The epidemiology of road accidents in childhood.

We report the incidence of traffic injuries to children in Montreal: 33.4 per 10,000, 57 per cent pedestrians, 24.5 per cent passengers, and 18.4 per cent bicyclists. Nearly 20 per cent were hospitalized and 1.2 per cent died. One-third had MAIS scores of 2 or more with the highest rate of severe injuries found among pedestrians. Pedestrian and bicycle (but not passenger) injuries in low income areas were four to nine times greater than those in more affluent areas.     

2017年我国6个省份28个县（区）儿童道路交通伤害流行状况

目的 了解我国6个省份28个县（区）儿童道路交通伤害流行状况,并提出预防建议。方法 采用普查的方法,于2017年对6个省份28个县（区）61个乡镇/街道（社区）特定年龄段儿童的道路交通伤害发生情况进行问卷调查。结果 共调查204 628名儿童,发生908人次（0.44%）道路交通伤害,未上幼儿园儿童的道路交通伤害发生率最高,为0.94%。男童的道路交通伤害发生率（0.54%）高于女童（0.34%）。7月份是儿童道路交通伤害的高发期（12.92%）。儿童道路交通伤害发生时活动前三位依次是玩耍/娱乐（21.61%）、骑/乘电动自行车（20.40%）、步行（20.07%）。绝大多数病例的伤害性质以挫伤/擦伤为主,占病例总数的42.26%。受伤部位主要以下肢（38.85%）、上肢（23.29%）、头部（20.20%）为主。儿童道路交通伤害病例大多数治疗后痊愈,占全部病例数的85.43%。发生道路交通伤害的儿童,住院时间M为7 d,花费M为3 000元。结论 我国6个省份28个县（区）男童道路交通伤害发生率高于女童,未上幼儿园儿童的发生率高于其他学段的儿童,儿童在玩耍/娱乐、骑/乘电动自行车、步行时容易发生道路交通伤害。     

Road traffic accidents in a Swedish municipality

A continuous all embracing registration of acute, in-patient and out-patient visits at hospitals and primary health care centres, was conducted in Skaraborg County in western Sweden. A special focus was directed at accident cases which account for 20% of the total number of acute visits. The accidents were divided up by environment: home, work, traffic and other. Cases of road traffic accidents have been mapped out in more detail with the help of standardised and structured surveys via telephone interviews, information from hospital records, and death certificates. This study aimed at achieving an increased understanding and knowledge about the accident pattern in the traffic environment in a municipality. Road traffic accidents accounted for 6.5% of all accidents. Cyclists, car drivers, car passengers and pedestrians were the most common victims. Children showed a high frequency of bicycle accidents. There was an increased risk of injury for young car-drivers. Thirty-six per cent were single-accidents. Cars and bicycles dominated among injury-inducing vehicles. Head, arm and knee injuries were most common. Twenty-six per cent of the victims were hospitalized. Safety devices were not used in 10% of cases where they should have been used according to legislation. A comparison of our registration system for road traffic accidents with the official statistics of Sweden reveals a substantial under-reporting of road traffic accidents in the latter. Consequently, a need exists for the surveillance of injuries by the public health services as a basis of injury control.     

Socioeconomic differences in road traffic injuries during childhood and youth: a closer look at different kinds of road user

STUDY OBJECTIVE: To investigate if there are socioeconomic differences in road traffic injuries among Swedish children and adolescents, and if this applies to the same extent to all categories of road users. To assess the modification effect of gender of child. DESIGN: A closed population-based cohort study based on the Swedish Population and Housing Census of 1985. Individual census records are linked to Sweden's National Hospital Discharge Register (1987-1994). SETTING AND SUBJECTS: All children aged 0-15 years in 1985 (approximately 1.5 million subjects) were monitored for five categories of road traffic injuries over eight years, and divided into seven socioeconomic groups on the basis of parental socioeconomic status. Odds ratios and population attributable risks were computed using the children of intermediate and high level salaried employees as reference group. MAIN RESULTS: The injury risks of pedestrians and bicyclists are 20% to 30% higher among the children of manual workers than those of intermediate and high level salaried employees. Socioeconomic differences are greatest for injuries involving motorised vehicles-that is, moped, motorcycle and car. If all children had the same rate as children in the reference group, the rate for all groups would be 25% lower for moped riders and 37% lower for car drivers. CONCLUSIONS: Socioeconomic differences in road traffic injuries are substantial for both boys and girls. Socioeconomic injury-risk differentials increase when young people use motorised vehicles.     

