儿童重症意外伤害病例临床分析

目的 分析PICU收治的重症意外伤害患儿的临床特点,为重症意外伤害的监测与预防提供参考.方法 回顾性分析我院 PICU 2012 年 1 月 至 2015 年 12 月收治的儿童重症意外伤害病例的临床资料.结果 共收治意外伤害患儿 315 例,占 PICU 收治患儿总数的 9.38%;男198 例,女117例,男女比例为1.7∶1.意外伤害种类按照例数排序依次为中毒,坠落伤,气管异物,溺水(溺粪),车祸,窒息,食管异物.幼儿期是意外伤害的高发年龄段,为164例,占52.06%,其次是学龄前期组59例(18.73%)及婴儿组35例(11.11%).各年龄段发生重症意外伤害的原因不同,婴儿组以跌落伤12例(34.29%)和窒息8例(22.86%)为主,其余年龄段均以中毒为主.车祸伤住院人均费用最高,为63120.05 元,其次为跌落伤(55783.53元),而食管异物的人均住院天数最长,为12.88 d.结论 儿童重症意外伤害不仅严重威胁儿童身心健康,也造成了巨大的经济负担和社会负担.建立完善的儿童意外伤害预防急救系统十分重要,而制定儿童意外伤害预防措施时应考虑区域、年龄、性别及伤害类型等因素,切实减少意外伤害的发生.     

重症监护病房中意外伤害患儿病因及影响因素的分析

目的 分析儿童重症监护病房（PICU）收治的意外伤害患儿的病因及影响因素,为预防儿童意外伤害和降低儿童意外伤害的病死率提供指导依据。方法 回顾性分析2012年12月至2017年12月PICU收治的意外伤害患儿的临床资料。结果 该阶段共收治意外伤害患儿102例,占PICU收治患儿总数的3.30%（102/3087）。儿童意外伤害的类型居前三位分别为食物/药物中毒、溺水、气道/食道异物。儿童意外伤害发生情况与性别和年龄密切相关,男孩意外伤害发生比例明显高于女孩,年龄越小意外伤害发生占比越高（P < 0.05）。儿童意外伤害类型与年龄也有明显的相关性,不同年龄组常见的意外伤害类型有差异。不同类型意外伤害的发生比例在城乡间差异无统计学意义（P > 0.05）。意外伤害后发生器官功能障碍的数量,以及呼吸、心血管、神经、肾脏、血液五大器官功能障碍与患儿死亡的发生密切相关（P < 0.05）,但不是导致患儿死亡的独立危险因素（P > 0.05）。结论 预防是降低儿童意外伤害发生的关键,应根据性别、年龄特点和不同意外伤害类型,采取有针对性的预防措施。同时应该普及急救知识,完善急救转运系统,PICU医生应该重视意外伤害患儿器官功能的保护,以降低意外伤害患儿的病死率。     

海南省海口市城乡儿童意外伤害横断面调查

目的 通过调查海南省海口市城乡儿童意外伤害流行病学特征,为热带海岛地区儿童意外伤害的预防和干预提供依据。方法 自行设计儿童意外伤害登记表格,回顾性收集三级甲等医院（海南医学院附属医院、海南省人民医院)和二级甲等医院（海南省海口市第四人民医院、琼山区人民医院）被诊断为意外伤害的0~14岁儿童信息,包括性别、年龄、户籍（城市和农村）、意外伤害时间（以月份为统计）、意外伤害原因、意外伤害地点和伤害结局。结果 共收集儿童意外伤害病例2 006例,男童1 114例,女童892例,男、女比例为1.25∶1。儿童性别构成比在1～4岁段不明显（P＞0.05）,5～14岁段男童人数多于女童（P<0.05）;1～4岁段儿童意外伤害人数最多,随着年龄增长,儿童意外伤害人数逐渐减少（P<0.05）。1～2月份和5～9月份是儿童意外伤害发生的高峰期。儿童意外伤害发生在家庭总体上农村高于城市（P<0.01）,发生在学校和公路/街道总体上城市高于农村（P均<0.05）。儿童意外伤害跌倒/坠落、交通事故总体上城市高于农村（P均<0.05）,烧烫伤、溺水总体上农村高于城市（P均<0.05）。导致死亡前3位的意外伤害原因依次是溺水、跌倒/坠落和交通事故,不同伤害原因的儿童意外伤害结局差异有统计学意义（P<0.05）。结论 海口地区儿童意外伤害的发生时间和危险因素与其他地区不同,政府、学校和家庭应因地制宜,制定科学的儿童意外伤害干预措施,保障儿童生命健康安全。     

