Driveway motor vehicle injuries in children

OBJECTIVES: To describe the frequency, nature and outcome of driveway injuries in children. DESIGN: Retrospective case series of driveway-related injuries in children under 16 years of age admitted to the New Children's Hospital (NCH), New South Wales, from November 1995 to February 2000, and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry from January 1988 to December 1999. MAIN OUTCOME MEASURES: Circumstances of injury; type and number of injuries identified. RESULTS: 42 children were admitted to our institution with driveway-related injuries over four years and four months. These represent 12% of all children admitted with pedestrian motor vehicle injuries. Fourteen deaths (including one of the children admitted to NCH) were reported to the NPTD Registry over 12 years, accounting for 8% of all paediatric pedestrian motor vehicle deaths reported to the registry. Typically, the injury involved a parent or relative reversing a motor vehicle in the home driveway over a toddler or preschool-age child in the late afternoon or early evening. Four-wheel-drive or light commercial vehicles were involved in 42% of all injuries, although they accounted for just 30.4% of registered vehicles in NSW. These vehicles were associated with a 2.5-times increased risk of fatality. In 13 of the 14 deaths, the cause was a severe head injury not amenable to medical intervention. CONCLUSIONS: Driveway injuries in children account for a significant proportion of paediatric pedestrian motor vehicle injuries and deaths in NSW. Prevention represents the only effective approach to reducing deaths from this cause.     

Injuries in Rugby League football

All injuries occurring in the top three grades of a New South Wales club were documented over a one-year period (1978). Two hundred and four injuries were recorded and over half of these injuries (51%) occurred in the lower limbs. The injury rate was calculated at one injury per 3.6 man hours of play. There was a significant difference in the type of injury sustained by forwards and backs, the forwards receiving more cuts, bruises and haematomas, and fewer joint injuries. This difference is probably because of the nature of the game played by these subgroups.     

Trauma studies. I. Metropolitan Sydney trauma data

A review of trauma statistics in metropolitan Sydney over a three-year period was undertaken. Data were obtained from the NSW Department of Health on hospital separations for trauma diagnoses for the two financial years 1985-1986 and 1988-1989 and from the Roads and Traffic Authority of New South Wales and the NSW Ambulance Service. Marked differences emerged in the pattern of overall trauma between the 1985-1986 and 1988-1989 periods, the most noteworthy being the reduction of teaching hospital separations both for total trauma and for transport related trauma which is responsible for the majority of serious injuries. The implementation of a State-wide policy for trauma services in New South Wales is now occurring. The information obtained from this study indicates that much of the baseline data used in formulating that policy were misleading. The policy of concentrating major trauma resources (level 3 trauma centres) in the eastern half of the city is found to be at odds with the finding of a high morbidity and mortality from transport related trauma in the western half of the city and the lack of such resources in that area.     

Road traffic injury in Thailand：systematically underestimated？

Road traffic injury is the fifth leading cause of death and disability in Thailand,with an estimated one million people seriously injured and 14000 deaths each year.Given the magnitude of the problem,it is important to validate road traffic injury statistics,in order to determine trends and the effect of prevention efforts.The Ministry of Public Health established an injury surveillance system in 1995 to collect injury data from 4 provincial hospitals and one hospital in Bangkok.This system was designed to evaluate the quality of acute trauma care and referral services,and to improve injury prevention and control at local and national level.However,many injuries are not treated at health facilities where these data are collected.This is the first study to measure the reporting gap for injury statistics on a national level.We compared data from the Thai National Injury Survey to that gathered by the injury surveillance system and find that the former records a rate 3 times higher than the hospital-based injury surveillance system in all five regions(mean injury incidence:596/100000 vs 129/100000).Most injuries that need medical care are not treated in hospital,and do not count in the national statistics in Thailand.     

Tuberculosis in New South Wales

Surveillance of tuberculosis in New South Wales depends on notification of cases by medical practitioners and careful follow-up by public health nurses dedicated to the control of tuberculosis. Evaluation of tuberculosis surveillance data enables identification of patterns of infection, highlighting areas requiring specific interventions. In 1986, 290 cases of tuberculosis were notified to the Department of Health, New South Wales. The majority of patients (72.8%) were diagnosed as having pulmonary disease. The highest rates of infection were in people from Southeast Asian countries. Whereas 5.2% of cases were identified when the patients entered Australia, a substantial proportion of diagnoses (23.1%) were made in people who had been resident in Australia for 10 or more years. This article highlights the need to continue efforts to improve tuberculosis surveillance and control programmes in New South Wales.     

