南京城区及周边农村地区儿童意外伤害的调查与分析

目的了解南京城区及周边农村地区儿童意外伤害的情况。方法对2007年1月至2009年12月某医科大学附属儿童医院收治的意外伤害儿童2551例进行问卷调查,调查意外伤害儿童的性别、年龄、伤害发生的原因以及治疗结果等。结果南京城区及周边农村地区儿童意外伤害的类型按照人数进行排序,前3位依次为：跌倒/跌落、气管异物及烧/灼/烫伤;1～3岁是儿童意外伤害发生的高峰;发生意外伤害的2551例儿童中,南京周边农村地区儿童1618例（占63.4%）,南京城区儿童933例（占36.6%）,农村地区意外伤害的儿童数多于城区。结论应对儿童及其家长进行针对性的育儿安全宣传教育,使家长了解不同年龄、不同季节儿童发生意外伤害的特点及预防应对方法,避免儿童意外伤害的发生。     

Prevention of unintentional childhood injuries

Injuries are the leading cause of death in children and teenagers in the United States. The leading causes of unintentional injury vary by age and include drowning, poisoning, suffocation, fires, burns, falls, and motor vehicle, bicycle, and pedestrian-related crashes. Most injuries are preventable by modifying the child's environment (e.g., use of stair gates) and having parents engage in safety practices (e.g., keeping matches or lighters out of reach of children). Effective injury prevention methods include the use of childproof caps on medications and household poisons, age-appropriate restraints in motor vehicles (i.e., car seats, booster seats, seat belts), bicycle helmets, and a four-sided fence with a locked gate around residential swimming pools.     

Self-inflicted burn injuries: an 11-year retrospective study

The burns unit at the Royal Brisbane Hospital accepted a total of 2275 admissions from 1986 to 1996. During this 11-year period, 65 cases of self-inflicted burn injury were treated, which made up 2.9% of the total number of admissions. A mortality rate of 21.5% (14 patients) is noted, with all patients dying after admission to the hospital. A common feature of people that self-inflict burn injuries is a psychiatric history, with many patients having histories of self-harm or suicide attempts. Two distinct groups were identified--those with suicidal intent and those with intent of self-harm. Those patients with self-inflicted injuries have an increased mean of 31.4% total body surface area burned as compared with those patients whose injuries are accounted for as accidental, which have a mean total body surface area burned of 10%. Additionally, the mean length of stay in the hospital for patients with self-inflicted injuries was 40 days for acute injuries, which is prolonged; the mean length of stay for acute injuries that were not self-inflicted was 14 days. This investigation discovered 3 cases of repeated self-inflicted burn injury.     

An analysis of 550 hospitalized pediatric burn patients in Hong Kong

A total of 550 acute burn patients under the age of 15 years were admitted to the Burns Unit of Prince of Wales Hospital, Hong Kong between March 1993 and February 1999. There were 337 males and 213 females with a male to female ratio of 1.58:1. The median age was 2.5 years and the median burn size was 5% total body surface area (TBSA). Toddlers of age < 2 years accounted for 235 (42.7%) of admission. Domestic burns resulted in 481 (87.5%) injuries followed by play-related burns that caused 34 (6.2%) admissions. Scalding was the most common cause of injury, which accounted for 497 (90.4%) admissions, followed by flame burns, which resulted in 45 (8.2%) injuries. Nine patients (1.6%) had inhalation injury requiring intubation and ventilatory support. The median hospital stay was 8 days and there was no seasonal variation in admission. The majority of patients (80.2%) had their wounds healed without any operation. Only 19 out of 550 patients (3.5%) had burns of 30% TBSA or larger, and only nine patients (1.9%) had inhalation injuries. Only one patient died in this series, which yielded a mortality rate of 0.2%.     

