Severe injury among Hispanic and non-Hispanic white children in Washington state

OBJECTIVES: The authors' anecdotal experience at a regional Level I trauma center was that Hispanic children were overrepresented among burn patients, particularly among children with burns due to scalding from hot food. This study describes injury incidence and severity among Hispanic and non-Hispanic white infants, children, and adolescents with serious traumatic injuries in Washington State. METHODS: Data from the Washington State Trauma Registry for 1995-1997 were used to identify injured individuals aged < or = 19 years. Ratios of overall and mechanism-specific injury incidence rates for Hispanic children relative to non-Hispanic white children were calculated using denominator estimates derived from U.S. Census Bureau population data. Hispanic children and non-Hispanic white children were also compared on several measures of severity of injury. RESULTS: In 1995-1997, serious traumatic injuries were reported to the Registry for 231 Hispanic children aged < or = 19 years (rate: 54 per 100,000 person-years) and for 2,123 non-Hispanic white children (56 per 100,000 person-years), yielding an overall rate ratio (RR) of 1.0 (95% confidence interval [CI] 0.8, 1.1). Motor vehicle crashes and falls accounted for one-third to one-half of the injuries for each group. Infants, children, and adolescents identified as Hispanic had higher rates of injuries related to hot objects (i.e., burns) (RR=2.3; 95% CI 1.3, 4.1), guns (RR=2.2; 95% CI 1.5 to 3.3), and being cut or pierced (RR=3.5; 95% CI 2.2 to 5.5). The Hispanic group had a lower injury rate for motor vehicle accidents (RR=0.7; 95% CI 0.5, 0.9). Mortality rates were similar (RR=1.1; 95% CI 0.7, 1.7). The mean length of hospital stay was 5.5 days for the Hispanic group and 8.8 days for the non-Hispanic white group (difference=3.3 days; 95% CI -0.7, 7.4). CONCLUSIONS: The study found little difference between Hispanic and non-Hispanic white infants, children, and adolescents in the burden of traumatic pediatric injury. However, burns, guns, drowning, and being pierced/cut appeared to be particularly important mechanisms of injury for Hispanic children. More specific investigations targeted toward these injury types are needed to identify the underlying preventable risk factors involved.     

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.     

Unintentional home-related injuries in the Islamic Republic of Iran: findings from the first year of a national programme

BACKGROUND: As elsewhere, unintentional injuries are a leading cause of death in Iran, but non-fatal injuries occurring in the home environment have not been analysed. OBJECTIVES: The primary purposes of this study were to describe the pattern of home-related injuries and to obtain incidence rates for their determinants in order to monitor intervention programmes for preventive purposes. METHODS: A surveillance system for home-related injuries in selected rural and urban areas was established for the systematic collection of data. The information obtained covers emergency department visits and health services provided between March 1998 and March 1999. RESULTS: In total, 79,723 unintentional home-related injuries were reported, primarily burns (49%, incidence of 19/10,000 rural and 13/10,000 urban inhabitants) and lacerations/cuts caused by contact with sharp instruments (30%, incidence of 8.4/10,000 rural and 11/10,000 urban inhabitants). Injury rates were highest among children aged 0--4 years and lowest among the elderly (60 years or over). Rates varied between the sexes; among children under 15 years of age, most patients were male, but the opposite applied to all groups >15 years of age. Leading causes of death were burns, falls and poisoning among 628 people who died because of home-related injuries. CONCLUSIONS: The injury pattern found in this study is generally similar to that of many other countries, with the striking exception of burns. Other reports focus on the same problem, particularly with regard to Iran. The prevention of burns should be an important feature of any national injury prevention programme. Due to the varied causes of home-related injuries in Iran, interventions should be targeted at people at the greatest risk, namely children. Home visitation as a tool for face-to-face training with a sharper focus on burns, falls and poisoning prevention can be recommended as a part of primary health care policy. Greater investment in surveillance also provides a way of reducing the threat of injury in the community.     

