 27% between 5 and 9 years, 16% between 15 and 17 years, 15% between 1 and 4 years, and 13% less than 1 year old. The most common mechanisms of injury were due to motor vehicle traffic (39%), falls (24%), child abuse (8%), and sports (5%). Of those resulting from motor vehicle traffic, 53 (57%) were occupants, 22 (24%) were pedestrians, and 18 (19%) were cyclists. When combining traffic and nontraffic mechanisms, 26 (11% of all severe trauma cases) occurred as a result of cycling incidents. The most severe injury in 65% of patients was to the head and neck body region.
Research efforts and activities to prevent severe pediatric trauma in our region should focus on road safety, protection from head injuries, avoidance of falls, and prevention of child abuse.
To present a geographic information systems (GIS) method for exploring the spatial pattern of injuries and to demonstrate the utility of using this method in conjunction with classic ecological models of injury patterns.
Profiles of patients' socioeconomic status (SES) were constructed by linking their postal code of residence to the census dissemination area that encompassed its location. Data were then integrated into a GIS, enabling the analysis of neighborhood contiguity and SES on incidence of injury.
Data for this analysis (2001-2006) were obtained from the British Columbia Trauma Registry. Neighborhood SES was calculated using the Vancouver Area Neighborhood Deprivation Index. Spatial analysis was conducted using a join-count spatial autocorrelation algorithm.
Male and female patients over the age of 18 and hospitalized from severe injury (Injury Severity Score >12) resulting from an assault or intentional self-harm and included in the British Columbia Trauma Registry were analyzed.
Male patients injured by assault and who resided in adjoining census areas were observed 1.3 to 5 times more often than would be expected under a random spatial pattern. Adjoining neighborhood clustering was less visible for residential patterns of patients hospitalized with injuries sustained from self-harm. A social gradient in assault injury rates existed separately for men and neighborhood SES, but less than would be expected when stratified by age, gender, and neighborhood. No social gradient between intentional injury from self-harm and neighborhood SES was observed.
This study demonstrates the added utility of integrating GIS technology into injury prevention research. Crucial information on the associated social and environmental influences of intentional injury patterns may be under-recognized if a spatial analysis is not also conducted. The join-count spatial autocorrelation is an ideal approach for investigating the interconnectedness of injury patterns that are rare and occur in only a small percentage of the population.
INTRODUCTION: Bicycle accidents are the most frequent traffic accidents in Denmark. Most of these accidents are one-vehicle accidents. The aim of this study was to investigate the differences between one-vehicle accidents and accidents with a counterpart in order to suggest focused prevention. MATERIALS AND METHODS: The analysis was based on data of the Danish Accident Registry using all bicycle accidents reported to five Danish emergency departments in the period 1998-2000. RESULTS: 81% of the bicycle accidents were one-vehicle accidents which frequently resulted in injuries of the upper extremities. They frequently resulted in fractures and open wounds compared to other bicycle accidents. For intoxicated bicyclists, 95% were one-vehicle accidents, and injuries to the head constituted 63% of the injuries. DISCUSSION: One-vehicle accidents often result in severe injuries indicating a need for prevention. Special attention should be given to the young and the elderly. Although many bicycle accidents have no immediate cause, preventive measures should be taken, such as better clearing of roads and bicycle tracks and campaigns against drink-riding.
Traffic collisions and fatalities during the holiday festive periods are apparently on the rise in Alberta, Canada, despite the enhanced enforcement and publicity campaigns conducted during these periods. Using data from 2004 to 2008, this research identifies the factors that delineate between crashes that occur during public holidays and those occurring during normal weekends. We find that fatal and injury crashes are over-represented during holidays. Amongst the three risky behaviors targeted in the holiday blitzes (driver intoxication, unsafe speeding and restraint use), non-use of restraint is more prevalent whereas driver intoxication and unsafe speeding are less prevalent during holidays. The mixed results obtained suggest that it may be time to consider a more balanced approach to the enhanced enforcement and publicity campaigns.