荆门市729例0~6岁儿童非故意伤害病例特征分析

目的了解荆门市0~6岁儿童非故意伤害流行状况,为制定荆门市0~6岁儿童伤害干预策略提供科学依据。方法对2016—2019年荆门市三家伤害哨点监测医院门(急)诊首次就诊上报的0~6岁儿童伤害病例进行分析。结果共报告729例0~6岁儿童非故意伤害病例,男女比例为1.72∶1。伤害发生原因前三位分别为跌倒/坠落、机动车交通伤害和刀/锐器伤,分别占总伤害病例的61.45%、10.15%、7.00%;伤害发生地点以家中为主(65.02%)、伤害发生时的活动以玩耍为主(63.92%)。伤害性质以锐器伤、咬伤、开放伤为主,共占总病例的81.62%。一年中伤害发生的高峰期在7~9月,三个月伤害病例数占总病例数的32.37%;一天中9:00—10:00、10:00—11:00、15:00—16:00和16:00—17:00是发生伤害病例最多的时间段,共占总伤害病例数的38.13%。结论荆门市0~6岁儿童以跌倒/坠落为主的非故意伤害发生率较高,应根据伤害发生的原因、性质、时间等有针对性地制定相应的评估和干预措施,减少0~6岁儿童非故意伤害的发生。     

Functional outcome following traumatic brain injury: the Turkish experience

The objectives of this study were to describe the demographic characteristics and the nature of the functional recovery in a group of Turkish survivors of traumatic brain injury (TBI) who were referred for inpatient rehabilitation and identify variables correlated with discharge functional status as measured by the Functional Independence Measure (FIM). There were 40 patients in the study, 32 (69.6%) male and eight (17.4%) female, mean age 28+/-9.8 years. Motor vehicle accidents accounted for 62.5% of injuries, 22.5% of injuries occurred from violence and 15% resulted from falls. The mean durations of acute hospital stay, coma, and rehabilitation stay was 68, 26.7, and 78.4 days, respectively. Extracranial injuries including bone fractures were the most common associated injuries and medical complications such as spasticity and contractures were present in more than half of the patients.TBI survivors in this study made statistically significant functional improvements. Discharge FIM were significantly correlated with the admission FIM, durations of acute hospital stay and coma, and time since TBI. Multiple regression analysis of the data disclosed that FIM score obtained at the time of discharge from rehabilitation service was best predicted by two variables, time since brain injury and the FIM score at admission (multiple R=0.78, R=0.60, P<0.001). This sample of Turkish TBI survivors showed significant functional improvements after rehabilitation and admission functional status and the time since TBI had the most impact on discharge functional outcome.     

Return to work following hand burns

Time to return to work following hand burns was studied in 70 patients in relation to several variables: 1. total body surface area (TBSA) burned; 2. hand burned; 3. grafting; 4. patient age; 5. occupational category. Return to work data were also compared by meta-analysis to data in prior reports on return to work in nonburn hand injuries. Patients were evaluated during their hospital stay on all independent variables, and at 8 months following discharge as to the date of return to work. Of the 70 patients selected for the study, 52 (74%) had returned to work at the 8-month assessment. The best predictor of time to return to work was TBSA burned, followed by "grafting" and "hand burned." No significant differences or predictors were found for patient age, occupational category, or between nonburn hand trauma patients in prior reports. Conclusions are drawn concerning the usefulness of these results in terms of case management and economic impact in hand-burn injuries.     

Thermal injury in the elderly. The limited need for nursing home care

Although it appears that survival has been increased and hospital stays have been decreased in elderly patients with burn injuries, limited information is available on the functional status of these patients at the time of discharge from the hospital. Because this information is necessary to assess more fully the success or failure of current modes of therapy, we have reviewed the records of 99 surviving patients with burn injuries over the age of 55 years. These patients had a mean age 71.8 years and a mean +/- SD burn size of 8.9% +/- 8.6%, with 36 patients having burns over greater than 10% of body surface area and 14 patients having burns over greater than 20%. The mean hospital stay of these patients was 16.9 days, and 75% of the patients required surgery to heal the burn wounds. Since just five (5%) of the 99 patients required nursing home placement at discharge, it appears that the majority of elderly patients with burn injuries recover sufficiently from the injuries to resume their preinjury life-style.     

A descriptive summary of New Jersey's 1985 burn population

Data obtained from the New Jersey State Department of Health on the 1985 hospitalized patients with burns and data collected from the National Burn Victim Foundation's standard burn reporting form were analyzed to gather information about the epidemiology of burns. Children (0 to 4 years of age) continue to be the largest percentage of the 0- to 18-year-old age group who sustain burn injuries, and 67% of those injuries are sustained by children under the age of 5. Males accounted for 69% of the total burn population; 58% of admissions were white; 69% of patients were admitted for partial-thickness burns, and 31% were admitted for full-thickness burns; the largest primary payer was third-party payers; and 92% of patients with burns were discharged to home or self-care. Data were also analyzed by examination of selected age groups to determine individual needs of specific groups. An analysis of burn injuries reported to the National Burn Victim Foundation confirmed previous reports that the home is the most likely place for a burn injury to occur and that flame and scald injuries predominate; scald injuries comprise 50% of all sustained burns. Gasoline vapors accounted for 54% of burn injuries caused by flames. The data supported efforts to develop programs that address the needs of the urban child, the 17- to 19-year-old age groups, and the elderly. The information that was collected served to redefine objectives for burn prevention programs.     

