Population-based incidence of injuries among preschoolers

Risk factors for falls among children aged 0-18 years: a systematic review

BACKGROUND

Accidental falls are the most common cause of injury in children. These falls not only result in pain and injury to children but also can pose a significant financial burden to their families and society. The aim of this study is to identify risk factors for falls in children.

METHODS

We conducted a systematic review of the literature describing falls in children aged 0-18 years. Studies of falls from a height of 1 m or more were excluded from the analysis. We analyzed the included studies to identify risk factors for falls.

RESULTS

A total of 1496 articles were initially retrieved, leading to an included set of nine articles, which were published from 1995 to 2021. Risk factors related to fall injury in children aged 0-18 years included age, sex, extroversion, rural areas, history of falls, family factors, caregiver factors, medication use, intravenous therapy, tests requiring movement, disease factors and long hospital stay.

CONCLUSION

We identified 12 risk factors affecting falls in children, including individual characteristics and family and social factors.

Associations Between Children's Physical Activity, Pain and Injuries

Our aim in this study was to investigate the relationships between physical activity (PA), pain, and injury among children. Secondarily, we examined whether these relationships differed between children with normal versus excessive weight or obesity. This was a cross-sectional study of 102 children (57 girls) aged 8–12 years old. We assessed the prevalence of moderate and vigorous PA using accelerometry over a seven-day period. We examined the associations between moderate PA, vigorous PA, pain presence, and injury presence using generalized estimating equations with a logit link and binomial distribution. We adjusted the obtained models for potential confounders and explored the moderating effect of weight status. We found no association between moderate PA and pain, but time spent in vigorous PA was associated with pain. Neither moderate or vigorous PA were associated with injury, and there was no moderating effect of weight status in these relationships. In summary, we found that objectively measured vigorous PA is associated with pain among 8–12 year old children. While these results should be replicated in longitudinal studies, they suggest that an association between vigorous PA and pain should be considered when developing PA interventions for children.

Parental cannabis abuse and accidental intoxications in children: prevention by detecting neglectful situations and at-risk families

OBJECTIVES

Cannabis intoxication in toddlers is rare and mostly accidental. Our objectives were to focus on the characteristics and management of children under the age of 6 years who were admitted to our emergency department with cannabis poisoning reported as accidental by parents, and to point out the need to consider accidental cannabis ingestions as an indicator of neglect.

METHODS

The medical records of children hospitalized for cannabis poisoning in a pediatric emergency department from January 2007 to November 2012 were retrospectively evaluated. Data collected included age, sex, drug ingested, source of drug, intentional versus accidental ingestion, pediatric intensive care unit or hospital admission, treatment and length of hospital stay, toxicology results, and rate of child protectives services referral.

RESULTS

Twelve toddlers (4 boys and 8 girls; mean age, 16.6 months) were included. All had ingested cannabis. Their parents reported the ingestion. Seven children experienced drowsiness or hypotonia. Three children were given activated charcoal. Blood screening for cannabinoids, performed in 2 cases, was negative in both, and urine samples were positive in 7 children (70%). All children had favorable outcomes after being hospitalized from 2 to 48 hours. Nine children were referred to social services for further assessment before discharge.

CONCLUSIONS

Cannabis intoxication in children should be reported to child protection services with the aim of prevention, to detect situations of neglect and at-risk families. Legal action against the parents may be considered. Accidental intoxication and caring parents should be no exception to this rule.

Sports injuries among adolescents: incidence, causes and consequences

AIM

The purpose of this study was to evaluate the 1-year incidence, location, type, mechanism and severity of sports injuries for adolescents in Germany.

METHODS

Data were from the 'German Health Interview and Examination Survey for Children and Adolescents', a nationwide study of n = 17 641 children and adolescents. Analyses were based on a weighted total sample size of n(w) = 7451 adolescents between 11 and 17 years of age, 51% of them boys.