Pattern of Pedestrian Injuries in the City of Nairobi: Implications for Urban Safety Planning

Pedestrians are overrepresented in road traffic injuries and deaths in Nairobi, the capital city of Kenya, yet little research has been done to provide better understanding of the characteristics of pedestrian injuries. This paper presents the data obtained from road traffic injury admissions to Kenyatta National Hospital (KNH) over a 3-month period starting from 1 June to 31 August 2011. A total of 176 persons involved road traffic injuries in Nairobi were admitted to KNH during this period. Pedestrians comprised the highest (59.1 %) proportion of road traffic injury admissions, followed by motor vehicle passengers (24.4 %) and motor cyclists (9.7 %). Bicyclists and drivers accounted for 5.1 and 1.7 %, respectively. Cars (39.4 %) were the leading category of motorized four-wheeler vehicles that were involved in collisions with pedestrians, followed by matatus (35.5 %). Seventy percent of pedestrians were hit while crossing the road, 10.8 % while standing by the road, and 8.1 % while walking along the road. The highest proportion of pedestrian crashes occurred on Saturdays (25.5 %) and Sundays (16.7 %). Most of the pedestrian injuries (67.7 %) affected the limbs. The paper argues that safety of pedestrians should be a priority in road safety efforts in the city of Nairobi. Urban road safety planners should adopt existing cost-effective interventions to improve the safety of pedestrians such as area-wide traffic calming to limit the speeds of motor vehicles to 30 km/h, providing sidewalks for pedestrians, traffic calming in residential neighborhoods, people-and-not-car-oriented urban road designs, traffic education, and enforcement of traffic regulations.     

Severe traumatic brain injuries from motor vehicle‐related events in New Caledonia: epidemiology,outcome and public health consequences

Objective: Traumatic brain injuries (TBI), which are mostly due to road traffic crash (RTC), are a major public health concern. This article describes the incidence, severity and outcome of TBI caused by RTC in New Caledonia over a five‐year period. Methods: Data of all individuals admitted in intensive care unit with severe TBI (Glasgow Coma Scale score ≤8 at admission) caused by RTC in New Caledonia from 2008 to 2012 were analysed. Causes and severity of trauma, demographic data, and short‐term as well as last available long‐term outcome of patients were analysed. Five types of road users were compared (car drivers, car passengers, motorcyclists, bicyclists and pedestrians). Outcome was defined according to the Glasgow Outcome Scale classification. Results: A total of 109 patients were included in the study. The median age of patients was 24 [IQR18–33] years with a sex ratio of 2.8 (80 men/29 women). The rate of 44 among Melanesian males was two times higher that among 16 European males (22/100,000 people vs 11/100,000 people). The total survival at the Intensive Care Unit discharge (short‐term outcome) was 84%, being the highest among passengers (88%) and the lowest among motorcyclists (69%). Of the patients tested for psychoactive substances, half tested positive. Lost to follow‐up rate was 67%. Conclusion: Poor outcome occurs in patients with RTC‐related TBI, with young Melanesian men being the most affected. Public health action should focus on this group using culturally appropriate messages.     

A case-control study of childhood pedestrian injuries in Perth, Western Australia.