Trends in hospitalisation rates for road traffic injuries in child motor vehicle passengers in New South Wales, July 1998--June 2005

OBJECTIVE: To analyse changes in the incidence of injuries requiring hospitalisation for child passengers in motor vehicle crashes. DESIGN, SETTING AND PARTICIPANTS: Population-based study of children (aged 0 -15 years) residing in New South Wales and admitted to hospital for injuries resulting from a traffic crash in the period 1 July 1998 - 30 June 2005, identified from the NSW Inpatient Statistics Collection. MAIN OUTCOME MEASURES: Age-standardised rates of hospitalisation for injuries, and trends by inpatient demographics, severity of injuries, and injury sites and types. RESULTS: 2297 children were hospitalised for injuries sustained in a motor vehicle crash over the study period. The overall hospitalisation rate for injuries was relatively constant, with a non-significant decline of - 0.4% (95% CI, - 3.1% to 2.3%). The rate of hospitalisation for serious injuries also declined non-significantly (- 5.5% [95% CI, -11.8% to 1.1%]). Only hospitalisation rates for traumatic brain injuries declined significantly (-11.1% [95% CI, -19.0% to - 2.8%]) over the study period. CONCLUSION: The rate of hospitalisation for injuries to NSW-resident child motor vehicle passengers due to traffic crashes has not significantly decreased. High hospitalisation rates and the subsequent burden to the community and public health system make further injury prevention efforts for child motor vehicle passengers a priority.     

HIV diagnoses in Australia: diverging epidemics within a low-prevalence country

OBJECTIVE: To describe recent trends in the diagnosis of HIV infection in Australia. DESIGN AND SETTING: Analysis of national surveillance system data for 1993-2006. MAIN OUTCOME MEASURES: Number and population rate of new HIV diagnoses by year, exposure route and demographic characteristics. RESULTS: Between 1993 and 2006, 12 313 new diagnoses of HIV infection were reported in Australia. From 1993 to 1999, the annual number of diagnoses declined by 32% from 1056 to 718, and then increased by 31% from 763 in 2000 to 998 in 2006. Between 2000 and 2006, diagnosis rates significantly increased in Victoria, Queensland, South Australia and Western Australia. The most frequent route of HIV exposure was male-to-male sex, accounting for 70% of diagnoses. Heterosexual contact accounted for 18% of cases, with just over half of these people born in or having a sexual partner from a high-prevalence country. Exposure by injecting drug use remained infrequent. CONCLUSIONS: The number of HIV diagnoses has risen in the past 7 years, but not in New South Wales, which has long had the highest rates. The differences in rates between states/territories are likely to be due to divergent trends in sexual risk behaviour in men having male-to-male sex, which remains the predominant route of HIV transmission in Australia. There is a need for effective, innovative and evidence-based programs for HIV prevention, particularly among men having male-to-male sex.     

Hypertensive disorders in pregnancy: a population-based study

OBJECTIVES: To determine population-based rates and outcomes of hypertensive disorders in pregnancy. DESIGN: Cross-sectional study using linked population databases. SETTING AND PARTICIPANTS: All women, and their babies, discharged from hospital following birth in New South Wales, between 1 January 2000 and 31 December 2002. MAIN OUTCOME MEASURES: Rates of hypertensive disorders in pregnancy, maternal and infant morbidity and mortality, and level of hospital care for the birth admission. RESULTS: 250 173 women and their 255 931 infants were included in the study. Overall, 24 517 women (9.8%) had a hypertensive disorder in pregnancy, including 1411 (0.6%) with chronic hypertension, 10 379 (4.2%) with pre-eclampsia, 731 (0.3%) with chronic hypertension with superimposed pre-eclampsia, and 10 864 (4.3%) with gestational hypertension. Women with, and infants exposed to, hypertension were more likely to suffer death or major morbidity than those without hypertension. Infants of mothers with hypertension were more likely to be to born preterm and small for gestational age. Just over half the women with major morbidity or mortality delivered in hospitals with a high level of medical care. In contrast, most infants with major morbidity or mortality were delivered in hospitals with neonatal intensive care units. CONCLUSIONS: Hypertension is a common complication of pregnancy, and adverse outcomes are increased among hypertensive women and their babies. Clinicians appear to be better at identifying and seeking an appropriate level of care for pregnancies where the infant is at risk of a poor outcome than when the mother is at risk. More specific antenatal indicators of poor maternal outcome would help guide the referral of hypertensive women to higher levels of care.     

Ladders: accidents waiting to happen.

