Human bites in children.

Human bites are common during childhood and usually result from fights or aggressive play with another child. Bites may present as indentation marks, scratches, abrasions, contusions, or lacerations. Most human bite wounds are sustained on the upper extremities, followed by the face and neck, the trunk, and the lower extremities. Infection is the most common complication. Cultures of an infected bite wound yield an average of five microorganisms. This article reviews the current recommendations on the management of human bite wounds in children.     

Dog bites in urban children

As a result of a perceived increase in pit bull injuries, all children who presented to The Children's Hospital of Philadelphia during 1989 for evaluation of dog bite injuries were prospectively studied. Epidemiologic information was collected from parents, either at the time of visit or by phone on the following day. A total of 168 children were enrolled; the mean age was 8 years. Males outnumbered females 1.5:1. Most (61%) injuries occurred in or around the home and involved dogs known to the patient (77%). Types of injuries included abrasions (33%), punctures (29%), and lacerations (38%). Thirteen bites had associated complications; nine developed infection. Twelve (7%) children required admission to the hospital. More than 12 different purebreeds or cross-breeds were identified as perpetrators, including German shepherds (n = 35), pit bulls (n = 33), rottweilers (n = 9), and Dobermans (n = 7). Most (54%) animals were contained (ie, leashed, fenced, in-house) at the time of injury. Fewer (46%) were provoked prior to biting. Significantly more pit bull injuries (94% vs 43%, P less than .001) were the consequence of unprovoked attacks and involved freely roaming animals (67% vs 41%, P less than .01). Children aged 5 or younger were more likely to provoke animals prior to injury than were older children (69% vs 36%, P less than .001). It is recommended that families with young children be the target of pet safety education and that measures be sought that would lead to early identification of a potentially dangerous dog and restrict ownership.     

Lacerations in urban children. A prospective 12-January study

We prospectively investigated the epidemiologic characteristics of all lacerations (N = 2834) repaired at the Children's Hospital of Philadelphia (Pa) during 1987 and identified common hazards and possible avenues of intervention. Two-year-old children incurred most injuries; males outnumbered females 2:1. Almost two thirds (61.8%) of all lacerations occurred from May through September, and 62.2% between 3 and 9 PM. Most injuries occurred indoors (47.0%), on the sidewalk or street (22.5%), or in the residential yard (13.0%). Injuries usually occurred during play (42.3%) or daily activity (32.1%); 1247 (44.0%) involved some sort of fall. Vectors most frequently causing injury were broken glass bottles (15.0%), wooden furniture (12.0%), and asphalt or concrete (11.0%). Broken glass bottles also most frequently inflicted injuries resulting in functional impairment (0.2%), hospitalization (0.9%), or both. Complications were seen in 8% of all lacerations. Our data confirm the importance of injury-prevention strategies aimed at reduction of discarded glass objects (ie, recycling legislation), improved furniture design, and improved municipal services (ie, street repair).     

Bunk bed-related injuries sustained by young children treated in emergency departments in the United States, 2001-2004, National Electronic Injury Surveillance System - All Injury Program.

OBJECTIVE: To characterize children's bunk bed-related injuries. METHODS: Data are from the 2001-2004 National Electronic Injury Surveillance System - All Injury Program. Cases were defined as children aged 0-9 years treated for a non-fatal, unintentional injury related to a bunk bed. RESULTS: An estimated 23 000 children aged 0-9 years were treated annually in emergency departments for bunk bed fall-related injuries, including 14 600 children aged <6 years. Overall, 3.2% were hospitalized. The injuries sustained were largely fractures, lacerations, contusions and abrasions, and internal injuries, with 25.2% injured in a fall from the top bunk. The most commonly injured body region was the head and neck. CONCLUSIONS: Strategies are needed to reduce the most serious injuries. Bunk beds should meet CPSC standards, and the youngest children should not sleep or play in the upper bunk or on ladders. Making care givers aware of the risks, and modifying the living environment are essential.     

Incidence and description of high chair-related injuries to children.