Increases in age-group-specific injury mortality--United States, 1999-2004

From 1979 to 1999, total injury mortality rates declined overall in the United States, despite increases in suicide rates in the late 1980s and in homicide rates in the early 1990s (CDC, unpublished data, 2007). From 1999 to 2004, however, total injury mortality rates increased 5.5%, from 53.3 to 56.2 per 100,000 population, the first sustained increase in 25 years. To assess this increase, CDC analyzed the most recent data from the National Vital Statistics System (NVSS). This report summarizes the results of that analysis, which determined that U.S. mortality rates increased from 1999 to 2004 for unintentional injuries, suicides, and injuries of undetermined intent; homicide rates were stable. Among persons aged 45-54 years, the total injury mortality rate increased 24.5%, including an 87.0% increase in the mortality rate from unintentional poisoning (most commonly drug poisoning) and a 48.0% increase in suicide by hanging/suffocation. Among persons aged 20-29 years, the total injury mortality rate increased 7.7%, including a 92.5% increase in the death rate from unintentional poisoning and a 31.7% increase in suicide by hanging/suffocation. Parallel increases in multiple categories and mechanisms of injuries within these two age groups suggest an increase in one or more shared risk factors (e.g., drug abuse); prevention programs that focus on shared risk factors might help reduce deaths from injuries.     

Unintentional injuries in the home in the United States Part I: mortality

BACKGROUND: Unintentional injuries are a leading cause of death in the United States. It is unclear, however, what proportion of these injuries occur in the home. The purpose of this paper is to quantify and describe fatal unintentional injuries that take place in the home environment. METHODS: Data from the National Vital Statistics System (NVSS) were used to calculate average annual rates for unintentional home injury deaths, with 95% confidence intervals from 1992 to 1999 for the United States overall, and by mechanism of injury, gender, and age group. RESULTS: From 1992 to 1999, an average of 18,048 unintentional home injury deaths occurred annually in the United States (6.83 deaths per 100,000). Home injury deaths varied by age and gender, with males having higher rates of home injury death than females (8.78 vs 4.97 per 100,000), and older adults (>/=70 years) having higher rates than all other age groups. Falls (2.25 per 100,000), poisoning (1.83 per 100,000), and fire/burn injuries (1.29 per 100,000) were the leading causes of home injury death. Rates of fall death were highest for older adults, poisoning deaths were highest among middle-aged adults, and fire/burn death rates were highest among children. Inhalation/suffocation and drowning deaths were important injury issues for young children. CONCLUSIONS: Unintentional injury in the home is a significant problem. Specific home injury issues include falls among older adults, poisonings among middle-aged adults, fire/burn injuries among older adults and children, and inhalation/suffocation and drowning among young children. In addition, recommendations are presented for improvements to the NVSS.     

The injury mortality burden in Guinea

ABSTRACT: BACKGROUND: The injury mortality burden of Guinea has been rarely addressed. The paper aimed to report patterns of injury mortality burden in Guinea. METHODS: We retrieved the mortality data from the Guinean Annual Health Statistics Report 2007. The information about underlying cause of deaths was collected based on Guinean hospital discharge data, Hospital Mortuary and City Council Mortuary data. The causes of death are coded in the 9th International Classification of Diseases (ICD-9). Multivariate Poisson regression was used to test the impacts of sex and age on mortality rates. The statistical analyses were performed using Statatm 10.0. RESULTS: In 2007, 7066 persons were reported dying of injuries in Guinea (mortality: 72.8 per 100,000 population). Transportation, fire/burn, falls, homicide and drowning were the five leading causes of fatal injuries for the whole population, accounting for 37%, 22%, 12%, 10% and 6% of total deaths, respectively. In general, age-specific injury causes displayed similar patterns of the whole population except that poisoning replaced falls as a leading cause among children under five years old. Males were at 30-50% more risk of dying from six commonest causes than females and old age groups had higher injury mortality rates than younger age groups. CONCLUSION: Transportation, fire/burn, falls, homicide, and drowning accounted for the majority of total injury mortality burden in Guinea. Males and old adults were high-risk population of fatal injuries and should be targeted by injury prevention. Lots of work is needed to improve weak capacities for injury control in order to reduce the injury mortality burden.     

