The incidence of injuries in young people: I. Methodology and results of a collaborative study in Brazil, Chile, Cuba and Venezuela

Injuries and accidents are acknowledged as leading causes of mortality among children and adolescents in the developing countries of the world. However, little is known of the extent of non-fatal injuries and of their potential risk factors. The Pan American Health Organization sponsored the first collaborative study to examine morbidity incidence in specified areas of four selected countries in Latin America, and to test the feasibility and practicality of the developed methodology for application in other regions of the world. The study subjects were injured children and adolescents (0-19 years of age) presenting at the study hospitals in the chosen urban centres, as well as injured that were surveyed in households in the catchment area of the hospitals. Falls constituted the most common (40-52%) cause of injury in all areas, and tended to occur in the younger age groups. Motor vehicle injuries were not as frequent (5-24%) as expected from mortality studies. Males outnumbered females 2:1. The home was the most frequent (37-57%) site of injuries, especially for younger ages. Few received medical care at the site of the injury or en route to a hospital, if they went at all. The results found are consistent with those found in other studies in the developed world. The study methodology provides initial valid information for investigating the injury situation in countries with limited resources.     

11142例伤害监测病例的流行病学特征分析

目的研究安徽省肥西县伤害发生的特点和规律,为开展伤害预防与控制提供科学依据。方法采取分层随机整群抽样方法随机抽取肥西县县级综合医院、乡镇中心卫生院、乡镇普通卫生院各一所,研究这3所医院2006年1月1日～2007年12月31日就诊的所有初诊伤害患者。结果共报告有效数据11 142例,其中男性7 174名,女性3 968名,男女性别比1.81∶1,平均年龄为（34.56±16.00）岁,职业以农民（40.04%）和学生（20.62%）为主,伤害多发生于家中（33.48%）和公路街道（32.14%）,时间多集中在上午9～10时（19.22%）和下午15～16时（17.62%）,伤害发生的原因主要为跌落（32.12%）、机动车车祸（20.33%）、钝器伤（16.60%）和动物伤（11.67%）,以意外伤害为主（87.70%）。结论农民职业伤害、交通事故和青少年伤害是危害本地区青壮年农民、中小学学生健康和生命的主要危险因素,政府部门应采取有效的措施进行干预。     

香港地区儿童家庭意外事故416例分析

目的：了解前来急诊室就医的意外事故儿童的伤害类型、伤害程度等情况,为将来开展“儿童意外事故的预防控制提供参考依据。方法：采用病例的描述性分析。结果：在本次分析的４１６例意外事故儿童中,男童（５６．７％）多于女童（４１．３％）,年龄最小者不中１个月,最大１４岁,平均３．１９％（Ｓｄ,３．０５）岁,４岁以下的受伤儿童占６０％。８６．８％的意外故事发生在儿童家中,其中以客厅、卧室所占比例最大,分别为３８     

Das Unfallgeschehen bei Kindern und Jugendlichen in Deutschland

Compared to adults, children and adolescents run a considerably higher risk of suffering unintentional injuries (UI). To prevent UI, detailed knowledge of the overall accident occurrence and the determinants of UI is needed. This article gives an overview of the data sources covering the occurrence of UI among children and adolescents in Germany. According to the Robert Koch Institute’s German Health Interview and Examination Survey for Children and Adolescents (KiGGS), approximately 15.3?% of children and adolescents (1–17 years) in Germany suffer at least one UI within 12 months. Most accidents (60.7?%) occur at home or during leisure-time activities. In 2011, the German Statutory Accident Insurance (DGUV) registered more than 1.4 million accidents among children in day-care facilities and students in educational institutions. According to official statistics, in the same year, more than 50,000 children and adolescents were injured in traffic accidents. Moreover, the Federal Statistical Office registered 260,534 hospital admissions due to injuries and poisonings among children and adolescents. All data sources revealed age- and sex-specific differences. Boys suffer UI more frequently than girls do and they show higher injury rates in adolescence than during childhood. While UI among children mostly happen at home, road traffic and leisure-time accidents increase in occurrence during adolescence. In Germany, there are numerous initiatives dedicated to the prevention of UI in children and adolescents. The creation of target group-specific prevention measures is complicated by the fact that the methodological approaches of existing data sources differ considerably.     

Low-income neighborhoods and the risk of severe pediatric injury: a small-area analysis in northern Manhattan.