STUDY OBJECTIVE: To describe the incidence, circumstances, and types of high chair-related injuries among US children. DESIGN: Retrospective review of data for children 3 years old and younger from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for 1994-98. RESULTS: There were an estimated 40 650 high chair-related injuries (95% confidence interval [CI], 32 657-48 643) to children 3 years old and younger treated in hospital emergency departments in the US during the 5-year study period. An estimated 5231 injuries (13%) were related to use of an attachable high chair (including booster seats), and an estimated 4067 (10%) were related to the use of a youth chair. The annual rate of injury among children < or =3 years old was 5.3 per 10 000. The mean age was 10 months (median, 1 year); 56% were boys. Ninety-four percent of injuries resulted from a fall from the chair. Most injuries involved the head (44%) or face (39%). Injury diagnoses included contusions or abrasions (36%), lacerations (25%), closed head injury (21%), and fractures (8%). Two percent of injured children, an estimated 941 (95% CI, 399-1487), were admitted to the hospital during the study period, an annual admission rate of 0.1 per 10 000. There were no significant differences between attachable high chairs, youth chairs, and high chairs in anatomic sites of injury, injury diagnosis, or frequency of hospital admission. CONCLUSIONS: Injuries related to high chairs are common, particularly among children in the first year of life. They often result from falls from the chair. The data suggest that restraint use would prevent most of these injuries.     

Tykes and bikes: injuries associated with bicycle-towed child trailers and bicycle-mounted child seats

OBJECTIVES: To describe the incidence, type, and severity of injuries related to the use of bicycle-towed trailers for transporting children and to compare them with injuries associated with the use of child seats mounted on adult bicycles. DESIGN: A retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for 1990 to 1998. RESULTS: There were 49 injuries to children during the 9-year study period (estimated 2338 injuries; 95% confidence interval [CI], 1121-3555): 6 were associated with the use of bicycle-towed trailers (an estimated 322 injuries; 95% CI, 158-486) and 43 were related to the use of bicycle-mounted child seats (an estimated 2015 injuries; 95% CI, 988-3042). The mean age of injured children was 2.4 years and 51% were male. A collision with a motor vehicle accounted for 2 (33%) of the injuries associated with bicycle-towed trailers; 3 (50%) of the injuries were the result of falls. A motor vehicle was involved in 4 injuries (9%) related to the use of bicycle-mounted child seats (Fisher exact test, P<.13 vs bicycle-towed trailers); 31 (72%) were the result of falls (Fisher exact test, P<.26 vs bicycle-towed trailers). Contact with a bicycle wheel or spokes was the mechanism of 1 injury associated with the use of a bicycle-towed trailer (17%) and the mechanism for 8 (19%) of the injuries associated with the use of a bicycle-mounted child seat (Fisher exact test, P<.69). The head or face was the most common site of injury, accounting for 5 (83%) injuries among those riding in bicycle-towed trailers and 21 (49%) injuries among children in bicycle-mounted child seats (Fisher exact test, P<.12). All 6 children injured in bicycle-towed trailers had contusions/ abrasions or lacerations; 22 (51%) children injured using bicycle-mounted child seats had contusions/abrasions or lacerations and 9 (21%) had fractures. Two children (33%) injured in bicycle-towed trailers and 2 (5%) injured in bicycle-mounted child seats were admitted to the hospital (Fisher exact test, P<.06). CONCLUSIONS: When compared with bicycle-mounted child seats, there were fewer reported injuries to children associated with the use of bicycle-towed trailers. Motor vehicle involvement and need for hospital admission were similar among injured children in both groups, and the head or face was the most common site of injury. These data imply that ongoing surveillance efforts to identify injuries associated with use of bicycle-towed child trailers are warranted and that bicycle helmets should be worn by children riding in bicycle-towed child trailers and in bicycle-mounted child seats.     