儿童意外伤害315例分析

目的 探讨儿童意外伤害的原因及预防措施.方法 对2007年9月至2011年9月就诊云南省保山市人民医院的儿童意外伤害病例,根据年龄分组,参照国际疾病分类(ICD 10)进行分析.结果 儿童意外伤害的发生率男孩高于女孩.6～ 12岁学龄儿童为意外伤害事故发生的高峰年龄段.0 ～ 14岁儿童意外伤害类型主要为交通事故、跌落伤、烧烫伤.结论 应重视意外伤害的预防,采取家庭、学校、社会相结合的预防方法,并根据性别、年龄进行针对性预防.     

儿童意外伤害相关因素分析与干预

目的分析5年中儿童意外伤害的病因,寻求降低意外伤害发生的有效措施。方法回顾性分析2000年1月~2004年12月急诊创伤中心就诊的3 744例意外伤害病例的临床资料。结果3 744例中各意外类型的年龄分布有显著差异,各意外伤害原因的时间分布有显著差异。意外伤害发生率男性高于女性,意外创伤占意外伤害发生率的81.62%;学龄前儿童意外伤害占意外伤害发生率的65.01%;家中发生意外伤害占意外伤害发生率的43.14%;意外伤害急诊死亡27例(0.72%),占同期急诊患儿死亡数的26.47%。结论儿童意外伤害以意外创伤为首位,学龄前是意外伤害发生的主要年龄段,意外伤害发生以春夏季节为主,家庭是意外伤害最易发生的场所,其急诊病死率已占其他急诊疾病病死数的1/4以上,要降低儿童期意外伤害的发生率与病死率应以预防为主。     

2286例儿童意外伤害的临床分析

目的 分析儿童意外伤害的临床特点,为儿童意外伤害的预防及干预提供有价值的信息.方法 回顾性分析2013年1月至2015年12月广西医科大学第一附属医院收治的0~14岁意外伤害儿童的临床资料.结果 收集病例2286例,男1507例(65.92%),女779例(34.08%),高发年龄为1~3岁896例(39.19%).意外伤害原因前5位分别为:烧/烫伤840例(36.74%)、坠落/跌倒464例(20.30%)、钝器伤290例(12.68%)、各种异物(食道或气道等)253例(11.07%)、利器伤153例(6.68%);不同年龄意外伤害种类有差别,1~3岁组以烧/烫伤及各种异物(食道或气道等)多见,6~14岁组以坠落/跌倒及钝器伤为主;农村儿童发生意外伤害1547例(67.67%),城市儿童739例(32.33%);意外伤害后果较严重的是:钝器伤55例(26.96%)、利器伤45例(22.06%)、烧/烫伤26例(12.75%)、爆炸伤23例(11.27%)及坠落/跌倒20例(9.80%).发生伤残/后遗症204例(8.92%),死亡10例(0.44%).死亡病例中以坠落/跌倒4例、交通意外3例居多.结论 儿童意外伤害高危人群是1~3岁幼儿,以烧/烫伤及各种异物(食道或气道等)为主,男孩多于女孩.农村儿童发生意外伤害比例高于城市.儿童意外伤害后果较严重的是钝器伤、利器伤、烧/烫伤、爆炸伤及坠落/跌倒,死亡病例中以坠落/跌倒、交通意外居多.加强儿童意外伤害防范知识的宣传,是减少儿童意外伤害发生的关键.     

