Epidemiology of paediatric trauma in Norway: a single-trauma centre observational study

Adolescent optimism - Coping well after severe injury: A qualitative study

BACKGROUND

Trauma is the leading cause of death and disability in children globally. Studies indicate that severe traumatic brain injury (TBI) negatively affects quality of life (QoL) in children, but little is known about QoL after injury in children without TBI. This study aimed to investigate QoL in this group six months post-discharge.

METHODS

Trauma patients aged 13-17 years admitted to a major Scandinavian trauma center were eligible if they met the following criteria: received by a trauma team, ISS > 9, required ICU monitoring, and hospital stay > 4 days. Patients with moderate to severe head injuries (AIS > 2) were excluded. Eighteen consenting adolescents were interviewed six to nine months after discharge.

RESULTS

The main finding was that most participants were "coping well after experienced injuries." A minority reported challenges in daily life, including fatigue and difficulty in keeping up. Few used regular painkillers, and most were unconcerned about long-term consequences. However, many felt that more structured follow-up post-discharge would have been helpful.

CONCLUSION

Among 18 moderate to severely injured adolescents, we found that the majority were coping well. Strong social relationships and involvement in school and social activities was important in all interviews. While several experienced fatigue and challenges in keeping up, the negative impact on daily life was manageable at the time of the interviews.

Pediatric trauma over a decade: demographics, mechanisms of injury, and mortality at a major Danish trauma center-a retrospective cohort study

BACKGROUND

In recent decades, the number of fatal accidents among children and adolescents has declined. Nevertheless, trauma remains a significant cause of death among children and adolescents in high-income countries, despite significant advancements in prevention and care. Pediatric trauma patients differ substantially from adults in terms of their physiology, anatomy, and daily activities; therefore, they show distinct injury patterns and require different care. The aim of this study was to investigate mortality from trauma in pediatric patients admitted by trauma team activation at the Aarhus University Hospital Trauma Center (AUH-TC) in a highly developed country with exceptionally low child mortality, where trauma is a leading cause of death in this age-group. By evaluating trends in demographics, mechanisms of injury, injury severity, and outcomes, this study aims to provide insights into trauma care and outcomes.

METHODS

This retrospective cohort study included 1,037 pediatric patients (< 18 years old) consecutively admitted by trauma team activation from 1 January 2011 to 31 December 2021. The pediatric patients accounted for 14% of the total trauma population, which consisted of 7307 patients in total. Data on demographics, Injury Severity Score (ISS), mechanism of injury, and 30-day mortality were analyzed. Descriptive statistics were reported.

RESULTS

Boys accounted for 58% of the patients (n = 595). Falls were the mechanism of injury in 47% (n = 308) of children under 13 years old, while traffic-related injuries accounted for 38% (n = 139) of adolescents aged 14-17 years. Severe injuries (ISS > 15) were associated with traffic accidents in 25% of cases. The number of traumas peaked on weekends (71%) and during the spring/summer (29%). The ISS was greater than 15 in 13% (n = 130) of the patients, and the overall 30-day mortality rate was 1.6% (n = 17).

CONCLUSIONS

This study found no significant change in pediatric trauma incidence at AUH-TC over a decade. In Denmark, the few children with an ISS above 15 are predominantly injured in traffic accidents, with risk increasing with age. There was a low incidence of patients with an ISS above 15, and mortality rates were lower than in similar studies. These findings on injury patterns and severity may aid in risk assessment, accident prevention, and hospital resource planning. Further research with extended follow-up is recommended to assess potential trends in trauma mechanisms over time.

Emergency pediatric patients and use of the pediatric assessment triangle tool (PAT): a scoping review

BACKGROUND

We conducted a scoping review of the evidence for the use of the Pediatric Assessment Triangle (PAT) tool in emergency pediatric patients, in hospital and prehospital settings. We focused on the psychometric properties of the PAT, the reported impact, the setting and circumstances for tool implementation in clinical practice, and the evidence on teaching the PAT.