STUDY OBJECTIVES: To identify the determinants of childhood pedestrian injuries, taking the child's exposure to the road environment into account. DESIGN: This was a case-control study. SETTING AND PARTICIPANTS: The study was conducted in Perth, Western Australia between 1991 and 1993. Altogether 100 injured and 400 uninjured child pedestrians aged 1 to 14 years were studied. Aspects of the child's social and physical environments, measures of his or her behaviour, cognitive skills, and "habitual" exposure to the road environment, as well as his or her knowledge of road safety, were recorded. MAIN RESULTS: The likelihood of injury increased by 12% with each 10,000 vehicles per day increase in the volume of traffic (odds ratio (OR) 1.12, 95% confidence interval (CI) = 1.05, 1.19) on roads most frequently crossed. In addition, the presence of visual obstacles on the verge of the child's street of residence increased the likelihood of injury by more than 2.6 times (OR 2.68, 95% CI = 1.42, 5.02). In contrast, the absence of footpaths was associated with a 52% reduction in the likelihood of injury compared with the presence of footpaths on the child's street of residence (OR 0.48, 95% CI = 0.27, 0.87). CONCLUSION: The amount of exposure to the road environment and the nature of the road environment to which the child pedestrian was exposed partly influenced the likelihood of injury in children from low socioeconomic areas, male children, and children aged 13 to 14 years. Until now, the excess incidence of childhood pedestrian injuries in these subgroups of the population had not been explained because the child's exposure per se had not been examined.     

Road traffic accidents in Greece: Recent trends (1981–1991)

This study describes trends of road traffic accidents (RTAs) in Greece over the past 11-year period. All casualties that occurred in Greece during the period 1981–1991 are analyzed. Trends in severity (as judged by the proportion of fatal or serious casualties) are studied. The rate 'casualty per registered vehicle' is also used and is mainly based on the number of road users killed or seriously injured. The total number of deaths presents a considerable increase by about 32%, but an important reduction of serious injuries was observed during the same period. The number of fatal injuries increased significantly only in drivers whereas no such increase is observed in passengers and pedestrians. In all three categories of road users, serious injuries decreased significantly with a similar linear regression slope. RTAs in Greece are also becoming less severe in all categories of road users. Accidents per registered vehicle decrease significantly in all road user groups and age groups. The slope of this decrease is rather exponential, suggestion that any further increase of the number of registered vehicles will be followed by a similar increase of the number of casualties so that the rate will tend to remain stable. This represents a very challenging situation of how to keep the number of casualties as low – or, at least, as stable – as possible despite high vehicle densities. There is uncertainty about the factors that led to the observed decreases, as it was difficult to single out effects of specific measures, because of data limitations. An improved data collection system is necessary in order to enable a more thorough analysis of casualty trends not fully addressed in this study.     

Pediatric victims of traffic accidents admitted to a university hospital: epidemiological and clinical aspects

This study analyzes epidemiological and clinic characteristics of victims of traffic accidents. Data were obtained from medical records of children under 15 years of age (n = 1,123) admitted to a university hospital in Uberlandia, Minas Gerais State, Brazil, from 1999 to 2003. Mean age was eight years, 65.7% were boys, 76.6% were cyclists or pedestrians, 45.9% suffered head injuries, and 9% remained in hospital for more than two weeks. Fourteen (1.2%) died, 78.6% of these within 48 hours of hospitalization, and 85.7% with brain injuries. Among the passengers of motorcycles and larger vehicles, 58.8% were not using security devices properly at the time of the accident. Among the cyclists, 61% suffered isolated limb injuries. Meanwhile, pedestrians tended to suffer multiple lesions (57.5%) and be admitted to intensive care (7.1%), and represented 66.7% of the deaths. Epidemiological data on pediatric traffic victims can be useful for accident prevention programs.     

Global childhood unintentional injury surveillance in four cities in developing countries: a pilot study

Objective

To determine the frequency and nature of childhood injuries and to explore the risk factors for such injuries in low-income countries by using emergency department (ED) surveillance data.

Methods

This pilot study represents the initial phase of a multi-country global childhood unintentional injury surveillance (GCUIS) project and was based on a sequential sample of children < 11 years of age of either gender who presented to selected EDs in Bangladesh, Colombia, Egypt and Pakistan over a 3–4 month period, which varied for each site, in 2007.

