单中心儿科门急诊0~16岁儿童10年死亡数据分析

目的 通过回顾性分析首都医科大学附属北京潞河医院急诊0~16岁儿童青少年死亡病例,探讨急诊儿童青少年死亡原因及特点,以期寻找救治急重症儿童,减少急诊儿童死亡的切入点,为降低儿童青少年病死率制定防治策略提供临床依据。方法 从“人口死亡信息登记管理系统”中调取首都医科大学附属北京潞河医院2009年1月至12月期间16岁以下儿童死亡数据,按照不同的年龄段分为新生儿组(≤28 d)、婴儿组(28 d＜年龄≤1岁)、幼儿组(1岁＜年龄≤3岁)、学龄前组(3岁＜年龄≤6岁)、学龄期组(6岁＜年龄≤10岁)、青春期组(10岁＜年龄≤16岁),进行统计和分析。结果 导致儿童青少年死亡的主要原因:意外伤害死亡、猝死、疾病终末期,呼吸衰竭及呼吸、心跳骤停等。死亡原因第一位是意外伤害,占40%;第二位是猝死,占15%;第三位是呼吸衰竭和疾病终末期,各占13%。在意外伤害死亡病例中,男女性别比例为1.86∶1。其中交通伤占首位(42.5%),其次是坠/跌落伤(25.0%)。儿童死亡存在年龄阶段的差异,青春期组以交通伤为主要伤害类型(42.85%),学龄前组、学龄期组和婴儿组以交通伤和坠/跌落伤为主要伤害类型,幼儿组以交通伤(28.57%)和异物(28.57%)为主要伤害类型,其次是坠/跌落伤(14.28%)、溺水(14.28%)及中毒(14.28%)。儿童死亡地点发生在来院途中是第一位占37%,其次是在家中占32%,院前死亡占69%,新生儿期、婴幼儿期儿童发生院前死亡明显高于学龄前期及学龄期组儿童。结论 通州区0~16岁儿童青少年急诊死亡前3位的原因是:意外伤害死亡、猝死、呼吸衰竭及疾病终末期,不同年龄段死亡原因不同,死亡地点多为院前,年龄越小发生院前死亡风险越高,男孩多于女孩。     

Horse-related injuries in children

OBJECTIVES: To identify the frequency, spectrum and outcome of horse-related injuries in children. DESIGN AND SETTING: Retrospective case series of horse-related injuries in children admitted to the Children's Hospital at Westmead (CHW) from January 1988 to December 1999, the John Hunter Children's Hospital (JHCH) from January 1991 to December 1997 and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry from January 1988 to December 1999. MAIN OUTCOME MEASURES: Circumstances of injury; helmet use; adult supervision; type and number of injuries identified. RESULTS: 232 children were admitted with horse-related trauma, 97 to the CHW over 12 years and 135 to JHCH over seven years, with one death at each hospital. There were six deaths reported to the NPTD Registry over 12 years. The median age was 11 years (range, 1-17). Girls accounted for 65% of those injured and 75% of children were injured while riding. Falls caused the injury in 76.3% of cases. Head and upper-limb trauma accounted for 216 of the injuries (73%). Five out of six children with severe head injuries died. In the CHW group, helmet use was documented in only 24 riders (38%) and adult supervision in 22 (22.9%). CONCLUSIONS: Horse-related trauma accounts for a considerable number of deaths and injuries in children in NSW. The use of a Standards-approved helmet for riding or horse-related activities might have decreased the severity of head injuries.     

Pattern of poisoning cases in Emergency Department of Kathmandu Medical College Teaching Hospital

Objective: This study was conducted to determine the pattern and severity of poisoning cases in Emergency Department of Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal (KMCTH). Design: Retrospective observational study. Materials and methods: Hospital records of all admissions to the Emergency Department of Kathmandu Medical College Teaching Hospital (KMCTH) following acute poisoning were revised and all data from February 2007 to February 2008 were analyzed retrospectively. Results: This retrospective observational study was performed on 148 cases of poisoning who attended Emergency Department of KMCTH over a period of one year. The overall male to female ratio was 1.05:1. Poisoning was most common in the age group 21-30 years (40.5%). The most common causes of poisoning in adults were organophosphorous compounds and in children was kerosene oil. Oral route (79.05%) was the most common route of administration. 66.2% of cases were intentional poisoning for suicidal attempt. Students (43.9%) and service holders (18.9%) were commonly involved in poisoning. Conclusion: It was seen that adult between 21-30 years of age were more prone to suicidal poisoning with organophosphorous compounds and children of 1-10 years of age were more susceptible to accidental poisoning with kerosene oil. Key words: Organophosphorous; Poisoning; Suicide; Kerosene.     

