Paediatric and adolescent horse‐related injuries: Does the mechanism of injury justify a trauma response?

Objective: To identify the frequency, variety and disposition of horse‐related injury presentations to the ED and to use this information to evaluate the existing institutional trauma team activation criteria following horse‐related injuries. Methods: A retrospective case analysis was performed of all horse‐related injury presentations to the ED of Women's and Children's Hospital, Adelaide, Australia, in the 5 year period between January 1999 and December 2003. Results: A total of 186 children presented with horse‐related injuries during the 5 year study period. The median age of injury was 9 years (range 1–17 years), with 81% of presentations female and 60% of patients hospitalized. The mechanism of injury was divided into four groups: 148 falls (79%), 28 kicks (15%), 7 tramples (4%) and 5 bites (3%). There was one death. Seven presentations rated an Injury Severity Score >15, with full trauma team activation occurring for two of these presentations. Conclusion: Although horse‐related injury presentations are uncommon, severe injuries do occur. Patients presenting with severe horse‐related injuries do not always activate a full trauma team response based on current trauma team activation criteria. These severe injury presentations are supported by a limited trauma team response, which activates on the mechanism of injury. The effectiveness of this as a contingency system needs to be evaluated.     

Emergency department electric scooter injuries after the introduction of shared e-scooter services: A retrospective review of 3,331 cases

BACKGROUND: To determine the frequency, characteristics, and use of resources related to electric scooter(e-scooter) injuries in the emergency department(ED) of a major metropolitan area hospital.METHODS: We performed a retrospective review of all ED presentations related to e-scooter injuries at a level I trauma center between May 2017 and February 2020. We identified ED presentation data, injury-related data, patients’ clinical course after evaluation, injury diagnosis, surgical procedures, and ED readmissions.RESULTS: A total of 3,331 patients with e-scooter injuries presented to the ED over a 34-month period. There was a 6-fold increase in e-scooter-related injuries presenting to the ED, from an average of 26.9 injuries per month before the introduction of shared e-scooter services in August 2018 to an average of 152.6 injuries per month after its introduction. The average injury rate during weekdays was 3.27 per day, with the majority of injuries occurring in the afternoon. The most common mechanism of injury was rider fall(79.1%). There were a total of 2,637 orthopedic injuries, of which 599(22.7%) were fractures. A total of 296(8.9%) patients were hospitalized following the initial ED admission, and 462 surgeries were performed within 7 days of ED arrival.CONCLUSIONS: The introduction of the shared e-scooter services is associated with a dramatic increase in e-scooter injuries presenting to the ED. E-scooter use carries considerably underestimated injury risks of high-energy trauma and misunderstood mechanisms of injuries. These injuries challenge the healthcare system, with a major impact on both EDs and surgical departments.     

A Prospective Study of In-line Skating: Observational Series and Survey of Active In-line Skaters—Injuries, Protective Equipment, and Training

Objectives: 1) To assess the relationship between types of injuries incurred and training and protective equipment worn by adults injured while in–line skating; 2) to observe the type and amount of protective equipment worn by in–line skaters while skating; and 3) to survey active in–line skaters about formal training, protective equipment, and history of injuries incurred, and the effect of such injuries on the protective equipment subsequently worn. Methods: A prospective study of consecutive adult patients presenting to the ED for evaluation of in–line skating injuries; a consecutive–series observational study of active in–line skaters to assess protective equipment worn; and a survey of selected active in–line skaters. Eighty–five adult patients were included who presented with a history of injury related to in–line skating to the EDs of an urban academic medical center, a suburban academic–affiliated hospital, and a community hospital. Four hundred eleven active in–line skaters on the Chicago lakefront were observed for protective equipment worn, 91 of whom participated in the survey. Results: Of those presenting to the ED with injuries, only 15% indicated that they had received formal inline skating instruction. Of the ED patients, 50% wore no protective equipment; overall, 6% wore a helmet; 44%, wrist protection; 23%, knee protection; and 19%, elbow protection. Only 2% wore all of the above equipment. The primary mechanism of injury reported was a loss of balance (58%); others included collision with objects (25%), collision with bicycles (11%), and collision with cars (5%). Fractures or dislocations occurred in 48% of the patients; 6% had head injuries necessitating CT scans. Those who wore no protective gear were more likely to require hospital admission (p < 0.05). Of the 411 in–line skaters observed, 157 (38%) wore no protective equipment. Compared with the injured group presenting to the ED, fewer observed participants were without protection (p < 0.(35). Among those surveyed, prior injury was not associated with the subsequent use of protective gear. Conclusion: Patients who present to the ED for evaluation of in–line skating injuries have a high incidence of fractures/dislocations. Few injured or surveyed in–line skaters had formal training. Use of protective equipment by injured skaters was associated with a decreased likelihood of hospitalization. Observed in–line skaters more commonly wore protective gear than did those who presented to the ED with injuries.     