Motor vehicle accident trauma and restraint usage patterns in children less than 4 years of age

In a sample of children less than 4 years of age, treated in an emergency room after a motor vehicle accident, 22% were restrained in a child safety seat (improper and proper), 12% were restrained by a vehicle seat belt, and 70% were unrestrained. Trauma and injury patterns related to the various restraint use patterns are described. Most children in safety seats and seat-belted children, if injured, sustained minor contusions, abrasions, or lacerations. Injury among properly restrained children in safety seats was primarily the result of unavoidable mechanisms (eg, flying glass, intrusion). Improper use contributed to injury among safety-seat-restrained children, primarily by allowing the child to hit against the vehicle interior. Seat-belted children also were injured, primarily by hitting against the vehicle interior. Although some of the restrained children were seriously injured, in general, restrained children tended to sustain less serious and fewer injuries than the unrestrained children.     

Childhood injuries treated at a university clinic for traumatology (author's transl)]

The accidents to all children up to the age of 14 years admitted to the I. Universit?tsklinik für Unfallchirurgie in Wien in 1976 (2977 children) were analysed as to age-distribution, cause of accident, type and location of injury. There was an increase in accidents to older children. 13% of the injuries were due to traffic accidents; 60% occurred in the course of play; 27% on the field of sport. More than 60% were only minor injuries such as abrasions, lacerations, crushed fingers and toes etc., 30% bone fractures and ligamental injuries; 2,5% brain traumas. Most of the bone fractures were localized iment and no lethal injuries.     

Patterns of injuries to children on public playgrounds.

The incidence and pattern of injuries to children in public playgrounds presenting to the accident and emergency department were reviewed over two six month summer periods in Cardiff. A total of 178 children (mean age 7.5 years) attended with a playground injury representing 1.1% of all the children attending. One hundred and five children fell from equipment, of which the commonest was the climbing frame; 125 children had playground surface related injuries, 86 on bark and 30 on concrete. The pattern of injuries on the playground surfaces was different: fractures and sprains were more common on bark surfaces and lacerations and abrasions on concrete surfaces. Comparison of total injury rates showed there were fewer injuries on modernised playgrounds than expected but these differences were not significant. Modernised playgrounds are more popular, have new exciting equipment, and offer good play opportunities for children. However, the high fracture rate on modernised bark playgrounds is concerning and requires further research.     

Patterns of injuries to children on public playgrounds

The incidence and pattern of injuries to children in public playgrounds presenting to the accident and emergency department were reviewed over two six month summer periods in Cardiff. A total of 178 children (mean age 7.5 years) attended with a playground injury representing 1.1% of all the children attending. One hundred and five children fell from equipment, of which the commonest was the climbing frame; 125 children had playground surface related injuries, 86 on bark and 30 on concrete. The pattern of injuries on the playground surfaces was different: fractures and sprains were more common on bark surfaces and lacerations and abrasions on concrete surfaces. Comparison of total injury rates showed there were fewer injuries on modernised playgrounds than expected but these differences were not significant. Modernised playgrounds are more popular, have new exciting equipment, and offer good play opportunities for children. However, the high fracture rate on modernised bark playgrounds is concerning and requires further research.     

Injuries in the tenth and eleventh years of life

From a sample of 803 children, 307 were involved in 413 separate incidents which resulted in injuries requiring medical attention. The most common injuries were lacerations, fractures, abrasions, and sprains. The majority of injuries were of minor severity. The most common incident resulting in an injury was a fall, followed by incidents where a child was struck by a person or object. A fifth of all falls was from bicycles. Sporting and playground equipment were associated with a large number of injuries, particularly at school. The study serves to highlight shortcomings in national injury data bases, in particular the absence of injury severity indices, codes for sports and recreation, and inadequate codes for falls. A case is made for integrating injury prevention within the school syllabus. The importance of bicycle injuries and the need for an injury surveillance based on accident and emergency centres is stressed.     