Stab injury--the experience of an East London Hospital 1978-1983

A retrospective review of 201 patients with stab wounds admitted to an East London Hospital over a period of six years was performed. There was no striking increase in the annual incidence of these injuries over the period reviewed. The majority of patients were young males who arrived at the Accident and Emergency Department after 1800 h on a Friday, Saturday, or Sunday and had consumed alcohol prior to admission. There were 47 abdominal injuries (23%), 69 thoracic (34%), 51 limb injuries (25%) and 34 injuries involving the head and neck (17%). Forty patients (20%) had injuries involving more than one site. Abdominal stabbings were managed by a selective approach resulting in 28 laparotomies of which only 2 (7%) were negative. Evisceration of small bowel or omentum was always associated with significant intraperitoneal injury.     

湖南某三甲综合医院85例PICU儿童意外伤害临床分析

目的探讨儿童意外伤害的防范措施,为永州地区儿童意外伤害的有效干预提供一定的理论依据。方法回顾性研究2017年1月至2019年12月在本院PICU救治的85例儿童意外伤害病例,统计分析儿童意外伤害的不同影响因素及分布特点。结果儿童意外伤害病例中男童多于女童,农村多于城市;年龄分组中以幼儿期组最多见;种类分布以中毒(43.53%),尤其是以药物中毒最常见(28.24%);不同年龄组意外伤害种类分布不同。因意外伤害死亡的病例占同期死亡病例的41.38%。结论重症监护室意外伤害儿童死亡率高,具有性别、年龄及分布特点,对不同区域、不同年龄段儿童,尤其是男童,要有侧重地采取防范措施、加强监护、提高安全意识,可有效预防儿童意外伤害事件的发生。     

Nonfatal childhood injuries: a survey at the Children's Hospital of eastern Ontario.

OBJECTIVE: To examine the types and severity of injuries seen in the Emergency Department of the Children's Hospital of Eastern Ontario and the circumstances surrounding the events. DESIGN: Chart review. SETTING: A tertiary care hospital that serves a child population of 600,000 in eastern Ontario and western Quebec. PARTICIPANTS: Every sixth day's charts of children up to 17 years of age who visited the Emergency Department because of injuries between Sept. 1, 1984, and Aug. 31, 1985, were examined retrospectively. RESULTS: A total of 2886 charts were reviewed. There were more boys than girls. Most (1354 [46.9%]) of the accidents had occurred at home. Falls and sports-related accidents were the leading causes of injury (in 1088 [37.7%] and 560 [19.4%] of the cases respectively). Most of the visits were for minor injuries (bumps, swellings, cuts, bruises and scrapes), and only 114 (4.0%) of the children were admitted to the hospital. Injuries from motor vehicle accidents accounted for the highest admission rate (17.4%). Important information regarding the circumstances surrounding the events (e.g., whether a seat belt or car seat was used) was frequently missing from the charts. CONCLUSIONS: Nonfatal injuries are common, especially in or around the home, and remain a significant problem in our society in terms of radiographic and consulting fees, time off from school or work and pain. Given the difficulties in obtaining information on the circumstances surrounding the events prospective studies are needed. Factors related to the occurrence and severity of childhood injury and whether these factors can be altered remain a high priority for research.     