OBJECTIVES. The purpose of this study was to investigate the relationship between socioeconomic disadvantage and the incidence of severe childhood injury. METHODS. Small-area analysis was used to examine socioeconomic risk factors for pediatric injury resulting in hospitalization or death in Northern Manhattan, New York, NY, during a 9-year period (1983 through 1991). RESULTS. The average annual incidence of all causes of severe pediatric injury was 72.5 per 10,000 children; the case-fatality rate was 2.6%. Census tract proportions of low-income households, single-parent families, non-high school graduates, and unemployment were significant predictors of risk for both unintentional and intentional injury. Among the socioeconomic factors considered, low income was the single most important predictor of all injuries; other socioeconomic variables were not independent contributors once income was included in the model. Compared with children living in areas with few low-income households, children in areas with predominantly low-income households were more than twice as likely to receive injuries from all causes and four and one half times as likely to receive assault injuries. The effect of neighborhood income disparities on injury risk persisted after race was controlled. CONCLUSIONS. These results illuminate the impact of socioeconomic disparities on child health and point to the need for injury prevention efforts targeting low-income neighborhoods.     

Verletzungen bei Kindern und Jugendlichen (1–17 Jahre) und Umsetzung von persönlichen Schutzmaßnahmen

Parent interviews with regard to their children's accidents and to accident protective measures in the Health Interview and Examination Survey for Children and Adolescents (KiGGS) aimed at extending our knowledge of age- and gender-specific injuries and to identify risk groups and risk factors for injury prevention. The parents of 16,706 children (aged 1-17 years) were asked about their children's injuries within the last 12 months which were medically treated, and about accident mechanisms, consequences of injuries, and ambulatory and hospital treatment. In addition, parents and children aged 11 to 17 years (n = 6813) were asked to give information on protective measures. According to the parents 15.9 % of the children had at least one injury within the last 12 months, 15.2 % because of an accident and 0.8 % because of assault. In the age group 1-17 boys have been injured significantly more often than girls (17.9 % vs. 14,0 %). Overall, 13.3 % of 2,410 injured children and adolescents were hospitalized. Two thirds of the accidents among toddlers were domestic accidents (60 %) whereas leisure and sport accidents were most prevalent in children and adolescents aged 5-14 years and 15-17 years (32.1 % and 38.9 %). The proportion of accidents in child care facilities and educational institutions tripled from infancy to school age (age 5-14 years) (10.9-28.7 %), as did traffic accidents (5.6-16.7 %). The three most frequent injury mechanisms in the age range 1-17 years were falls on level ground (35.2 %), falls from heights (25.2 %) and collisions with objects or persons (20.6 %). Falls from heights showed the highest risk in toddlers (35.8 %). Contusions, sprains and strains increased to a highest level of 50.9 % in adolescents; likewise, bone fractures increased from 10.7 % in toddlers to 21.8 % in adolescents aged 15-17 years. An influence of socioeconomic status on injuries overall and on consequences of injuries was not seen. For traffic accidents in children aged 1-17 years boys (p = 0.019) and girls (p = 0.047) from families with lower socioeconomic status showed higher rates of accidents than children from families with higher socioeconomic status. The application of protective measures was lowest in the age group 14-17 years. While according to the parents about 90 % of children aged 3-4 years wear a helmet when riding a bicycle or when skating, this quote was lower in the age group 5-14 (60 %) and dropped to about 15 % in the age group 14-17 (about 15 %). Also the rate for using protective clothes was lowest in age group 14-17 (boys 41.8 %; girls 52.2 %). In children and adolescents the rate of self-reported helmet use is lower than estimated by their parents. In all age groups migration background and low socioeconomic status were associated with lower use of protective measures (helmets and protective clothes). The age related data analysis should be the starting point in prevention measures for specific risk groups considering migration and socioeconomic status. Prevention activities in traffic should focus on families with low social status. Adolescents should be specifically and adequately addressed regarding the benefits of certain safety measures when riding a bicycle and when skating.     