Injuries in the tenth and eleventh years of life

Abstract From a sample of 803 children, 307 were involved in 413 separate incidents which resulted in injuries requiring medical attention. The most common injuries were lacerations, fractures, abrasions, and sprains. The majority of injuries were of minor severity. The most common incident resulting in an injury was a fall, followed by incidents where a child was struck by a person or object. A fifth of all falls was from bicycles. Sporting and playground equipment were associated with a large number of injuries, particularly at school. The study serves to highlight shortcomings in national injury data bases, in particular the absence of injury severity indices, codes for sports and recreation, and inadequate codes for falls. A case is made for integrating injury prevention within the school syllabus. The importance of bicycle injuries and the need for an injury surveillance based on accident and emergency centres is stressed.     

儿童急性运动轴索性多发性神经病临床-电生理特征及预后

目的：探讨中国南方儿童急性运动轴索性多发性神经病（acute motor axonal neuropathy, AMAN）的临床特征、电生理特点及其预后。方法：对6例AMAN患儿的临床和神经电生理资料进行分析和随访。结果：（1）患儿平均发病年龄为4.4岁,均来自农村,多有前驱感染史（5例）,发病时间无明显季节性差异。肌无力为主要首发症状,病情达高峰的平均时间为4.2 d。（2）神经电生理检查：所有患儿神经传导检测均表现为运动神经反应电位波幅显著减低,降低至（22.3%～73.4%）正常值低限,四肢远端神经受损程度较近端重（P0.05）,运动神经电位传导速度和感觉神经传导正常。全部患儿给予静脉丙种球蛋白（IVIG）治疗。（3）随访3个月至1年,4例患儿已能独立行走。结论：儿童AMAN好发于农村,全年均可发病;最常见的首发症状为肌无力,多在病程早期达到疾病高峰;神经电生理对AMAN的诊断、鉴别诊断提供了客观依据;部分患儿起病后1年能恢复独立行走能力;尽早IVIG治疗有利于促进临床神经功能恢复。     

儿童过敏性紫癜临床特征分析(附184例报道)

目的 了解过敏性紫癜儿童的临床特征。方法：回顾性分析过敏性紫癜患儿184例，对其临床表现及特征进行分析。结果：①发病年龄均>2岁，平均发病年龄(7.8±2.6)岁；67.4%患儿于秋冬季节发病；62.5%患儿有明确诱因，以上呼吸道感染为主。②所有病人均有典型皮肤紫癜，分布于下肢(100%)、臀部(47.3%)、上肢(17.4%)等。89.1%患儿以皮肤紫癜首发，少数以胃肠道及关节症状为首发症状后2周内出疹，先出现肾脏损害而后出疹者罕见。胃肠道及关节症状发生率分别为60.9%和44.6%。紫癜性肾炎发生率为52.2%，临床上主要表现为血尿和(或)蛋白尿(68.8%)，病理改变主要为Ⅰ～Ⅲ级(85.2%)。③44.0%病人血沉增快，24.1% ASO增高；63.7%病人IgA增高，IgG，IgM及补体绝大多数正常。结论：过敏性紫癜为儿童常见病，且有其本身临床特征及发病规律。     

儿童过敏性紫癜临床特征分析(附184例报道)

目的　了解过敏性紫癜儿童的临床特征。方法　回顾性分析过敏性紫癜患儿 184例 ,对其临床表现及特征进行分析。结果　①发病年龄均 >2岁 ,平均发病年龄 (7.8± 2 .6 )岁 ;6 7.4 %患儿于秋冬季节发病 ;6 2 .5 %患儿有明确诱因 ,以上呼吸道感染为主。②所有病人均有典型皮肤紫癜 ,分布于下肢 (10 0 % )、臀部(47.3% )、上肢 (17.4 % )等。 89.1%患儿以皮肤紫癜首发 ,少数以胃肠道及关节症状为首发症状后 2周内出疹 ,先出现肾脏损害而后出疹者罕见。胃肠道及关节症状发生率分别为 6 0 .9%和 4 4 .6 %。紫癜性肾炎发生率为 5 2 .2 % ,临床上主要表现为血尿和 (或 )蛋白尿 (6 8.8% ) ,病理改变主要为Ⅰ～Ⅲ级 (85 .2 % )。③ 4 4 .0 %病人血沉增快 ,2 4 .1%ASO增高 ;6 3.7%病人IgA增高 ,IgG ,IgM及补体绝大多数正常。 结论　过敏性紫癜为儿童常见病 ,且有其本身临床特征及发病规律     

