Implementation of a system of surveillance of childhood injuries involved in a Safe Community program: the example of Boulogne-Billancourt (France)

OBJECTIVES

To provide precise information about child injuries, intended to promote preventive actions, in keeping with the general pattern of a Safe Community program implemented in Boulogne-Billancourt (France) since 1997.

METHODS

Information about children under 16 injured in the city of Boulogne-Billancourt and its surroundings, are extracted in a database.

DISCUSSION

The Boulogne-Billancourt database is the first permanent and specific childhood injury surveillance system in France integrated in a "Safe Community". It may constitute an "alarm system" by allowing rapid implementation of preventive action. The final evaluation of the collected data will be performed at the end of the program (after five years).

[Frequency of childhood injuries: first results of the Boulogne-Billancourt registry]

BACKGROUND

Boulogne-Billancourt database is in France the only permanent and specific childhood injury surveillance system. Integrated in an safe community program designed by the World Health Organization (WHO), the aims of a local database are to provide precise information intended to implement prevention actions.

METHOD

All children less than sixteen years old living in Boulogne-Billancourt, victims of injuries occurring in that town, and requiring hospital care, are targeted.

RESULTS

Two thousand five hundred and eighty accidents have been computed between 1(st) January 1998 and 31 December 1999, i.e. an average annual incidence of 79.7/1000 children. As in other similar databases, domestic accidents are prevalent in the average (40%), even though after five years old school injuries become the most frequent ones (36%). Falls are the main mechanism involved in injury at any age (44 to 54%). Distribution of other mechanisms varies with respect to age: foreign body prevalence is maximum between one and four (2.5%), struck-collisions (38%) between ten and fifteen years old. A significant increase of falls involving roller-skates or skateboards has been observed between 1998 and 1999 (3.8% versus 1.1%, p<0.001). Predominanting injury causes are contusions (38%), mainly head trauma (10%), open wounds (16%), fractures (10%), and sprains (6%). Two hundred and twenty four injuried children have been admitted in 1998, 205 in 1999, i.e. respectively 13.8/1000 and 12.7/1000 children dwelling in Boulogne. Overall recurrence rate is 32%, reaching 47% after eleven years old. A significant relationship has been observed between injury recurrence and problems related to education (odds ratio: 2.95; 95% CI: 1.75-5.00), atypical parenting situation (odds ratio: 1.70; 95% CI: 1.20-2.30), and family discord (odds ratio: 1.62; 95% CI: 1.05-2.50). Household accidents are the most avoidable ones in parents'opinion. This is not the case for road-traffic accidents, given evidence of the lack of means of protection observed in bicycle injuries.

CONCLUSION

In spite of methodological issues such as control of exhaustivity of data, or difficulties to maintain a long-term surveillance sytem, this project worth carrying on with regard to provided information and usefulness for prevention. Other similar community experiences should be implemented with the aim of setting up a national-wide surveillance system, based on an homogenous data collection.

[Epidemiological study of sequelae of injuries in adolescents]

BACKGROUND

In all industrialized countries, injuries constitute the primary public health problem during adolescence; study of long-term outcome of injuries to adolescents remains poor.

POPULATION AND METHODS

A longitudinal epidemiological study performed on 8,140 students in 17 secondary schools in Paris and the Department of the Côte-d'Or followed the development over one year of 777 adolescents who had injuries in 1990. All injuries, both within and outside school, were included if they fulfilled the following criteria: school absence or excused from vocational training exceeding or equal to 2 days, or excused from physical education classes for at least 14 days.

RESULTS

One year after the injury, 13% of the adolescents were still bothered by their injury, especially those who were older and the girls. Among described impairments, musculo-skeletal problems (88% of cases) were the major difficulty. These impairments were primarily in the lower limbs (53%). Unaesthetic scars were found in 17% of cases, and a psychological impact was found in 16.5% of the adolescents. The presence of sequelae was related to the type of initial lesion (present in 24% of head injuries and in 16% of cases affecting the lower limbs). The most serious difficulties were caused by dislocations, serious sprains and fractures. One year after the injury, sequelae were serious in 10% of those adolescents still experiencing problems; they had some impact on the daily life of the adolescents in 36% of cases, that is, 5% of all adolescents experiencing an injury. These sequelae were responsible for a high level of consumption of medical services.

CONCLUSIONS

Although observed sequelae were relatively minor, the high frequency of injuries during adolescence, as well as their high economic costs, justify the most appropriate care available for victims of injuries, even those which appear benign. In addition, longitudinal studies should be prepared using adapted tools (scales for the evaluation of the gravity of injury sequelae).