The increasing problem of motorcycle injuries in children and adolescents

OBJECTIVE: To quantify an anecdotally apparent increase in motorcycle-related injuries in children and adolescents across Victoria. DESIGN, SETTING AND PARTICIPANTS: Retrospective analysis of paediatric motorcycle injuries (1 July 2000 - 30 June 2004) from a statewide emergency department (ED) database (Victorian Emergency Minimum Dataset [VEMD]) and the Trauma Registry database at the Royal Children's Hospital (RCH), Melbourne. MAIN OUTCOME MEASURES: Trends in paediatric motorcycle-related injuries over time; patient demographics, circumstances of accidents (on or off road), and injury characteristics, including severity markers. RESULTS: The VEMD recorded 3163 patients aged < or = 16 years presenting to EDs with motorcycle injuries during the study period; population-based rates of these injuries increased by an average of 9.6% per year (95% CI, 6.2%-13.1%; P < 0.005). In the same period, there was a total of 167 motorcycle-related admissions to the RCH, increasing annually in line with statewide ED presentations. About a quarter of paediatric motorcycle accidents occurred in children aged under 10 years (VEMD, 22%; RCH, 27%) and most occurred off road (VEMD,89%; RCH, 71%). At the RCH, median length of stay was 3 days (interquartile range [IQR], 1-7 days) and the median Injury Severity Score was 9 (IQR, 4-10); 41% of patients required an operation, 13% were admitted to an intensive care unit, and two died. CONCLUSION: In Victoria, the incidence of motorcycle-related injuries is increasing in children and adolescents. Most of these injuries occur off road, outside of any legislative framework. There is an urgent need for coordinated legislative changes and educational efforts to decrease motorcycle injuries in children.     

Epidemiology of head injury in Malaysian children: a hospital-based study

A prospective observational study was carried out at the Emergency Department, Hospital Kuala Lumpur to determine the proportion of accidental head injury among children and the circumstances of injury. The study was carried out from November 1993 to January 1994 on all children below 14 years who presented to the Emergency Department with accidental head injury. Accidental head injury made up (4.75%) of all cases seen at the Casualty Department. The ratio of boys to girls was 2:1. The mean age of head injured children was 5.2 (S.D. 3.63) years. The leading cause of head injury was fall (63%) followed by road traffic accidents (RTA) in (30.7%) while the rest were due to 'impact' (injury caused by flying object or missiles) injuries. More than half (54.4%) of those injured in RTA were pedestrians. Pedestrian injury was particularly important in the 5-< 14 years age group, where adult supervision was lacking in two thirds of the children. None of the patients who were involved in vehicle-related injuries had used a suitable protective or restraining device. All three patients who died were from this group. This study emphasises the need for stricter enforcement of laws related to the use of protective devices and measures to decrease child pedestrian injury. The issues of lack of adult supervision, both in and outside the home need to be addressed.     

Snowmobile-related deaths in Ontario: a 5-year review.

OBJECTIVES: To investigate the demographic characteristics and circumstances surrounding fatal snowmobile accidents in Ontario, to examine the risk factors and to observe any fatality trends over the study period. DESIGN: Case series. PATIENTS: All 131 people who died accidentally while operating a snowmobile in Ontario from 1985-86 to 1989-90. Records were obtained from the chief coroner's office; registration data were obtained from the Ministry of Transportation. RESULTS: Although the absolute number of deaths increased each year, owing to a rapid increase in the number of registered snowmobiles, the risk of death from snowmobile accidents remained relatively constant. Deaths occurred most frequently in northeastern Ontario. Youths and men predominated among the victims. Fatal accidents occurred more often on lakes (in 66% of the cases in which this information was known) than on roads (in 26%) or trails (in 8%). Weekend fatalities predominated, and deaths occurred most often during times of suboptimal lighting (from 4 pm to 8 am). The driver was killed in 84% of the cases in which the person's role was known. Alcohol use before death was implicated in 69% of the cases, the level exceeding the Ontario legal limit in 59%. CONCLUSION: Snowmobile-related deaths result from factors that are generally avoidable. Strategies need to be instituted to reduce the rate of these events.     

