[Bicycle accidents treated in emergency departments. A multicentre study]

Effects of Fall Training Program on Automatization of Safe Motor Responses During Backwards Falls in School-Age Children

A significant number of children suffer injuries from falls. The current measures of prevention and education regarding falls are not sufficient, as falling is still the main cause of injury at this age. This study aimed to evaluate the risk of injury during a backward fall and assess the effect of the Safe Fall training program on this risk. 457 primary school children between the ages of 6 and 12 (mean age of 9) were enrolled in a 6-week randomized intervention. The program was carried out during physical education classes and consisted of an intervention group that followed the Safe Fall training program and a control group that was given equilibrium exercises. The risk of injury was assessed before and after the implementation using the Information Scale on Safe Ways of Falling observation scale, evaluating the responses of five different body parts (head, hip, knees, upper limbs and back). Students’ natural response to falls was associated with a high risk of injury in more than 90% of the cases. The implementation of the Safe Fall program resulted in a considerable decrease in this risk, with percentages lowered to levels between 8.7% and 18.3%.

Children's Improvement of a Motor Response during Backward Falls through the Implementation of a Safe Fall Program

The World Health Organization has warned that, in children, the second cause of death from unintentional injuries are falls. The objective of this study was to analyze the motor response of primary schoolchildren when a backwards fall occurs. These analyses occurred before and after interventions of the Safe Fall program, which aims to teach safe and protected ways of backward falling. A quasi-experimental research design was used, with a sample of 122 Spanish (Sevillian) schoolchildren in the 10⁻12 age bracket. The INFOSECA ad-hoc observation scale was used for data collection: this scale registers 5 essential physical reactions throughout the process of a safe and protected backwards fall. After that, a number of descriptive, correlational and contrast statistics were applied. The value used in the McNemar test to establish statistical significance was p < 0.05. Results showed that over 85% of students had developed the competence to correctly perform all five physical motions that allow for a safer backward fall. The teaching of safe and protected techniques for falling backwards in child population in Primary Education is possible through the implementation of the Safe Fall program in Physical Education classes, which can help making falls safer, diminishing the risk and severity of the injuries they cause.

[Emergency department consultations associated with unintentional injuries: A cases series]

OBJECTIVE

To analyse the clinical and epidemiological characteristics of children who are attended in Emergency Departments (EDs) for an unintentional injury in Spain.

METHODS

Multicentre case series with prospective data collection conducted during 12 months in the ED of 11 hospitals belonging to the Spanish Paediatric Emergency Research Group. Data were collected between September 2014 and January 2015, continuing for one year in all paediatric EDs, and included children between 0 and 16 years old seen for an unintentional injury.

RESULTS

A total of 10,175 episodes were recorded during the study, of which 1,941 were due to unintentional injuries (19.1%, 95% CI: 18.3%-19.8%), and 1,673 of these were included in the study. Falling, direct injuries, and injuries due to sports activities represented more than 80%, with significant variations in the injuries mechanism observed in different age groups. More than occurred at home or school. About 40% of the unintentional injuries were not witnessed by an adult. The most frequent diagnosis was limb trauma (63.0%), with a fracture being observed in 242 (14.4% of unintentional injuries). As regards fractures, 34 (2.0%) were admitted to hospital, with 21 (61.8%) for surgical reduction of the fracture. No deaths were recorded in the first 24h.

CONCLUSIONS

Unintentional injuries constitute a very common reason for consultation in EDs in Spain. The circumstances surrounding the unintentional injuries should be considered, in order to develop preventive measures and to improve the training of people involved in the care of these children.

Unintentional injuries and associated factors among children and adolescents. An analysis of the Spanish National Health Survey

OBJECTIVES

To describe the prevalence of unintentional injuries in children and adolescents aged 6-18 years and to identify factors associated with a greater risk of suffering accidents.

METHODS

A cross-sectional study conducted with data collected from three consecutive Spanish National Health Surveys. Data were analyzed using multivariate logistic models.

RESULTS

The reported prevalence of unintentional injuries in children and adolescents decreased from 12.8% in 2003 to 8.7% in 2011. Most of these injuries occurred at the "workplace or place of study" and "on the street". Boys suffered unintentional injuries 1.64 more times than girls (OR = 1.64; 95% CI 1.48-1.82). Children aged 11-14 years (OR = 1.22; 95% CI 1.09-1.37) and adolescents aged 15-18 years (OR = 1.24; 95% CI 1.07-1.42) had a higher probability of reporting an unintentional injury when compared to children aged 6-10 years. Multivariate analysis showed that the adjusted odds of injuries decreased in 2006 (OR = 0.87; 95% CI 0.77-0.97) and in 2011 (OR = 0.66; 95% CI 0.57-0.76).

CONCLUSIONS

The odds of overall UI are being gradually reduced over the years. Prevention policies are effective and it is necessary to continue promoting and motivating prevention actions aimed at the family, the school, and the community.

Effectiveness of Bicycle Safety Helmets in Preventing Facial Injuries in Road Accidents

BACKGROUND

The effectiveness of bicycle safety helmets in preventing head injuries is well- documented. Recent studies differ regarding the effectiveness of bicycle helmets in preventing facial injuries, especially those of the mid-face and the mandible.

OBJECTIVES

The present study was conducted to determine the protective effect of a bicycle helmet in preventing mid-face and mandibular fractures.

PATIENTS AND METHODS

Data from an accident research unit were analyzed to collect technical collision details (relative collision speed, type of collision, collision partner, and use of a helmet) and clinical data (type of fracture).

RESULTS

Between 1999 and 2011, 5,350 bicycle crashes were included in the study. Of these, 175 (3.3%) had fractures of the mid-face or mandible. In total, 228 mid-face or mandibular fractures were identified. A significant correlation was found between age and relative collision speed, and the incidence of a fracture. While no significant correlation was found between the use of a helmet and the incidence of mid-facial fractures, the use of a helmet was correlated with a significantly increased incidence of mandibular fractures.

CONCLUSIONS

Higher age of cyclists and increasing speed of the accident opponent significantly increase the likelihood of sustaining facial fractures. The use of bicycle helmets does not significantly reduce the incidence of mid-facial fractures, while being correlated with an even increased incidence of mandibular fractures.

[Epidemiology and risk factors in injuries due to fall in infants under one year-old]

OBJECTIVES

To describe the epidemiological characteristics of unintentional injuries due to falls in children under one year and to analyse the risk factors associated with severe injuries.

PATIENTS AND METHODS

This multicentre, observational and cross-sectional study included all children less than one year treated for unintentional fall in the Emergency Departments of 8 Spanish Hospitals, belonging to the «Unintentional Paediatric Injury Workshop» of the Spanish Paediatric Emergency Society, between March 1st, 2014 and February 28th, 2015.

RESULTS

Out of 289,887 emergency department cases, 1,022 were due to unintentional falls. The median age was 8 months and 52.5% were males. Fall injuries were more frequent among children aged 9-12 months (37.6%), and 83.5% occurred at home. The most common mechanism was fall from nursery equipment (69.4%), and 47.8% occurred from a height under 50cm. More than two-thirds (68%) of falls were witnessed, but in half of the cases (329) the caregiver was not in area. Serious injuries were seen in 12% of cases. In this study, a fall height greater than 50cm, falls in the street, from the arms of the carer, and from the stairs were identified as independent risk factors for worse outcomes.

CONCLUSIONS

The most serious injuries occur in children <3 months and from a height of >50cm, though not related to unwitnessed falls. Because the most common serious injury mechanism is the fall from the arms of the carer, from stairs, and falls in the street, these facts should be highlighted in order to avoid morbidity.