Tram‐related trauma in Melbourne,Victoria

Objectives: To establish the incidence and pattern of injuries in patients presenting to hospital with tram‐related injuries. Methods: Data on tram‐related injury pertaining to 2001–2008 calendar years were extracted from three datasets: the population‐based Victorian State Trauma Registry for major trauma cases, the Victorian Emergency Minimum Dataset for ED presentations and the National Coroners' Information System for deaths. Incidence rates adjusted for the population of Melbourne, and trends in the incidence of tram‐related ED presentations and major trauma cases, were analysed and presented as incidence rate ratios (IRR). Results: There were 1769 patients who presented to ED after trauma related to trams in Melbourne during the study period. Of these, 107 patients had injuries classified as major trauma. There was a significant increase in the rate of ED presentations (IRR 1.03, P= 0.010) with falls (46%) the most commonly reported mechanism. Most falls occurred inside the trams. There was also a significant increase in the incidence rates of major trauma cases (IRR 1.12, P= 0.006) with pedestrians accounting for most major trauma cases. Conclusions: Most cases of trauma related to trams have minor injuries and are discharged following ED management. Primary prevention of falls in trams and the separation of pedestrians from trams are key areas requiring immediate improvement. In the face of increasing trauma associated with trams, continuing safety surveillance and targeted public safety messages are important to sustain trams as safe and effective mode of transport.     

Microscooter injuries in the paediatric population.

OBJECTIVES: To illustrate the types of injuries seen by the accident and emergency department as a result of the use of non-motorized 'microscooters' in children, and to increase awareness of scooter-related triplane fractures of the ankle. STUDY DESIGN: A retrospective study conducted in an accident and emergency department of a district general hospital on all children who had a scooter-related limb injury over a 6-month period and were referred for orthopaedic review. METHODS: The analysis involved a case note review. Information recorded included the injury sustained, protective equipment worn at the time of the accident and management by the orthopaedic team. RESULTS: Scooter injuries accounted for 10 fractures in this period. There were three 'triplanar' injuries, which required operative fixation, and three injuries requiring manipulation under anaesthesia. No protective gear was worn by any of the patients. CONCLUSION: The popularity of microscooters seems to represent a significant risk of bony injury in the paediatric population. Medical personnel who manage acute paediatric trauma should be aware of scooter-related triplanar ankle injuries.     

Past-Year Intentional and Unintentional Injury Among Teens Treated in an Inner-City Emergency Department

