Glass injuries to children

Glass injuries seen in the emergency department of a South African district hospital

BACKGROUND

The emergency department of Embhuleni Hospital frequently manages patients with glass-related injuries. This study assessed these injuries and the glass that caused them in more detail.

AIM

The objectives of our study included determining the type of glass causing these injuries and describing the circumstances associated with different types of glass injuries.

SETTING

The emergency department of Embhuleni Hospital in Elukwatini, Mpumalanga province, South Africa.

METHODS

This was a cross-sectional study with a sample size of 104 patients. Descriptive statistics were used to assess the characteristics of the glass injuries.

RESULTS

Five different types of glass were reported to have caused the injuries, namely car glass (7.69%), glass ampoules (3.85%), glass bottles (82.69%), glass windows (3.85%) and street glass shards (1.92%). Glass bottle injuries were mainly caused by assaults (90.47%) and most victims were mostly young males (80.23%). The assaults occurred at alcohol-licensed premises in 65.11% of cases. These injuries occurred mostly over weekends (83.72%), between 18:00 and 04:00. The face (34.23%) and the scalp (26.84%) were the sites that were injured most often.

CONCLUSION

Assault is the most common cause of glass injuries, usually involving young men at alcohol-licensed premises. Glass injuries generally resulted in minor lacerations, with few complications (2.68%).

Holiday ornament-related injuries in children

OBJECTIVES

Holiday ornament injuries in children have not been well documented in the medical literature. Our aim was to investigate the patterns of injuries sustained from these ornaments as a first measure toward prevention.

METHODS

This was a retrospective cohort analysis of all patients examined in an urban pediatric emergency department over a 13-year period ending in March 2008 for holiday ornament-related injuries. Cases were identified using a computer-assisted text query followed by a manual chart review. Data collected from each chart included the child's age, sex, injury characteristics, physical examination findings, radiographic imaging, interventions, and disposition. To analyze injury rates over the years, we used a multiplicative Poisson model allowing varying exposures.

RESULTS

Over the study period, we identified 76 eligible patients. The median age was 2 years (interquartile range, 1.17-3.3 years); 44.7% were female. Forty-three of the 76 cases (53.9%) involved ingestions: 35 were of holiday ornaments, and 8 were of light bulbs. All but one of these ornaments were made of glass. In 28%, there was an associated bleed either from the mouth or as a delayed gastrointestinal bleed. Other patients experienced lacerations (27.6%), eye injuries (5.1%), and minor electrocution injury (2.5%). Imaging was performed in 85%. A subspecialty consult was obtained in 23%, primarily addressing a foreign body ingestion or removal after skin exploration. The incidence rate has not changed over the years.

CONCLUSIONS

Holiday ornament-related injuries primarily involve foreign body ingestions and glass-related injuries. Over half of the injuries involved small light bulbs and ornaments made of glass placed at the level a toddler can reach. Pediatricians are advised to discuss these points with families during holiday season.

Children's perceptions and behavior with respect to glass littering in developing countries: a case study in Palestine's Nablus district

The aims of this study were to assess the current situation regarding glass litter on the streets and children's attitudes, and behavior concerning glass litter. Out of 240 interviewed children, 41.7% admitted glass littering. This was reflected in the high incidence of injuries caused by street glass among children; 140 (58.3%) of the children interviewed had been injured by broken glass at least once while walking outdoors and 95 of the children had received professional medical care for the lacerations. As reported by the children who admitted to glass littering, the most effective elements (29.6%) in preventing them from littering the streets with glass were moral and religious convictions, and the next most effective practice (20.4%) was improved street cleanliness. Preventive measures such as encouraging moral and religious convictions among children, more effective street cleaning by local authorities, improved footwear, education, and glass recycling incentives, as well as engaging the community in street cleaning campaigns, are all needed to address this public health hazard. More recreational facilities should be provided. Public awareness initiatives led by environmentalists, social workers, primary health care providers or home healthcare providers may also help educate children to wear shoes, prevent glass injuries and increase glass litter awareness.

Glass table-related injuries in children

OBJECTIVES

To investigate the patterns of injury sustained from glass table-related accidents to estimate whether tempered glass would prevent injuries.

METHODS

We conducted a retrospective cohort analysis of all patients in an urban pediatric emergency department between October of 1995 and May for 2007 for glass table-related accidents. Data collected included age, sex, injury characteristics, examination findings, radiographic imaging, interventions, and disposition.We used a preventability score ranging from I (fully preventable injury with safety glass) to IV (unlikely to be preventable with safety glass).

RESULTS

We identified 174 eligible patients during the study period. The median age was 3.4 years (interquartile range, 2.0-6.6 years); 62.1% were boys. The face was most commonly involved (45.6%) followed by lower (23.8%) and upper extremities (18.9%). Patients younger than 5 years were associated with more facial injuries (odds ratio, 6.0; 95% confidence interval, 2.9-12.6). Radiographs were obtained in 68 patients, and computed tomographic scans in 3 (total, 40.1%). Surgical repair was needed in 143 patients (82.1%), of whom 15 (10.5%) underwent procedural sedation and 8 (5.6%) required operative management. Reviewers ranked 74 patients (42.5%) as grade I, 20 patients (11.5%) as grade II, 64 patients (36.8%) as grade III, and 16 patients (9.2%) as grade IV.

CONCLUSIONS

Glass table injuries are associated with significant morbidity. More than half of the injuries may have been prevented or mitigated with the use of tempered glass. Pediatricians are advised to discourage families from the purchase of nontempered glass tables, while advocating for legislation mandating the use of tempered glass.