儿童意外伤害924例分析

目的：分析儿童意外伤害的原因,探讨其预防措施,为降低儿童意外伤害的发生提供参考。方法：回顾性分析 2008年 1 月至2010年 12 月中山市博爱医院924 例儿童意外伤害住院病例的临床资料。结果：在924病例中,跌落/坠落伤居儿童意外伤害的首位（26.4%）,其他依次为烧烫伤（15.7%）、异物（14.0%）、道路交通伤（13.1%）。意外伤害主要集中在0~3岁儿童（67%）。不同季节儿童意外伤害的发生也有差别,其中7~9月的发生比例最高,尤以烧烫伤为著（P<0.05）。家庭是意外伤害最易发生的场所,发生比例占36.9%;外地户籍儿童发生交通伤害比例较本地户籍儿童高（P<0.001）。父母未受教育或初中文化程度以下者意外伤害发生比例最高（45.5%）;农村意外伤害发生比例较城市高（P<0.05）。结论：跌落/坠落伤是儿童意外伤害的首位原因;婴幼儿是意外伤害发生的主要人群;家庭是意外伤害发生最高的场所。外地户籍儿童交通伤害发生比例较本地户籍儿童高;儿童意外伤害的发生与父母受教育程度有关。要降低儿童期意外伤害的发生应以预防为主,根据儿童年龄、性别特点以及家庭背景,着重于加强安全教育。     

Features of unintentional injury in children under the impact of coronavirus disease 2019北大核心CSCD

目的探究新型冠状病毒肺炎疫情下儿童意外伤害的特征,旨在为疫情背景下儿童意外伤害的防治提供参考。方法回顾性分析2019年7月—2022年6月上海交通大学附属医学院新华医院收治的意外伤害患儿2526例的病例资料,按时间段分为5个阶段:疫情前(2019年7—12月)、武汉疫情期(2020年1—4月)、全国疫情平稳期(2020年5月—2022年2月)、上海疫情期(2022年3—5月)、上海疫情平稳期(2022年6月)。比较不同时间阶段和年龄阶段儿童意外伤害发生情况,并进一步对其中107例患儿进行问卷调查,探讨儿童意外伤害的特征。结果5个时间阶段意外伤害患儿的性别构成、年龄、年龄分布及多种类型意外伤害构成比的比较,差异均具有统计学意义(P<0.05)。武汉疫情及上海疫情期因意外伤害就诊的人数明显减少。外伤相关意外伤害患儿在各个阶段占比均超过50%,其中武汉疫情期及上海疫情期外伤相关意外伤害人数占比分别为63.9%和82.0%。意外伤害多见于学龄期及学龄前期儿童(1823例,72.17%)。与2021年同期相比,上海疫情期发生意外伤害患儿年龄更小(中位数7岁vs 11岁),外伤相关意外伤害患儿占比增加(97%vs 69%),差异均有统计学意义(P<0.05)。结论新型冠状病毒肺炎疫情背景下儿童意外伤害病例数减少,而外伤相关意外伤害占比增加。学龄前期及学龄期儿童意外伤害更常见。     