RESULTS

A total of 577 adolescents (8%) reported having experienced a sports injury during the past year. Collisions and falls were reported as being the most important causes. The most frequent diagnoses were contusions, dislocations, strains and sprains (60%), followed by fractures (26%). Most injuries (88%) were treated on an outpatient basis with only 12% resulting in hospitalisation. Gender-specific analyses showed that 9% of the boys and 7% of the girls suffered from a sports injury during the past year. After adjusting for the level of physical activity, these gender differences disappeared (OR(girls) 0.94; 95% confidence intervals: 0.74-1.18). Excluding injuries incurred from falls while horse riding, there were no gender differences in the mechanism of injury. Among boys, 30% of all injuries were fractures, among girls 20% (P < 0.05). Apart from fractures, no further differences between the sexes in the range of diagnoses were identified.

CONCLUSIONS

Although these results suggest that the risk of sports injuries does not differ significantly based on adolescents' gender, the incidence rate of adolescent sports injuries within Germany is relatively high.

Risk groups for sports injuries among adolescents--representative German national data

BACKGROUND

Physical activity during childhood and adolescence is of major importance with regard to an individual's engagement with sports in later life. Apart from the physical trauma, sports injuries often have negative effects on the motivation to remain physically active. This study evaluates data to gain detailed knowledge on 1-year incidence and risk groups with the aim of providing information for the development of preventive measures.

METHODS

Our data analysis is based on a net sample from a national study in Germany including 7697 children and adolescents aged 11 to 17 years. Within the statistical analyses, we developed weighting factors and calculated group differences as well as regression models for sports injury incidence.

RESULTS

A total of 7.7% of the children and adolescents reported a sport injury during the last 12 months. Bivariate analyses showed significant associations between sports injuries and several social and lifestyle-related covariates. After adjustment for participation in leisure time physical activity, age, non-migrant status and residence in a large city remained positively associated with the incidence of sports injuries.

CONCLUSIONS

In comparison with other results for developed countries, the incidence seems rather high. It remains to be clarified whether this is because of our use of more accurate population-based data. The results suggest that while developing preventive measures, the interaction between preferences for high-risk sports and physical as well as psychological development has to be considered.

Influence of sociodemographic factors on the risk of unintentional childhood home injuries

BACKGROUND

While social differences in childhood injuries are recognized, less is known about how social and demographic differences relate to injury mechanism. The purpose of the study was to reveal how sociodemographic factors affect the incidence of unintentional home injuries in Danish children for specific injury mechanisms and involved products.

METHODS

Information on injuries in 173 504 children treated at emergency departments was recorded for the period 1998-2003. The information was linked to data including parents' education and income and family type, and the results were compared with those for a random sample of the population.

RESULTS

A total of 50 561 injuries were analysed. The risk was 1.5 (1.5-1.6) for children with mothers having only primary education compared to tertiary education, and 1.5 (1.4-1.6) for children in families with the lowest vs. the highest income. Risk differences were found for all injury mechanisms; however the risk for burns was 1.9 (1.6-2.3) times higher in the lowest-income group than in the highest-income group, the relative risk for poisoning was 1.7(1.4-2.1). For scalds from hot water, tea or coffee, the relative risk for the lowest-income group was 2.4(1.8-3.2). Living in a one- or two-parent family and size of the dwelling had little or no effect on risk.

CONCLUSION

Childhood injury incidence depended on sociodemographic factors. The effect of the sociodemographic factors varied between injury mechanisms and products involved in the injury.

Socio-economic status and types of childhood injury in Alberta: a population based study

Background

Childhood injury is the leading cause of mortality, morbidity and permanent disability in children in the developed world. This research examines relationships between socio-economic status (SES), demographics, and types of childhood injury in the province of Alberta, Canada.

Methods

Secondary analysis was performed using administrative health care data provided by Alberta Health and Wellness on all children, aged 0 to 17 years, who had injuries treated by a physician, either in a physician's office, outpatient department, emergency room and/or as a hospital inpatient, between April 1^st. 1995 to March 31^st. 1996. Thirteen types of childhood injury were assessed with respect to age, gender and urban/rural location using ICD9 codes, and were related to SES as determined by an individual level SES indicator, the payment status of the Alberta provincial health insurance plan. The relationships between gender, SES, rural/urban status and injury type were determined using logistic regression.