OBJECTIVES: To examine the nature, severity and outcomes of injuries sustained from ladder falls. DESIGN: Retrospective survey of medical records. PATIENTS AND SETTING: Patients who presented after a fall from a ladder to the emergency department of a tertiary hospital in Melbourne, Victoria, between January 1994 and December 1997. MAIN OUTCOME MEASURES: Demographic characteristics; height and mechanism of fall; injury site and Injury Severity Score (ISS); rate of hospital admissions. RESULTS: 163 patients presented after ladder falls. They were aged 2.5 to 86 years (mean age, 48 years); 83% were male, and 78% were injured in non-occupational settings. Almost half the accidents (43%) were caused by ladder instability (ladder sliding from position or tilting sideways). Most patients had mild or moderate injuries (usually of the extremities), but 13% had an ISS > or = 16 (indicating severe trauma), usually with head, chest or spinal injuries; 42% were admitted to hospital. Multiple regression analyses showed that ISS increased signficantly with height of fall and age (P< 0.05 for both), although a substantial amount of variation was not attributable to these variables. Likelihood of hospital admission increased linearly with increasing ISS to an ISS of 8 and remained high thereafter. CONCLUSIONS: Ladder falls resulted in significant morbidity, with men undertaking non-occupational activities comprising most of those injured. New strategies to encourage safe ladder use are needed.     

Horse-related injuries in children

OBJECTIVES: To identify the frequency, spectrum and outcome of horse-related injuries in children. DESIGN AND SETTING: Retrospective case series of horse-related injuries in children admitted to the Children's Hospital at Westmead (CHW) from January 1988 to December 1999, the John Hunter Children's Hospital (JHCH) from January 1991 to December 1997 and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry from January 1988 to December 1999. MAIN OUTCOME MEASURES: Circumstances of injury; helmet use; adult supervision; type and number of injuries identified. RESULTS: 232 children were admitted with horse-related trauma, 97 to the CHW over 12 years and 135 to JHCH over seven years, with one death at each hospital. There were six deaths reported to the NPTD Registry over 12 years. The median age was 11 years (range, 1-17). Girls accounted for 65% of those injured and 75% of children were injured while riding. Falls caused the injury in 76.3% of cases. Head and upper-limb trauma accounted for 216 of the injuries (73%). Five out of six children with severe head injuries died. In the CHW group, helmet use was documented in only 24 riders (38%) and adult supervision in 22 (22.9%). CONCLUSIONS: Horse-related trauma accounts for a considerable number of deaths and injuries in children in NSW. The use of a Standards-approved helmet for riding or horse-related activities might have decreased the severity of head injuries.     

Implementing the national priorities for injury surveillance

Injury is a leading cause of disability and death in Australia and is recognised as a national health priority area. The foundation of successful injury prevention is injury surveillance, and national policies and strategies developed over the past 20 years to reduce the burden of injury in Australia have included 22 recommendations on surveillance--only three of which have been completely implemented. Priorities for improving injury surveillance include: improving current injury mortality and morbidity data collection systems; filling the gaps in injury surveillance; maintaining vigilance over data quality; increasing the integration and accessibility of injury data; developing technical expertise in surveillance. Barriers to implementation of the current National Injury Prevention and Safety Promotion Plan include the lack of an implementation plan, performance management structure, appropriate national governance structure and resources--all of which could be overcome with government commitment.     

Skateboard injuries

The recent increase in skateboard injuries is causing concern. Over a 30-month period there were 80 admissions (69 children) to Westmead Hospital because of skateboard injuries. Among children most injuries were minor, involving fractures to the upper limbs (47) or minor head injuries (8). The only serious injuries were a ruptured urethra and a closed head injury. Over the same time period skateboard riding caused five deaths in New South Wales. These all involved head injuries and in four instances collisions with cars. The data strongly support other studies that show skateboard riding is particularly dangerous near traffic and should be proscribed. However, in parkland and around the home the skateboard is an enjoyable toy with an acceptable risk of minor injury. Helmets should be worn and would have prevented all the head injury admissions in this series. Children under 10 have a higher risk of fractures and head injuries due to insufficient motor development to control the boards and the resultant falls. Skateboard injuries are an example of injuries caused by a "fad epidemic". To cope with these types of periodic events up-to-date data collection is needed, followed rapidly by an intervention programme so that serious injuries can be kept to a minimum.     

