Hospitalizations due to falls in Jewish and Arab children in northern Israel

Better safe than sorry: Evaluating the implementation process of a home-visitation intervention aimed at preventing unintentional childhood injuries in the hospital setting

Background

Child home injuries prevention interventions have rarely been implemented in hospitals. The SHABI program ("Keeping our Children Safe"; in Hebrew: "SHomrim Al BetIchut Yeladenu") recruits at-risk families arriving with child injury to the Emergency Department. Medical/nursing students conduct two home visits four months apart, providing safety equipment and guidance. One hundred thirty-five families had a first visit and 98 completed the second. Fifty percentage of families were ultra-Orthodox Jews, 11% Arab, and 28% had ≥3 preschool children. We investigated SHABI's implementation using the Consolidated Framework for Implementation Research (CFIR).

Methods

Between May 2018 and March 2021 SHABI was implemented in the Emergency Department of a hospital in Israel's northern periphery, an area with high child injury rates. The Implementation process was examined through Emergency Department medical records and tracking registries, hospital management, nurses', and home visitors' meetings notes (n = 9), and a research diary. Hospital's inner setting and SHABI's characteristics were evaluated through interviews with hospital management, nurses, and home visitors 8 months after baseline (n = 18). Home visitors' characteristics were evaluated through interviews, post-visit questionnaire on challenges encountered (n = 233), families' perceptions of SHABI and home visitors' skills through telephone interviews (n = 212); and home visitors awareness of dangers at home (n = 8) baseline and 8 months later. Qualitative data were analyzed through explanatory content analysis according to CFIR constructs. Quantitative data were analyzed using X2 and Wilcoxon test for dependent subgroups.

Results

Despite alignment between SHABI and the hospital's mission, structural hospital-community disconnect prevented implementation as planned, requiring adaptation and collaboration with the medical school to overcome this barrier. Recruitment was included in the initial patient triage process but was only partially successful. Medical/nursing students were recruited as home visitors, and following training proved competent. Children were a distraction during the visits, but home visitors developed strategies to overcome this.

Conclusions

Injury prevention programs in hospitals have significant benefits. Identifying implementation barriers and facilitators allowed implementers to make adaptations and cope with the innovative implementation setting. Models of cooperation between hospital, community and other clinical settings should be further examined.

Keeping children safe: a model for predicting families at risk for recurrent childhood injuries

OBJECTIVE

Existing research on recurrent unintentional injury (UI) focuses on the individual child rather than family risks. This study developed a statistical model for identifying families at highest risk, for potential use in targeting public health interventions.

STUDY DESIGN

A retrospective birth cohort study of hospital and emergency room (ER) medical records of children born in Ziv hospital between 2005 and 2012, attending ER for UI between 2005 and 2015, was conducted.

METHODS

Using national IDs, we assigned children to mothers and created the family entity. Data were divided into two time periods. Negative binomial regression was used to examine predictive factors in the first period for recurrent child UI in the second period. Sensitivity analyses were conducted to examine the model's robustness.

RESULTS

Eight predictive factors for child injury (P < 0.05) were found: male gender, the number of UI visits, the number of illness visits, age 36-59 months, birth weight <1500 g, maternal ER visits, siblings' UI visits, and the number of younger siblings. Some predictive factors are documented in the literature; others are novel. Five were significant in all sensitivity analyses.

CONCLUSIONS

These factors can assist in predicting risk for a child's repeat UI and family's cumulative UI risk. The model may offer a valuable and novel approach to targeting interventions for families at highest risk.

Age, Ethnicity, and Socioeconomic Factors Impacting Infant and Toddler Fall-Related Trauma

OBJECTIVE

To characterize trauma-related falls in infants and toddlers aged 0 to 3 years over a 4-year period and develop a risk stratification model of causes of fall injuries.

METHODS

Data on falls of 0 to 3 year olds from 2009 to 2012 were identified from a Jerusalem tertiary hospital trauma registry (N = 422) and the National Trauma Registry of Israel (N = 4,131).

RESULTS

Almost half of falls occurred during the first year of life, and 57% of the children were Jewish. The majority of the children lived in low socioeconomic environments, both in the Jewish (59.2%) and Arab (97.6%) samples. Most (74%) of the falls resulted in head injury. A classification and regression tree analysis indicated that falls from furniture were the leading cause of injury in 0 to 12 month olds (estimated probability of 37.9%), whereas slipping is the leading cause in 13 to 36 month olds (estimated probability of 38.4%). Age and ethnicity emerged as the leading predictors of the nature of a fall; Injury Severity Score and the child's sex were secondary. Compared with the national data, Jerusalem children had a higher incidence of falls from buildings (9.3%; 2.4%), a higher moderate-severe Injury Severity Score (>16), a higher incidence of traumatic brain injury, and a longer hospital length of stay (P < 0.001).

CONCLUSIONS

The leading determinants of fall injuries in children below the age of 3 years are age, ethnicity, and low socioeconomic status. Future outreach community interventions should target these risk groups and be tailored to their defining characteristics.

Trend and Demographic Characteristics of Maxillofacial Fractures in Level I Trauma Center

AIM

The aim of this study was to analyze the pattern and treatment of craniomaxillofacial injuries in the northern part of Israel, within a Jewish majority and large Arab minority population.

PATIENTS AND METHODS

A 5-year retrospective study evaluated patients treated for craniomaxillofacial fractures. Fracture cause, type, site, and patient demographics were evaluated.