常山县儿童2004-2010年交通伤害监测结果分析

目的了解常山县儿童青少年交通伤害发生状况,为制定预防干预措施提供依据。方法根据《全国伤害监测方案》,在常山县人民医院、招贤中心卫生院、辉埠卫生院建立医院急诊伤害监测系统,以首次在监测医院就诊的各类伤害病例作为监测对象,采用哨点监测方式,以年度为单位持续进行医院伤害监测。结果常山县2004-2010年监测医院共报告交通伤害病人14 122例,其中儿童青少年交通伤害1 937例,占13.72%;以5～14岁在校学生为多,占14.71%;交通伤害中男、女之比为1.66︰1;伤害发生原因机动车车祸比非机动车车祸多。伤害发生场所以公路/街道为主,占94.11%;伤害发生时活动以驾乘交通工具和休闲活动为多,分别占52.30%和32.32%。结论 5～14岁在校学生为伤害预防干预的重点。应有针对性地开展预防干预措施,减少伤害的发生。     

上海市松江区0～14岁儿童伤害的特征

目的了解上海市松江区儿童伤害的流行病学特征和规律,为降低儿童伤害的发生提供科学依据。方法以上海市松江区3家二级医院作为伤害监测哨点医院,对2006年1月1日--12月1日首次就诊于哨点医院的0～14岁儿童伤害门诊和急诊病例进行分析。结果共调查伤害病例3080例,男童是女童的1．77倍,6～11岁学龄儿童为伤害事故发生的高峰年龄段。伤害类型及排位在0—14岁儿童中主要为跌落伤、钝器伤、交通事故、烧烫伤,50．46％的儿童伤害发生在家里或宿舍。结论跌落伤、学龄儿童及男童伤害是该区伤害干预的重点,应针对不同性别、年龄制定和实施不同的伤害防制措施。     

2016—2018年甘肃省0~6岁儿童伤害病例流行病学特征分析

  目的  了解甘肃省0~6岁儿童伤害发生特征,为儿童伤害防控提供依据。  方法  收集2016-2018年因伤害在哨点医院就诊的儿童伤害病例信息并进行流行病学特征分析。  结果  共收集0~6岁儿童伤害病例7 054例,男女童性别比为1.5∶1。伤害发生前3位原因依次是跌倒/坠落(42.2%)、烧烫伤(31.5%)及钝器伤(7.2%)。78.7%的儿童伤害发生在家中。伤害部位主要为头部(41.9%)、上肢(24.6%)和下肢(13.6%)。伤害严重程度以轻度为主(68.9%)。伤害结局以处理后离院为主(75.6%)。  结论  0~6岁儿童伤害病例以男童居多,以跌倒/坠落为主要伤害原因,伤害多发生在家中,头部是儿童伤害的主要受伤部位。应根据0~6岁儿童伤害发生特点,采取针对性干预措施。     

Intentional injuries among the young: presentation to emergency rooms, hospitalization, and death in Israel

Purpose: To study the incidence and outcome of intentional injuries requiring emergency room (ER) care among children and adolescents in a national sample.

Method: The population included 0- to 17-year-olds who presented to the ER for injuries in 23 hospitals over a 1-year period. A 6% to 9% random sample of days was selected in each hospital, and for each selected day the relevant ER record was reviewed for cause, nature, and outcome of injuries and sociodemographic information.

Results: The annual incidence for intentional injuries resulting in ER visits was 19.6 in 10,000 children and adolescents aged 0 to 17 [95% confidence interval (CI) 17.4–21.8 in 10,000]. Fights/assaults constituted 54.1% of the presentations, abuse and rape, 10.3%, and self-inflicted injuries, 10.8%. Overall rates were higher among 10- to 17 year olds than at younger ages. The rates were higher among boys than girls for fights/assaults and abuse, whereas attempted suicide and rape were three times higher among girls than boys. Nearly twice as many Jewish children and adolescents presented to the ER for intentional injuries than Arab children and adolescents, with the ratio becoming even greater for attempted suicide.

Of all the intentionally injured, 21.7% were hospitalized. The mortality rate was 1.1 in 100,000 (95% CI = .7–1.7/100,00) with no significant gender difference observed. No cases of suicide were reported for the Arab population.

Conclusions: Adolescents aged 10 years and older are at higher risk for intentional injuries than younger children. The ethnic differences evident in this study, especially for attempted and completed suicide, may be real or the result of differential disclosure of information owing to sociocultural norms or differential recording by health professionals.     