2004～2007年深圳市宝安区伤害流行病学特征分析

目的探讨伤害流行特征,为开展伤害预防干预提供依据。方法采用描述性研究方法,以2004—2007年深圳市宝安区医院急诊伤害监测点伤害患者为研究对象。分析急诊患者年龄、性别、职业和伤害类型、原因、发生地点和伤害发生时的活动。结果伤害病例数呈逐年上升趋势,伤害病例人次数男高于女,2004～2005年以儿童伤害为主,2006—2007年以工人职业伤害为主。结论深圳宝安区伤害由儿童伤害为主过渡到以工人的职业伤害为主,职业伤害成为一个严重的公共卫生问题,是当前宝安区预防伤害优先干预的领域。     

Bicycle-related injuries: a prospective study of 200 patients

INTRODUCTION: This study aims to evaluate the magnitude, mechanism, distribution and outcome of bicycle-related injuries managed at the Emergency Department, Al-Ain Hospital, United Arab Emirates. METHODS: 200 patients, who were treated at the emergency department of Al-Ain Hospital during the period of October 2001 to January 2003, were prospectively studied. A hard copy protocol was designed and data was collected on a daily basis. RESULTS: 175 patients (87.5 percent) were males. The average age was 16.1 +/- 13.7 years. Only two were wearing helmets (one percent). The majority of injuries occurred in the evening and was due to a fall from a bicycle in 163 patients (81.5 percent). 88 patients had lower limb injuries (44 percent), and 72 had head and neck injuries (36 percent). Only 31 patients (15.5 percent) needed hospitalisation. Of these, four (12.9 percent) were admitted to the intensive care unit. The mean (range) hospital stay was 6.3 (1-23) days. Patients who were admitted to the hospital were older males, involved in motor vehicle collisions, and had more head injuries. Three patients (1.5 percent) died. CONCLUSION: Bicyclists' head injuries, caused by a motor vehicle collision, are a main cause of hospital admission. Helmet compliance in our community is alarmingly low, indicating the need for legislation and education on the use of helmets.     

Pattern of injury in fatal road traffic accidents in a rural area of western Maharashtra,India

Background

Fatal road traffic accidents (RTA) are a major cause of concern all over the world. The outcome of injuries sustained in an RTA depends on various factors including but not limited to: the location of the event, type of vehicle involved, nature of the roads, the time of accident, etc.

Aims

This study aims to investigate and evaluate prospectively the socio-demographic profile and pattern of injuries in victims of RTA in the rural area of the Ahmedanagar district of Maharashtra state.

Method

This prospective study included all victims of RTA that presented to our emergency room from 1 June 2007 to 31 May 2009 and were either found dead on arrival or died during treatment. All the victims were autopsied at the post-mortem centre of Rural Medical College, Loni.

Results

Ninety-eight RTA victims were studied during the period. The most commonly affected age group was 20-39 years. Men died in RTA more than women. Fatal RTA were more prevalent on the secondary road system (47.97 per cent) and especially involved pedestrian and two wheeler vehicle users. Large numbers (n=63, 64.28%) of victims either died on the scene or during transportation. Numbers of skeletal injuries (199) and internal organ injuries (202) exceeded the total number of victims (98) clearly indicating the multiplicity of injuries. The majority of RTA victims (n=46, 46.93%) died due to head injury. The study showed that most deaths in RTA, brought to a tertiary care rural hospital, took place either on the spot or within 24 hours of injury which is very alarming and highlights the need to take urgent steps to establish good pre-hospital care and provision of trauma services at site.

Conclusion

A computerised trauma registry is urgently needed to highlight risk factors, circumstances and chains of events leading to accidents. This would be extremely helpful in policy making and health management in India.     

A retrospective review of trampoline-related injuries presenting to a paediatric emergency department in Singapore

