Maternal reports of child injuries in Canada: trends and patterns by age and gender

Child injuries in Lebanon: assessing mothers' injury prevention knowledge attitude and practices

BACKGROUND

Childhood injury is a neglected public health problem with a sizeable burden on children's well-being and their families. This study aims to describe the pattern and types of childhood injuries and to determine the level of mothers' Knowledge, Attitude, and Practices (KAP) towards childhood injury prevention in Lebanon. The study further examines the association between childhood injury occurrence and mothers' supervision.

METHODS

This cross-sectional study recruited mothers of children aged up to 10 years from multiple sites (i.e., a medical center, a private clinic, a healthcare facility, and a refugee camp clinic). Data were collected on mothers' KAP toward childhood injuries using self-administrated questionnaires. A summation score for KAP correct answers was calculated and descriptive and statistical analyses were performed to measure the association between the outcomes.

RESULTS

A total of 264 mothers were surveyed and injury data were collected on their 464 children. The prevalence of childhood injury was 20% in the past 12 months, mostly sustained by males (53.8%) and children aged 5-10 years (38.7%). The most common type of injury was fall (48.4%), followed by burns (%7.5), and sports injuries (7.5%). Hospitalized children were more likely to be males and older than 5 years (p < 0.001). More than one-third of the mothers demonstrated poor knowledge, while the majority showed poor practice (54.4%), and fair attitude (45.6%) towards child injury prevention. Children of working mothers have three times higher odds of sustaining injuries (OR: 2.95, 95% CI: 1.60;5.47) compared to those of non-working mothers, accounting for possible confounders (p = 0.001).

CONCLUSION

Childhood injuries represent a major health problem in Lebanon. Findings from this study showed that mothers are less knowledgeable and unprepared to prevent their children from getting injured. Educational programs are much needed to address the gap in the mothers' KAP toward child injury prevention. Further studies are recommended to understand the cultural context and examine its key determinants to identify effective strategies and develop tailored interventions for preventing childhood injuries.

Factors Related to Locomotive Syndrome in School-Aged Children in Okazaki: A Cross-Sectional Study

The relationship of locomotive syndrome with other physical characteristics and lifestyle habits in children has not been fully elucidated. The aim of this study was to assess the prevalence of children's locomotive syndrome, and to determine its relationship with the above-mentioned factors. This was a cross-sectional study of 285 elementary school children who volunteered to participate in a medical checkup for physical function. Data was collected via medical examination, clinical measurements, and questionnaires. A multivariable logistic regression model was used to determine the relationship (odds ratios; ORs) of participants' characteristics, physical functions, and other outcomes determined by questionnaire on locomotive syndrome. The following factors were related to locomotive syndrome: older age (OR = 1.421, 95% confidence interval [CI] [1.039, 1.945]), male sex (OR = 4.011, 95% CI [2.189, 7.347]), and more time spent watching television per day (OR = 1.281, 95% CI [1.001, 1.640]). These results may assist in the encouragement of children to perform appropriate physical activities and avoid unhealthy lifestyle habits, reducing the occurrence of locomotive syndrome.

Developmental and behavioural associations of burns and scalds in children: a prospective population-based study

OBJECTIVE

To investigate child developmental and behavioural characteristics and risk of burns and scalds.

DESIGN

Data on burns in children up to 11 years from 12 966 participants in the Avon Longitudinal Study of Parents and Children were linked to developmental profiles measured before the burn injury.

MEASURES

Preinjury profiles of the children derived from maternal questionnaires completed in pregnancy, and at 6, 18, 42, 47 and 54 months. Injury data collected by questionnaire at 6, 15 and 24 months and 3.5, 4.5, 5.5, 6.5, 8.5 and 11 years of age.

RESULTS

Incidence: Burn rates were as follows: birth-2 years 71.9/1000/year; 2-4.5 years 42.2/1000/year; 5-11 years 14.3/1000/year. Boys <2 years were more likely to sustain burns, and girls had more burns between age 5 and 11 years. Medical attention was sought for 11% of burn injuries. Development: Up to age 2 years, burns were more likely in children with the most advanced gross motor developmental scores and the slowest fine motor development. Children with coordination problems at 4.5 years of age had increased risk of burns between 5 and 11 years. No associations were observed with cognitive skills. Behaviour: At 3.5 years, the Strengths and Difficulties Questionnaire scores and reported frequent temper tantrums predicted subsequent burns in primary school age. After adjustment for confounders, burns in the preschool period were related to gender and motor development, and in school-aged children, to frequent temper tantrums, hyperactivity and coordination difficulties.