Firefighter burn injuries: predictable patterns influenced by turnout gear

Approximately 100 firefighters suffer fatal injuries annually and tens of thousands receive nonfatal injuries. Many of these injuries require medical attention and restricted activity but may be preventable. This study was designed to elucidate etiology, circumstances, and patterns of firefighter burn injury so that further prevention strategies can be designed. In particular, modification of protective equipment, or turnout gear, is one potential strategy to prevent burn injury. An Institutional Review Board-approved retrospective review was conducted with records of firefighters treated for burn injury from 2005 to 2009. Data collected included age, gender, TBSA, burn depth, anatomic location, total hospital days per patient, etiology, and circumstances of injury. Circumstances of injury were stratified into the following categories: removal/dislodging of equipment, failure of equipment to protect, training errors, and when excessive external temperatures caused patient sweat to boil under the gear. Over the 4-year period, 20 firefighters were treated for burn injury. Mean age was 38.9 ± 8.9 years and 19 of 20 patients were male. Mean burn size was 1.1 ± 2.7% TBSA. Eighteen patients suffered second-degree burns, while two patients suffered first-degree burns. Mean length of hospitalization was 2.45 days. Scald burns were responsible for injury to 13 firefighters (65%). Flame burns caused injury to four patients (20%). Only three patients received contact burns (15%). The face was the site most commonly burned, representing 29% of injuries. The hand/wrist and ears were the next largest groups, with 23 and 16% of the injuries, respectively. Other areas burned included the neck (10%), arm (6.5%), leg (6.5%), knees (3%), shoulders (3%), and head (3%). Finally, the circumstance of injury was evaluated for each patient. Misuse and noncontiguous areas of protective equipment accounted for 14 of the 20 injuries (70%). These burns were caused when hot steam/liquid entered the gear via gaps in the sleeve or face mask. Three patients (15%) received injury due to removal/dislodging of their safety equipment, two patients (10%) suffered their injuries during training exercises when they were not wearing their safety equipment, and the final patient (5%) received burns due to sweat evaporation. Firefighter burn injuries occur to predictable anatomic sites with common injury patterns. Modification and optimization of gear to eliminate gaps that allow steam/hot liquid entry may decrease burn injury. Improving education regarding the use of protective equipment may also be beneficial.     

2010年广东省深圳市光明新区医院急诊伤害监测资料分析

目的 了解广东省深圳市光明新区医院急诊伤害分布情况,为伤害事件预防与控制提供依据。 方法 采用统一的调查表对在深圳市光明新区伤害监测哨点医院急诊科就诊的首诊伤害病例进行登记,运用描述流行病学方法进行分析。 结果 2010年全年累计伤害病例22 784例,伤害发生的主要原因为钝器伤(40.24%)、跌倒/坠落(16.46%)、动物伤(13.28%)、刀/锐器伤(11.43%)、机动车车祸(10.51%),发生地点主要是工业和建筑场所(40.80%)、公路/街道(22.65%)等;以非故意伤害事故(83.97%)和轻度伤害(76.30%)为主,机动车车祸是造成重度伤害的主要原因(55.26%);总病例在各时间段分布无明显高峰,不同职业伤害发生时间段不同(2=998,P=0.00),大部分伤害事故发生在08:00-22:00之间,占总登记数的85.51%,一天中17:00-20:00为学龄前儿童伤害事件发生的相对高峰时段(37.43%),16:00-19:00为在校学生伤害事件发生的相对高峰时段(36.91%),00:00时段(12.85%)、20:00时段(8.38%)、21:00时段(8.38%)为自残/自杀意图伤害事件发生的3个高峰时段。 结论 职业伤害、动物伤害及交通伤害是干预重点,对不同人群、不同地点、不同时间预防控制伤害事件发生要采取不同措施。     

The epidemiology of pediatric trauma

Trauma is the leading cause of death in children. Children in the toddler and preschool age groups are more prone to falls, poisonings, and foreign body aspirations, whereas school-age children are more likely to be involved in pedestrian and bicycle accidents. In all age groups, males are more likely to receive injuries than females. Major mechanisms of injury include motor-vehicle--occupant and -pedestrian accidents, bicycle accidents, and falls. Most injuries are blunt in nature and occur to the central nervous system, musculoskeletal system, and thoracic-abdominal area. Head injuries account for most of the injuries and fatalities in pediatric multiple trauma patients.     