RESULTS

Patient age ranged from 1 to 94 years with an average age of 36.7 years; 52% of the victims were Jews and 48% Arabs. There was male predilection in both sectors (78.3% vs 21.7%). The main site of injury was the zygomatic bone (33.5%) followed by nasal bone, orbital, mandible, frontal sinus, and maxillary fractures. The main etiology of injuries was falls (45.4%) with significantly more falls reported by females (52.1% vs 43.2% in males). Motor vehicle accidents caused injuries more frequent in males. Arabs experienced CMF fractures at a younger age compared to Jews (27.8 and 44.8 average age, respectively). In the elderly, the trend reversed where Jews were more prone to craniomaxillofacial fractures.

CONCLUSIONS

Compared to their weight in the population, the Arab sector experiences more craniomaxillofacial injuries. The Jewish elderly population tends to reside in nursing homes where they are more susceptible to accidental falls, whereas young Arab males are more exposed to motor vehicle accidents and interpersonal violence. Falls were the main cause of injuries particularly in women. This may reflect the women's fear of reporting domestic violence. We believe that increased government investments in infrastructures and education will lower the incidence of craniomaxillofacial trauma and balance the gap between both sectors and sexes.

A comparison of two mechanisms of severe paediatric injury in northern Israel

BACKGROUND

An increased incidence of severe injury due to falls from buildings (FFB) is reported in the rural area of northern Israel. This makes FFB, and motor vehicle collision (MVC) the two leading causes of severe paediatric trauma.

METHODS

A single-centre, age-sex matched comparison analysis of the two mechanisms of injury was conducted. Children involved in MVC (study subjects) or FFB (controls), who were brought by the Emergency Medical System Mobile-Intensive-Care-Unit from the field to the trauma bay of the Emergency Department (ED) were enrolled on the basis of a convenience sample. Immediately following ED admission, heart rate (HR), systolic blood pressure (SBP), and base deficit (BD) were recorded. Types of injuries, Glasgow Coma Score (GCS) on scene, and Injury Severity Score (ISS) were also obtained.

RESULTS

Eleven study subjects and 22 controls were enrolled during a 1-year period. The mean ISS for the study subjects group and for the controls was 23.4 and 19.5, respectively. No difference was found in comparing the ISS, BD, SBP and HR of the two groups (p=0.261, p=0.421, p=0.314, and p=0.824, respectively). Controls had a lower GCS (p<0.031) and were more likely to have a skull fracture (p<0.0082). Study subjects were more likely to have limb injuries (p<0.0001) and thoracoabdominal injuries (p<0.0059).

CONCLUSIONS

This study suggests that the Injury Severity Score of the two mechanisms of paediatric injury is high. The haemodynamic characteristics on ED admission were comparable between the two groups of patients but the likelihood of specific type of injury was different.

Paediatric rehabilitation in Israel: unique problems, exceptional solutions

Mind the gap: Israel straddles the gap between Western medicine and Middle-Eastern cultural and political challenges. Maintaining state-of-the-art paediatric rehabilitation in an era of economic and political constrictions is described and analysed in this review.

Youth injury in Israel: an appeal for change

Unintentional injury in children and adolescents have raised public health concerns in recent years, because it is the leading cause of death, a physical burden for the injured person, an emotional and social burden for the families together with an economic burden for society. The National Center for Children's Safety and Health in Israel was established in 1995 at the Schneider Children's Medical Center in order to focus on prevention of childhood and adolescent injury and safety. Over these years data has been collected from the Central Bureau of Statistics, the Ministry of Health, the National Trauma Register, Police and the National Poison Center in order to look for trends and develop strategies for intervention. These efforts, together with the active prevention programs that have been established, resulted in a national report (1) presented to the Minister of Health and other policy makers in 2003. The current situation of youth injuries in Israel, which over the years have not shown any improvement, necessitates a new agenda with a focus on prevention and collaboration between various ministries and agencies in order to implement it. The report alone cannot have an impact upon youth safety, but we hope that it will provide an impetus for developing youth safety strategies and programs based on data. We also believe there is a need for long-term monitoring and follow-up of youth injury trends in Israel.

Home accidents in Arab Bedouin children in southern Israel

Home accidents are a major health problem; no data about the specific types of home accidents in the pediatric Bedouin population of southern Israel is available. We sought to delineate the specific types of home accidents in Arab Bedouin children in southern Israel. The study was conducted in a primary care clinic in an Arab Bedouin town in southern Israel. An interview of every patient or parent who presented to the clinic for a home accident in a child from December 2000 until mid November 2001 was conducted. A total of 235 accidents were recorded from 219 patients (153 males and 66 females). The most prevalent injury was burns (85 cases--36.1%) followed by falls (67 cases--28.5%), contusions, (31 cases--13.2%), lacerations (29 cases--12.3%), and nail penetrations (19 cases--8%). Thirteen patients were hospitalized, 6 with burns and 7 due to falls. A total of 209 days of hospitalization were recorded, 195 days due to burn and 14 days due to falls, (p < 0.05). Burn rates were highest in children younger than 2 years of age, 39/57 (68.4%), and an increased risk for burns was significantly correlated to younger age (p < 0.0001). We conclude that in our study population, burns represent the most prevalent home accident and that burns cause a much longer hospital stay than any other type of accident. The risk for burns is correlated to younger age. A burn prevention plan is needed.