METHODS

We followed the Joanna Briggs Institute methodology for scoping reviews and registered the review protocol. We searched MEDLINE, PubMed Central, the Cochrane Library, Epistemonikos, Scopus, CINAHL, Grey literature report, Lens.org, and the web pages of selected emergency pediatrics organizations in August 2022. Two reviewers independently screened and extracted data from eligible articles.

RESULTS

Fifty-five publications were included. The evidence suggests that the PAT is a valid tool for prioritizing emergency pediatric patients, guiding the selection of interventions to be undertaken, and determining the level of care needed for the patient in both hospital and prehospital settings. The PAT is reported to be fast, practical, and useful potentially impacting overcrowded and understaff emergency services. Results highlighted the importance of instruction prior using the tool. The PAT is included in several curricula and textbooks about emergency pediatric care.

CONCLUSIONS

This scoping review suggests there is a growing volume of evidence on the use of the PAT to assess pediatric emergency patients, some of which might be amenable to a systematic review. Our review identified research gaps that may guide the planning of future research projects. Further research is warranted on the psychometric properties of the PAT to provide evidence on the tool's quality and usefulness. The simplicity and accuracy of the tool should be considered in addressing the current healthcare shortages and overcrowding in emergency services.

REVIEW REGISTRATION

Open Science Framework; 2022. https://osf.io/vkd5h/.

Pediatric trauma patients in Swedish ambulance services -a retrospective observational study of assessments, interventions, and clinical outcomes

BACKGROUND

Pediatric trauma patients constitute a significant portion of the trauma population treated by Swedish Emergency Medical Services (EMS), and trauma remains a notable cause of death among Swedish children. Previous research has identified potential challenges in prehospital assessments and interventions for pediatric patients. In Sweden, there is limited information available regarding pediatric trauma patients in the EMS. The aim of this study was to investigate the prevalence of pediatric trauma patients within the Swedish EMS and describe the prehospital assessments, interventions, and clinical outcomes.

METHODS

This retrospective observational study was conducted in a region of Southwestern Sweden. A random sample from ambulance and hospital records from the year 2019 was selected. Inclusion criteria were children aged 0-16 years who were involved in trauma and assessed by EMS clinicians.

RESULTS

A total of 440 children were included in the study, representing 8.4% of the overall trauma cases. The median age was 9 years (IQR 3-12), and 60.5% were male. The leading causes of injury were low (34.8%) and high energy falls (21%), followed by traffic accidents. The children were assessed as severely injured in 4.5% of cases. A quarter of the children remained at the scene after assessment. Complete vital signs were assessed in 29.3% of children, and 81.8% of children were assessed according to the ABCDE structure. The most common intervention performed by prehospital professionals was the administration of medication. The mortality rate was 0.2%.

CONCLUSIONS

Pediatric trauma cases accounted for 8.4% of the overall trauma population with a variations in injury mechanisms and types. Vital sign assessments were incomplete for a significant proportion of children. The adherence to the ABCDE structure, however, was higher. The children remained at the scene after assessment requires further investigation for patient safety.

Children's risk assessment in street crossing using virtual reality

INTRODUCTION

Crossing streets represents a risky task for children where they have to assess both the probability and harm severity of being hit by a vehicle. To cross streets safely, children must perceive and interpret the traffic environment and scale their movements to the flow of traffic. Their ability to gather information about the surrounding environment through visual search strategies is essential in this process. This study aimed to explore children's street crossing behaviors and to identify successful risk-assessment strategies.

METHOD

Virtual reality (VR) with built-in eye tracking was used for this investigation; 55 children between 7 and 10 years old completed six street crossing tasks with varying complexity and difficulty.

RESULTS

Varying competencies in street crossing were demonstrated among the children. Those who crossed safely looked to the left and right more often to check for traffic and spent more time assessing the traffic environment by following oncoming vehicles with their gaze before crossing than those who crossed dangerously. No apparent differences between children who crossed safely and those who crossed dangerously were found while crossing.

CONCLUSIONS

The findings suggest that dangerous street crossings were, on different levels, related to assessment time before crossing, visual search strategies during assessment time, and the tasks harm severity and probability risk.