急性肾衰竭临床特点的变迁

目的 探讨急性肾衰竭(ARF)的病因、临床特点、病理、治疗及转归的变化.方法 回顾性分析本科诊治的183例ARF患儿的临床资料,并将近6 a(2004 -2009年)与前16 a(1988 -2003年)2个阶段住院ARF患儿的临床特点和转归进行比较.结果 近6 a共诊治101例ARF患儿,与前16 a82例患儿比较,患病人数明显增多.ARF病因特点也发生了明显的变化:肾性因素所占比例下降(78.1％ vs 48.5％,P＜0.01),而肾后性因素所占比例上升(2.40％vs25.75％,P＜0.01),2组肾前性因素比例比较差异无统计学意义( 19.50％vs25.75％,P＞0.05).不同年龄组ARF患儿病因特点不同,婴儿以肾前性因素常见,而年长儿多见于肾性因素.共30例行肾活检,其病理类型主要为系膜增生性肾小球肾炎.前16a行血液净化治疗6例,而近6 a行血液净化治疗16例(x2 =4.18,P＜0.05).经过治疗,前16a的82例患儿中,治愈32例(39.0％),好转27例(32.9％),未愈2例(2.5％),住院期间和放弃治疗共死亡21例(25.6％);近6 a的101例患儿中,治愈43例(42.5％),好转41例(40.6％),未愈3例(3.0％),住院期间和放弃治疗共死亡14例(13.9％).与前16a比较,近6 a治疗有效率明显提高(x2=3.99,P＜0.05),病死率明显降低(x2=4.01,P＜0.05).结论 ARF的发病呈增多趋势,且病因构成发生了变化.不同年龄组ARF的病因构成不同.适时肾活检对于明确诊断、指导治疗、估计预后有重要意义.早期行血液净化治疗是ARF抢救成功的关键.     

住院患儿营养风险筛查及营养评估

目的 调查住院患儿的营养风险及营养不良发生情况,为临床进行营养支持提供依据.方法 采用STRONGkids营养风险筛查工具对651例住院患儿进行营养风险筛查,并通过体格测量评估儿童营养状况,同时记录住院期间患儿的诊断、住院时间等资料并进行分析.结果 651例住院患儿中,7.07％(46例)存在高度营养风险,80.95％(527例)存在中度营养风险,11.98％(78例)为低度营养风险.营养不良检出率是22.58％,其中中度营养不良111例(17.05％),重度营养不良36例(5.53％).先天性心脏病、慢性肝病、慢性肾病为存在高度营养风险疾病前3位(x2=21.43,P＜0.01);根据营养评价的结果显示患有先天性心脏病、慢性肾病的患儿发生重度营养不良的比例远高于其他疾病(x2=16.53,P＜0.05).高度营养风险患儿住院期间较低度营养风险患儿更容易出现体质量丢失(P＜0.05),其住院时间明显长于中、低度营养风险患儿(P＜0.05).结论 住院患儿营养不良发生率高,营养风险不同导致临床结局不同;STRONGkids评分法评估住院儿童的营养风险,能早期发现住院期间营养不良以及有恶化可能的患者,有利于及时给予全面的营养评估以及早期合理的营养治疗,改善临床结局.     

Unintentional Window Falls in Children and Adolescents

ObjectiveUnintentional window falls represent a preventable source of injury and death in children. Despite major campaigns in some larger cities, there continue to be unintentional falls from windows throughout the United States. We aimed to identify risk factors and trends in unintentional window falls in the pediatric population in a national and regional sample.MethodsA retrospective analysis of annual emergency department (ED) visits from the National Electronic Injury Surveillance System using product codes specific to windows, as well as patient encounters for unintentional window falls from January 2007 to August 2017 using site-specific trauma registries from 10 tertiary care children's hospitals in New England. National and state-specific census population estimates were used to compute rates per 100,000 population.ResultsThere were 38,840 ED visits and 496 regional patients who unintentionally fell from a window across the study period between 0 and 17 years old. The majority of falls occurred in children under the age of 6 and were related to falls from a second story or below. A decreased trend in national ED visits was seen, but no change in rates over time for regional trauma center encounters. A high number of falls was found to occur in smaller cities surrounding metropolitan areas and from single family residences.ConclusionsFalls from windows represent a low proportion of overall types of unintentional sources of injury in children but are a high risk for severe disability. These results provide updated epidemiologic data for targeted intervention programs, as well as raise awareness for continued education and advocacy.     