All-terrain vehicle injuries in central Wisconsin: a continuing problem

All-terrain vehicles (ATVs) have become well recognized as associated with injuries. This recognition has resulted in attempts at education and regulation to reduce the number and severity of injuries and number of deaths. The Marshfield Clinic and St. Joseph's Hospital surveyed all-terrain vehicle accidents in the Emergency Department in 1985 and again in 1988 and followed these patients for at least 1 year after the injury. Between the two dates, extensive educational and legislative activity had taken place. The actual number of all-terrain vehicle accidents had increased. The characteristics of victims who were involved in all-terrain vehicle accidents did not change. The actual number of accidents associated with three-wheeled ATVs did not appreciably decrease but the number of accidents associated with four-wheeled ATVs did increase. To date, it is not clear that legislative and educational activities are effective in reducing the number of ATV accidents or in changing the pattern of the accidents.     

Bicycle-related injuries: a survey in a pediatric emergency department.

The number of bicycle-related injuries has risen significantly with the increased popularity of bicycle riding in Canada. The risk of injury is highest among children. To assess the magnitude of the problem and to identify the contributing factors we used a questionnaire, injury reports and patient charts to survey bicycle-related injuries among children brought to the emergency department of the Children's Hospital of Eastern Ontario, Ottawa, between May 1 and Sept. 30, 1988. The questionnaire was completed for 517 (91%) of the 568 children; 70% were boys, and the mean age was 9.4 years. Only 2% of the patients had been wearing a helmet at the time of injury, although 13% claimed to own one for cycling. Over 60% of the accidents were attributable to carelessness or poor bicycle control; mechanical failure and environmental hazards were minor factors. Over 80% of the injuries occurred within a kilometre of the child's home. Of the 97 children admitted to hospital 49% had head and skull injuries and 40% had limb fractures. Bicycle-related injuries represented 14.8% of all nonwinter (Apr. 1 to Oct. 31) trauma admissions among children 5 years or older. Our results further document bicycle-related injuries as an important childhood problem and underscore the need for improved safety measures.     

Association between exposure/non-exposure to the mandatory seat belt law with regards to compliance in vehicle accident victims--a hospital review

OBJECTIVE: Injuries sustained in motor vehicle accidents (MVAs) are a major challenge to the Jamaican healthcare system. In November 1999, Jamaica enacted legislation to make seat belt usage in motor vehicles compulsory. The effect of this policy change on seat belt usage is unclear. This study therefore sought to determine the prevalence of seat belt usage and to determine the association between exposure/non-exposure to the mandatory seat belt law and seat belt use in subjects who presented to the Accident and Emergency Department (A&E) of the University Hospital of the West Indies (UHWI) as a result of motor vehicle accidents. METHODS: Subjects were recruited from June to November 2003, post-seat belt law (POBL) period, and May to October 1999, pre-seat belt law (PRBL) period. Data collected included demographic variables, seat belt use and position of the occupants in the vehicle. RESULTS: Of the 277 patients who were eligible for inclusion, data were complete in 258 subjects, 87 in the PRBL period and 171 in the POBL period. The prevalence of seat belt use was 47% (PRBL) and 63% (POBL) respectively. There was no significant gender difference at each period. The odds of wearing seat belt in the rear of a motor vehicle were significantly lower than that of a driver (Table 3, OR 0.19, 95% CI 0.07, 0.48). Adjusting for age, gender and position in vehicle exposure, there was about 100% increase in the odds of seat belt use during the post seat belt law era (OR = 2.09, 95% CI 1.21, 3.61). CONCLUSION: It is concluded from this hospital-based study that the mandatory seat belt law legislature was associated with increased seat belt use in motor vehicle accident victims. However, current data from the Road Traffic Agency indicate that there is still an alarming number of fatalities. This clearly suggests that additional public health measures are needed to address the epidemic of motor vehicle trauma in Jamaica.     