PRACTICAL APPLICATIONS

Future research could suggestively include indicators such as assessment time and visual search strategies, and tasks could discern harm severity and probability risk. These indicators might also be considered for training programs aiming to enhance children's pedestrian safety.

Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study

BACKGROUND

Trauma is one of the most common causes of death in childhood, but data on severely injured Swiss children are absent from existing national registries. Our aim was to analyze trauma activations and the profiles of critically injured children at a tertiary, non-academic Swiss pediatric emergency department (PED). In the absence of a national pediatric trauma database, this information may help to guide the design of infrastructure, processes within organizations, training, and policies.

METHODS

A retrospective analysis of pediatric trauma patients in a prospective resuscitation database over a 2-year period. Critically injured trauma patients under the age of 16 years were included. Patients were described with established triage and injury severity scales. Statistical evaluation included logistic regression analysis.

RESULTS

A total of 82 patients matched one or more of the study inclusion criteria. The most frequent age group was 12-15 years, and 27% were female. Trauma team activation (TTA) occurred with 49 patients (59.8%). Falls were the most frequent mechanism of injury, both overall and for major trauma. Road-traffic-related injuries had the highest relative risk of major trauma. In the multivariate analysis, patients receiving medicalized transport were more likely to trigger a TTA, but there was no association between TTA and age, gender, or Injury Severity Score (ISS). Nineteen patients (23.2%) sustained major trauma with an ISS > 15. Injuries of Abbreviated Injury Scale severity 3 or greater were most frequent to the head, followed by abdomen, chest, and extremities. The overall mortality rate in the cohort was 2.4%. Conclusions: Major trauma presentations only comprise a small proportion of the total patient load in the PED, and trauma team activation does not correlate with injury severity. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED. Our findings indicate that high priority should be given to training in the management of severely injured children in the PED. The leading major trauma mechanisms were preventable, which should prompt further efforts in injury prevention.

Epidemiology of pediatric trauma in Makkah, Kingdom of Saudi Arabia: An observational cohort study

OBJECTIVES

To explore the epidemiology and patterns of pediatric trauma in addition to length of hospital stay and outcome.

METHODS

A single-center retrospective study of 605 patients aged 14 years and younger was carried out from January to December 2022. The study included all patients who experienced intentional or unintentional trauma aged 14 years or below in 2022 and excluded trauma that did not prompt an emergency room visit.

RESULTS

Most pediatric trauma cases involved boys (69.1%, n=418), and girls comprised only 30.9% (n=187). Trauma was most common in children one to 5 years old (41.5%, n=251). Falling from a height was the most common mode of injury in both girls and boys (n=253, 41.8%). The most common body parts involved were the extremities (n=357, 59%), followed by the head (n=210, 34.7%). Most children were transferred to hospital via emergency medical services (n=234, 38.7%). In most cases, the child was admitted to the surgical ward (n=458, 75.7%), while others were managed in the emergency department without admission (n=93, 15.4%). Most patients were stable after receiving standard care (n=558, 92.2%).

CONCLUSION

To reduce health care expenses and improve public health outcomes, prioritizing preventive measures is crucial. This includes increasing public awareness, implementing safety protocols, and enacting government regulations to prevent avoidable injuries.

Virtual Risk Management-Exploring Effects of Childhood Risk Experiences through Innovative Methods (ViRMa) for Primary School Children in Norway: Study Protocol for the ViRMa Project

BACKGROUND

Research indicates that risky play benefits children's risk assessment and risk management skills and offers several positive health effects such as resilience, social skills, physical activity, well-being, and involvement. There are also indications that the lack of risky play and autonomy increases the likelihood of anxiety. Despite its well-documented importance, and the willingness of children to engage in risky play, this type of play is increasingly restricted. Assessing long-term effects of risky play has been problematic because of ethical issues with conducting studies designed to allow or encourage children to take physical risks with the potential of injury.

OBJECTIVE

The Virtual Risk Management project aims to examine children's development of risk management skills through risky play. To accomplish this, the project aims to use and validate newly developed and ethically appropriate data collection tools such as virtual reality, eye tracking, and motion capturing, and to provide insight into how children assess and handle risk situations and how children's past risky play experiences are associated with their risk management.

