An Epistemological View on Risk Exposure Assessment: A Case Study

Background:

Research in Health Risk Assessment is increasingly covering a preeminent role in health care studies. However, risk assessment faces the issue of properly measuring risk exposure.

Objective:

The aim of the study has been to tackle some methodological issues regarding the risk assessment analysis in the health field, giving more emphasis to a philosophical and epistemological approach in order to show the difficulties in adopting suitable exposure assessment techniques.

Method:

Here, we present a methodological review and a critical discussion of foreign body injuries articles in child population as a case study. A Medline, Econlite and CIS bibliographic search was conducted considering the term “foreign bodies” only in “children” and “risk”. Only English papers are considered. Further research on CDC, CPSC, DGSANCO databases has been performed. Different approaches in risk assessment are reviewed using four case-study papers with the purpose of pointing out their limitations.

Result:

Ten papers are retrieved though literature review reporting risk estimate of foreign bodies injuries in children.

Conclusion:

Considering that different variables affecting the risk of choking injuries, like intrinsic characteristic of a product or the intensity levels at which children are exposed, and then it seems very difficult to correctly evaluate risk of injuries. For this reason, we have argued for an epistemological and holistic approach toward risk assessment.

Comparing models for quantitative risk assessment: an application to the European Registry of foreign body injuries in children

Risk Assessment is the systematic study of decisions subject to uncertain consequences. An increasing interest has been focused on modeling techniques like Bayesian Networks since their capability of (1) combining in the probabilistic framework different type of evidence including both expert judgments and objective data; (2) overturning previous beliefs in the light of the new information being received and (3) making predictions even with incomplete data. In this work, we proposed a comparison among Bayesian Networks and other classical Quantitative Risk Assessment techniques such as Neural Networks, Classification Trees, Random Forests and Logistic Regression models. Hybrid approaches, combining both Classification Trees and Bayesian Networks, were also considered. Among Bayesian Networks, a clear distinction between purely data-driven approach and combination of expert knowledge with objective data is made. The aim of this paper consists in evaluating among this models which best can be applied, in the framework of Quantitative Risk Assessment, to assess the safety of children who are exposed to the risk of inhalation/insertion/aspiration of consumer products. The issue of preventing injuries in children is of paramount importance, in particular where product design is involved: quantifying the risk associated to product characteristics can be of great usefulness in addressing the product safety design regulation. Data of the European Registry of Foreign Bodies Injuries formed the starting evidence for risk assessment. Results showed that Bayesian Networks appeared to have both the ease of interpretability and accuracy in making prediction, even if simpler models like logistic regression still performed well.

Modeling the risk: innovative approaches to understand and quantify the risk of severe FB injury

OBJECTIVES

The entry of a small item into the respiratory or digestive tract is still one of the leading causes of injuries in children up to 14 years old. The aim of the paper is to provide a quantitative risk assessment analysis for identifying consumer product features which contribute to increase the risk of sustaining a severe injury.

METHODS

Data on foreign body injuries were collected in 28 European countries and one Pakistani hospital. A total of 7296 cases were classified according to ICD-9CM 931-935. Information about injuries included age and gender of the injured child, circumstances of the accident and foreign body features. A classification tree was set up in order to analyze the impact of the item features like volume shape and rigidity on the severity of the injury.

RESULTS

Males are involved in severe injuries more often than females. Most severe injuries when the foreign body is localized in the ears were due to objects with volume lesser than 49 mm(3). Volume cut-off is slightly higher for foreign bodies that have been found in the nose (55 mm(3)). Objects with conforming rigidity pose children to higher risk of severe injury.

CONCLUSIONS

The presence and supervision of an adult is crucial in reducing the risk for severe injuries both in pharynx and laryhnx and in mouth.

The Susy Safe project overview after the first four years of activity

OBJECTIVES

to collect relevant, up-to-date, representative, accurate, systematic information, related to foreign bodies (FB) injuries.