Impact of an inpatient rehabilitation facility on functional outcome and length of stay of burn survivors

This study reviewed the use of an inpatient rehabilitation unit for burn survivors. We hypothesized that adult burn patients admitted earlier to inpatient rehabilitation have an equal or better functional outcome than those remaining in acute burn center for rehabilitation care. Functional Independence Measure (FIM) data were prospectively collected on our burn center admissions dating January 2002 to August 2003. National rehabilitation data were acquired from eRehabData and burn literature. A total of 217 adult patients survived until hospital discharge, with 21 (9.7%) discharged to inpatient rehabilitation (REHAB). REHAB had larger burn injuries, more inhalation injuries, higher incidence hand/foot burns, and longer length of stay (LOS). REHAB had lower FIM upon rehabilitation facility admission than national averages but greater FIM improvement during comparable rehabilitation LOS. Although our earlier rehabilitation admission strategy results in more frequent rehabilitation unit referrals, patients had shorter burn center LOS and greater FIM improvement compared with limited national burn patient functional outcome data currently available.     

The epidemiology of childhood injury in Maputo, Mozambique

Background

Injury remains a major cause of death and disability worldwide.

Aims

This study describes the characteristics of childhood injury at three hospitals in Maputo, Mozambique.

Methods

An observational, prospective convenience study was conducted in June and July 2007. We prospectively collected data on 335 children (0–14 years) who presented to three hospitals in Maputo during the study period.

Results

The prevalence of trauma-related complaints on presentation to the hospital in this study was 12%, with higher rates in boys (59%) and in those between the ages of 5–9 years (34.9%). Falls were the most common mechanism of injury (40.6%), followed by burns (19.1%) and road traffic injuries (RTI) (14.3%). The majority of falls occurred in the home (61.8%) and were unintentional. (94.1%) Burns were predominantly due to hot liquids (82.8%) and less frequently due to fire (17.2%). The majority of burns involved the patient alone (62.5%). The majority of RTIs were pedestrians struck by vehicles (81.2%). A substantial number of patients presented more than 24 h after injury (23.3%). Children from households living with a lower family income in general suffered trauma more often regardless of the mechanism.

Conclusions

Childhood injury accounts for a substantial burden of disease in Maputo, Mozambique. This study highlights the fact that many of these injuries are consistent with the injury patterns seen in children in other low and middle income countries, and are amenable to prevention, access, and emergency care programs targeted at children and their families, schools, and the local and national community.     

Childhood injury: a status report,part 2

The October issue of The Journal of Pediatric Nursing carried the first of two parts on childhood injury. That article reviewed the importance of prevention, the short- and long-term effects of injury on the child and the family, and how to incorporate prevention strategies at home and at work. Also reviewed were three of the most common mechanisms of injury, motor vehicle crashes, bicycle crashes, and pool drowning, and prevention measures. In this second part, the remaining primary areas of concern for common pediatric injuries are addressed: poisoning, fires and burns, and firearms.     

The epidemiology, management, outcomes and areas for improvement of burn care in central Malawi: an observational study

This report describes the epidemiology of burn injuries and quantifies the appropriateness of use of available interventions at Kamuzu Central Hospital, Malawi, between July 2008 and June 2009 (370 burn patients). Burns accounted for 4.4% of all injuries and 25.9% of all burns presenting to the hospital were admitted. Most patients (67.6%) were < 15 years old and 56.2% were male. The most frequent cause was scalding (51.4%). Burns occurred most frequently in the cool, dry season and in the evening. The mean burn surface area (second/third degree) was 14.1% and most burns (74%) presented within 8 h. The commonest procedure was debridement and/or amputation. The mean hospital stay was 21.1 days, in-hospital mortality was 27% and wound infection rate was 31%. Available interventions (intravenous fluids, nutrition therapy, physiotherapy) were misapplied in 59% of cases. It is concluded that primary prevention should address paediatric and scald burns, and secondary prevention should train providers to use available interventions appropriately.