METHODS

We will recruit 500 children aged 7-10 years and their parents from primary schools in Norway. Children's risk management will be measured through data concerning their risk assessment, risk willingness, and risk handling when completing a number of tasks in 3 categories of virtual reality scenarios: street crossing, river crossing, and playing on playground equipment. The children will move around physically in a large space while conducting the tasks and wear 17 motion-capturing sensors that will measure their movements to analyze motor skills. We will also collect data on children's perceived motor competence and their sensation-seeking personality. To obtain data on children's risk experiences, parents will complete questionnaires on their parental style and risk tolerance, as well as information about the child's practical risk experience.

RESULTS

Four schools have been recruited to participate in data collection. The recruitment of children and parents for this study started in December 2022, and as of April 2023, a total of 433 parents have consented for their children to participate.

CONCLUSIONS

The Virtual Risk Management project will increase our understanding of how children's characteristics, upbringing, and previous experiences influence their learning and ability to handle challenges. Through development and use of cutting-edge technology and previously developed measures to describe aspects of the children's past experiences, this project addresses crucial topics related to children's health and development. Such knowledge may guide pedagogical questions and the development of educational, injury prevention, and other health-related interventions, and reveal essential areas for focus in future studies. It may also impact how risk is addressed in crucial societal institutions such as the family, early childhood education, and schools.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45857.

Factors associated with discharge destination from acute care after moderate-to-severe traumatic injuries in Norway: a prospective population-based study

BACKGROUND

Previous studies have demonstrated that the trauma population has needs for rehabilitation services that are best provided in a continuous and coordinated way. The discharge destination after acute care is the second step to ensuring quality of care. There is a lack of knowledge regarding the factors associated with the discharge destination for the overall trauma population. This paper aims to identify sociodemographic, geographical, and injury-related factors associated with discharge destination following acute care at trauma centers for patients with moderate-to-severe traumatic injuries.

METHODS

A multicenter, population-based, prospective study was conducted with patients of all ages with traumatic injury [New Injury Severity Score (NISS) > 9] admitted within 72 h after the injury to regional trauma centers in southeastern and northern Norway over a 1-year period (2020).

RESULTS

In total, 601 patients were included; a majority (76%) sustained severe injuries, and 22% were discharged directly to specialized rehabilitation. Children were primarily discharged home, and most of the patients ≥ 65 years to their local hospital. Depending on the centrality of their residence [Norwegian Centrality Index (NCI) 1-6, where 1 is most central], we found that patients residing in NCI 3-4 and 5-6 areas sustained more severe injuries than patients residing in NCI 1-2 areas. An increase in the NISS, number of injuries, or a spinal injury with an Abbreviated Injury Scale (AIS) ≥ 3 was associated with discharge to local hospitals and specialized rehabilitation than to home. Patients with an AIS ≥ 3 head injury (RRR 6.1, 95% Confidence interval 2.80-13.38) were significantly more likely to be discharged to specialized rehabilitation than patients with a less severe head injury. Age < 18 years was negatively associated with discharge to a local hospital, while NCI 3-4, preinjury comorbidity, and increased severity of injuries in the lower extremities were positively associated.

CONCLUSIONS

Two-thirds of the patients sustained severe traumatic injury, and 22% were discharged directly to specialized rehabilitation. Age, centrality of the residence, preinjury comorbidity, injury severity, length of hospital stay, and the number and specific types of injuries were factors that had the greatest influence on discharge destination.