Findings

Of 1559 injured children across all sites, 1010 (65%) were male; 941 (60%) were aged ≥ 5 years, 32 (2%) were < 1 year old. Injuries were especially frequent (34%) during the morning hours. They occurred in and around the home in 56% of the cases, outside while children played in 63% and during trips in 11%. Of all the injuries observed, 913 (56%) involved falls; 350 (22%), road traffic injuries; 210 (13%), burns; 66 (4%), poisoning; and 20 (1%), near drowning or drowning. Falls occurred most often from stairs or ladders; road traffic injuries most often involved pedestrians; the majority of burns were from hot liquids; poisonings typically involved medicines, and most drowning occurred in the home. The mean injury severity score was highest for near drowning or drowning (11), followed closely by road traffic injuries (10). There were 6 deaths, of which 2 resulted from drowning, 2 from falls and 2 from road traffic injuries.

Conclusion

Hospitals in low-income countries bear a substantial burden of childhood injuries, and systematic surveillance is required to identify the epidemiological distribution of such injuries and understand their risk factors. Methodological standardization for surveillance across countries makes it possible to draw international comparisons and identify common issues.     

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.     

中小学生交通伤害影响因素分析

目的 探讨学生认知行为、道路环境等与道路交通伤害的关系及影响因素.方法 采用多阶段分层整群抽样方法,抽取深圳市6个区的27 175名中小学生进行问卷调查,对可能危险因素进行Logistic回归分析.结果 交通伤害发生率为5.2%,男生高于女生(χ2=56.000,P=0.000).10～14岁的儿童步行者交通伤害发生率最高,为6.4%.路上打闹行为(OR=2.123)、过路口方便感(OR=1.565)、路标判断(OR=1.558)、信号灯识别(OR=1.440)、步行路段安全感(OR=1.141)、上学途径路口数(OR=1.036)等是交通伤害发生的重要危险因素.结论 道路交通伤害与学生认知行为、道路环境等因素密切相关,可针对这些危险因素采取相应措施,以降低学生交通伤害的发生.     

Differences between males and females in traffic accident risk in France

BACKGROUND: In France 7,720 people were killed in traffic accidents in 2001, 75% of which were men; the number of injured people is estimated at 153,945, of which 65% were men. The objective of the study is to describe differences between males and females regarding accidents, and to explain the main reasons for these differences. METHODS: Analysis is conducted from both national police data (2001) and data from the Rhone medical road accident trauma Register (1996-2001). RESULTS: The male/female incidence rate is 3.1 for mortality (95% CI: 3.0-3.3) and 1.7 for morbidity (95% CI: 1.7-1.8). Two-wheel motorised vehicle accidents are very specific to males, which explains part of this overrepresentation. The fatality rate and the severe injuries rate among survivors are higher for males. This is true for every main user group (car users, motorised two-wheelers, cyclists, pedestrians) after adjusting for accident circumstances and age of casualties. Males are more severely injured for all body regions and have more often severe after-effects. CONCLUSIONS: This paper shows the mechanisms leading to this unfavourable outcome for men. They correspond to differences in the number of trips, in the choice of road transport types, and moreover to differences in risk-taking behaviours. Underlying these behaviours, deep-rooted, strong and rather invariant differences between genders are to be found in the values associated with risk-taking on the road.     