CONCLUSION

Child factors associated with increased risk of burns were male gender in infancy and female gender at school age, advanced gross motor development, coordination difficulties, hyperactivity and problems with emotional regulation.

Caregiver-related predictors of thermal burn injuries among Iranian children: A case-control study

PURPOSE

Burns are a common and preventable cause of injury in children. The aim of this study was to investigate child and caregiver characteristics which may predict childhood burn injuries among Iranian children and to examine whether confounding exists among these predictors.

METHODS

A hospital based case-control study was conducted using 281 burn victims and 273 hospital-based controls, which were matched by age, gender and place of residence (rural/urban). The characteristics of the children and their caregivers were analyzed using crude and adjusted models to test whether these were predictors of childhood burn injuries.

RESULTS

The age of the caregiver was significantly lower for burn victims than for the controls (P<0.05). Further, the amount of time the caregiver spent outdoors with the child and their economic status had a significant positive association with the odds of a burn injury (P<0.05). A multivariate logistic regression found that Type A behaviour among caregivers was independently associated with the child's odds of suffering a burn injury (OR = 1.12, 95% CI: 1.04-1.21). The research also found that children with ADHD (Inattentive subscale: Crude OR = 2.14, 95% CI: 1.16-3.95, Adjusted OR = 5.65, 95% CI: 2.53-12.61; Hyperactive subscale: Crude OR = 1.73, 95% CI: 1.23-2.41, Adjusted OR = 2.53, 95% CI: 1.65-3.87) also had increased odds of suffering a burn injury. However, several variables were identified as possible negative confounder variables, as the associations were stronger in the multivariate model than in the crude models.

CONCLUSION

The caregiver's characteristics which were predictors of burn injuries among Iranian children were: being younger, high socio-economic status, Type A behavioural pattern and spending more time outdoors. In addition, the relationship between a child's ADHD scores and the odds of a burn injury may be negatively confounded by the caregivers predictor variables.

Maternal organ donation and acute injuries in surviving children

PURPOSE

The purpose of this study is to test whether maternal deceased organ donation is associated with rates of subsequent acute injuries among surviving children after their mother's death.

METHODS

This is a longitudinal cohort analysis of children linked to mothers who died of a catastrophic brain event in Ontario, Canada, between April 1988 and March 2012. Surviving children were distinguished by whether their mother was an organ donor after death. The primary outcome was an acute injury event in surviving children during the year after their mother's death.

RESULTS

Surviving children (n=454) had a total of 293 injury events during the year after their mother's death, equivalent to an average of 65 events per 100 children per year and a significant difference comparing children of mothers who were organ donors to children of mothers who were not organ donors (21 vs 82, P<.001). This difference in subsequent injury rates between groups was equal to a 76% relative reduction in risk (95% confidence interval, 62%-85%).

CONCLUSIONS

Deceased organ donation was associated with a reduction in excess acute injuries among surviving children after their mother's death. An awareness of this positive association provides some reassurance about deceased organ donation programs.

Children's perceptions about falls and their prevention: a qualitative study from a rural setting in Bangladesh

Background

Childhood falls is a major public health problem in Bangladesh. In-depth understanding of the situation by the target groups and their families is necessary for successful development, implementation and evaluation of any intervention. The study aimed at knowing the views of Bangladeshi rural children about childhood falls and their suggestions for prevention.

Methods

Children of 10–17 were selected purposely from 4 villages of Sherpur Sadar upazila (sub-district), Sherpur district of Bangladesh. Six focus group discussions and ten in-depth interviews were conducted during July-August 2010 for this study. Gender and education of the participants were considered. Major themes were identified, coded and categorized from content analysis.

Results

Participants stated that young children (<5 years of age) and boys appeared to be the main victims of falls and majority of these injuries occurred in and around the households. Boys commonly fall from the tree around their premises and high places. Girls usually fall when they remain busy in household chores and playing with friends around their premises. Participants also mentioned that children mostly sustained injury when they are unsupervised. Supervision, public awareness and putting barriers (e.g. door barrier, putting pillow and use net around the bed etc.) were suggested as the preventive measures.

Conclusion

Findings of this study could be considered as part of knowledge-base in designing interventions to address childhood falls.

Stimulant treatment and injury among children with attention deficit hyperactivity disorder: an application of the self-controlled case series study design

OBJECTIVE

The aim of the present work was to assess the short-term effects of stimulant medication use on risk of injury among children diagnosed as having attention deficit hyperactivity disorder (ADHD).