An inner-city emergency department (ED) visit provides an opportunity for contact with high-risk adolescents to promote injury prevention. Objectives: To identify the prevalence of injuries sustained over the past year by teens presenting to an inner-city ED, and to identify factors associated with recent injury to inform future ED-based injury prevention initiatives. Methods: Over 1 year, 7 days a week, from 1:00–11:00 p.m., patients aged 14–18 years presenting to the ED participated in a survey regarding past-year risk behaviors and injuries. Results: Of the entire group of teens presenting to the ED (n = 1128) who completed the survey (83.8% response rate), 46% were male, and 58% were African-American. Past-year injuries were reported by 768 (68.1%) of the teens; 475 (61.8%) of those reported an unintentional injury and 293 (38.1%) reported an intentional injury. One-third of all youth seeking care reported a past-year sports-related injury (34.5%) or an injury related to driving or riding in a car (12.3%), and 8.2% reported a gun-related injury. Logistic regression found that binge drinking (adjusted odds ratio [AOR] 1.95) and illicit weapon carrying (AOR 2.31) predicted a past-year intentional injury. African-American youth (AOR 0.56) and those receiving public assistance (AOR 0.73) were less likely to report past-year unintentional injuries. Conclusions: Adolescents seeking care in an inner-city ED, regardless of the reason for seeking care, report an elevated prevalence of recent injury, including violence. Future injury screening and prevention efforts should consider universal screening of all youth seeking ED care.     

Emergency department visits for electric scooter-related injuries after introduction of an urban rental program

BackgroundProviders in Salt Lake City emergency departments (EDs) anecdotally noted a significant number of electronic scooter (e-scooter)-related injuries since the launch of e-scooter rentals in the downtown area in June 2018. The aim of this study was to quantify and characterize these injuries.MethodsWe reviewed the electronic medical records of the University of Utah ED and the Salt Lake Regional Medical Center ED. Using a broad keyword search for “scooter,” we examined all notes for ED visits between June 15–November 15, 2017, and June 15–November 15, 2018, and identified e-scooter related injuries. The 2017 data pre-dated the launch of the e-scooter share programs in Salt Lake City and served as a control period.ResultsWe noted 8 scooter-related injuries in 2017 and 50 in 2018. Injury types from the 2018 period included: major head injury (8%); major musculoskeletal injury (36%); minor head injury (12%); minor musculoskeletal injury (34%); and superficial soft tissue injury (40%). 24% of patients presented via ambulance and 6% presented as a trauma activation. 16% of patients required hospital admission and 14% had an injury requiring operative repair. 16% reported alcohol intoxication and none of the patients reported wearing a helmet at the time of the injury.ConclusionSince the launch of e-scooter share programs in Salt Lake City, we have seen a substantial increase in e-scooter related trauma in our EDs. Of particular note is the number of patients with major head injuries and major musculoskeletal injuries.     

The usefulness of a modified adult protocol for the clearance of paediatric cervical spine injury in the emergency department

Objective: To determine if the use of a modified adult protocol that uses cervical spine imaging on presentation for the assessment of cervical spine injury in children improves clinical outcome. Methods: This is a case series study on all consecutive trauma patients presenting from April to July 2000 inclusive to the ED of a major paediatric trauma hospital. Children presenting to the ED with potential cervical spine injury (CSI) were identified using standard selection criteria. Patient demographics, mechanism of injury, method and time of presentation, associated injuries, radiological investigation and clinical outcome were recorded. The major outcome measures for this study were: time to clearance of the cervical spine, length of stay in the ED and admission to an in‐hospital bed. Data were analysed for compliance to the protocol, this being the standard assessment pathway of cervical spine clearance used by our trauma service. Results: The trauma registry identified 1721 trauma presentations during the 4‐month study period; 208 presentations representing 200 children with potential CSI were entered into the study. Males represented 72.5% of the study population, having a mean age of 8.32 years, although 29% were less than 5 years of age. The majority of presentations (69%) occurred outside of normal working hours. In 17.8% of cases the cervical spine was cleared based on clinical assessment alone, half less than 5 years of age. Compliance to the protocol occurred in 78% of presentations. However, when examined by age group, children 5 years of age or above were 1.5 times more likely to comply with the protocol as compared with younger children. Adequate plain imaging was not obtained in 18% of presentations, this group almost exclusively less than 5 years of age. There were no missed injuries and no short or long‐term neurological sequelae reported during this study. There were no differences in time to clearance, length of stay and admission rate between compliant and non‐compliant groups. Conclusions: Modified adult protocols for cervical spine clearance offer guidance in managing the majority of children suffering blunt trauma. However, we recommend caution in rigidly applying such protocols, especially to children of young age.     