The hidden menace of non-equine horses

An emergency department audit of horse-related injury presentations alerted researchers to a hitherto uninvestigated source of childhood harm: non-equine horses. A search for the term "horse" in the database of the South Australian Injury Surveillance and Control Unit was performed for presentations of horse-related injuries to a paediatric emergency department of an Australian tertiary teaching hospital over a 5-year period. After all equine-related episodes were extracted, the remaining presentations were herded together and conclusions were jumped to. When legitimate science and research technique failed, poetic licence was prevailed upon.     

Unnecessary admissions of head-injured patients at the University Hospital of the West Indies

The prospectively collected data in the Jamaica National Trauma Registry operated by the Section of Surgery identified 88 patients who were admitted with head injury to the University Hospital of the West Indies over a one-year period. There were 67 males (76.1%), the mean (SD) age of the entire group being 35.02 (+/- 18.45) years. Intentional injuries occurred in 47.2%. The Injury Severity Score was greater than 15 in 19.3%, severe head injuries occurred in 19% and overall mortality was 16%. Care in the Intensive Care Unit (ICU) was extended to only half of those with the severe injuries. The Scottish Intercollegiate Guidelines Network (SIGN) method was used to assess the appropriateness of admission to hospital. Sixteen (18%) of the 88 patients were inappropriately admitted according to SIGN guidelines. Increased efficiency may result from standardization of admission criteria for head-injured patients and consistent implementation of the SIGN guidelines for admission without increased risk to patients. This may be expected to minimize unnecessary admissions and result in considerable cost savings.     

Injury prevention: the time has come.

Although cancer, heart disease and stroke occupy much of society's attention to health matters, injuries account for more potential years of life lost before age 65 than all these diseases combined. The time has come to set the record straight and to give injury its rightful place on the health policy agenda. Contrary to popular belief, most injuries are no accident. More than 90% of injuries are both predictable and preventable. Injury prevention, a multidisciplinary effort, is coming of age in Canada. Education alone is not enough. New technology, innovative approaches to safety education and the mobilization of community resources can help to change behaviour and legislation to decrease the risk of injury. Physicians have an important role to play in this process.     

Meningococcal serogroups in New South Wales, 1977-1987

Data are presented on serogroups of meningococci (Neisseria meningitidis) that were submitted to Westmead Hospital and The Children's Hospital, Camperdown, from patients in Sydney and in rural areas of New South Wales, from January 1, 1977 to December 31, 1987. One hundred and ten organisms that were isolated from cerebrospinal fluid or from blood were examined. All organisms were isolated from sporadic cases of meningococcal disease. Patients in the zero-to-two-years' age-group were affected most commonly, but 36.3% of isolates were from older children and adults. The distribution of serogroups was as follows: serogroup B, 43.6; serogroup A, 28.2%; serogroup C, 10.0%; serogroup W135, 8.2%; serogroup Y, 4.5%; and serogroup Z, 0.9%. The isolates that were serogrouped by us represented approximately half the cases of meningococcal meningitis that were notified in New South Wales during this period. Serogrouping of meningococcal isolates is very important in order to follow epidemiological trends in the disease and to monitor the serogroups that cause outbreaks, where vaccination of contacts may be indicated. Our laboratories are prepared to receive isolates for serogrouping and antibiotic sensitivity testing from across New South Wales.     

Intravenous contrast media: use and associated mortality

OBJECTIVE: To determine the extent of use and mortality associated with peripheral intravenous injections of radiocontrast media. DESIGN: A retrospective study of injection data was made for the three and a half year period from January 1987 to June 1990 using the Health Insurance Commission database and the records of public hospital x-ray departments. Information about deaths associated with the injections was obtained from a survey of all radiologists and from other relevant sources. SETTING AND PARTICIPANTS: The study related to the entire population of New South Wales and the Australian Capital Territory, approximately 6 million people. INTERVENTIONS: Intravenous injections of radiographic contrast medium for computed tomographic scans, intravenous pyelograms and venograms. MAIN OUTCOME: A comprehensive record of intravenous contrast usage and associated mortality in a large community. RESULTS: Between January 1987 and June 1990, 613 581 intravenous injections of radiocontrast media were administered in New South Wales and the Australian Capital Territory. The overall annual incidence of use was estimated to be 2.9% and was markedly age dependent being more than 7% in subjects over 65 years. Eight deaths were documented, representing an overall mortality of 13 per million injections (95% confidence interval [CI], 5.6-25.7). Mortality appeared to be age related being 35 per million (95% CI, 12.7-75.6) in those over 65 years compared with 4.5 per million (95% CI, 0.6-16.4) in those under 65 years. Two of the deaths involved low osmolar contrast media. CONCLUSIONS: Death after injection of intravenous contrast medium is a rare event. There was no evidence that mortality was lower with the newer, low osmolar media than with the older, high osmolar media.     