Epidemiological Pattern of Musculoskeletal Injuries in Children Aged 16 Years and Below in a Regional Trauma Centre in Nigeria

Introduction Injuries in children and adults contribute a large percentage to the global burden of disease. Findings in this study will help authorities and governments in our clime to make policies aimed at the prevention and reduction of this burden. Methods This study is a retrospective review of cases of musculoskeletal injuries in children aged 0-16 years seen at the National Orthopaedic Hospital, Lagos, Nigeria, over a period of three years (from January 2017 to December 2019). Results Ninety children were included in this study, made up of 58 males (64.4%) and 32 females (35.4%), presenting a male: female ratio of 1.8:1. The combined average age of the children of both sexes was 8.15+/-4.03 years. The home was the most common place (47.8%) where injuries took place, followed by streets/roads (25.6%). Fall was the commonest etiology/mode of injury (57.8%), followed by traffic accidents (23.3%). The 90 patients studied had 96 injuries, of which 92 (95.8%) were close injuries, and the rest were open injuries. The children sustained 101 fractures of individual bones; the femur was the most frequently fractured bone (36, 35.6%), followed by the humerus (30, 29.7%). Treatment modalities offered included closed reduction with casting, open/closed reduction and K-wire fixation of fractures, wound debridement/care for open injuries, and others. Conclusion Falls and traffic accidents were responsible for most of the injuries in the children studied. Appropriate policies by those in government/authority and the right measures by parents and caregivers will help to reduce the incidence of these largely preventable injuries.

Outcomes of basic versus advanced prehospital life support in severe pediatric trauma

OBJECTIVE

The role of basic life support (BLS) vs. advanced life support (ALS) in pediatric trauma is controversial. Although ALS is widely accepted as the gold standard, previous studies have found no advantage of ALS over BLS care in adult trauma. The objective of this study was to evaluate whether ALS transport confers a survival advantage over BLS among severely injured children.

METHODS

A retrospective cohort study of data included in the Israeli National Trauma Registry from January 1, 2011, through December 31, 2020 was conducted. All the severely injured children (age < 18 years and injury severity score [ISS] ≥16) were included. Patient survival by mode of transport was analyzed using logistic regression.

RESULTS

Of 3167 patients included in the study, 65.1% were transported by ALS and 34.9% by BLS. Significantly more patients transported by ALS had ISS ≥25 as well as abnormal vital signs at admission. The ALS and BLS cohorts were comparable in age, gender, mechanism of injury, and prehospital time. Children transported by ALS had higher in-hospital mortality (9.2% vs. 0.9%, p < 0.001). Following risk adjustment, patients transported by ALS teams were significantly more likely to die than patients transported by BLS (adjusted OR 2.27, 95% CI 1.05-5.41, p = 0.04). Patients with ISS ≥50 had comparable mortality rates in both groups (45.9% vs. 55.6%, p = 0.837) while patients with GCS <9 transported by ALS had higher mortality (25.9% vs. 11.5%, p = 0.019). Admission to a level II trauma center vs. a level I hospital was also associated with increased mortality (adjusted OR 2.78 (95% CI 1.75-4.55, p < 0.001).

CONCLUSIONS

Among severely injured children, prehospital ALS care was not associated with lower mortality rates relative to BLS care. Because of potential confounding by severity in this retrospective analysis, further studies are warranted to validate these results.

Pediatric Trauma in The Netherlands: Incidence, Mechanism of Injury and In-Hospital Mortality

BACKGROUND

In the Netherlands, there are no specialized or certified pediatric trauma centers, especially for severely injured children. National and regional agreements on centralization of pediatric trauma care are scarce. This study aims to describe the incidence, injury mechanism and in-hospital mortality of pediatric trauma in the Netherlands, as a prelude to the further organization of pediatric trauma care.

METHODS

A retrospective cohort analysis of data from the Dutch National Trauma Registry in 2009-2018, concerning all children (0-16 years) hospitalized due to injury in the Netherlands.

RESULTS

The annual number of admitted injured children increased from 8666 in 2009 to 13,367 in 2018. Domestic accidents were the most common cause of non-fatal injury (67.9%), especially in children aged 0-5 years (89.2%). Severe injury (injury severity score ≥  16) accounted for 2.5% and 74% of these patients were treated in level-1 trauma centers. In both deceased and surviving patients with severe injuries, head injuries were the most common (72.1% and 64.3%, respectively). In-hospital mortality after severe injury was 8.2%. Road-traffic accidents (RTAs) were the leading cause of death (46.5%).