METHODS

The study group for this self-controlled case series study was children aged 1-18 years old diagnosed as having ADHD who experienced an incident medically-attended injury event and received at least one prescription for stimulant medication between 1993 and 2008 (n=328), identified from The Health Improvement Network primary care database from the UK. Conditional Poisson regression was used to estimate incident rate ratios (IRR) and 95% CIs for injury comparing periods of time exposed to stimulant medication to unexposed periods.

RESULTS

Among children with ADHD prescribed stimulant medication, the rate of medically-attended injury was decreased during periods of stimulant medication use as compared to unexposed periods (IRR 0.68, 95% CI 0.50 to 0.91). There was evidence of a protective association among males and among children aged 10-14 years. This effect did not change over time on treatment.

CONCLUSIONS

Stimulant medication use may decrease the risk of injury among children treated for ADHD, although unmeasured time varying confounding may be an alternative explanation. Injury risk may be considered during the decision-making process with regard to medication continuation among children with ADHD.

Effects of gender, indigenous status and remoteness to health services on the occurrence of assault-related injuries in children and adolescents

BACKGROUND

Assault-related injury is a devastating consequence of violence and is a prominent cause of morbidity and mortality in young age. However, reliable data sources are scarce and there has been a paucity of studies examining possible predisposing factors on the incidence of assault-related injury.

METHOD

Logistic regression analyses were conducted to examine the effect of gender, indigenous status and remoteness to health services on sustaining assault-related injuries in patients aged 17 years and under by using data from the state-wide trauma registry in Queensland, Australia from 2005 to 2008.

RESULTS

A total of 282 assault-related injury cases were identified. Indigenous females were at the highest risk of sustaining assault-related injuries (odds ratio (OR): 15.3, 95% confidence interval (CI): 8.17-28.6), followed by indigenous males (OR: 6.55, 95% CI: 3.60-11.9) and non-indigenous males (OR: 2.82, 95% CI: 1.78-4.47). Males were at a significantly higher risk than females in the group aged 13-17 years (OR: 2.11, 95% CI: 1.34-3.31). Living in a regional area was associated with a lower risk compared to major cities for non-indigenous people (OR: 0.59, 95% CI: 0.44-0.78). Indigenous people were at higher risk of sustaining an assault-related injury than non-indigenous people in regional areas (OR: 4.8, 95% CI: 3.14-7.42) and in remote areas (OR: 10.1, 95% CI: 2.64-38.69).

CONCLUSIONS

The current study provides evidence of interaction effects among the predisposing factors. Identifying these factors is important to conduct effective preventive measures and trauma management plans focussing on high-risk groups of assault-related injuries in young age.

Injuries in preschool children: the hypothetical protector effect of minor injuries and risk factors for minor and medically attended injuries

This study aimed to investigate the relationship between minor and medically attended injuries and to analyse the influence of child-related factors and family-related factors in injuries of preschool children. Individual interviews were conducted with 335 parents of 1- to 5-year-old children. Parents informed about the child and the family variables and reported the child's history of injuries in the last year. The frequencies of minor injuries and medically attended injuries were not correlated. The risk factors for both kinds of injuries include the number of siblings and the size of the family. Minor injuries were more frequent in older than in younger children. Medically attended injuries were more frequent in boys than in girls. The risk factors that influence minor and medically attended injuries are different, suggesting that the strategies to prevent and reduce injuries need to take that difference into consideration.

Injury and health among children in vulnerable families

BACKGROUND

Injury is the leading cause of death for children older than 1 year. The incidence of childhood injury varies greatly depending on social factors, including income, family violence, and other social stressors. This study reports the incidence of injury among children aged 5 years in a cohort of vulnerable families.

METHODS

The Fragile Families and Child Wellbeing Study is a longitudinal cohort of approximately 5,000 at-risk families across the United States. Data from interviews with mothers conducted shortly after giving birth and follow-up surveys at 1 year, 3 years, and 5 years were used. Multivariate regression analysis was used to identify independent risk factors for injury in year 5.

RESULTS

Five-year follow-up data on injury was complete for 2,397 families. Two hundred ninety-six children were injured at the age of 5 years (12.3%). Multivariate regression found that the strongest predictors of injury in year 5 were male gender (OR, 2.62; 95% CI, 1.02-6.75; p = 0.04) and being in the lowest income stratum (OR, 1.23; 95% CI, 1.01-1.49; p = 0.03).