Pediatric Tree House–Related Injuries Treated in Emergency Departments in the United States: 1990–2006

Objectives:  The objective was to describe the epidemiology of tree house–related injuries in the United States among children and adolescents.
Methods:  The authors conducted a retrospective analysis using data from the National Electronic Injury Surveillance System for patients ≤19 years who were treated in an emergency department (ED) for a tree house–related injury from 1990 through 2006.
Results:  An estimated 47,351 patients ≤19 years of age were treated in EDs for tree house–related injuries over the 17-year study period. Fractures were the most common diagnosis (36.6%), and the upper extremities were the most commonly injured body part (38.8%). The odds of sustaining a head injury were increased for children aged <5 years. Falls were the most common injury mechanism (78.6%) and increased the odds of sustaining a fracture. Falls or jumps from a height ≥10 feet occurred in 29.3% of cases for which height of the fall/jump was recorded. Boys had significantly higher odds of falling or jumping from a height of ≥10 ft than girls, and children 10 to 19 years old also had significantly higher odds of falling or jumping from a height of ≥10 feet, compared to those 9 years old and younger. The odds of hospitalization were tripled if the patient fell or jumped from ≥10 feet and nearly tripled if the patient sustained a fracture.
Conclusions:  This study examined tree house–related injuries on a national level. Tree house safety deserves special attention because of the potential for serious injury or death due to falls from great heights, as well as the absence of national or regional safety standards. The authors provide safety and prevention recommendations based on the successful standards developed for playground equipment.     

External injury documentation in major trauma victims is inadequate: Grounds for routine photography in the emergency department?

Objective: There is no widely accepted measure of clinical documentation quality in the ED. The present study creates a measure for comparing the quality of clinical documentation of external injuries with autopsy reports. This is used to discuss the advantages and disadvantages of introducing routine photography to improve clinical documentation of injuries. Methods: This retrospective case series addressed all non‐surviving major trauma patients (Injury Severity Score ≥15) presenting to St. Vincent's Hospital ED, Sydney, within the 5 year period from 1 July 2002 to 30 June 2007. Comparison between clinical and autopsy documentation of external injuries was completed for each major trauma patient. Results: Of the 48 major trauma patients, there were an average of 11.6 injuries missed in documentation per patient (P < 0.001, 95% CI 8.6–14.6). ED documentation recorded on average 29% (95% CI 26%?32%) of the external injuries that appeared in the autopsy report. We call this percentage the external injury documentation rate. The external injury documentation rate was influenced by injury count and body region, but was not influenced by age, sex, severity (using the Abbreviated Injury Scale and Injury Severity Score), or whether the clinician used a trauma survey or standard progress notes or not, and there was no visible trend over time. Conclusion: Clinical documentation of external injuries in major trauma is poor. This is presumably because of many factors, including time pressures and high‐stress environments. A possible strategy to improve this documentation is routine photography, which should offer both clinical and legal benefits.     

The incidence of neurogenic shock in patients with isolated spinal cord injury in the emergency department