The starting lists for the alpine disciplines during the 1994 Olympic Winter Games in Lillehammer totalled 555 racers, but only 354 of them (64%) completed the different races. The race completion rate was 43% in the slalom, 51% in the giant slalom, 75% in the super giant slalom and 91% in the downhill. In combined downhill/slalom the race completion rate was 60%, but 96% in the downhill and 68% in the slalom part of the combination, respectively. Only three injuries were recorded, all in females. Including the training competitions a total of 1541 runs through the different alpine courses was recorded during the games. This means an injury rate of 1.9 injuries per 1000 runs. For downhill the injury rate was only 1.1 per 1000 runs. If the injury rate is related to the number of skiers who did not finish the race because of falls or skiing errors, the rate was 21.1 injuries per 1000 falls (skiing errors) for all alpine races. In conclusion, the race completion rate was twice as high in downhill as in slalom, and the injury rate was low.
Doctors in Norway are obliged by law to submit reports to central authorities about injuries and risk of injury arising from medical equipment and drugs. Deaths following health care procedures must be reported to the police, and major injuries to the County Medical Officer. Most hospitals have their own rules requiring health care providers to report all incidents resulting in injury or risk of injury. The author contends that fewer than 5% of the injuries are reported. Neither the law, nor the hospital rules, require that the incidents in general are evaluated, with feed-back to the care providers. Most incidents do not seem to be evaluated. There is much left to do, both in building a set of regulations and in implementing better hospital practice, by using records of injuries and mishaps to identify and prevent further mishaps.
Comment In: Tidsskr Nor Laegeforen. 1992 Dec 10;112(30):38401485306
Pedestrians and bicyclists account for a significant share of deaths and serious injuries in the road transport system. The protection of pedestrians in car-to-pedestrian crashes has therefore been addressed by friendlier car fronts and since 1997, the European New Car Assessment Program (Euro NCAP) has assessed the level of protection for most car models available in Europe. In the current study, Euro NCAP pedestrian scoring was compared with real-life injury outcomes in car-to-pedestrian and car-tobicyclist crashes occurring in Sweden. Approximately 1200 injured pedestrians and 2000 injured bicyclists were included in the study. Groups of cars with low, medium and high pedestrian scores were compared with respect to pedestrian injury severity on the Maximum Abbreviated Injury Scale (MAIS)-level and risk of permanent medical impairment (RPMI). Significant injury reductions to both pedestrians and bicyclists were found between low and high performing cars. For pedestrians, the reduction of MAIS2+, MAIS3+, RPMI1+ and RPMI10+ ranged from 20-56% and was significant on all levels except for MAIS3+ injuries. Pedestrian head injuries had the highest reduction, 80-90% depending on level of medical impairment. For bicyclist, an injury reduction was only observed between medium and high performing cars. Significant injury reductions were found for all body regions. It was also found that cars fitted with autonomous emergency braking including pedestrian detection might have a 60-70% lower crash involvement than expected. Based on these results, it was recommended that pedestrian protection are implemented on a global scale to provide protection for vulnerable road users worldwide.
Injuries disproportionately affect children from deprived areas. This study examines the links between the material and social dimensions of deprivation and injury hospitalizations in children aged 14 years or under from 2000 to 2004. Hospitalization data are from the Quebec hospital administrative data system, whereas socio-economic characteristics of individuals were estimated based on the smallest geographic areas for which Canadian census data were disseminated. The Poisson regression model was used to calculate the relative risks of hospitalization for seven categories of unintentional injury. A total of 24 540 injury hospitalizations were examined. Hospitalization in children is associated with both dimensions of deprivation. Injuries to pedestrians and motor vehicle occupants and injuries related to burns and poisonings are clearly associated with both dimensions of deprivation. These inequalities should be considered in the development of preventive measures.
Because labour laws and regulations protect minors by preventing them from working, this population is often excluded from labour data. However, work is common among Canadian youth. Young teens, and especially pre-teens, have informal employment arrangements such as odd jobs, yard work, babysitting and deliveries. Work injuries occurring in these informal employment arrangements are surprisingly frequent and not usually captured by traditional occupational health and safety data sources (e.g. workers' compensation claims). We analyzed data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) and found 999 youths (5 to 17 years) who had suffered a work-related injury between 1995 and 1998. They were concentrated in two main areas: clerical/service and manual labour. Work-related injuries increased with age. Approximately one third of the youth experienced open wounds and 5.5 percent had animal bites. Collisions with someone or something were common, as were falls. Others or animals were frequently involved. For the majority of cases, the direct cause of injury corresponds to one of ten categories. Injuries and circumstances varied by occupation. Even informal work arrangements (e.g. delivering newspapers) contained hazards and these varied by workplace. The injuries of young workers have implications for future research, prevention efforts, health services policy and legislative and regulatory efforts.