Results

Twenty-four percent of Alberta children had an injury treated by physician during the one year period. Peak injury rates occurred about ages 2 and 13–17 years. All injury types except poisoning were more common in males. Injuries were more frequent in urban Alberta and in urban children with lower SES (receiving health care premium assistance). Among the four most common types of injury (78.6% of the total), superficial wounds and open wounds were more common among children with lower SES, while fractures and dislocations/sprains/strains were more common among children receiving no premium assistance.

Conclusion

These results show that childhood injury in Alberta is a major health concern especially among males, children living in urban centres, and those living on welfare or have Treaty status. Most types of injury were more frequent in children of lower SES. Analysis of the three types of the healthcare premium subsidy allowed a more comprehensive picture of childhood injury with children whose families are on welfare and those of Treaty status presenting more frequently for an injury-related physician's consultation than other children. This report also demonstrates that administrative health care data can be usefully employed to describe injury patterns in children.

Injury morbidity in an urban and a rural area in Tanzania: an epidemiological survey

Background

Injuries are becoming a major health problem in developing countries. Few population based studies have been carried out in African countries. We examined the pattern of nonfatal injuries and associated risk factors in an urban and rural setting of Tanzania.

Methods

A population-based household survey was conducted in 2002. Participants were selected by cluster sampling. A total of 8,188 urban and 7,035 rural residents of all ages participated in the survey. All injuries reported among all household members in the year preceding the interview and resulting in one or more days of restricted activity were included in the analyis.

Results

A total of 206 (2.5%) and 303 (4.3%) persons reported to have been injured in the urban and rural area respectively. Although the overall incidence was higher in the rural area, the incidence of major injuries (≥ 30 disability days) was similar in both areas. Males were at a higher risk of having an injury than females. Rural residents were more likely to experience injuries due to falls (OR = 1.6; 95% CI = 1.1 – 2.3) and cuts (OR = 4.3; 95% CI = 3.0 – 6.2) but had a lower risk of transport injuries. The most common causes of injury in the urban area were transport injuries and falls. In the rural area, cuts and stabs, of which two thirds were related to agriculture, formed the most common cause. Age was an important risk factor for certain types of injuries. Poverty levels were not significantly associated with experiencing a nonfatal injury.

Conclusion

The patterns of injury differ in urban and rural areas partly as a reflection of livelihoods and infrastructure. Rural residents are at a higher overall injury risk than urban residents. This may be important in the development of injury prevention strategies.

Individual and contextual effects in injury morbidity in Barcelona (Spain)

OBJECTIVE

To determine the relationship between socioeconomic level (measured through individual educational level and material deprivation in the areas of residence) and injury morbidity in different age groups and in males as well as in females.

DESIGN

Cross-sectional survey.

SETTING

Barcelona (Spain).

METHODS

The study population included all cases over the age of 19 who, as a result of an injury (motor vehicles injuries, falls, hits and cuts), were admitted to the emergency departments of the six main hospitals of the city during the years 1990-1991. Age- and sex-specific morbidity rates were calculated for each educational level and each cause of injury. The contextual variable included was the proportion of unemployment in each neighbourhood. Multilevel Poisson regression models were fitted.

RESULTS

Morbidity rates were higher in males, in young people and for lower educational levels. Results from the multilevel models show that, at contextual level, neighbourhoods with more unemployment present a higher risk of injuries. At individual level, after adjusting for contextual variables, the risk of sustaining injuries was higher among young men and women for all injury causes except falls among women where the risk was higher in the elderly; among both men and women, the risk of sustaining injury was higher in the population with lower educational level (RR = 1.79, 95% CI = 1.73-1.86 in men; RR = 2.12, 95% CI = 2.04-2.21 in women). This trend was also observed separately for traffic injuries, falls, hits and cuts.

CONCLUSION

Our results provide information about individual and contextual social inequalities in injury morbidity, the highest risks of injury occur in individuals of lower educational level and who reside in the more private neighbourhoods. These results underscore the need to implement injury prevention strategies not only at the individual level, but also to tailor them to the socioeconomic position of the population.