CONCLUSIONS

Children in vulnerable families are at higher risk for injury. The incidence of 12.3% found in this cohort is substantially higher than CDC risk for 5-year-old children, that is, overall 9.3%. This longitudinal cohort has demonstrated a persistently elevated risk of childhood injury, but risk factors for injury have changed with age. As these children reached school age, low household income and male gender were risk factors for injury. This suggests that recognition of gender differences and targeted interventions for caregivers and play environments may be useful.

Children hospitalized with lower extremity fractures in the United States in 2006: a population-based approach

OBJECTIVE

The purpose of this study was to examine the demographic and hospitalization characteristics of children hospitalized with lower extremity fractures in the United States in 2006.

METHODS

Children aged 0 to 20 years with a diagnosis of lower extremity fracture in the 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) were included. Lower extremity fractures were defined by International Classification of Diseases, 9th Revision, Clinical Modification codes 820-829 under "Injury and Poisoning (800-999)." Patient demographic and hospitalization-related data were analyzed by chi-square testing and unbalanced analysis of variance.

RESULTS

There were more boys than girls with lower extremity fractures and 53% had private insurance as their primary payer. About one half of the children were between the ages of 13 and 20 years, but all ages were represented from age 0 to 20. White children accounted for 56%. Urban hospitalizations accounted for 93% of cases and 66 percent of admissions were to teaching hospitals. All patients had an average length of stay (LOS) 4.04 days, and infant patients had the longest average LOS of 5.46 days. The average number of diagnoses per patient was 3.07, and the average number of procedures per patient was 2.21. The average charge per discharge was $35,236, and the oldest patients had the largest average charge of $41,907. The average number of comorbidities increased with increasing patient age. There was a 55.6% greater mortality risk in non-teaching hospitals than in teaching hospitals and there was at least ten times the mortality risk in rural hospitals than in urban hospitals.

CONCLUSIONS

This study provides an understanding of the demographic and hospitalization characteristics of children with lower extremity fractures in the United States in 2006. This information may be useful in implementing measures to help prevent similar injuries in the future. Further research is required to determine causality of the associations found including increased mortality risk for this population at rural and non-teaching hospitals.

Are overweight and obese youth at increased risk for physical activity injuries?

OBJECTIVE

To determine whether relationships between physical activity and physical activity injuries are modified by BMI status in youth.

METHOD

Data were obtained from the 2006 Canadian Health Behaviour in School-Aged Children survey; a representative study of 7,714 grade 6-10 youth. A sub-sample of 1,814 were re-administered the survey in 2007. Analyses considered relationships among the major variables in theory-driven cross-sectional and longitudinal analyses.

RESULT

Among normal weight youth, cross-sectional analyses indicated that those who reported high levels of physical activity outside of school experienced 2.28 (95% confidence interval 1.95-2.68) the relative odds for physical activity injury in comparison to those with low levels of physical activity outside of school. Analogous odds ratios for overweight and obese youth were 1.89 (1.31-2.72) and 3.72 (1.89-7.33), respectively. BMI status was not an effect modifier of the relationship between physical activity and physical activity injury. Similar observations were made in the confirmatory longitudinal analyses.

CONCLUSION

Concerns surrounding the design of physical activity programmes include side-effects such as injury risk. This study provides some re-assurance that physical activity participation relates to injury in a consistent manner across BMI groups.

Relating intimate partner violence to heath-care utilisation and injuries among Pacific children in Auckland: the Pacific Islands Families Study

AIM

Despite well-known emotional and behavioural sequela, few studies investigate health-care utilisation and injury impacts of children exposed to intimate partner violence (IPV). This study examines the association between mothers' IPV experience and general practitioner (GP) and hospital presentations by their children within the first 6 years of life.

METHODS

In 2000, a cohort of Pacific infants born in Auckland was established. At 6 weeks, 2 years and 6 years post-partum, maternal home interviews were conducted and IPV experience elicited using the Conflict Tactic Scale, together with reports of children's GP and hospital visitations.

RESULTS

At 6 weeks, 2 years and 6 years, 1098, 921 and 799 participating mothers were in intimate relationships. Severe physical IPV was reported by 22.1, 23.0 and 7.1% of mothers, respectively, and minor IPV was reported by another 18.7, 16.9 and 6.1%, respectively. Compared with children without maternal physical IPV exposure, children of mothers disclosing severe physical IPV were 1.19 (95% confidence interval (CI): 1.08-1.31) times as likely to visit GPs, and children of mothers disclosing minor physical IPV were 1.13 (95% CI: 1.02-1.25) times as likely to visit GPs, after adjusting for socio-demographic, maternal mental health and other confounding factors. No significant association was found between maternal IPV and children's hospital visits, or GP or hospital visits for injury.