CONCLUSIONS

Domestic accidents are the most common cause of injury, especially in younger children, whereas RTAs are the lead cause of fatal injury. Severe pediatric trauma in the Netherlands is predominantly managed in level-1 trauma centers, where a multidisciplinary team of experts is available. Improving the numbers of severely injured patients primarily brought to level-1 trauma centers may help to further reduce mortality.

Close to zero preventable in-hospital deaths in pediatric trauma patients - An observational study from a major Scandinavian trauma center

BACKGROUND

In line with international trends, initial treatment of trauma patients has changed substantially over the last two decades. Although trauma is the leading cause of death and disability in children globally, in-hospital pediatric trauma related mortality is expected to be low in a mature trauma system. To evaluate the performance of a major Scandinavian trauma center we assessed treatment strategies and outcomes in all pediatric trauma patients over a 16-year period.

METHODS

A retrospective cohort study of all trauma patients under the age of 18 years admitted to a single institution from 1st of January 2003 to 31st of December 2018. Outcomes for two time periods were compared, 2003-2009 (Period 1; P1) and 2010-2018 (Period 2; P2). Deaths were further analyzed for preventability by the institutional trauma Mortality and Morbidity panel.

RESULTS

The study cohort consisted of 3939 patients. A total of 57 patients died resulting in a crude mortality of 1.4%, nearly one quarter of the study cohort (22.6%) was severely injured (Injury Severity Score > 15) and mortality in this group decreased from 9.7% in P1 to 4.1% in P2 (p<0.001). The main cause of death was brain injury in both periods, and 55 of 57 deaths were deemed non-preventable. The rate of emergency surgical procedures performed in the emergency department (ED) decreased during the study period. None of the 11 ED thoracotomies in non-survivors were performed after 2013.

CONCLUSION

A dedicated multidisciplinary trauma service with ongoing quality improvement efforts secured a low in-hospital mortality among severely injured children and a decrease in futile care. Deaths were shown to be almost exclusively non-preventable, pointing to the necessity of prioritizing prevention strategies to further decrease pediatric trauma related mortality.

A GoPro Look on How Children Aged 17–25 Months Assess and Manage Risk during Free Exploration in a Varied Natural Environment

Research indicates that risky play has positive effects on children’s development, learning and health, and ability to assess and manage risk, but there is a lack of knowledge on how toddlers engage in risky play. This study aims to investigate how toddlers assess and manage risk in free exploration in a varied natural environment and was conducted within an explorative qualitative approach. Observations were collected through head-mounted GoPro cameras while seven toddlers freely explored a natural environment. The results show that toddlers are able to assess and manage risks in challenging natural environments. They develop their own risk management skills and assess risks directly and indirectly. The results also show that practitioners sometimes perform risk assessment/management on behalf of the child and thus override the child’s own actions. The findings suggest implications for an early childhood education and care (ECEC) practice where children even as young as 17–25 months should be allowed to explore challenging environments and learn how to assess and manage risks.

Epidemiology of Pediatric Musculoskeletal Trauma Patients Admitted to the Trauma Center of King George’s Medical University (KGMU) During COVID-19-Induced Lockdown

Purpose: This retrospective study aims to document the epidemiology of pediatric musculoskeletal trauma patients admitted over a one and half year period to the trauma center of King George's Medical University (KGMU) and the effect of COVID-19-induced lockdown on the timeliness of care.

Methods: We analyzed data of 174 patients for demography, types of injuries, mechanism of injuries, the site where the injury was sustained, the severity of injuries, nature of the injury, and the regions involved by the injuries.

Results: Mean age was 12.44±4.4. One hundred and twelve (67.46%) were males and 62 were females (32.54%). When compared with the period prior to lockdown, significantly higher times were recorded during the lockdown for time to a reception at the trauma center (p=0.028) and the time spent in receiving area of the trauma center (p<0.001). The most common mode of injury was low energy falls (n=68; 40.96%). The most commonly involved region was the lower limb (n=156; 51.82%). The region involved by the injury and the frequency of fracture types varied with the age of the subjects. The frequency distribution of injuries in males and females was almost similar till the age of nine years. The most common injuries of the lower extremity and upper extremities were fracture shaft of the femur and supracondylar fracture of the humerus, respectively.