BACKGROUND: Spinal cord injury (SCI) is recognised to cause hypotension and bradycardia (neurogenic shock). Previous studies have shown that the incidence of this in the emergency department (ED) may be low. However these studies are relatively small and have included a mix of blunt and penetrating injuries with measurements taken over different time frames. The aim was to use a large database to determine the incidence of neurogenic shock in patients with isolated spinal cord injuries. METHODS: The Trauma Audit and Research Network (TARN) collects data on patients attending participating hospitals in England and Wales. The database between 1989 and 2003 was searched for patients aged over 16 who had sustained an isolated spinal cord injury. The heart rate (HR) and systolic blood pressure (SBP) on arrival at the ED were determined as was the number and percentage of patients who had both a SBP<100mm Hg and a HR<80 beats per minute (BPM) (the classic appearance of neurogenic shock). RESULTS: Four hundred and ninety patients had sustained an isolated spinal cord injury (SCI) with no other injury with an abbreviated injury scale (AIS) of greater than 2. The incidence of neurogenic shock in cervical cord injuries was 19.3% (95% CI 14.8-23.7%). The incidence in thoracic and lumbar cord injuries was 7% (3-11.1%) and 3% (0-8.85%). CONCLUSIONS: Fewer than 20% of patients with a cervical cord injury have the classical appearance of neurogenic shock when they arrive in the emergency department. It is uncommon in patients with lower cord injuries. The heart rate and blood pressure changes in patients with a SCI may develop over time and we hypothesise that patients arrive in the ED before neurogenic shock has become manifest.     

Emergency Department Visits for Injury in School-aged Children in the United States: A Comparison of Nonfatal Injuries Occurring Within and outside of the School Environment

Objectives: To compare the demographic and injury characteristics of children visiting the emergency department (ED) for nonfatal injuries occurring at school with those of same‐aged children who were injured outside of school. Methods: Data from a stratified probability sample of U.S. hospitals providing emergency services in the National Electronic Injury Surveillance System (NEISS) were analyzed for 2001 and 2002. School and nonschool injury‐related ED visits were analyzed for patients who were 5 through 19 years of age. Results: There were an estimated 58,147,518 injury visits in all ages to the ED in 2001 and 2002. Injuries to school‐aged children (ages 5–19) accounted for an estimated 15,405,392 (26%) visits overall, of which 1,859,215 occurred at school (16.5% of visits by school‐aged children when location of injury was known). Males accounted for 63% of injuries at school; middle‐school children (ages 10–14 yr) accounted for a significantly greater proportion of injuries (46%) than did primary‐ (5–9 yr, 24%) or secondary‐school (15–19 yr, 30%) children (p < 0.001). In contrast, for injuries outside of school, secondary‐school children were injured most (40%), followed by middle‐ (32%) and primary‐aged children (27%). Nearly 11% of school injuries were classified as violent, whereas only 6.4% of the nonschool injuries in school‐aged children were violent (p < 0.001). Similarly, sports injuries were significantly more common at school (53% of injuries) than outside of school (32.9%; p < 0.001). Conclusions: A significant proportion of injuries to school‐aged children occur at school. Notable differences exist between the epidemiology of in‐ and out‐of‐school injuries. The nature of these injuries differs by age group. Efforts to reduce school injuries will require that these differences be examined further and incorporated into prevention initiatives.     

Work-related Injuries in a Rural Emergency Department Population

Objective: To describe the spectrum of work-related injury evaluated in a rural ED population. Methods: An ED-based injury surveillance system (EDBISS) was used to collect injury data for all ED patients seen over a 1-year period. A patient was classified as injured if his or her record contained an ED log injury code, an ICD-9 N-code between 800 and 995 in any diagnostic field, an E-code, or an entry in the trauma registry. An injury was considered work-related if the patient reported that the injury had occurred while at work. Results: Work-related injuries accounted for 1,539/12,321 (12.5%) of all injuries. The mean age of patients injured on the job was 33.8 years (range, 16–77 years), compared with a mean age of 27.7 years for all the injured patients. Males accounted for 1,026/1,537 (67%) of the work-related injury visits, compared with 57% of all the injury visits. The most common mechanisms of work-related injuries were: overexertion (313; 20%); cut or pierced by sharp implements (248; 16%); falls (250; 16%); struck by object (202; 13%); and transportation-related injuries (71; 5%). Sprains and strains were the most common type of injury sustained (415; 27%), followed by wounds to upper limbs (283; 18%), contusions (182; 12%), and fractures (151; 10%). Of the 1,539 patients presenting with occupational injuries, 178 (12%) presented to the ED via ambulance. Most (1,401; 91%) were treated and released from the ED, with the remainder (136; 9%) hospitalized. The mechanisms of injury that most commonly resulted in hospitalization included struck by an object (28; 21%), transportation (26; 19%), falls (27; 20%), crushing mechanism (13; 10%), and machinery (20; 15%). Of those requiring hospitalization, 132/136 (97)% were male, and the average length of stay was 4.4 days. Four of the hospitalized persons died of their work-related injuries. Known medical charges incurred by patients injured at work were as high as $62,622. The average charge for those treated and released was $273; the average charge for those who required hospitalization was $10,910. Conclusions: Occupational injuries contribute significantly to the overall incidence of injuries seen in this ED and are responsible for significant medical charges each year.     