2012年江西省哨点医院伤害监测分析

目的 分析江西省伤害监测点居民伤害的流行病学特点,为制定相关政策和措施提供科学依据. 方法 资料来源于江西省3家不同级别伤害监测哨点医院,对2012年1月1日-12月31日首次就诊的伤害病例进行分析.结果 2012年共监测伤害病例7 477例,男女性别比为1.5∶1,伤害发生以45～64岁年龄组人数最多（38.2％）.伤害发生原因前三位依次为跌倒/坠落（58.8％）、道路交通伤（16.1％）和钝器伤（8.2％）;伤害发生部位主要集中在下肢和上肢,占总病例的59.3％;伤害发生地点男性以公路/街道为首（35.0％）,女性以家中为首（42.5％）;伤害主要发生在休闲活动、驾乘交通工具和有偿工作时;伤害病例主要以非故意伤害（95.5％）、轻度伤害（76.1％）为主. 结论 2012年江西省伤害监测病例男性多于女性,主要伤害原因为跌倒/坠落、道路交通伤和钝器伤,以非故意伤害和轻伤为主.应根据伤害分布特征,对重点人群采取有针对性的干预措施,以降低伤害对居民健康的危害.     

The incidence rates and risk factor of mild injury for two weeks: using Korea national health and nutrition examination survey 2001

OBJECTIVES: This study was performed to provide the basic data for establishing countermeasures for preventing injury by analyzing the incidence rates, the risk factors, the characteristics of the injury and the utilization of medical care for mild injury that lasted for two weeks. METHODS: We examined the injury survey data among the National Health and Nutrition Survey data. The definition of mild injury that lasted for two weeks was that the injury that caused pain at least once a day for two weeks or the injury for which the usual daily activity of the injured person was severely affected. We used statistical analysis methods such as chi-square test and multiple logistic regression analysis. RESULTS: The incidence rate of injury that lasted for two weeks was 4.7 per 1,000 persons. On the multiple logistic regression, the children and adolescents (OR=3.80, 95%CI=1.63-8.84) had higher rates of injuries than the adults, and the middle and high school (OR=0.51, 95%CI=0.31-0.85) and college(OR=0.34, 95%CI=0.17-0.68) students had lower rates of injuries than the elementary school students. The unemployed (OR=0.39, 95%CI=0.20-0.73) and others (OR=0.38, 95%CI=0.21-0.70) had lower rates of injuries than the blue collar workers. The major causes of injuries were found to be falling and slipping, and the most prevalent place of occurrence was near or at home. CONCLUSIONS: A prevention program needs to be developed and continuous education must be offered to the children, adolescents and blue collar workers.     

Injuries associated with landmines and unexploded ordnance--Afghanistan, 1997-2002

Landmines and unexploded ordnance (UXO) pose a substantial public health risk. Approximately 60-70 million landmines are scattered in approximately 70 countries, and an estimated 24,000 persons, mostly civilians, are killed or injured annually by landmines and UXO. In Afghanistan, approximately 5-7 million landmines are scattered throughout the country. During 2000-2001, Afghanistan had the highest number of reported landmine and UXO casualties in the world. This report presents analyses of surveillance data on landmine- and UXO-related injuries in Afghanistan during January 1997-September 2002, which indicate that the proportion of victims injured by UXO increased during this time, compared with the proportion injured by landmines. The majority (61%) of adult victims were injured by landmines, and the majority (66%) of children and adolescents were injured by UXO. Mine-risk education programs should focus on UXO hazards for children and on landmine hazards for adults and should address age-specific risk behaviors.     

2012年江西省哨点医院伤害监测分析

目的 分析江西省伤害监测点居民伤害的流行病学特点,为制定相关政策和措施提供科学依据. 方法 资料来源于江西省3家不同级别伤害监测哨点医院,对2012年1月1日-12月31日首次就诊的伤害病例进行分析.结果 2012年共监测伤害病例7 477例,男女性别比为1.5∶1,伤害发生以45～64岁年龄组人数最多（38.2％）.伤害发生原因前三位依次为跌倒/坠落（58.8％）、道路交通伤（16.1％）和钝器伤（8.2％）;伤害发生部位主要集中在下肢和上肢,占总病例的59.3％;伤害发生地点男性以公路/街道为首（35.0％）,女性以家中为首（42.5％）;伤害主要发生在休闲活动、驾乘交通工具和有偿工作时;伤害病例主要以非故意伤害（95.5％）、轻度伤害（76.1％）为主. 结论 2012年江西省伤害监测病例男性多于女性,主要伤害原因为跌倒/坠落、道路交通伤和钝器伤,以非故意伤害和轻伤为主.应根据伤害分布特征,对重点人群采取有针对性的干预措施,以降低伤害对居民健康的危害.     