A comparison of injury death rates in China and the United States, 1986.

BACKGROUND: The importance of injury as a public health problem is not well recognized in many developing countries. Data have recently become available on injury mortality in China. METHOD: We compared Chinese injury data based on a 100 million population segment for 1986 with data for the United States. RESULTS: The age-adjusted death rate from all injuries for China exceeds the rate for the US (69.0 vs 61.3 per 100,000). The US has higher death rates from motor vehicle crashes, fires, and homicide; China has greater mortality from drowning, poisoning, falls, and suicide. Especially noteworthy in China are the high drowning rates among young children and the elderly and the high suicide rates in rural areas among young adults and the elderly. CONCLUSION: Injury is an important public health problem in China, exceeding in many respects the problem in the United States. It is urgent for China to place high priority on injury research and prevention.     

北京市石景山区2564例2～16岁流动儿童伤害现况调查

目的 了解北京市石景山区衙门口村社区流动儿童伤害现况。方法 采用自行设计的问卷对流动儿童父母进行调查。结果 2 564名流动儿童年龄2～16岁,伤害总发生率为38.1%;976名有过伤害的儿童在2015年6月前共发生1 490人次伤害。3～6岁是伤害高发年龄段;跌落伤、摔伤、碰撞伤是伤害的首要类型（31.1%）,其次是烧烫伤（20.7%）、动物咬伤（19.5%）;儿童伤害后就医率为82.4%;父母是小学及以下文化程度的儿童伤害发生率最高（χ_父亲组2=19.01,P<0.001;χ_母亲组2=20.28,P<0.001）。结论 流动儿童面临更大的伤害威胁,应提高儿童看护人,主要是母亲的文化程度、安全意识,为流动儿童提供安全的生活环境。     

Incidence rates of firearm injuries in Galveston, Texas, 1979-1981

Firearm injury mortality rates have been characterized in various settings, but little is known of the total magnitude of firearm injury, including morbidity. The authors determined population-based incidence rates of firearm injury among residents of Galveston, Texas, from 1979-1981 by using police, emergency department, hospital, emergency medical services, medical examiner, and vital records to identify 239 firearm injury cases. Vital records, medical examiner, and police records each identified more than 95% of the fatalities, but police records (sensitivity = 98%) were better than emergency department or hospital records (sensitivity = 82% and 28%, respectively) for identifying all nonfatal cases. The annual age-adjusted incidence rate of firearm injury was 128 per 100,000 persons. Black males, with the highest firearm injury rate (459 per 100,000 persons), were injured at 46 times the rate of white females (10 per 100,000 persons). The overall case fatality rate was 30%, including 25% of the assaults/homicides, 81% of the parasuicides/suicides, and 0% of the unintentional injuries. On the basis of the case fatality rates, an estimated 140,000 firearm injuries occur in the United States annually. The case fatality rate for penetrating head injuries was 80% versus 48% for chest injuries and 6% for all other parts of the body. The results are discussed with respect to policy recommendations for reducing firearm injuries.     