INTRODUCTIONTrampolining is a popular activity. However, to our knowledge, no studies on paediatric trampoline-related injuries (TRIs) have been conducted in Asia. We aimed to provide an Asian perspective on paediatric TRIs and evaluate current safety measures.METHODSPatients aged under 16 years who presented to the emergency department at KK Women’s and Children’s Hospital, Singapore, from March 2012 to June 2016 with a TRI were identified from the National Trauma Registry. Data was collated retrospectively focusing on age, location of the trampoline, mechanism and location of injury, treatment, disposition, and follow-up treatment.RESULTS137 children were seen for a TRI during this period. There was even representation across age groups (< 6 years, 6–11 years and 11–16 years). 60.6% of these injuries occurred in a public trampoline park, and a smaller proportion involved home and school trampolines. 61.3% of injuries occurred on the trampoline and 25.5% involved a fall off it, while the remaining were incurred by hitting the trampoline frame. The most common injury was soft tissue injury, followed by fractures and dislocations, of which 16.7% required surgical intervention. Most patients were discharged to an outpatient clinic. 14.6% of all patients required admission and 9.5% eventually required surgical intervention. There were three stable head injuries and no cervical spine injuries or deaths.CONCLUSIONThe existence of trampoline parks has contributed to a rise in TRIs. We recommend measures such as general education, changes in the setup around the trampoline, increasing the age limit for trampolining, adult supervision and discouraging double bouncing.     

Bicycle-related injuries: a survey in a pediatric emergency department.

The number of bicycle-related injuries has risen significantly with the increased popularity of bicycle riding in Canada. The risk of injury is highest among children. To assess the magnitude of the problem and to identify the contributing factors we used a questionnaire, injury reports and patient charts to survey bicycle-related injuries among children brought to the emergency department of the Children's Hospital of Eastern Ontario, Ottawa, between May 1 and Sept. 30, 1988. The questionnaire was completed for 517 (91%) of the 568 children; 70% were boys, and the mean age was 9.4 years. Only 2% of the patients had been wearing a helmet at the time of injury, although 13% claimed to own one for cycling. Over 60% of the accidents were attributable to carelessness or poor bicycle control; mechanical failure and environmental hazards were minor factors. Over 80% of the injuries occurred within a kilometre of the child's home. Of the 97 children admitted to hospital 49% had head and skull injuries and 40% had limb fractures. Bicycle-related injuries represented 14.8% of all nonwinter (Apr. 1 to Oct. 31) trauma admissions among children 5 years or older. Our results further document bicycle-related injuries as an important childhood problem and underscore the need for improved safety measures.     

An assessment of clinical predictors of intracranial head injury identified by computed tomography scan

A prospective study was done during a six-month period on 104 consecutive patients who were seen at the Accident and Emergency (A&E) Department of the UHWI and referred for CT scans of the head within 24 hours of sustaining head injuries. There were 74 (71.1%) males and 30 (28.8%) females. The mean age for females was 40.6 years and 32.4 years for males. Patients were clinically assessed for the presence or absence of vomiting, amnesia, loss of consciousness, bleeding of ear, nose and throat (ENT) and Glasgow Coma score (GCS). Negative predictive values were calculated for each parameter individually as well as the combination of all five. The absence of vomiting, amnesia, "loss of consciousness" (LOC) or ENT bleed had negative predictive values of 68%, 73%, 76% and 61.6% respectively. An assessment of Glasgow Coma Scale (GCS) of 15 had a 77.5% negative predictive value. When the history was indeterminate, the negative predictive values were 19%, 25%, 60% and 18% respectively for vomiting, amnesia, LOC and ENT bleed. When all four clinical indicators were absent in the history and examination and the GCS score 15, the negative predictive value for intracranial injury was 89.4%. In summary, the clinical indicators reviewed, alone or in combination, cannot exclude the presence of intracranial injury.     

谷城县0～14岁儿童意外死亡调查

目的 :了解谷城县 0～ 14岁儿童意外死亡的主要原因及其在全死因中的构成。方法 :对湖北省谷城县1990～ 1992年 6月间 0～ 14岁儿童死因进行全面的回顾性调查。结果 :谷城县 0～ 14岁儿童全死因死亡率为2 0 7.0 5 / 10万 ,意外伤害死亡率为 81.84/ 10万 ,占全死因的 39.5 % (2 83/ 716 ) ,为 0～ 14岁儿童的首位死因。男、女儿童意外死亡的前 3位死因均为溺死 (男 5 0 .6 % ,女 5 1.2 % )、机械窒息 (男 2 1.6 % ,女 2 5 .6 % )和车祸 (男 8.6 % ,女 9.1% )。结论 :意外伤害是谷城县 0～ 14岁儿童死亡的主要原因 ,应加强对意外伤害的预防和控制。     