北京老年道路交通损伤特点分析

背景：道路交通损伤是一个持续的全球健康问题,其增长的趋势和经济发展、机动车的普及密切相关。但是,目前公布的数据和相关分析缺少对于北京老年人群的研究。 目的：收集北京市急救中心的数据,从公共卫生的角度,呈现出北京市老年道路交通损伤患者的情况。同时,为道路交通安全相关部门和道路交通损伤的防治,提供确实可靠的数据资料。 方法：在该回顾性研究中,收集从2004年到2010年期间,年龄在65岁及以上道路交通交通伤患者资料,共计1706例。所有个人信息,损伤时间,急救反应时间,道路使用类型和交通事故车辆类型,以及损伤的部位和严重程度,进行卡方和回归分析。 结果：北京老年患者年发生道路交通损伤21.8人/10万人。其发生率从2004年至2010年期间呈下降趋势（p<0.001）。平均年龄是72.92 ? 5.67,其中,911（53.40%）患者为男性。总体来说,大多数患者出现头部损伤（42.9%）和下肢损伤(34.82%)。中等损伤（65.51%）为主。老年交通损伤大多发生在日间,但并非上下班高峰时间。汽车撞击事故（85.64%）是主要交通事故类型,行人受伤者(79.19%)是损伤的主要人群。另外,有三项因素和损伤的严重程度相关,包括腹部损伤（p<0.001）,损伤部位的数量（p=0.027）和头部损伤（p=0.034）。道路交通伤下降的主要人群是65至74岁的患者和行人损伤患者。损伤程度整体呈下降趋势。 结论：本研究显示北京老年道路交通损伤在2004年至2010年期间呈下降趋势。尽管交通伤情况在改善,但仍是严重的公共健康问题。仍需要有效的道路交通规定和措施进一步加强老年人的道路损伤防治工作。     

Head injuries in childhood: a 2-year survey.

A retrospective study was conducted of the 880 children with head injuries consecutively admitted to the Children's Hospital of Eastern Ontario in Ottawa from July 1976 to June 1978. It confirmed a boy:girl ratio of about 2:1, with a peak of 3.5:1 around 7 years of age. The largest number of head injuries was in children under 1 year of age. Injuries were most common in summer and spring, and most were caused by falls. The most common place for head injuries was in the home, but the single most common cause of injuries was bicycle accidents, which were responsible for 12% of all the head injuries. Skull fractures were found in 30% of all the patients. Of the 34 patients with severe head injuries 8 (24%) died, 9 (26%) had a moderate residual disability and 17 (50%) made a good recovery. There were no other deaths, so the mortality for the entire group of 880 patients was 0.9%.     

Potential role for advanced trauma life support programme in improving trauma care in Jamaica

Data from the Road Safety Unit in the Ministry of Transport and Works, Jamaica, show an increase in road traffic accidents from 7861 in 1991 to 11,010 in 1999. The average number of deaths annually was 380 +/- 48 (SD) while injuries averaged 3320 +/- 262 per year. This represents an injury to death ratio of 8.7 compared with 24.9 for Trinidad and Tobago and 40 for Canada. During the period 1991 to 2000, an average of 796 +/- 159 (SD) murders were committed annually. The number of murders increased by over 280 per cent between the decade of the seventies and the nineties. Data from the trauma registry of the University Hospital of the West Indies showed that 29.6 per cent of all admissions to the surgical ward between January 1998 and December 31, 2000, were due to injuries. There were 97 deaths (3%) during this period and 33 occurred in the Accident and Emergency Department with 70 per cent occurring within 120 minutes of their arrival. The Advanced Trauma Life Support (ATLS) Programme emphasizes the resuscitation and stabilization of injured patients in the first few hours after injury. Most Emergency Departments in Jamaica are staffed by relatively junior medical officers and the low injury to death ratio among victims of motor vehicle accidents may be due to suboptimal care. Introduction of an ATLS programme in Jamaica may reduce the number of preventable deaths and also stimulate interest in trauma care thus increasing preventative measures to decrease the high incidence of trauma in Jamaica.     

Serious childhood injuries caused by air guns.