广州市14岁以下儿童步行者道路交通事故伤害流行特征分析

目的描述儿童步行者交通事故伤害的流行特征,分析与步行者交通事故伤害相关的人、车、路因素。方法利用广州市公安交警系统收集的2000-2004年0～14岁儿童步行者交通伤害数据,用描述流行病学分析儿童步行者伤害的特征。结果2000-2004年共1440名儿童步行者发生交通事故,伤害年均发生率、死亡率和致死率分别为17．63／10万、1．78／10万、10．07％。5～9岁组年发生率和死亡率最高,分别为26．80／10万、2．57／10万;0～4岁组致死率最高,为13．29％。男孩步行者伤害年发生率(20．98／10万)和死亡率(2．00／10万)均高于女孩(分别为13．83／10万、1．52／10万)(P值均<0．05)。儿童步行者交通伤害最常见的部位是多部位(40．34％)、头部(26．75％)、下肢(21．53％)。死亡、重伤和轻伤所占的比例分别为10．07％、66．18％、23．75％。伤害主要由机动车驾驶员(57．50％)和步行者(33．47％)过失造成。导致伤害事故的主要车辆是客车、两轮摩托车和货车,分别占40．14％、34．38％、22．15％。结论儿童步行者交通伤害严重危害儿童的生命和健康,在人、车、路系统中,司机和步行者过失是儿童步行者伤害的主要原因,必须加强对机动车司机的教育以及儿童的看护。     

Evidence-based policy on road safety: the effect of the demerit points system on seat belt use and health outcomes

OBJECTIVE: To assess the effect of a demerit points system, introduced in Italy in July 2003, on the prevalence of seat belt use (intermediate outcome) and the number of road traffic deaths and injuries (health outcomes). DESIGN: Pre- and post-intervention regional observational study for seat belt investigation (April 2003, October 2004); national time-series analysis of road traffic deaths and injuries between 1999 and 2004 for health outcomes. SETTING: Veneto region, Italy. PARTICIPANTS: 19,551 drivers, 19,057 front passengers and 8,123 rear passengers estimated to be aged over 11 years were included in the investigation into seat belt use. 38,154 fatalities and 1,938,550 injured subjects were examined for the time-series analysis. INTERVENTIONS: Demerit points system. MAIN OUTCOME MEASURES: The proportions of drivers and front and rear passengers observed to be using seat belts before and after the intervention; estimates of lives and injuries saved through the implementation of a penalty points system. RESULTS: The demerit points system was followed by an increase in observed seat belt use of 51.8% (95% confidence interval 48.7% to 54.9%) among drivers, of 42.3% (95% confidence interval 39.2% to 45.5%) among front passengers and of 120.7% (95% confidence interval 99.4% to 144.3%) among rear passengers. It is estimated that 1,545 (95% confidence interval 1387 to 1703; p<0.0001) deaths and 91,772 (95% confidence interval 67,762 to 115,783; p<0.0001) injuries were prevented in the 18 months after the introduction of the legislation, i.e. an 18% reduction (1545/8570) in fatalities and a 19% reduction (91,772/473,048) in injuries. CONCLUSIONS: The demerit points system is effective both in encouraging drivers and passengers to adhere to the law and in terms of health outcomes, substantially contributing to road safety.     

A prospective population based study of childhood injuries: the Velestino town study

BACKGROUND: Unintentional injuries in childhood constitute a significant public health problem. Our purpose is to estimate the incidence of identifiable unintentional childhood injuries of any type and severity, and to document risk factors of non-transient nature. METHODS: We have undertaken a prospective population-based investigation in a Greek town with a population of 748 children (0-14 years old). All identifiable injuries have been monitored during a twelve-month period through information provided by the health care outlets or educational institutions as well as the police station and the regional hospital. RESULTS: The overall incidence was 28.2 per 100 person-years (95% confidence interval from 24.4 to 32.0), whereas the incidence of injuries with Hopkins Injury Severity Score equal to or higher than four was 6.3 with 95% confidence interval 4.5 to 8.1. The incidence of total injuries was higher among boys than among girls (p<0.01) and the gender difference was particularly evident among older children. Almost half of the injuries were due to falls and more than 20% were due to cutting. Children of younger and less educated parents have higher risk for injury and children from families with more injuries were more likely to be injured themselves. There was no evidence that somatometric characteristics were associated with injury risk. CONCLUSION: The incidence of unintentional childhood injuries is high and represents a considerable health burden. Family related variables are important risk factors for childhood injuries, whereas somatometric characteristics play a minimal role. Key points: Incidence and risk factors of all injuries in a population-based study among children. About 28 per 100 children got injured over a period of one year. There is evidence that younger paternal age and lower education may be associated with increased injury risk. Family related variables seem to be important risk factors for childhood injuries, whereas somatometric characteristics play minimal role.     