Paracetamol ingestions at the Children's Emergency Department--a three year series

This is a three-year retrospective review of 96 cases of paracetamol ingestions seen by KK Children's Emergency Department. Paracetamol is the commonest substance (23%) involved in childhood poisonings. More than 60% occurred in children aged one to three years old with an equal gender distribution. Eighty-six percent were accidental ingestions and the intentional ones had a significant female bias, all occurring in children aged 12 and above. These older children ingested higher doses of paracetamol (average dose of 233 mg/kg) and had potentially serious serum paracetamol levels. There was no significant morbidity and no mortality in this series.     

Head injuries to children riding bicycles

This article examines the characteristics of 150 children who were admitted to Brisbane hospitals with head injuries that were caused by bicycle riding. These children constitute over 20% of all the children with head injuries who were admitted to hospital; accidents involving bicycle riding are the second largest single cause of head injury in these children, after falls. There was one death in the group, and three children were moderately disabled nine months after the injury. These four children all had Glasgow coma scores of less than 9 on their admission to hospital. Only two of the 150 children wore helmets. A survey of a random subgroup of children who had sustained head injuries confirmed our opinion that many children owned helmets but did not wear them for fear of peer derision. It is suggested that this refusal can be overcome by a combination of legislative enforcement, helmet design and promotion.     

Domestic accidental injuries to children presenting at a rural general practice

A survey of domestic childhood accidental injuries was conducted at a rural general practice in Arau, Perlis. Data was collected from parents or other caregivers of 171 children, aged 12 years and below, using a pretested questionnaire. Male children between the ages of 6 and 12 years were the most common group affected, with a male to female ratio of 1.7:1. The three most common accidents were injuries from falls (28%), cuts, lacerations, bruises and puncture wounds not resulting from falls (26%), and thermal injuries (22%). The most commonly affected parts of the body were the limbs. Most injuries to children between ages 4 to 12 years occurred in the house compounds, while those to children below 4 years occurred in the kitchen and other locations within the house. Major contributing factors to the injuries were the existence of unsafe home environments, the risk taking activities of the children, the presence of hazardous products in the household and unrealistic parental attitudes to injury prevention.     

Risk factors for fireworks-related injury in Washington State

To determine the frequency and effects of and risk factors for fireworks -related injury, we identified all 146 persons who were injured by fireworks and sought emergency care during the 1983 July 4 holiday in the Seattle area. The mean charge for medical care for the injuries received was +562; 7.1% of those injured required hospitalization. In a matched-pair case-control study, use of either of two fireworks types-- firecrackers or aerial devices--was significantly associated with injury (odds ratios [ORs], 3.3 and 2.9, respectively; 95% confidence intervals [CI], 1.2, 8.5, and 1.2, 6.6, respectively). Also associated with injury were several fireworks misuse behaviors, including lack of adult supervision of children (OR, 11.5; CI, 2.8, 100.6). We conclude that fireworks cause serious injuries that theoretically could be prevented by behavioral changes or decreased availability of high-risk fireworks devices.     

北京老年道路交通损伤特点分析

背景：道路交通损伤是一个持续的全球健康问题,其增长的趋势和经济发展、机动车的普及密切相关。但是,目前公布的数据和相关分析缺少对于北京老年人群的研究。 目的：收集北京市急救中心的数据,从公共卫生的角度,呈现出北京市老年道路交通损伤患者的情况。同时,为道路交通安全相关部门和道路交通损伤的防治,提供确实可靠的数据资料。 方法：在该回顾性研究中,收集从2004年到2010年期间,年龄在65岁及以上道路交通交通伤患者资料,共计1706例。所有个人信息,损伤时间,急救反应时间,道路使用类型和交通事故车辆类型,以及损伤的部位和严重程度,进行卡方和回归分析。 结果：北京老年患者年发生道路交通损伤21.8人/10万人。其发生率从2004年至2010年期间呈下降趋势（p<0.001）。平均年龄是72.92 ? 5.67,其中,911（53.40%）患者为男性。总体来说,大多数患者出现头部损伤（42.9%）和下肢损伤(34.82%)。中等损伤（65.51%）为主。老年交通损伤大多发生在日间,但并非上下班高峰时间。汽车撞击事故（85.64%）是主要交通事故类型,行人受伤者(79.19%)是损伤的主要人群。另外,有三项因素和损伤的严重程度相关,包括腹部损伤（p<0.001）,损伤部位的数量（p=0.027）和头部损伤（p=0.034）。道路交通伤下降的主要人群是65至74岁的患者和行人损伤患者。损伤程度整体呈下降趋势。 结论：本研究显示北京老年道路交通损伤在2004年至2010年期间呈下降趋势。尽管交通伤情况在改善,但仍是严重的公共健康问题。仍需要有效的道路交通规定和措施进一步加强老年人的道路损伤防治工作。     