Epidemic syphilis among homosexually active men in Sydney

OBJECTIVES: To describe trends in the notification of infectious syphilis in New South Wales, the characteristics of homosexually active men recently notified with early syphilis, and the seroprevalence and incidence of syphilis, as well as associated risk factors, in a Sydney cohort of HIV-negative homosexually active men. DESIGN, SETTING AND PARTICIPANTS: Secondary analysis of New South Wales infectious syphilis surveillance data from 1998 to 2003; a case series of 57 homosexually active men diagnosed with early syphilis in inner Sydney from December 2002 to January 2004; and a prospective cohort study of syphilis among 1333 HIV-negative homosexually active men in Sydney recruited from June 2001 to December 2003. MAIN OUTCOME MEASURES: Rates of notification of infectious syphilis in New South Wales and in areas of inner Sydney; behavioural and clinical features of men with syphilis in the case series; and incidence of syphilis and hazard ratios (HRs) associated with sexual behaviours in the cohort study. RESULTS: Infectious syphilis notifications in inner Sydney rose more than 10-fold (from 6 in 1999 to 162 in 2003), and the increase was confined to men. Of 57 men with early syphilis in the case series, 54% were HIV-positive and 32% reported no symptoms of syphilis. These 57 men were highly sexually active and likely to report recreational drug use. In the cohort study, 1292 men (97% of participants) consented to syphilis testing; the incidence of syphilis was 0.78 per 100 person-years, and risk factors included reporting unprotected anal intercourse with HIV-positive partners (HR, 5.31; 95% CI, 2.00-184.93) and insertive oral sex (HR, 4.55; 95% CI, 1.14-18.18). CONCLUSION: Syphilis has been re-established among homosexually active men in Sydney, and HIV-positive men are over-represented. Frequent screening is needed in this population to curb the transmission of both syphilis and HIV.     

呼和浩特市三级综合医院压力性损伤现患率的调研及结果分析

目的：通过横断面调查研究获取呼和浩特市三级综合医院住院患者的压力性损伤现患率和医院获得性压力性损伤发生率的基线数据,压力性损伤的现患率、部位分布特征、科室分布特点等。初步了解三级综合医院压力性损伤危险预测及预防资源使用情况,为评估压力性损伤预防措施的效果提供依据。方法:采用欧洲压力性损伤专家组设计的并经过信效度检验的Minimum Data Set(MDS)作为压力性损伤现患率调査工具。使用横断面调查方法获得呼和浩特市三所三级综合医院压力性损伤的现患率和医院获得性压力性损伤的发生率。结果:呼和浩特三所综合医院的压力性损伤现患率为0.74%,医院获得性压力性损伤发生率为0.25%,其中内蒙古医科大学附属医院的现患率为0.70%,呼和浩特市医院为0.64%,内蒙古自治区人民医院为0.61%。压力性损伤的好发部位分别是:骶尾部、髋部、大转子等。结论:本次研究首次联合了呼和浩特三所三级综合医院,获得了呼和浩特市三级综合医院压力性损伤现患率和医院获得性压力性损伤发生率的基线数据。为初步了解医院压力性损伤危险预测及预防资源使用情况,评估压力性损伤预防措施的效果提供了依据。     

Hospital costs of older people in New South Wales in the last year of life

OBJECTIVE: To estimate hospital inpatient costs by age, time to death and cause of death among older people in the last year of life. DESIGN AND SETTING: Cross-sectional analytical study of deaths and hospitalisations in New South Wales from linked population databases. PARTICIPANTS: 70,384 people aged 65 years and over who died in 2002 and 2003. MAIN OUTCOME MEASURES: Hospital costs in the year before death. RESULTS: Care of people aged 65 years and over in their last year of life accounted for 8.9% of all hospital inpatient costs. Hospital costs fell with age, with people aged 95 years or over incurring less than half the average costs per person of those who died aged 65-74 years ($7028 versus $17,927). Average inpatient costs increased greatly in the 6 months before death, from $646 per person in the sixth month to $5545 in the last month before death. Cardiovascular diseases (43.1% of deaths) were associated with an average of $11,069 in inpatient costs, while cancer (25.0% of deaths) accounted for $16,853. The highest average costs in the last year of life were for people who died of genitourinary system diseases ($18,948), and the highest average costs in the last month of life were for people who died of injuries ($8913). CONCLUSION: Population ageing is likely to result in a shift of the economic burden of end-of-life care from the hospital sector to the long-term care sector, with consequences for the supply, organisation and funding of both sectors.