Conclusion: Our study presents a precise estimate of demography and injury characteristics of pediatric musculoskeletal injuries, which may be helpful in planning and policymaking. The effect of the pandemic on the timeliness of care can be used for improving the infrastructure required to handle future waves of the pandemic.

Paediatric injury in Beirut: a multicentre retrospective chart review study

OBJECTIVE

This study aims to assess the epidemiology of paediatric injury in Beirut, giving insights into their characteristics, contributing risk factors and outcomes.

DESIGN AND SETTING

A retrospective study was conducted to review medical charts for children aged 0-15 years presented to five hospital emergency departments (ED) located in Beirut over a 1-year period (June 2017-May 2018).

PARTICIPANTS

A total of 1142 trauma-related visits for children under 15 years of age were included. A descriptive analysis and a bivariate analysis were performed to investigate admitted and treated/discharged patients.

PRIMARY OUTCOME

A logistic regression was conducted to identify factors associated with hospital admission among injured children.

RESULTS

A total of 1142 cases of paediatric injury ED cases were sampled, mean age was 7.7±4.35 years. Children aged 0-5 years accounted for more than one-third of the total cases, 40.0% (206/516) of the fall injuries and 60.1% (220/366) of home injuries. The leading cause of paediatric injury was fall (45.2%), nearly 4.1% of the cases were admitted to hospitals. Factors associated with admission included injury to abdomen (OR=8.25 (CI 1.11 to 61.24)), to upper extremity (OR=5.79 (CI 2.04 to 16.49)), to lower extremity (OR=5.55 (95% CI 2.02 to 15.20) and other insurance type (OR=8.33 (CI 2.19 to 31.67)). The three types of injuries mostly associated with hospital admission were fracture (OR=13.55 (CI 4.77 to 38.44)), concussion (OR=13.60 (CI 2.83 to 65.41)) and organ system injury (OR=31.63 (CI 3.45 to 290.11)).

CONCLUSIONS

Injury remains a major health problem among the paediatric population in Lebanon. Parental child safety educational programmes and age-targeted injury prevention strategies should be initiated and implemented to mitigate the burden of child injuries and improve child safety and well-being.

Epidemiology of pediatric trauma in the Kingdom of Bahrain: a national pediatric trauma registry pilot study

Background

A pediatric trauma registry for the Kingdom of Bahrain would be a novel public health tool for the Bahraini health system. The aim of this study was to explore the epidemiology of pediatric trauma at the national level by describing the distribution of pediatric injury in the Kingdom, and quantifying the burden of injury shouldered by the study population.

Methods

This multicenter observational cross-sectional study was conducted in Bahrain using data from the Pediatric Trauma Registry (PTR), which was a short-term paper-based prospective trauma registry that collected data over a three-month period in 2018. PTR was based in the pediatric emergency departments (ED) of the three national referral hospitals in the Kingdom. By simultaneously collecting data from all three trauma hospitals in the country, it was assumed that during the data collection period all major pediatric trauma patients in the country would be captured by the study, and that the data collected would provide national estimates of trauma. Inclusion criteria for the study was any individual under the age of 14, that arrived at the ED seeking care for intentional and unintentional injuries.

Results

A total of 1328 patients were included in the study. Sixty-nine percent of patients were treated and discharged from the ED, 30.5% were admitted to the hospital, admitted for surgery, or seen by a specialist, and 0.5% were declared deceased. The percentage of patients documented as unrestrained during Motor Vehicle Collisions (MVC) was 92.3%, and amongst those involved in MVC, 12% were ejected from the cabin of the vehicle.

Conclusions

There are significant implications that this study holds for policy implementation and practice surrounding injury prevention in the Kingdom of Bahrain. Low seatbelt utilization and the high proportion of ejection amongst MVC victims warrant immediate public health policy implementation, including enforcement of seat belt laws, strengthening of the traffic court system, and awareness campaigns for MVC prevention. Additionally, pediatric drowning prevention programs centered on constant adult supervision, pool isolation fencing, personal flotation devices, and swimming education should be created to address the mortality attributable to drowning in this study.