Utilizing United States Coast Guard data to calculate incidence rates and identify risk factors for occupational fishing injuries in New Jersey

Commercial fishing has high rates of work-related injury and death and needs preventive strategies. Work-related fatal and nonfatal injury rates for New Jersey (NJ) commercial fishermen who suffered unintentional traumatic injuries from 2001 to 2007 are calculated using data from the United States Coast Guard (USCG) Marine Safety and Pollution Database and estimated denominator data. Fatalities were compared to those ascertained by the NJ Fatality Assessment Control and Evaluation (FACE) surveillance system. For the study years, 225 nonfatal injuries and 31 fatal injuries were reported. Among nonfatal injuries, the causes by frequency were fall onto surface, crushed between objects, struck by moving object, line handling/caught in lines, collision with fixed objects, fall into water, and other noncontact injuries. The distribution of fatal injuries differed, with the most frequent cause as crushed between objects. Falls into water and several noncontact injuries accounted for most of the other fatalities. The large majority (96%) of nonfatal injuries were contact injuries, whereas only 68% of fatalities were classified as contact. The overall incidence rate of nonfatal injuries was 1188 per 100,000 full-time equivalents (FTEs) per year. The rate varied considerably by year, from a low of 286 per 100,000 FTEs in 2001 and 2007 to 3806 per 100,000 FTEs in 2003. The overall occupational fatality rate over the period 2001-2007 was 164 per 100,000 FTEs per year. These results can aid in targeting the commercial fishing industry for injury prevention strategies and interventions, especially for falls, crushing injuries, and drownings.     

Injury mortality rates in Native and non-Native children: a population-based study

OBJECTIVES: To examine injury mortality rates in Native and non-Native children in the province of Alberta, Canada, over a 10-year period, temporal trends in injury mortality rates (Native vs. non-Native), as well as relative risks of injury mortality (Native vs. non-Native) by injury mechanism and intent, were calculated. METHODS: An observational, population-based study design was used. Mortality data were obtained from provincial vital statistics, with injury deaths identified using external injury codes (E-codes). The relative risk (RR) of injury mortality (Native vs. non-Native) along with 95% confidence intervals (CIs) were calculated. Stratified analyses and Poisson regression modeling were used to calculate adjusted relative risk. RESULTS: Injury mortality rates declined over the study period, with no difference in the rate of decline between Native and non-Native children. The adjusted relative risk for all-cause injury death (Native vs. non-Native) was 4.6 (95% CI 4.1 to 5.2). The adjusted relative risks (Native vs. non-Native) by injury intent categories were: unintentional injuries, 4.0 (95% CI 3.5 to 4.6); suicide, 6.6 (95% CI 5.2 to 8.5); and homicide, 5.1 (95% CI 3.0 to 8.5). Injury mortality rates were consistently higher for Native children across all injury mechanism categories. The largest relative risks (Native vs. non-Native) were pedestrian injury (RR = 17.0), accidental poisoning (RR = 15.4), homicide by piercing objects (RR = 15.4), and suicide by hanging (RR = 13.5). CONCLUSION: The burden of injury mortality is significantly greater in Native children compared with non-Native children. Therefore, injury prevention strategies that target both intentional and unintentional injuries are needed.     

Why does Sweden have the lowest childhood injury mortality in the world? The roles of architecture and public pre-school services

Of interest is how some countries have achieved a profound reduction of child injury mortality. Still little is reported on the impact of a combination of urban planning, social welfare development and safety measures. We therefore present trends in childhood (0-14 years) injury mortality in Sweden 1966-2001 and discuss the factors behind any reductions observed. Annual total and cause-specific injury mortality rates were computed by age subgroups and gender. Trend analyses were performed with year as independent and mortality rate as dependent variable. A piecewise linear function was fitted to the annual mortality rates. Data were categorized into five 7-year intervals. In total, there were 5264 deaths due to injury in the study population during the period 1966-2001, of which 3368 (64%) were of boys and 1896 (36%) girls. The most frequent external cause of death was transport injury (48%), drowning (14%), homicide (5.8%), fire (5%), and fall (2.7%). About 66% (n=3474) of deaths occurred during the first half of the study period (1966-1981) with an average incidence rate of mortality 13.0 compared to 5.6 per 100,000 inhabitants during the second half of the period (1982-2001). For total injuries, there was a statistically significant decrease in mortality among all subgroups of children in both sexes. The slopes are greater among the younger children (0-4, 5-9 years) than the older ones (10-14 years). Several factors behind this strong decline of childhood injury mortality of interest to evaluate are (i) the implementation of the functionalist architectural style including transport separation, legislation and safety in cars; (ii) the expansion of public child day-care centers including more organized leisure activities; (iii) the establishment of long-term nationwide mandatory program for swim training among school children and (iv) local child-safety programs considering differences in exposure to risk between urban and rural areas.     