Safety of a preadolescent basketball program

A preadolescent youth basketball program was prospectively studied to determine injury rates and the kinds of injuries sustained. The overall injury rate was 7.6% (39 injuries among the 510 children aged 5 to 12 years). Girls had a higher injury rate than boys (P less than .02). Only 12 children (2.4%) suffered significant injuries as defined by the inability to play for at least one session. Most injuries were contusions (35.9%), followed by strains or sprains (28.2%), epistaxis (12.8%), lacerations (5.1%), and one finger fracture (2.6%), the most significant injury. Games were more likely to produce injuries than practice sessions; most injuries occurred in the second half of game play. This study documents a low injury rate in an organized preadolescent basketball program.     

地震伤患儿挤压综合征及其严重程度的相关因素分析

目的 探讨汶川地震伤后儿童发生CS及其严重程度的相关因素,为临床应对突发灾难事件提供救治方法.方法 回顾性分析我院收治的98例汶川地震伤儿童,统计患儿年龄、性别、被困时间、受伤部位、受伤类型、伤口感染、透析治疗等资料,采用T-test/X2/Fisher精确概率以及Binarylogistic回归分析,对各个可能影响CS发生的相关因素及影响CS严重程度的各个危险因素进行统计分析.结果 15例CS患儿均来自四肢挤压伤患儿,CS在地震伤儿童发生率达15.3%,在四肢挤压伤发生率达25.4%.CS发生的多个相关因素的Binary logistic逐步回归分析中,患儿年龄、被困时间、闭合型挤压伤与CS的发生密切相关,其OR值分别为1.049、1.221、0.068(均P<0.05),而与患儿性别、上或下肢损伤、伤口感染无明显的相关性.各类伤口感染率比较,开放性损伤与CS减张切口感染率明湿高于其他切口,但两组间无统计学意义(P=0.754);在影响CS严重程度的各因素比较发现,CS减张切口感染在影响CS严重程度上有统计学意义(P=0.041).结论 儿童挤压伤后CS的发生主要是四肢损伤为主,与患儿年龄、被困时间以及闭合型挤压伤有关,减张切口感染是影响CS严重度的危险因素.     

Major injuries from “domestic” animals in children

Domestic animals are a potential cause of serious injury to handlers and children. In developed countries dogs are the most common cause of such injuries, but in developing countries childhood injuries from domestic animals have not been given much attention. A retrospective analysis of major injuries from domestic animal attacks in children aged 12 years or less in a developing country showed 17 injuries in 16 children. The locations were the abdomen (6), head and neck (4), extremities (3), external genitalia (3), and back (1). A big-horned cow was the cause of injury in 11 patients, a donkey in 4 and a ram in 1. Children under 10 years were injured by provoked animals, mostly as bystanders, while older children were handlers. Four abdominal injuries were penetrating with evisceration and contusion of bowel and required a laparotomy. One blunt splenic injury was managed non operatively and one by partial splenectomy. Two head injuries were managed non operatively. All other injuries were examined and explored with the child under general anaesthesia. These injuries were debrided and closed primarily or closure was delayed when contamination was heavy or adequate debridement was limited by vital neighbouring structures. Broad-spectrum antibiotics and tetanus prophylaxis were given for all open wounds. The average duration of hospital stay was 7.3 days. Three patients had wound infections resulting in long hospitalizations. Two patients died (12.5%), 1 from a severe head injury and 1 from an overwhelming infection. The management of major injuries from domestic animals in children requires meticulous evaluation and examination during general anaesthesia to establish the extent of injury and avoid missed injuries. Prevention of these injuries requires public education about the proper and compassionate handling of domestic animals. Accepted: 14 September 1999