Socioeconomic differences in childhood injury: a population based epidemiologic study in Ontario, Canada

OBJECTIVE

To determine whether risks for childhood injury vary according to socioeconomic gradients.

DESIGN

Population based, retrospective study. The percentage of individuals living below the poverty line (described ecologically using census data) was the primary measure of socioeconomic status.

SETTING

Catchment area of a tertiary medical centre that provides emergency services to all area residents. Area residents aged 0-19 years during 1996 were included.

OBSERVATIONS

Injuries that occurred during 1996 were identified by an emergency department based surveillance system. The study population was divided into socioeconomic grades based upon percentages of area residents living below the poverty line. Multiple Poisson regression analyses were used to quantify associations and assess the statistical significance of trends.

RESULTS

5894 childhood injuries were identified among 35380 eligible children; 985 children with missing socioeconomic data were excluded. A consistent relation between poverty and injury was evident. Children in the highest grade (indicating higher poverty levels) experienced injury rates that were 1.67 (95% confidence interval 1.48 to 1.89) higher than those in the lowest grade (adjusted relative risk for grades 1-V: 1.00,1.10,1.22,1.42, 1.67; Ptrend < 0.001). These patterns were observed within age/sex strata; for home, recreational, and fall injuries; and for injuries of minor and moderate severities.

CONCLUSIONS

Socioeconomic differences in childhood injury parallel mortality and morbidity gradients identified in adult populations. This study confirms that this health gradient is observable in a population of children using emergency department data. Given the population based nature of this study, these findings are likely to be reflected in other settings. The results suggest the need for targeted injury prevention efforts among children from economically disadvantaged populations, although the exact requirements of the optimal prevention approach remain elusive.

Frequency and predictors of medically attended injuries in HIV-infected children

The extent to which medically attended injuries complicate the clinical course of HIV-infected (HIV+) children is unknown. In a cohort of HIV+ children delivered from 1985 to 1990 and aged less than 60 months, we determined medically attended injuries per 100 child-years, Injury Severity Scores (ISS), and predictors of medically attended injuries by using New York State Medicaid claims from 1986 to 1992 linked to birth certificates. Injury rates and ISS were compared to those of a population of black, inner city children aged less than 60 months from emergency room records. HIV+ children had slightly more injuries (19.3 vs. 16.8/100 child-years) but similar ISS (2.4 vs. 2.3). Predictors of injuries in HIV+ children included younger maternal age (24/100 child-years, p = 0.008) and delivery outside of New York City (29/100 child-years, p = 0.02). Illicit drug use and alcohol use were associated with greater ISS while cocaine use was associated with a higher rate of possibly intentional injuries. Medically attended injuries affected one in five HIV+ children in our cohort annually, slightly more than the comparison population. Specific maternal and birth characteristics such as substance abuse and younger age at delivery may help target at-risk children.

Cumulative mortality in children aged 1 to 6 years born in Western Australia from 1980-89

PURPOSE

To investigate cumulative mortality for children aged 1-6 years born in Western Australia from 1980 to 1989.

STUDY DESIGN

Births and deaths were ascertained from a linked total population database supplemented by information from postmortem records. Deaths were classified according to the underlying cause, and mortality rates, including factor specific rates, were calculated. Trends were investigated and comparisons were made using relative risks with 95% confidence intervals.

RESULTS

Cumulative mortality was 2.2/1000 infant survivors, with a significant decrease during the years studied. Mortality was almost four times higher for Indigenous children, with no decrease. Accidents comprised 45.6% of all deaths, birth defects 17.3%, cancer and leukaemias 12.5%, and infections 11.0%. Low birth weight, preterm birth, and young maternal age significantly increased the risk of death in both Indigenous and non-Indigenous children; single marital status was also a significant risk factor for non-Indigenous children.

CONCLUSION

High quality data and appropriate classification systems are essential to enable effective monitoring of childhood deaths and the planning of preventive programmes. Further decreases in mortality rates might be dependent on ensuring that resources are directed towards improving social and economic conditions for Indigenous and other disadvantaged families.