垂杨柳医院儿童意外损伤资料分析

目的了解城乡结合部儿童意外损伤的原因及危险因素.方法对我院1998年4月～2000年12月意外损伤的96例儿童进行回顾性分析.结果儿童意外损伤,城市前3位为动物致伤、中毒和跌落伤,分别为42.9%、21.4%和17.8%,农村为中毒,动物致伤和烫伤,分别为55.7%、8.6%和7.1%;中毒农村高于城市,动物致伤和跌落伤城市高于农村,2者比较差异有显著性(P＜0.01);中毒城市乡均以一氧化碳为首位,其次,城市以药物,农村以有机磷和灭鼠药为主;3岁前儿童意外损伤以窒息和气管异物为主,3岁以上以动物致伤和跌落伤为主;意外损伤致死23例,占意外损伤儿童的23.5%(23/98),致死原因主要为车祸和溺水.结论城乡结合部儿童重点预防中毒、动物致伤、跌落伤和烫伤,同时防止车祸和溺水导致儿童意外死亡.     

Environmental-temperature injury in a Canadian metropolis

This study performed a preliminary investigation of the incidence and determinants of environmental-temperature injury among residents of Montreal Island, Quebec, Canada. Incidence rates, mortality rates and determinants of environmental-temperature injury were estimated for Montreal Island's 1,802,309 urban and suburban residents. Sources of information included coroner's reports, death certificates, hospital discharge summaries, and hospital chart reviews. The estimated incidence rate for environmental-temperature injury requiring hospitalization on Montreal Island was 3.1 per 100,000 person-years. The estimated mortality rate for all environmental-temperature injuries on Montreal Island was 0.3 per 100,000 person-years. The majority of hospitalizations and deaths were due to cold injury. Male gender, alcohol intoxication, psychiatric illness, older age, and homelessness were suggestive of important risk factors in cold injury. All deaths due to heat injury occurred in elderly females. Montreal Island's ambulance transport service, with its unique database, was identified as a novel surveillance design for environmental-temperature injury. Knowing more about the incidence and determinants of environmental-temperature injury may suggest priorities for interventions to decrease morbidity and mortality.     

Differences in injury rates in child motor vehicle passengers in rural and urban areas in New South Wales, July 2000 to June 2004

OBJECTIVES: To investigate whether the pattern of hospitalised injuries in injured child motor vehicle passengers involved in traffic crashes differs in rural and urban residents of New South Wales (NSW). METHODS: This study compared injuries of hospitalised child motor vehicle passengers resident in rural areas with those from urban areas. The NSW Inpatient Statistics Collection (ISC), a population-based dataset, was used to select cases for the period of July 2000 to June 2004. The hospitalised injury rate was calculated according to urban/rural status using Poisson regression. Injury rate ratios (IRR) comparing rural and urban children were computed overall and for specific injury types. RESULTS: Overall, 1,286 children (aged 0-15 years) residing in NSW were identified from the NSW ISC internally linked datasets as being separated from hospital for injuries resulting from a motor vehicle crash. The overall hospitalised injury incidence rates for child motor vehicle passengers resident in rural and urban NSW areas were 46.75 (95% CI 36.63-59.66) and 20.13 (95% CI 17.94-22.58) per 100,000 children respectively. The rural/urban IRR for comparing the incidence of hospitalisation was significantly elevated (IRR=2.10, 95% CI 1.78-2.48). The IRR was also significantly elevated across most injury types. The largest risk disparity between rural and urban children was in 9-12 year-olds (IRR=2.33, 95% CI 1.73-3.13). CONCLUSION AND IMPLICATIONS: There is an elevated injury incidence rate in rural resident children, compared with their urban counterparts. This differential should be addressed in future road safety initiatives.     