CONCLUSIONS

IPV is common for many mothers of Pacific children, and is associated with significantly more GP visits for exposed children. Identification of maternal IPV during mothers' and children's GP and hospital visits may help guide services to prevent future presentations to children.

Preventing childhood falls at home: meta-analysis and meta-regression

BACKGROUND

Childhood falls are an important global public health problem, but evidence on their prevention has not been quantitatively synthesized. Despite social inequalities in childhood injury rates, there is a lack of evidence examining the effect of fall-prevention practices by social group.

METHODS

A systematic review of literature was conducted up to June 2004 and meta-analysis using individual patient data to evaluate the effect of home-safety interventions on fall-prevention practices and fall-injury rates. Meta-regression examined the effect of interventions by child age, gender, and social variables. Included were 21 studies, 13 of which contributed to meta-analyses.

RESULTS

Home-safety interventions increased stair-gate use (OR=1.26; 95% CI=1.05, 1.51), and there was some evidence of reduced baby-walker use (OR=0.66; 95% CI=0.43, 1.00), but little evidence of increased possession of window locks, screens, or windows with limited opening (OR=1.16, 95% CI=0.84, 1.59) or of nonslip bath mats or decals (OR=1.15; 95% CI=0.51, 2.62). Two studies reported nonsignificant effects on falls (baby-walker-related falls on flat ground [OR=1.35; 95% CI=0.64, 2.83] or down steps or stairs [OR=0.70; 95% CI=0.14, 3.49]) and medically attended falls (OR=0.78; 95% CI=0.61, 1.00).

CONCLUSIONS

Home-safety education and the provision of safety equipment improved some fall-prevention practices, but the impact on fall-injury rates is unclear. There was some evidence that the effect of home-safety interventions varied by social group.

Parenting behaviors and attitudes about supervision among parents of acutely poisoned children

OBJECTIVE

This study describes the supervision beliefs of parents of children with unintentional poisonings and examines the relationship between supervision beliefs, household composition, and parental age.

METHODS

Children aged <60 months presenting with an unintentional poisoning to an emergency department or urgent care of an urban, academic medical center in Kansas City, Missouri, were identified. Parents completed the Beliefs About Supervision Questionnaire (BAS-Q) by phone within 2 weeks of their child's visit. The questionnaire consisted of 14 child activity scenarios, each followed by 2 questions: What age would you permit your child to perform this activity without constant supervision? How often would you check on a child of this age while engaged in the activity? Two scores were derived: mean age across all scenarios (BAS-Age) and mean time until child is checked on across all scenarios (BAS-Time).

RESULTS

One hundred parents completed the BAS-Q. The majority of respondents were mothers (82%), 40% had 2 or more children in the home aged 5 years or younger, and 61% had 2 or more adults living in the home. Pearson correlations revealed associations for BAS-Time with total children within the home (r = .28, P < .005) and number of children aged 6 to 12 years in the home (r = .28, P < .005). BAS-Age was not related to any aspect of household composition.

CONCLUSION

Less vigorous parental supervision was associated with an increased number of children in the home. Parental supervision may be influenced by reliance on other children in the home.

Stages of development and injury patterns in the early years: a population-based analysis

Background

In Canada, there are many formal public health programs under development that aim to prevent injuries in the early years (e.g. 0–6). There are paradoxically no population-based studies that have examined patterns of injury by developmental stage among these young children. This represents a gap in the Canadian biomedical literature. The current population-based analysis explores external causes and consequences of injuries experienced by young children who present to the emergency department for assessment and treatment. This provides objective evidence about prevention priorities to be considered in anticipatory counseling and public health planning.

Methods

Four complete years of data (1999–2002; n = 5876 cases) were reviewed from the Kingston sites of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), an ongoing injury surveillance initiative. Epidemiological analyses were used to characterize injury patterns within and across age groups (0–6 years) that corresponded to normative developmental stages.

Results

The average annual rate of emergency department-attended childhood injury was 107 per 1000 (95% CI 91–123), with boys experiencing higher annual rates of injury than girls (122 vs. 91 per 1000; p < 0.05). External causes of injury changed substantially by developmental stage. This lead to the identification of four prevention priorities surrounding 1) the optimization of supervision; 2) limiting access to hazards; 3) protection from heights; and 4) anticipation of risks.

