Injuries in a problematic socioeconomic context: a population-based study in Réunion, Indian Ocean, 1993-1994. GEAR. Groupement d'Etude sur les Accidents à la Réunion

Suspected child abuse among victims of home accidents being admitted to the emergency department: a prospective survey from Turkey

OBJECTIVES

Association between home injuries and child abuse has received interest in Western countries. Inasmuch as it is now known that cultural differences may have an impact on child-rearing practices and the definition of maltreatment, we aimed to assess the suspected physical abuse in children presenting to the emergency department with home injuries and determine the risk factors associated with suspected child maltreatment in our region.

METHOD

The study is prospective in design. The sample was composed of 87 children younger than 72 months with presenting histories of home accidents. Data were collected by interview with the parents and by application of various questionnaires and inventories to both children and their parents.

RESULTS

Suspected physical abuse was identified in 16.1% of cases presenting with home injuries. The significant factors associated with suspected abuse were child's age younger than 12 months, having developmental delays in the social and self-care domains, younger paternal age, paternal alcohol abuse, marital discordancy, repeated history of home injuries, and requirement for radiological examination.

CONCLUSION

A missed diagnosis of child abuse can result in repeated injury, cause severe morbidity, and even result in death. This research indicates the features of "victims of accidents" who require special attention to recognize suspected abuse at the emergency department. Cultural factors might also provide additional indications that might aid in determining the cases of child maltreatment.

Home delivery of an injury prevention kit for children in four French cities: a controlled randomized trial

OBJECTIVES

Home delivery of counselling and safety devices to prevent child injuries could help parents to adopt safe behaviour. The aim of this study was to test a safety kit designed and used in Quebec (Canada).

DESIGN AND SUBJECTS

One hundred families from four towns in the Paris suburbs were visited at home by nurses or doctors when their child reached 6-9 months. Selection criteria were: primipara, medical problem, psychological, and/or socioeconomic difficulties.

INTERVENTIONS

During the first visit, 50 families (group 1) received counselling and a kit including preventive devices and pamphlets about indoor injuries and ways to avoid them. The other 50 families (group 2) received counselling but not the kit. A second home visit was made 6-8 weeks later.

MAIN OUTCOME MEASURES

The number of safety improvements was calculated 6-8 weeks after a first home visit. Perceived usefulness of the kit was collected from families and from interviewers.

RESULTS

Between the first and the second visits, safety improvement was significantly higher in the group with the kit. This was mainly related to the risk of fall (p<0.02), fire and burns (p<0.001), poisoning (p<0.01), and suffocation (p<0.001). For improvement related to devices provided in the kit, the difference between the groups was significant: 64.4% improvement in group 1 versus 41.2% in group 2 (p<0.01). The relative risk (RR) of safety improvement between groups was 1.56 (95% confidence interval (CI) 1.35 to 1.80). Even for improvements not related to the kit the difference remained significant: 31.2% in group 1 versus 20.2% in group 2 (p<0.05); RR = 1.54 (95% CI 1.22 to 1.93).

CONCLUSION

Routine home visits by social services offer a good opportunity to tackle child injury prevention. Free delivery of prevention kits and counselling allow families to modify their behaviour and homes so as to reduce risks.

Role of individual and contextual effects in injury mortality: new evidence from small area analysis

OBJECTIVE

To analyse the role of individual and contextual variables in injury mortality inequalities from a small area analysis perspective, looking at the data for the city of Barcelona (Spain) for 1992-98.

SETTING

Barcelona (Spain).

METHODS

All injury deaths in residents older than 19, which occurred in the period 1992-98 were included (n=4393). Age and sex specific mortality rates were calculated for each educational level and each cause of death (traffic injuries, falls, drug overdose, suicide, other injuries). The contextual variables included were the proportion of men unemployed, and the proportion of men in jail, in each neighbourhood. Multilevel Poisson regression models were fitted using data grouped by age, educational level, and neighbourhood for each sex.

RESULTS

Death rates were higher in males, at the extremes of the age distribution (under 44 and over 74 years), and for lower educational levels. The results of the Poisson multilevel models indicate that inequalities by educational level follow a gradient, with higher risks for the population with no schooling, after having adjusted for the contextual variables of the neighbourhood. Such inequalities were more important in the youngest age group (20-34 years), as relative risk of 5.41 (95% confidence interval (CI) 3.9 to 7.4) for all injury causes in males and 4.38 (95% CI 2.3 to 8.4) in females. The highest relative risks were found for drug overdose. There was a contextual neighbourhood effect (the higher the deprivation, the higher the mortality) after having taken into account individual variables.

CONCLUSION

The findings underscore the need to implement injury prevention strategies not only at the individual level taking into account socioeconomic position, but also at the neighbourhood level.

Road accident statistics: discrepancies between police and hospital data in a French island

In most developed countries, information on road crashes are routinely collected by the police. However, comparison of police records and hospital data underlines a deficit of the number of road accidents in the routine statistics. In La Réunion, a French overseas dependency, an epidemiological study of injuries leading to hospitalisation or deaths has been performed from June 1993 to June 1994. The comparison between hospital data and police records showed that only 37.3% of non-fatally traffic-injured in-patients were recorded by the police. Length of stay in hospital, physician in charge of the first aid, urban place of the crash, type of vehicle involved, day and time of the crash and blood alcohol concentration were significantly associated with the presence in the police file. Police overestimated the severity of the injuries. Police notified 100 deaths on the 115 counted by the study. In France, non-fatally traffic-injured should be followed 30 days to improve quality of police death records. A capture-recapture method was used to estimate the total number of injured people. The capture-recapture method consists in merging information from several sources of notification to determine the real number of cases in the population and the exhaustivity of each source. We estimated that 346 subjects were injured in one month whereas police data recorded only 87 and hospital data 137. This method seems interesting to use in routine after validation when unique personal identifiers are available.