The heaviest repeat users of an inner city emergency department are not general practice patients

Objective: To test the hypothesis that frequent attenders to the ED are suitable for diversion to general practice. Methods: A retrospective review of a computerized database for the top 500 frequent presenters to an inner city adult teaching hospital ED. Results: Five hundred patients presented 12 940 times, an average of 26 times per patient, accounting for (8.4%[8.3, 8.6]) of total ED presentations over 64 months. There were 7699 (59.5%[58.7, 60.4]) presentations deemed appropriate for ED. Of the remaining 5241 presentations, 1553 (29.6%[28.4, 30.9]) were between 22.00 and 07.00 hours, outside the hours of most actual or proposed primary care clinics. This left 3688 (28.5%[27.7, 29.3]) presentations by the heaviest users of the ED as potentially appropriate for general practice. Of these presentations 1507 (40.9%[39.3, 42.5]) were by people who were homeless. A total of 2574 (69.8%[68.3, 71.3]) had pre‐existing case management, either by the hospital or another service. Nine hundred and seventy‐eight (26.5%[25.1, 28.0]) had primary psychiatric or altered conscious states due to drugs and alcohol as the presenting problem. At least 90 of these 500 frequently presenting patients died during the study period. Conclusion: The majority of the presentations by the heaviest users of an ED in a city teaching hospital are not suitable for general practice. Attempting diversion of the heaviest repeat ED users to a general practice in this setting may not be successful due to the severity, acuity and nature of casemix of the presentations and would have minimal impact on crowding in similar emergency departments.     

Compliance with advice and appropriateness of emergency presentation following contact with the HealthDirect telephone triage service

Objective: Evaluation of compliance with advice and appropriateness of emergency presentation following contact with a telephone triage service (HealthDirect). Methods: Compliance rates, triage distributions and admission rates were determined using linked HealthDirect and ED records for patients living within 2 km of an ED that presented during 2000. Results: Of 13 019 presentations, 842 (6.5%) were HealthDirect contacts. In the HealthDirect group there were a greater proportion of patients under the age of 15 (290, 34% vs 1598, 13.1%) and women (481, 57% vs 5610, 46%). The triage distributions and admission rates for HealthDirect contacts and other patients were similar (HealthDirect 37.6% admitted, 95% CI 34–41, others 38.4% admitted, 95% CI 38–39, Pχ² = 0.67). Of 3996 callers to HealthDirect, 3167 (79%) complied with advice with 963 (61%) complying with advice to present and 212 (9%, 95% CI 8–10%) presenting despite advice to defer presentation. Triage distributions and admission rates for compliers and non‐compliers were similar (compliers 38% admitted, 95% CI 34–41, non‐compliers, 37% admitted, 95% CI 30–44, Pχ² = 0.89). Conclusions: HealthDirect contacts were of similar appropriateness to non‐HealthDirect presenters and appear to attend the ED independent of HealthDirect advice. HealthDirect has a limited capacity to influence ED utilization or workload.     