Conclusion

This population-based injury surveillance analysis provides a strong evidence-base to inform and enhance anticipatory counseling and other public health efforts aimed at the prevention of childhood injury during the early years.

Non-fatal injuries among Pacific infants in Auckland: data from the Pacific Islands families first two years of life study

AIMS

Child injury is the leading cause of mortality and morbidity in developed countries. While Pacific infant death rates are relatively high in New Zealand, little is known about non-fatal injury rates. We seek to describe maternally reported injury in Pacific infants aged between 0-24 months.

METHODS

A cohort of Pacific infants born during 2000 in Auckland, New Zealand, was followed. Maternal home interviews were conducted at 6 weeks, 12 months and 24 months postpartum and injury events were recalled. Marginal models using generalized estimating equations (GEEs) were used to analysis the longitudinal data.

RESULTS

The inception cohort included 1398 infants at 6 weeks, 1241 infants at 12 months and 1161 infants at 24 months. The age-specific injury incidence per 1000 person-years exposure was estimated at 48 (95% CI: 23, 88) injuries for infants aged 0-6 weeks, 106 (95% CI: 88, 127) injuries for infants aged 7 weeks-12 months and 174 (95% CI: 151, 199) injuries for infants aged 13-24 months. In the multivariable GEE model, older infants (P < 0.001), infants who were male (P = 0.01), born to Pacific Island fathers and non-Pacific Island mothers (P < 0.001), and in higher or unknown income groups (P = 0.01) were significantly more likely to suffer injury events. No significant two-factor interaction with infant age was identified.

CONCLUSIONS

Among Pacific infants, non-fatal injury is common and injury incidence rates are considerably higher than national levels. Male infants and those born into ethnically mixed families, where the father was of Pacific Island ethnicity and the mother was non-Pacific, were at increased relative risk of injury and might benefit from specific injury prevention targeting. However, given the high injury incidence levels found, we advocate that investigation and targeting of culturally appropriate prevention strategies for all Pacific families with young children is required to reduce injury rates for Pacific infants in New Zealand.

Socioeconomic status and non-fatal injuries among Canadian adolescents: variations across SES and injury measures

Background

While research to date has consistently demonstrated that socioeconomic status (SES) is inversely associated with injury mortality in both children and adults, findings have been less consistent for non-fatal injuries. The literature addressing SES and injury morbidity among adolescents has been particularly inconclusive. To explore potential explanations for these discrepant research findings, this study uniquely compared the relationship across different measures of SES and different causes of injury (recreation versus non-recreation injuries) within a sample of Canadian adolescents.

Methods

The sample included adolescent participants (aged 12 to 19 years) in the Canadian 1996–1997 cross-sectional National Population Health Survey (n = 6967). Five SES measures (household income, two neighbourhood-level proxy measures, two parental indicators) were examined in relation to three injury outcomes (total, recreation, and non-recreation injuries) using multivariable logistic regression.

Results

Among males, a clear relationship with injury was observed only for a parental SES index, which was positively associated with total and recreation injuries (odds ratios for the highest versus lowest SES category of 1.9 for total and 2.5 for recreation injuries). Among females, there was some evidence of a positive relationship between SES and injuries, particularly for a neighbourhood-level education measure with total and recreation injuries (odds ratios of 1.7 for total and 2.0 for recreation injuries).

Conclusion

The results suggest that differences related to the measures of SES chosen and the causes of injury under study may both contribute to discrepancies in past research on SES and non-fatal injuries among adolescents. To clarify the potential SES-injury relationship among youth, the findings emphasize a need for a greater understanding of the meaning and relevance of different SES measures for adolescents, and for an exploration of the pathways through which SES may be related to injury risk.

Childhood femur fractures, associated injuries, and sociodemographic risk factors: a population-based study

OBJECTIVE

The objectives of this study were to determine the incidence of femur fractures in Colorado children, to assess underlying causes, to determine the prevalence and predictors of associated injuries, and to identify potentially modifiable risk factors.

METHODS

The study population included all Colorado residents who were aged 0 to 17 years at the time of injury between January 1, 1998, and December 31, 2001. Cases of femur fracture were ascertained using the population-based Colorado Trauma Registry and International Classification of Diseases, Ninth Revision, Clinical Modification codes 820.0 to 821.39. Associated injuries with an Abbreviated Injury Scale of 2 or higher were classified into 5 categories. Poisson regression, small area analysis, and multivariate logistic regression were used to identify predictors of femur fractures and associated injuries, respectively.