OBJECTIVE: To determine the severity of nonfatal injuries to children caused by air guns and pellet guns. DESIGN: Case series (hospital chart review). SETTING: Inpatient wards of the Children's Hospital of Eastern Ontario. PATIENTS: All children under 18 years of age admitted to the hospital from Jan. 1, 1979, to Dec. 31, 1989, under ICD code E917, E922, E955, E965, E970 or E985 who had suffered air gun injuries. MAIN OUTCOME MEASURES: Personal data, circumstances of event and clinical data. RESULTS: The 43 children (37 boys) had a median age of 12 years. The circumstances of the accident were known in 20 cases: 17 children were playing and 3 were cleaning the gun when it went off. Four children thought the gun was unloaded. In five cases the bullet ricocheted into the eye. Nine injuries were self-inflicted. Injury was to the extremities in 21 (49%), the eyes in 15 (35%) and the head and neck in 7 (16%). The median length of hospital stay was 4 days. Six children had long-term disabilities, all the result of eye injuries; two had cataract surgery, and four required enucleation of the eye. CONCLUSIONS: Air guns can cause serious injury to children. Their sale needs to be banned or at least carefully regulated.     

Factors influencing the presentation and care of elderly people in the emergency department.

OBJECTIVE: To provide Australian data from a community setting on the use of the Emergency Department by elderly persons. DESIGN: The paper describes three studies. Study 1 analyses patient admission patterns, and clinical data taken retrospectively from medical records for 1987. Studies 2 and 3 prospectively survey referral, transport, demographic profiles and clinical management practices in two patient samples taken during 1987 and 1988. SETTING: The Emergency Department of Sutherland Hospital, Sydney--a community based hospital of 374 beds. Patients: In study 1, we assessed 4609 hospital admissions of patients aged 60 years or more using ICD-9-CM coding. In Studies 2 and 3, samples of 74 patients aged 65 years or more and 100 patients aged 70 years or more who presented to the Emergency Department were assessed consecutively and prospectively. INTERVENTIONS: No specific interventions outside of usual Emergency Department routines were undertaken except for collection of demographic data. MAIN OUTCOME measures: Demographic characteristics, diagnostic categories, and referral, admissions and hospital separation data. RESULTS: In Study 1, of 4609 patients aged 60 years or more 3182 (69%) entered hospital via the Emergency Department. These 3182 represented 29% of total hospital admissions for that year. In Study 2 the male to female ratio was 32 to 42; the mean age was 78.16 years; 88% were pensioners; 20% had additional private insurance; 76% of women were widowed compared with 32% of men; 84% of the group lived in their own homes but, of these, 51% of women lived alone compared with 7.7% of men. The disease profile was that of acute organic disease in 97% of presentations. Ambulance transport to the Emergency Department was used by 65% of patients and Emergency Department facilities were used mostly during "working hours"; 64% of patients were admitted to hospital. The pre-hospital "activities of daily living" (ADL) functioning was assessed as being independent in 85%. In Study 3, the social and demographic profile was similar to Study 2. Fifty seven of the 100 patients used ambulance transport to the Emergency Department and this was initiated by a general practitioner in 13 instances. The general practitioner was the referring source in 28% of cases. Waiting times in the Emergency Department demonstrated a mean time from arrival to assessment by a medical officer of 30 minutes and a total time spent in the Emergency Department of 3 hours 4 minutes for those discharged home and 4 hours 24 minutes for those admitted. CONCLUSION: These studies demonstrate that the Emergency Department is a major area for care of the elderly and entry into the hospital system. Referral from a general practitioner and the use of ambulance transport from home to the Emergency Department are frequent pathways of care that may have important cost-benefit implications and deserve further study. The elderly in these studies appear to use the Emergency Department appropriately for acute medical/surgical need. The social profiles suggest that widowed women present a special case in terms of discharge plans for management.     

Motor vehicle childhood injuries caused by noncrash falls and ejections

In a sample of children aged 0 through 14 years who were treated for injuries incurred in a motor vehicle accident, a large proportion of those involved in noncrash events fell or were ejected from the vehicle. This study was designed to describe the patterns of passenger travel, precipitating causes, and severity of injury in noncrash falls or ejections. The data were obtained from a larger ongoing hospital-based monitoring system. The Abbreviated Injury Scale was used to grade injuries. Over 50% of those ejected sustained serious injuries compared with 5% of those who remained in the vehicle. Two high-risk patterns emerged: (1) the young child traveling in a passenger seat falling out of the vehicle, and (2) the older child riding on the exterior of the vehicle and falling off during a vehicle maneuver. Door locks, restraint use, and prohibition of travel in nonpassenger locations would prevent these serious noncrash injuries.     