Head injuries related to sports and recreation activities in school‐age children and adolescents: Data from a referral centre in Victoria,Australia

Objectives: Head injuries (HI) in children are common and even mild HI can lead to ongoing cognitive and behavioural changes. We set out to determine the causes of sport‐related HI in school‐age children presenting to a large urban ED as a basis for future interventions. Method: Identification and medical record review of all sport‐related HI in children aged 6–16 years at a tertiary children's hospital ED in Victoria, Australia, over a 1 year period. Information was collected on demographics, injury variables and radiology findings. HI were classified as mild, moderate and severe based on GCS and radiography reports. Results: Over 12 months there were 406 HI in school‐age children. Seventy per cent were male. A large number of HI (129; 33%) were related to sports. Of these, most were classified as mild and 13% were classified as moderate or severe. Among a range of sports, Australian Rules football was associated with more than 30% of all HI attributable to a sport and recreation cause. Equestrian activities were the main cause of moderate HI. Conclusion: The present study identified sports as a major cause of HI in the Victorian paediatric emergency setting with Australian Rules football the most commonly involved sport. Further prevention initiatives should consider targeting Australian Rules football and equestrian activities.     

External causes of emergency department presentations: A missing piece to understanding unintentional childhood injury in Australia

Objective

To identify external causes of unintentional childhood injury presenting to Australian EDs.

Methods

Six major paediatric hospitals in four Australian states supplied de-identified ED data for 2011–2017 on age, sex, attendance time/date, presenting problem, injury diagnosis, triage category and mode of separation. Three hospitals supplied data on external cause and intent of injury. A machine classifier tool was used to supplement the missing external cause coding in the remaining hospitals to enable the compilation of a standardised dataset for childhood injury causes analysis.

Results

A total of 486 762 ED presentations for unintentional injury in children aged 0–14 years were analysed. The leading specified cause of ED presentations was low fall (35.0%) followed by struck/collision with an object (13.8%) with little sex difference observed. Males aged 10–14 years had higher rates of motorcycle, pedal cycle and fire/flame-related injury and lower rates of horse-related injury and drug/medicinal substance poisoning compared with females. The leading specified external cause resulting in hospitalisation was low fall (32.2%) followed by struck/collision with an object (11.1%). The injuries with the highest proportion of children being hospitalised were drownings (64.4%), pedestrian (53.4%), motorcycle (52.7%) and horse-related injuries (50.0%).

Conclusions

This is the first large-scale study since the 1980s to explore external causes of unintentional childhood injury presenting to Australian paediatric EDs. It demonstrates a hybrid human–machine learning approach to create a standardised database to overcome data deficiencies. The results supplement existing knowledge of hospitalised paediatric injury to better understand the causes of childhood injury by age and sex, which require health service utilisation.     

Analysis of serious injuries caused by stairway falls

Objective : To study the demographics of patients who sustained serious injuries from falling down stairs. Method : This study is a retrospective analysis of all patients who presented to an urban hospital with an injury severity score of equal to or greater than 16 after falling down stairs during the period January 1992 to December 1996. Patient demographics, stair location and number, severity and anatomical nature of injuries, serum ethanol levels, patient referral characteristics and mortality rates were examined. Results : A total of 113 patients were studied; 74% were male. Sixty‐five per cent of falls occurred at the patient’s place of residence. Ethanol may have been a contributing factor in 55% of injuries. Ninety‐five per cent of victims had an injury severity score of equal to or less than 30. Head injuries were common with acute subdural haematoma occurring in 57% of patients. Head‐injured patients had a significantly higher mortality rate than non‐head‐injured patients (P = 0.02). Increasing age and higher injury severity score correlated with poor outcome in all patients. Thirty‐nine of the 113 stairway‐fall patients (35%) died in hospital compared with 207 of 1091 non‐stairway‐fall patients (19%) during the same period (P < 0.001). Conclusion : In the adult population, falls down stairs may result in serious injuries, particularly head trauma. In the present study, this group of patients had a significantly higher mortality than other trauma patients.