The increasing problem of motorcycle injuries in children and adolescents

OBJECTIVE: To quantify an anecdotally apparent increase in motorcycle-related injuries in children and adolescents across Victoria. DESIGN, SETTING AND PARTICIPANTS: Retrospective analysis of paediatric motorcycle injuries (1 July 2000 - 30 June 2004) from a statewide emergency department (ED) database (Victorian Emergency Minimum Dataset [VEMD]) and the Trauma Registry database at the Royal Children's Hospital (RCH), Melbourne. MAIN OUTCOME MEASURES: Trends in paediatric motorcycle-related injuries over time; patient demographics, circumstances of accidents (on or off road), and injury characteristics, including severity markers. RESULTS: The VEMD recorded 3163 patients aged < or = 16 years presenting to EDs with motorcycle injuries during the study period; population-based rates of these injuries increased by an average of 9.6% per year (95% CI, 6.2%-13.1%; P < 0.005). In the same period, there was a total of 167 motorcycle-related admissions to the RCH, increasing annually in line with statewide ED presentations. About a quarter of paediatric motorcycle accidents occurred in children aged under 10 years (VEMD, 22%; RCH, 27%) and most occurred off road (VEMD,89%; RCH, 71%). At the RCH, median length of stay was 3 days (interquartile range [IQR], 1-7 days) and the median Injury Severity Score was 9 (IQR, 4-10); 41% of patients required an operation, 13% were admitted to an intensive care unit, and two died. CONCLUSION: In Victoria, the incidence of motorcycle-related injuries is increasing in children and adolescents. Most of these injuries occur off road, outside of any legislative framework. There is an urgent need for coordinated legislative changes and educational efforts to decrease motorcycle injuries in children.     

Animal and human bite injuries in Victoria, 1998-2004

OBJECTIVE: To describe the epidemiology of mammal (human and non-human) bite injuries in Victoria. PARTICIPANTS, DESIGN AND SETTING: Retrospective case series of injuries recorded in the Victorian Emergency Minimum Dataset (VEMD) (1998-2004) and deaths recorded in the National Coroners Information System (1 July 2000 - 1 June 2006). MAIN OUTCOME MEASURES: Frequency, nature and outcome of injury as a function of mammal, victim demographics and season. RESULTS: Of 12 982 bite injuries identified in the VEMD, dogs, humans, and cats were implicated in 79.6%, 8.7%, and 7.2% of cases, respectively. Dog bite injuries were commonly sustained to the hands/wrists (31.3%) and face/head (25.4%); cat bites to the hands/wrists (67.6%) and arms (16.0%); and human bites to the hands/wrists (37.1%), arms (20.5%) and face/head (20.4%). Males comprised 73.7% and 56.3% of human and dog bite victims, respectively, while females comprised 64.1% of cat bite victims. A third of dog bite victims (33.4%) were children aged 14 years or less. Most human bite victims (79.8%) were adults aged 20-49 years, inclusive. More injuries were sustained on weekends and during the summer, 55.4% of injuries occurred in the home, and 11.6% of patients required hospital admission. Dog bites resulted in three deaths. CONCLUSIONS: Mammal bite injuries are common and often require inpatient care. Patterns of bite injuries relate to the type of mammal involved. These epidemiological data will inform prevention initiatives to decrease the incidence of mammal bites.