RESULTS

During the study period, 1139 Colorado children (795 boys, 344 girls) sustained femur fractures, resulting in the incidence of 26.0 per 100000 person-years. Rates were higher in boys than in girls in all age groups (overall risk ratio: 2.19; 95% confidence interval: 1.92-2.47) but did not differ by race/ethnicity. Femur fractures that were caused by nonaccidental trauma showed more distal and combined shaft + distal pattern; their incidence did not differ by gender or race but was higher in census tracts with more single mothers and less crowded households. Associated injuries were present in 28.6% of the cases, more often in older children. Fatalities occurred only among children with associated injuries. Children who were involved in nonaccidental trauma, motor vehicle crashes, or auto-pedestrian accidents were 16 to 20 times more likely to have associated injuries than those with femur fractures as a result of a fall. In small-area analysis, the incidence of femur fractures in infants and toddlers was higher in census tracts characterized by higher proportion of Hispanics, single mothers, and more crowded households. Among children 4 to 12 years of age, the incidence was higher in census tracts with fewer single-family houses and more crowded households. Finally, the incidence of femur fractures among teenagers was higher in rural tracts and those with a higher proportion of Hispanics.

CONCLUSIONS

Femur fractures and associated injuries remain a major cause of morbidity in children. Predictors of femur fractures change with age; however, the risk is generally higher among children who live in the areas with lower socioeconomic indicators.

The epidemiology of home injuries to children under five years in New Zealand

OBJECTIVE

This paper describes the epidemiology of injuries sustained by children under five in the home.

METHODS

Cases were selected from the New Zealand Health Information Service public hospital morbidity and mortality data, and included all 0-4 year olds where the place of injury occurrence was classified as 'home'. The circumstances of injury were coded according to the Supplementary Classifications of External Causes of Injury and Poisoning (E-codes) of the International Classifications of Diseases. Age-specific rates of death or hospitalisation due to injury were calculated using the population of 0-4 year olds in New Zealand for each year as the denominator.

RESULTS

The rate of death from an injury sustained at home between 1989 and 1998 was 13 per 100,000 population per year. The main causes of death were suffocation, submersion, homicide and fire. The rate of hospitalisation in children aged 0-4 years from an injury sustained in the home between 1989 and 2000 was 737 per 100,000 population per year. The most frequently recorded causes of hospitalisation were falls, scalds, poisonings and cut/piercing incidents.

CONCLUSION AND IMPLICATIONS

Although there has been an apparent decrease in the number of children hospitalised for injuries sustained in the home environment, it is not possible to determine if this is a 'real' change or a result of other factors affecting the data. While children continue to be killed and injured as a result of preventable incidents in the home environment, injury prevention strategies should be continued and strengthened.

A prospective population based study of childhood injuries: the Velestino town study

BACKGROUND

Unintentional injuries in childhood constitute a significant public health problem. Our purpose is to estimate the incidence of identifiable unintentional childhood injuries of any type and severity, and to document risk factors of non-transient nature.

METHODS

We have undertaken a prospective population-based investigation in a Greek town with a population of 748 children (0-14 years old). All identifiable injuries have been monitored during a twelve-month period through information provided by the health care outlets or educational institutions as well as the police station and the regional hospital.

RESULTS

The overall incidence was 28.2 per 100 person-years (95% confidence interval from 24.4 to 32.0), whereas the incidence of injuries with Hopkins Injury Severity Score equal to or higher than four was 6.3 with 95% confidence interval 4.5 to 8.1. The incidence of total injuries was higher among boys than among girls (p<0.01) and the gender difference was particularly evident among older children. Almost half of the injuries were due to falls and more than 20% were due to cutting. Children of younger and less educated parents have higher risk for injury and children from families with more injuries were more likely to be injured themselves. There was no evidence that somatometric characteristics were associated with injury risk.

CONCLUSION

The incidence of unintentional childhood injuries is high and represents a considerable health burden. Family related variables are important risk factors for childhood injuries, whereas somatometric characteristics play a minimal role.

KEY POINTS

Incidence and risk factors of all injuries in a population-based study among children. About 28 per 100 children got injured over a period of one year. There is evidence that younger paternal age and lower education may be associated with increased injury risk. Family related variables seem to be important risk factors for childhood injuries, whereas somatometric characteristics play minimal role.

Childhood behavior disorders and injuries among children and youth: a population-based study

CONTEXT

While an association between pediatric behavioral disorders and injuries is generally acknowledged, no studies have measured the risk for injury in the context of a large, population-based study that is free of cohort biases.