Walking, cycling and transport safety: an analysis of child road deaths

OBJECTIVE: To examine trends in road death rates for child pedestrians, cyclists and car occupants. DESIGN: Analysis of road traffic injury death rates per 100 000 children and death rates per 10 million passenger miles travelled. SETTING: England and Wales between 1985 and 2003. PARTICIPANTS: Children aged 0-14 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Death rates per 100,000 children and per 10 million child passenger miles for pedestrians, cyclists and car occupants. RESULTS: Death rates per head of population have declined for child pedestrians, cyclists and car occupants but pedestrian death rates remain higher (0.55 deaths/100,000 children; 95% confidence interval [CI] 0.42 to 0.72 deaths) than those for car occupants (0.34 deaths; 95% CI 0.23 to 0.48 deaths) and cyclists (0.16 deaths; 95% CI 0.09 to 0.27 deaths). Since 1985, the average distance children travelled as a car occupant has increased by 70%; the average distance walked has declined by 19%; and the average distance cycled has declined by 58%. Taking into account distance travelled, there are about 50 times more child cyclist deaths (0.55 deaths/10 million passenger miles; 0.32 to 0.89) and nearly 30 times more child pedestrian deaths (0.27 deaths; 0.20 to 0.35) than there are deaths to child car occupants (0.01 deaths; 0.007 to 0.014). In 2003, children from families without access to a vehicle walked twice the distance walked by children in families with access to two or more vehicles. CONCLUSIONS: More needs to be done to reduce the traffic injury death rates for child pedestrians and cyclists. This might encourage more walking and cycling and also has the potential to reduce social class gradients in injury mortality.     

江西省儿童道路交通伤流行病学分析

目的掌握江西省儿童道路交通伤流行病学特征。方法采用多阶段整群随机抽样方法。结果道路交通伤发生率在儿童各类伤害中排第三位。0～17岁儿童道路交通伤发生率为750.5/10万,各年龄组以10～14岁组发生率最高,男童发生率高于女童;上学放学时间是5～17岁儿童道路交通伤发生的高危时间段;城市儿童道路交通伤发生率高于农村儿童,不同的交通模式具有不同水平的危险性,骑自行车的危险水平最高,其次为徒步、摩托车。结论道路交通伤是引起儿童伤害的主要原因,建议针对儿童的年龄特征、城乡居住环境和不同交通模式等特点开展交通安全教育和干预措施。     

Childhood deaths and injuries in Finland in 1971-1995

BACKGROUND: This study examined the recent nationwide trends for the absolute number and the age- and sex-specific incidence rates of the fatal and serious non-fatal injuries among 0-14 year old children in Finland in 1971-1995. METHODS: We selected from Official Cause-of-Death Statistics and National Hospital Discharge Register children aged 0-14 years who died or required treatment at a hospital department because of an injury in 1971-1995. The number of Finnish children was 1.1 million in 1971, and 1.0 million in 1995. RESULTS: During the entire study period injuries were the leading cause of death in children aged 1-14 years, but not in infants. However, in these years the incidence (per 100 000 people) of fatal injuries in Finnish children decreased considerably in all age groups and both sexes, in girls from 20.1 in 1971 to 4.6 in 1995, and in boys from 36.7 in 1971 to 9.3 in 1995. In 1995, 41% of all the injurious deaths among 0-14 year old Finnish children were motor vehicle accidents, 12% were drownings, and 24% intentional injuries. The overall number and incidence of serious non-fatal injuries among Finnish children showed no clear trend change in 1971-1995. The mean hospitalization time of injured children shortened between 1971 and 1995, from 7.4 days to 2.7 days. CONCLUSIONS: We conclude that the number and incidence of fatal childhood injuries have decreased dramatically in Finland between 1971 and 1995. The reasons for this positive development are multifactorial, but improved traffic safety and trauma care are probably very important. In children's serious non-fatal injuries the development has not been so encouraging and therefore children's injury prevention should receive continuous intense attention.