Childhood injuries in Connecticut's Medicaid managed care program

This study describes childhood injuries and injury-related care using encounter data from a Medicaid managed care program. Enrollment and encounter data for federal fiscal year 2000 were used to identify children who received treatment for an injury, to identify risk factors, and to describe injury-related care. Twenty percent of children were treated for an injury. Preschool-age children and adolescents, males, whites, and residents of nonurban areas were at greatest risk. Sixty percent of injured children received emergency care or were hospitalized. Length of hospital stay for treatment of injuries was 33 percent longer than admissions for other conditions. E-codes were rarely reported. One of five children in Connecticut's Medicaid managed care program was treated for an injury in a one-year period. Medicaid managed care data can be used to determine the percentage of children who experience injuries, to identify risk factors, and to describe injury-related care.     

安徽省10市(县)医院伤害监测结果分析

目的掌握伤害发生的分布特征及变化趋势,为制定相关政策、评价伤害干预效果提供依据。方法选择30家伤害监测哨点医院。对2004年9月1日至2005年8月31日首次就诊于哨点医院的伤害病人进行调查。结果共调查37 031名受伤害者。其中,男、女性别比为1.9∶1;伤害高发年龄组为25~44岁(42.6%);除中毒以外的所有伤害原因的发生人数男性均明显高于女性;男性伤害以交通事故为主,女性以跌落为主;农民在各职业人群中占的比例最高;夏季发生的伤害人数最多(31.8%);意外伤害占伤害总人数的83.2%,在伤害类型中居首位;公路或街道是发生伤害事件的高发地点(38.4%):伤害发生后到医院经治疗后回家者居多(63.9%)。结论我省居民伤害以跌落和交通事故为主,劳动力人口和青少年是伤害威胁的重点人群。各地应围绕当地重点伤害深入研究危险因素,开展预防控制工作。     

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.     

2006-2010年河北省儿童伤害病例监测分析

目的分析河北省儿童伤害状况和危害程度,为制定有效的干预措施提供科学依据。方法资料来源于秦皇岛市、藁城市各3家不同级别伤害监测哨点医院急诊室。对2006年1月1日至2010年12月31日首次就诊于哨点医院的儿童伤害病例资料进行分析。结果共收集10738例伤害病例,男性多于女性,男女性别比为2．54：1,男、女性别伤害原因构成的差异有统计学意义（χ2=259．72,P〈0．01）;前5位伤害病例的原因依次是跌倒或坠落（38．94％）、机动车车祸（19．04％）、钝器伤（18．69％）、刀或锐器伤（7．15％）和非机动车车祸（6．71％）。钝器伤是15—17岁年龄组的首位伤害原因;火器伤、烧烫伤、窒息或悬吊、溺水和中毒造成的伤害程度较重;伤害部位以头部为主;伤害发生时间有一定规律性;自残或自杀造成的伤害病例78．38％需观察或住院或转院。结论河北省2006—2010年儿童伤害以跌倒或坠落、机动车车祸和钝器伤为主,监测的儿童病例数随年龄的增加而增加。在儿童青少年中应积极开展伤害预防控制工作。     

老年人口伤害特点及防范措施研究

目的分析大连市老龄人口伤害发生的分布特点及流行规律,为制定干预性措施提供依据。方法运用描述流行病学方法,将2006年1—12月在大连市3所3级甲等医院急诊室、其他门急诊及临床科室就诊后诊断为伤害的全部首诊病例作为监测对象并进行分析。结果全年3所医院共报告60岁以上老年伤害病例911例,男性390人,女性521人,男：女为0．75：1。前5位发生原因依次为跌倒／坠落（42．59％）、机动车车祸（24．04％）、钝器伤（13．28％）、刀／锐器伤（10．21％）、非机动车车祸（1．32％）;发生地点主要是家中（38．86％）、公路／街道（23．93％）、贸易和服务场所（24．82％）,公共居住场所（13．06％）、工业和建筑场所（2．41％）;伤害部位主要是头部（27．22％）、下肢（22．50％）、上肢（22．％％）、躯干（14．82％）;大多数伤害属于非故意伤害（86．39％）;57．19％的患者是轻度患者,治疗后可回家（69．59％）,死亡仅占0．22％。结论由于身体功能的衰退,老年人是各种伤害的高发人群,但所处环境相对较固定,活动范围较局限,因此伤害原因较集中,主要以跌倒／坠落和交通伤害为主,应强化针对性的防范措施。