Childhood injuries in the United States. Mortality, Morbidity, and cost

National estimates of the mortality, morbidity, and cost of childhood injuries are presented by specific causes. Motor vehicle-related injuries, homicide, and suicide are the leading causes of childhood injury deaths. Falls and sports-related injuries are the leading causes of hospitalizations and emergency department visits. We estimate that unintentional childhood injuries cost the nation $7.5 billion in 1982. The highest direct costs per year for unintentional injuries are attributable to falls, sports, and motor vehicle occupant injuries, while the highest indirect costs are related to motor vehicle occupant injuries, pedestrian injuries, and drowning. Injury accounts for 78% of the total fatalities among late adolescents (age 15 to 19 years), the pediatric age group at highest risk for injury mortality. A stronger federal and state commitment is needed to prevent childhood injury.     

Trends and patterns of playground injuries in United States children and adolescents.

OBJECTIVE: To determine the prevalence, trends, and severity of injuries attributable to playground falls relative to other common unintentional mechanisms that resulted in an emergency department (ED) visit in the United States. DESIGN AND SETTING: Data from the emergency subset of the National Hospital Ambulatory Medical Care Survey collected from 1992 to 1997 for children <20 years. METHODS: Injury rates and 95% confidence intervals (CIs) were estimated and injury severity scores were computed. RESULTS: There were 920551 (95% CI: 540803 to 1300299) ED visits over the 6-year study period by children and adolescents that were attributable to falls from playground equipment. The annual incidence of visits for playground injuries did not significantly decrease over the course of the study (187000 to 98000, P =.053). Injury visits for playground falls were twice as prevalent as pedestrian mechanisms, but they were less prevalent than visits for motor vehicle-- and bicycle-related injuries. A larger proportion of playground falls resulted in "moderate-to-severe" injury than did bicycle or motor vehicle injuries. Children aged 5 to 9 years had the highest number of playground falls (P =.0014). Playground falls were most likely to occur at school compared to home, public, and other locations (P =.0016). CONCLUSIONS: Playground injury emergency visits have not significantly declined and remain a common unintentional mechanism of injury. Injury visits for playground falls were proportionally more severe than injury visits attributable to other common unintentional mechanisms. Interventions targeting schools and 5- to 9-year-old children may have the greatest impact in reducing emergency visits for playground injuries.     

The rural-urban continuum: variability in statewide serious firearm injuries in children and adolescents

OBJECTIVE: To compare rates of serious firearm injuries among children and adolescents treated in a statewide trauma system. MATERIALS AND METHODS: We reviewed the Pennsylvania Trauma Systems Foundation (Mechanicsburg) registry from January 1, 1987, through December 31, 2000, for all pediatric and adolescent patients (age 0-19 years) who sustained a serious firearm injury. Data included age, sex, weapon, geographic region, injury circumstance, and outcome. RESULTS: During the 14-year period, 3781 children and adolescents sustained a serious firearm injury and were treated at a participating Pennsylvania trauma center. The population was 90.7% male, with a mean age of 16.5 years. Adolescents (age 15-19 years) represented more than 85% of the study population. There were 744 deaths (19.7%). The urban counties had an average annual population-based rate of serious firearm injury of 28.3/100 000; suburban counties, 2.8/100 000; metropolitan counties, 2.4/100 000; and nonmetropolitan counties, 2.4/100 000. Urban counties had a higher rate for all injury circumstances (unintentional, assault, and self-inflicted) than all nonurban counties. Assault was the most common overall injury circumstance (78.7%), and was the most common circumstance in urban counties (88.5%) and among adolescents (age 15-19 years [84.2 %]). Unintentional injuries predominated in nonmetropolitan counties (56.7%) and in young children (aged <5 years [50.6%] and 5-9 years [61.4%]). Handguns were the most common weapon type in all age groups, geographic regions, and injury circumstances. CONCLUSIONS: Rates of serious firearm injuries among children and adolescents are 10-fold higher in urban than nonurban regions. Assaultive injury mechanisms predominated in urban areas, unintentional injuries in the nonurban counties. Firearm injury statistics are heavily influenced by events in the urban counties. Intervention and prevention strategies need to account for these regional discordances to optimize efficacy.     