Pattern of the cases seen in the accident and emergency department in a Nigerian Tertiary Hospital over a period of twelve months

INTRODUCTION: There is a dearth of information on emergency medical services in Nigeria. This study was conducted to determine the age, sex distribution and the pattern of patient presentation in the Accident and Emergency Department of a Nigeria teaching hospital. METHODS: A retrospective study of all cases seen at the accident and emergency department of the University College Hospital in 2003 was carried out. The information extracted from the records includes age, sex, and diagnosis, department to which the patient was referred, the month of presentation and the outcome within the first twenty four hours of presentation. RESULTS: A total of 4674 patients attended the casualty, with a male: female ratio of 1.2:1. The third decade was the peak age distribution. There was a predominance of surgical cases (61%). In the treatment outcome, 52.1% were referred to other departments while there were ten (0.2%) mortalities. Trauma related cases constituted 45.1%. Road traffic accidents were the commonest cause of trauma. CONCLUSION: The largest proportion of patient were in the active third decade of life. Trauma is the commonest cause of presentation in the Accident and Emergency Department. A significant proportion of patients do not require admission. The doctor in the Accident and Emergency Department must be skilled in basic trauma care.     

Domestic accidental injuries to children presenting at a rural general practice

A survey of domestic childhood accidental injuries was conducted at a rural general practice in Arau, Perlis. Data was collected from parents or other caregivers of 171 children, aged 12 years and below, using a pretested questionnaire. Male children between the ages of 6 and 12 years were the most common group affected, with a male to female ratio of 1.7:1. The three most common accidents were injuries from falls (28%), cuts, lacerations, bruises and puncture wounds not resulting from falls (26%), and thermal injuries (22%). The most commonly affected parts of the body were the limbs. Most injuries to children between ages 4 to 12 years occurred in the house compounds, while those to children below 4 years occurred in the kitchen and other locations within the house. Major contributing factors to the injuries were the existence of unsafe home environments, the risk taking activities of the children, the presence of hazardous products in the household and unrealistic parental attitudes to injury prevention.     

152例道路交通事故致儿童眼损伤的法医学分析

目的:探讨道路交通事故致儿童眼损伤的类型、损伤特点、主要并发症及其伤残等级分布的特点,为此类案件的法医临床学鉴定提供参考。方法:对152例道路交通事故致儿童眼损伤的伤残评定资料按伤者受伤的临床诊断分类、有无并发症、并发症的类型及伤残程度进行统计分析。结果:1~3岁的儿童因交通事故致眼外伤构成比较低,4~6岁明显上升,11~14岁最高。大部分眼外伤为单眼损伤,眼部钝挫伤129眼,眼球穿通伤21眼,混合型眼部伤20眼,眼部烧伤2眼。主要并发症及后遗症为外伤性白内障53眼(30.8%)、外伤性青光眼18眼(10.5%)、外伤性视网膜脱离14眼(8.1%)、外伤性眼内炎9眼(5.2%)。结论:眼部钝挫伤在道路交通事故致儿童眼损伤中多见,并发症多预后差,鉴定难度较成人增大。针对学龄前和学龄期儿童因道路交通事故致眼损伤的伤残评定应适当放宽标准,伤残评定标准应增加专门针对儿童的条款。     

Pattern of poisoning cases in Emergency Department of Kathmandu Medical College Teaching Hospital

Objective: This study was conducted to determine the pattern and severity of poisoning cases in Emergency Department of Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal (KMCTH). Design: Retrospective observational study. Materials and methods: Hospital records of all admissions to the Emergency Department of Kathmandu Medical College Teaching Hospital (KMCTH) following acute poisoning were revised and all data from February 2007 to February 2008 were analyzed retrospectively. Results: This retrospective observational study was performed on 148 cases of poisoning who attended Emergency Department of KMCTH over a period of one year. The overall male to female ratio was 1.05:1. Poisoning was most common in the age group 21-30 years (40.5%). The most common causes of poisoning in adults were organophosphorous compounds and in children was kerosene oil. Oral route (79.05%) was the most common route of administration. 66.2% of cases were intentional poisoning for suicidal attempt. Students (43.9%) and service holders (18.9%) were commonly involved in poisoning. Conclusion: It was seen that adult between 21-30 years of age were more prone to suicidal poisoning with organophosphorous compounds and children of 1-10 years of age were more susceptible to accidental poisoning with kerosene oil. Key words: Organophosphorous; Poisoning; Suicide; Kerosene.     