OBJECTIVES

To examine the association between childhood behavior disorders ([CBDs] as indicated by prescription for methylphenidate [MPH]) and a variety of injury outcomes, and to evaluate the risk for injury among these children after controlling for known demographic correlates.

DESIGN

Population-based database analysis of all children in British Columbia (BC) under the age of 19 as of December 31, 1996; comparison of those who had been prescribed MPH and therefore placed in the CBD group (n = 16, 806) and those who were not (n = 1,010,067). Demographic information collected was as follows: age, sex, measures of socioeconomic status, and region of residence.

OUTCOME MEASURES

Common types of childhood injury in BC: International Classification of Diseases, Ninth Revision N-codes (fractures, open wounds, poisoning/toxic effect, concussion, intracranial, burns) and E-codes (falls, postoperative complications, motor vehicle accidents, struck by object, adverse effects of drugs, suffocation, drowning).

DATA SOURCE

BC Linked Health Data Set and the BC Triplicate Prescription Program.

RESULTS

After controlling for known demographic correlates, odds for injury was greater among those treated with MPH and presumed to have a behavioral disorder, when injury was characterized either by type (1.67; 99% confidence interval: 1.54-1.81) or cause (1.52; 99% confidence interval: 1.40-1.66) of injury. This increased risk extended to unexpected categories of injury such as postoperative complications and adverse effects of drugs.

CONCLUSIONS

Children with CBDs have >1.5 times the odds of sustaining injuries of a variety of types from a variety of causes, even after controlling for known demographic correlates, than those without behavioral disorders. The risks for these children extend beyond those that might be directly associated with impulsivity and overactivity. Injury prevention strategies aimed at this group of children and youth would be beneficial. Policy-makers should account for increased risk of a wide variety of injuries in this group of children and youth.

Parental correlates of unintentional burn injuries in infancy and early childhood

The main purpose of this paper is to review parental factors associated with unintentional burns in early childhood. The problem and characteristics of early childhood burns are discussed. Child injury prevention strategies and models are presented. Parental correlates of pediatric injuries in general and specific to burns are reviewed. In conclusion, the authors recommend greater examination of parental variables potentially amenable to treatment, such as psychological functioning, and improved methodology including the use of prospective analyses, multiple methods and informants, and comparison groups. These efforts should enable greater understanding of parental factors related and causal to early childhood burns and, in turn, guide prevention initiatives.

Epidemiology of pediatric injury-related primary care office visits in the United States

OBJECTIVES

Unintentional injuries are a major cause of childhood mortality and morbidity in the United States. However, there is little epidemiologic information about pediatric injuries seen in primary care settings. The objective of this study was to characterize types and external causes of childhood injuries seen by primary care physicians and to compare the demographic and visit characteristics of children with injury-related visits (IRVs) and non-IRVs.

METHODS

A stratified random sample survey of office-based practicing physicians in the National Ambulatory Medical Care Survey (1997 and 1998) was conducted. Injury-related primary care office visits were measured for patients who were <19 years (number of patient visits = 6358).

RESULTS

Visits for childhood injuries composed >10 million primary care office visits per year (a rate of 13.8 visits per 100 person-years). The most common diagnoses assigned to these injuries were open wounds, sprains and strains, contusions, and superficial injuries such as abrasions and splinters. Leading external causes of these injuries were sports and overexertion, accidental falls, natural factors such as bites and stings, and cutting instruments. The single most common cause of pediatric injuries was sports/overexertion. Children who had IRVs were more likely to be older (odds ratio [OR]: 1.10/year of age; 95% confidence interval [CI]: 1.08-1.12), to be male (OR: 1.5; 95% CI: 1.2-1.9), and to reside in the West (OR: 1.9; 95% CI: 1.4-2.6) or in a rural area (OR: 1.4; 95% CI: 1.1-1.9). They were less likely to be Asian (OR: 0.2; 95% CI: 0.1-0.5) or Hispanic (OR: 0.5; 95% CI: 0.3-0.8). At the visit, children with IRVs were more likely to see a physician who was not their primary care physician (OR: 1.8; 95% CI: 1.4-2.3) and to see a family physician rather than a pediatrician (OR: 2.3; 95% CI: 1.8-2.9).

CONCLUSIONS

IRVs account for a significant portion of primary care for children in the United States. Identifying potentially preventable external causes of injury and characteristics of children who are more likely to be injured is important both for injury prevention programs and for the education of physicians who care for children.