Paediatric injuries due to falls from windows and balconies: an 8-year prospective and retrospective review

BackgroundUnintentional falls from windows and balconies pose a serious health risk to children. Limited Canadian data describing such falls currently exist. This study aimed to describe the frequency, demographic characteristics, injury patterns, and risk factors associated with paediatric falls from windows and balconies.MethodsThis study employed both prospective data collection and retrospective medical record review. Prospectively, consenting families were enrolled from February 2015 to February 2017; retrospectively, charts from January 2009 to December 2014 were reviewed. Children 0 to 16 years of age, who presented to the Stollery Children’s Hospital (Edmonton, Alberta) emergency department due to a fall from a window or balcony, were included.ResultsA total of 102 children were included; thirty were enrolled prospectively and 72 retrospectively. Median age was 4.5 years (interquartile range 2.83 to 6.83) with 63.7% (65 of 102) males. About 87.2% (89 of 102) of falls were from windows and 12.8% (13 of 102) from balconies. The median estimated height of fall was 4.1 m (interquartile range 3.04 to 4.73). About 58.4% (59 of 101) had at least one major injury (i.e., concussion, fractured skull, internal injury, fractured limb, severe laceration), 36.6% had minor injuries only (i.e., abrasions, contusions, sprains), and 5.0% had no documented injuries. There were no fatalities. About 30.4% (31 of 102) were admitted, with 48.4% of these children (15 of 31) requiring surgery.ConclusionMost falls from windows and balconies occurred in children under the age of 5 years and were associated with serious morbidity, high admission rates, and need for surgery. Child supervision as well as installation of key safety features in windows may help minimize paediatric fall-related injuries.     

The history of injury control and the epidemiology of child and adolescent injuries

Unintentional injuries claim the lives of more children each year than any other cause of death. A substantial proportion of child hospitalizations and emergency department visits also are attributable to unintentional injuries. The conceptualization of unintentional injuries as a public health problem that is preventable has gained credibility over the past few decades, as effective solutions to reduce the burden of injuries--such as child safety seats, bicycle helmets, and smoke detectors--have been identified. Successful implementation of these strategies requires a clear understanding of the circumstances surrounding injuries and the risk and protective factors that influence the likelihood that a child will be injured. Although adequate data on these factors is available for some causes of injury, such as motor vehicle crashes, it is almost nonexistent for others, such as unintentional firearm injuries. Overall, unintentional injury rates are highest among adolescents ages 15 to 19, males, children from impoverished families, and minorities. Also, some injuries occur more often in rural areas. Although these demographic risk factors cannot be modified, environmental and behavioral risks, such as unsafe roads, alcohol intoxication, unfenced swimming pools, and the absence of a smoke detector in the home, can be modified successfully with appropriate strategies. Motor vehicle occupant, drowning, and pedestrian injuries were the most common unintentional injuries causing death among children ages 0 to 19 in 1996. Together, these mechanisms accounted for more than half of all unintentional injury deaths among children and adolescents, although rates varied considerably by age. Child injury death rates across most age categories and mechanisms of injury have declined during the past 20 years, yet the reasons for these declines are poorly understood. Additional research about risk and protective factors, and efforts to implement successful injury prevention strategies among populations at highest risk for injuries, are necessary to further reduce the toll on children's lives.     

Office-based counseling for unintentional injury prevention

Unintentional injuries are the leading cause of death for children older than 1 year. Pediatricians should include unintentional injury prevention as a major component of anticipatory guidance for infants, children, and adolescents. The content of injury-prevention counseling varies for infants, preschool-aged children, school-aged children, and adolescents. This report provides guidance on the content of unintentional injury-prevention counseling for each of those age groups.