Animal and human bite injuries in Victoria, 1998-2004

OBJECTIVE: To describe the epidemiology of mammal (human and non-human) bite injuries in Victoria. PARTICIPANTS, DESIGN AND SETTING: Retrospective case series of injuries recorded in the Victorian Emergency Minimum Dataset (VEMD) (1998-2004) and deaths recorded in the National Coroners Information System (1 July 2000 - 1 June 2006). MAIN OUTCOME MEASURES: Frequency, nature and outcome of injury as a function of mammal, victim demographics and season. RESULTS: Of 12 982 bite injuries identified in the VEMD, dogs, humans, and cats were implicated in 79.6%, 8.7%, and 7.2% of cases, respectively. Dog bite injuries were commonly sustained to the hands/wrists (31.3%) and face/head (25.4%); cat bites to the hands/wrists (67.6%) and arms (16.0%); and human bites to the hands/wrists (37.1%), arms (20.5%) and face/head (20.4%). Males comprised 73.7% and 56.3% of human and dog bite victims, respectively, while females comprised 64.1% of cat bite victims. A third of dog bite victims (33.4%) were children aged 14 years or less. Most human bite victims (79.8%) were adults aged 20-49 years, inclusive. More injuries were sustained on weekends and during the summer, 55.4% of injuries occurred in the home, and 11.6% of patients required hospital admission. Dog bites resulted in three deaths. CONCLUSIONS: Mammal bite injuries are common and often require inpatient care. Patterns of bite injuries relate to the type of mammal involved. These epidemiological data will inform prevention initiatives to decrease the incidence of mammal bites.     

Epidemiological Survey of the Prevalence of Non-fatal Injury among Children Aged 5-14 Years in China

ObjectiveTo determine the prevalence of non-fatal injuries among children aged 5–14 years in China.MethodsData of 21 973 children aged 5–14 years were extracted from the Fourth National Health Service Survey of China carried out between June 15 and July 10, 2008. Injury-related indicators included: history of ever having had an injury, and injury frequency, cause, location and severity.ResultsThe overall prevalence of non-fatal injuries among the children in the previous 12 months was 17.0 per 1000 subjects. The leading causes of non-fatal injuries were falls, animal bites, traffic accidents, falling objects and burns. The majority of children sustained only one injury. The main place of injury was at home in 40% and 54% of urban boys and girls, respectively, at school in 48% of rural boys, and at home and at school each in 33% of rural girls. Medical treatment for one day was the main option for 80% of urban boys and girls, 84% of rural boys, and 72% of rural girls.ConclusionNonfatal injuries among children aged 5–14 years are a serious public health concern in China.     

Effect of seat belts on injuries to front and rear seat passengers

Data on 2520 occupants of cars involved in accidents were analysed in relation to injury and the severity of the crash to investigate the effect of rear seat passengers on injury to restrained and unrestrained front seat occupants and vice versa. Unrestrained front seat occupants showed a higher incidence of serious injury when there were rear seat passengers. The presence of a rear seat passenger did not affect significantly the overall incidence of injury among restrained front seat occupants within the range of crash severity considered. Unrestrained rear seat passengers behind unrestrained front seat occupants showed a higher incidence of moderate injury and a lower incidence of no injury than those behind restrained front seat occupants. It is concluded that legislation on seat belts has not greatly increased the risk of person to person injury.     

急诊伤害调查

目的探讨急诊科伤害的流行特征。方法对我院2001年7月～2002年6月在急诊科就医的患者进行伤害现况调查,对急性损伤仅做抽样调查。结果调查伤害病例共1798例(急性损伤1494例,中毒304例)。80．14％为意外伤害,男女比为2．34：1,15～34岁占68．02％。前三位伤害种类依次为意外的机械性损伤、运输事故和中毒;前三位伤害的职业依次为工人(生产运输和专业技术人员)、服务业和学生。进一步分析了机械性等损伤和304例中毒的特点。结论建立以医院急诊科为基础的伤害监测,有其必要性、迫切性和可行性。