METHODS

The "Susy Safe" registry, a DG SANCO co-funded project gathering data on choking in all EU Countries and beyond, was established in order to create surveillance systems for suffocation injuries able to provide a risk-analysis profile for each of the products causing the injury. Main findings after 4 years of activities are resumed here.

RESULTS

16,878 FB injuries occurred in children aged 0-14 years have been recorded in the SUSY SAFE databases; 8046 cases have been reported from countries outside EU. Almost one quart of the cases involving very young children (less than one year of age) presented a FB located in bronchial tract, thus representing a major threat to their health. Esophageal foreign bodies are still characterizing injuries occurred to children younger than one year, in older children the most common locations are the ears and the nose. FB type was specified in 10,564 cases. Food objects represented the 26% of the cases, whereas non-food objects were the remaining 74%. Among food objects, the most common were bones, nuts and seed, whereas for the non-food objects pearls, balls and marbles were observed most commonly (29%). Coins were involved in 15% of the non-food injuries and toys represented the 4% of the cases.

CONCLUSIONS

this data collection system should be been taken into consideration for the calculation of the risk of injuries in order to provide the EU Commission with all the relevant estimates on FB injuries.

Framework model of product risk assessment

Risk assessment has been a vital tool in the consumer product safety arena. However, the challenges have been to ensure scientific and robust assessments and to eliminate diverging risk results. Back in year 2005, EuroSafe took the initiative and orchestrated a working group (WG) on risk assessment (EuroSafe WGRA). The WG includes subject experts from regulatory bodies and industry. In the past 2 years the WG has devoted itself to vigorous research in the harmonisation of nomenclatures and the identification of basic principles of non-food consumer product risk assessment. More importantly, it has undertaken the groundbreaking work of the establishment of a risk assessment framework model. The framework model took a step-by-step approach to exemplifying a disciplined thought process: defining the objective, hazard identification and characterisation, exposure assessment, risk characterisation, risk evaluation, risk reduction and residual risk communication. The model is enriched with information source inventories and resource recommendations that can be consulted to develop practical risk assessment methods.

Web-based tool for injury risk assessment of foreign body injuries in children

Web-based surveillance systems enhance the ability for identifying, estimating and assessing public health hazards. In this paper we describe the development of a Web-based surveillance registry called Susy Safe for inorganic foreign body injuries in children aged 0-14. The Susy Safe system, which collected 2103 cases during 2000-2002 in 19 European countries, allows for notifying from physicians over the internet thus taking advantage of Web reporting capabilities. Functions include automated risk analysis engine and results visualization. Risk analysis engine has been implemented in a Bayesian framework and provides an update estimate of the risk profile of the products causing injuries, effectively as new data become available. The system contributes to simplify the physician reporting and improve public health information dissemination within consumers and consumers' association. Also it gives physician and researcher the access of a large amount of data otherwise scattered all around in different hospitals. Finally, supplying a quantitative risk assessment for the identification of hazardous characteristics of objects, such as dimensions or shape, it works toward an improvement of consumer products' safety design.

Predicting severity of foreign body injuries in children in upper airways: an approach based on regression trees

The entry of a small item into the upper airways is one of the leading causes of injuries in children up to 14 years old. The aim of this study is to characterize types of objects causing choking along with the features of the children involved in the accident and compare results with current standards. The European Survey on Foreign Bodies Injuries Study (ESFBI) collected data on foreign body injuries from 19 European countries. The data from ESFBI were selected according to the ICD-9-CM codes 933 (foreign body in the pharynx and larynx) and 934 (foreign body in the trachea, bronchi, and lungs). Both a classification tree and a linear discriminant analysis (LDA) have been set up to predict the probability that an injured child experiences a hospitalization. The classification tree provides flowchart-type decision rules and allows for analyzing the impact of the item features, the children characteristics, and the circumstances of the accidents on the severity of the foreign body injuries. Results showed that children younger than 3.5 who are involved in an accident have a high probability to experience a hospitalization.