Characteristics of childhood homicide in Ohio, 1974-84.

Childhood homicide deaths in Ohio from 1974 to 1984 were examined using Ohio Vital Statistics records and US Census Data. Homicide rates varied from 25/100,000 for Black infant males to 0.8/100,000 for White females ages 5-9. Child battering was the leading cause of death for children less than 5 years. Firearms accounted for 56 per cent of homicide deaths for children 10-14 years of age. The childhood homicide rates in the four largest Ohio cities were substantially higher in areas with low socioeconomic indicators.     

Injury mortality in American Indian, Hispanic, and non-Hispanic white children in New Mexico, 1958-1982

Childhood fatalities from injuries are a serious public health problem in New Mexico, a state which ranks second in the nation in injury-related mortality rates. To determine the extent of injury mortality in children in this state, and to examine time trends and differences in mortality rates in New Mexico's American Indian, Hispanic, and non-Hispanic white children aged 0-14 years, we analyzed vital records collected from 1958 to 1982. American Indian children experienced the highest mortality rates from all external causes combined. Among all three major ethnic groups, children aged 0-4 years were at the highest risk for injury fatalities. Unintentional injuries accounted for 85% of all injury-related deaths. Motor vehicle crashes and drowning were the first and second leading causes of death in all three groups, while other important causes of death included fire, choking on food or other objects, poisoning, and homicide. Although the fatality rates on most types of injuries decreased over the 25-year period, childhood fatality rates for motor vehicle crashes and homicide increased in each ethnic group. Despite the overall decrease in injury mortality rates in New Mexican children, the rates are excessively high compared to other states, especially in American Indian children.     

遵义市农村学龄儿童烧烫伤特征及影响因素分析

目的探讨遵义市农村学龄儿童烧烫伤特征及影响因素,为制定预防儿童烧烫伤策略提供理论依据。方法采用多阶段整群随机抽样法抽取遵义市凤冈县2所小学和1所中学共465名儿童为调查对象,采用自制问卷调查近一年烧烫伤情况,运用单、多因素非条件Logistic回归分析其烧烫伤影响因素。结果烧烫伤发生率为8.82%,36.6%是热水和热油导致,发生部位主要是手掌/手臂(53.7%),主要发生地是家中(75.6%),发生季节主要是夏季(46.3%)。多因素分析显示,男童发生烧烫伤的危险性较女童高(OR=5.38)、独生子女(OR=11.05)、留守儿童(OR=8.61)等是儿童发生烧烫伤的危险因素。学习成绩好(OR=0.45)、懂得烧烫伤正确处理方法(OR=0.83)等是烧烫伤发生的保护因素。结论遵义市农村儿童烧烫伤发生率较高,应加强烧烫伤知识普及,关爱留守儿童,以降低其烧烫伤发生率。     

1223名农村小学生伤害现状调查

目的:调查唐山市农村儿童伤害发生现状,为开展健康教育以及伤害的预防提供依据。方法:采用儿童伤害相关行为调查表,按整群抽样的原则,对唐山所属县的3所小学学生进行自填式问卷调查,采用SPSS12.0统计软件对调查结果进行统计分析。结果:伤害的总发生率为48.1%,各年级伤害的发生率分别为32.0%、32.1%、45.9%、57.5%、70.9%、43.9%。伤害类型前5位依次是跌伤、烧烫伤、穿刺伤、碰击伤、刀割伤。软伤害发生率为50.6%,偶尔发生的为81.7%,经常发生的为18.3%。结论:儿童伤害发生率较高,应针对伤害危险因素加强意外伤害的健康教育,以提高儿童对伤害的预防和自我保护意识。