Enhanced solid waste management by understanding the effects of gender, income, marital status, and religious convictions on attitudes and practices related to street littering in Nablus - Palestinian territory

Litter is recognized as a form of street pollution and a key issue for solid waste managers. Nablus district (West Bank, Palestinian Territory), which has an established network of urban and rural roads, suffers from a wide-spread litter problem that is associated with these roads and is growing steadily with a well-felt negative impact on public health and the environment. The purpose of this research was to study the effects of four socio-economic characteristics (gender, income, marital status, and religious convictions) of district residents on their attitudes, practices, and behavior regarding street litter generation and to suggest possible remedial actions. All four characteristics were found to have strong correlations, not only with littering behavior and practices, but also with potential litter prevention strategies. In particular, the impact of religious convictions of the respondents on their littering habits and attitudes was very clear and interesting to observe.

Multiple lacerations in a pregnant woman caused by spontaneously exploding shower screen glass

Injuries caused by glass occur frequently, in particular in children, and make up an estimated 3% to 5% of all emergency visits, most frequently involving lacerations of hands, feet, and face. About 30% to 40% of glass injuries occur at home and often involve so-called architectural glass or bottles and glass containers. Accidents reported in association with showering mostly refer to falls or scalding by hot water. However, an increasing number of shower screens are made of tempered glass, which may potentially brake. Such injuries may be potentially severe, causing laceration of extremity arteries; requiring hospitalization or outpatient treatment for injuries; causing absence from work. These injuries are likely underreported in the medical literature but could have potential medicolegal consequences for the patient. We report a case of multiple lacerations developed in a third-trimester pregnant woman caused by the spontaneous shattering of a shower screen glass and discuss the apparent unawareness to this potential hazard in the scientific literature.

Influence of socio-economic factors on street litter generation in the middle east: effects of education level, age, and type of residence

Street littering is considered an important environmental health issue in the Middle East. This problem is growing steadily and is attracting great concerns within the communities. The purpose of this paper, which focuses on Nablus district (Palestinian Territory), is to measure the perception and opinion of residents toward littering, in addition to studying prevailing attitudes and practices on littering. This was achieved using an interview survey approach. The influence of three socio-economic factors; level of education, age, and type of residence, on the littering behaviour of individuals was studied. As a result, possible remedial actions have been suggested. The data presented in this work can be considered as one piece of information, which can be compiled with other future data to design an effective litter control programrhe for Middle Eastern countries.

Two unusual stab injuries to the neck: homicide or self-infliction?

A 31-year-old woman was found dead by her daughter, lying in the living room which showed a large pool of blood, secondary droplets and stains from arterial blood spatter, dropping and contact. This bloody scene and two puncture wounds at the anterior aspect of the neck, one of them transecting the left common carotid artery leading to exsanguination, arose suspicion of homicide. However, the wound morphology including notches and a parallel skin incision as well as microradiography demonstrated that the two puncture wounds had been produced by glass. At the scene, a broken wine glass with two dagger-like tips had been standing on a table in front of a sofa where the woman had been sitting, and she most likely sustained the injury when she suddenly moved her head downwards, thus moving into the protruding tips. This self-inflicted accident demonstrates that inspection of the scene and synthesis of autopsy and scene findings can be crucial for a successful medico-legal reconstruction. The mechanism of producing the accidental injury is very extraordinary, in that the woman actively moved into a shattered wine glass instead of falling into an intact architectural glass surface.

Accidental sharp force fatalities--beware of architectural glass, not knives

In a retrospective evaluation of 799 consecutive autopsies of victims of sharp force performed between 1967 and 1996 in Münster and Berlin, only 18 cases (2.3%) were classified as accidents. A typical pattern was present in 15 cases: inebriated adults (1.4-3.6g/l BAC) fell into an architectural glass surface in the form of a door or window (12 cases), an aquarium, a mirrored wardrobe or a telephone cell. Another man fell into a large drinking glass. Many victims in this group showed multiple scratches, abrasions and superficial incisions as well as one or more deep tear/cut/puncture injury. The wound margins can be clean-cut or irregular and abraded. Death was mostly caused by exsanguination except for one case of air embolism and one case of cerebral injury. The fatal injuries were produced by large and dagger-like slivers of glass, by sharp-edged fragments of glass remaining inside the frame or by a portion of glass which fell down and acted in a way similar to a guillotine. Ordinary types of flat glass were involved in all cases and it is not until the impact that sharp fragments or cutting edges are produced. So the motion of the person commonly provides the force necessary for a fatal injury. This was also true for the remaining two cases not involving architectural glass. A farmer suffered cerebral injury from a fall into the long prong of a pitch fork, and the wounding agent was a knife in only one case. A man who stated that he had fallen into the knife in his hand died from pneumonia after inadequate therapy following a single stab injury to the periphery of the left lung and liver. Accidents where the victim is killed by his own knife therefore appear to be extremely rare.

"Through-glass" injuries

This prospective trial collected all cases where injuries had resulted from the hand passing through or striking glass and had been referred to a hand injury service during 1 year. Eighty-seven cases were referred and the factors relating to these injuries were examined. A record was made of the structures damaged, the surgery performed and prevailing socioeconomic factors. These injuries were very costly in terms of morbidity, surgical effort and time, with significant resource implications. The study appears to confirm other reports that current legislation on glazing safety was too long delayed and is inadequate now that it is in place.