Pattern of pediatric ocular trauma in India

Objective : The aim of the study is to identify the causes, demographic and clinical profile and evaluate final visual outcome of pediatric ocular injuries.Methods : Two hundred and four children aged fourteen years or less presenting to the emergency services of a tertiary care centre with ocular injury were included. Demographic data, nature and cause of injury, duration between injury and presentation to an ophthalmologist and the diagnosis were recorded. Evaluation of visual acuity, anterior segment and fundus were done. All patients were appropriately managed and followed up on days 1, 7,1 month, 3 and 6 months.Result : Majority of injuries occurred in children of 5 years and older (87.7%). There were 133 (65.1%) boys and 71 (34.9%) girls. Forty-nine (24%) cases presented within 6 hours of injury while 70 (34.3%) presented after more than 24 hours after trauma. Most common cause of injury was bow and arrow (15.2%) followed by household appliances (14.3%). Closed globe injuries accounted for 42.2% injuries, open globe for 53.9% and 3.9% were chemical injuries. Best corrected visual acuity of 6/12 or better was achieved in 79 eyes (91.86%) in closed globe group. However, only 17 eyes (15.45%) in open globe group could achieve this.Conclusion : Most ocular injuries in children are preventable and occur from unsupervised games like bow and arrow and firecracker, which can lead to significant visual loss.     

Open globe injuries in children: a retrospective analysis

PURPOSE: To study the outcome of open globe injuries in patients aged <14 years and compare the results between patients who presented approximately 30 years ago and a recent series. METHODS: Between January 1970 and January 1993, 180 eyes of children who presented with an open globe injury were retrospectively analyzed. Patients were divided into two groups. One group of children underwent treatment of an open globe injury between January 1970 and December 1981 (group A) and another between December 1985 and January 1993 (group B). Main outcome measures studied were final visual acuity and enucleation rates. Risk factors studied included age, race, sex, visual acuity, type of trauma, and various injury characteristics at presentation. RESULTS: The factors associated with visual outcomes included: age, type of injury, wound size, initial visual acuity, and retinal detachment. Final visual outcome and enucleation rates were not significantly different between the older series (group A) and the recent series (group B). Lenticular damage, location, posterior extent of the injury, and presence of an intraocular foreign body had been significant prognostic factors in the older series, but were not statistically associated with the prognosis in the recent series. CONCLUSION: The nature of the injury and the patient's age are the main determining factors in the outcome of open globe injuries in children.     

Traumatismo ocular en Urgencias de Pediatría,características y factores de riesgo de secuelas inmediatas

ObjectiveThis study assesses the clinical characteristics and epidemiology of children with eye trauma presenting to the Emergency Department in Spain and analyze the risk factors associated with immediate sequelae.MethodsA multicentric prospective case series study conducted during 24 months of patients presenting to the Pediatric Emergency Departments in five hospitals collaborating with the Spanish Pediatric Emergency Research Group. Data were collected from October 2016 through September 2018, including all patients up to the age of 16 years old presenting to the Emergency Department with an ocular trauma. All injuries were classified by Birmingham Eye Trauma Terminology.ResultsA total of 242,134 visits to the Emergency Departments took place during the study period, being 1,007 ocular traumas (0.42%; IC 95% 0.40-0.45) and 858 were included in the study. Most commonly, injuries occurred while playing (54.7%), except in the 15 or more-age group, in which sports activities were more common (23.1%). The place of the trauma varied depending on the age group, being home (34.7%) and schools or sports areas (34.3%) the most recurrent. Blunt objects were the most frequent mechanism of trauma (48.6%). Most of the injuries were classified as closed globe (85.5%), mainly contusions (52.7%). Fifty-eight patients (6.8%) presented with immediate sequelae, being the impairment of visual acuity the most common (70.7%). The risk factors associated with immediate sequelae were the 10 or more-age group, the preexisting refractive errors, the open globe injuries and the injuries with blunt objects.ConclusionsOcular trauma is a frequent chief complaint in the Pediatric Emergency Departments in Spain. Increasing awareness of the serious nature of ocular injuries and the study of the risk factors will help to develop a comprehensive plan for educating both parents and children to minimize preventable eye injuries sequelae.     

Complications of ocular paintball injuries in children

PURPOSE: To evaluate the ocular complications of paintball injuries in children. METHODS: The clinical course of four children with traumatic ocular paintball injuries was evaluated. All patients underwent a complete ocular examination. Their age, injuries sustained, surgical procedure(s) performed, presence of protective eyewear at the time of injury, and final visual outcome was assessed. The presence of directly related anterior and posterior segment abnormalities were also evaluated. RESULTS: Four boys sustained traumatic paintball injuries. Average patient age was 11.25 years (range: 10-12 years). None of the children were wearing ocular or facial protection at the time of the initial injury. All patients had hyphema and traumatic cataract, and some form of retinal pathology (vitreous hemorrhage, epiretinal membrane, retinal hemorrhage, and choroidal rupture). One child had a partial-thickness corneal laceration that did not require surgical intervention. All other patients underwent ophthalmic surgery. Final visual acuity was 20/30 or better in two patients, and 20/100 or worse in the others. The cause of decreased visual acuity in these children was directly related to macular pathology. CONCLUSION: Ocular injuries resulting from paintball impact are often severe and usually occur when the participants are not wearing eye protection or this protection becomes dislodged. Treatment of these injuries is sometimes limited to an attempt to salvage what remains of useful vision. Unfortunately, most of these sports-related injuries could have been prevented if patients wore adequate eye protection when involved in this sport.     

Mechanical eye (globe) injuries in children

PURPOSE: The epidemiology of mechanical eye injuries in children was studied to identify the agents of injury and their contribution to the severity of visual loss and to suggest preventive measures. METHODS: The mode, type, and severity of injury were correlated with the visual acuity 6 months after the injury in all children with mechanical eye injuries between January 1994 to January 1999. RESULTS: Of the 68 children with mechanical eye injuries, the mode of injury was host (child) related in 12 (17.65%) patients, agent related in 40 (58.82%) patients, and environment related in 16 (23.53%) patients. Mild injuries were seen in 22 (32.35%) patients, 31 (45.59%) patients had moderate injuries, and 15 (22.06%) patients had severe injuries. None of the patients with host-related injuries had a severe injury. Six (66.67%) patients with host-related injuries had a good visual outcome and none had a poor outcome. Among patients with agent-related injuries, 11 (25%) had a good outcome, 14 (40%) patients had a fair outcome, and 10 (22.5%) patients had a poor outcome. Of the patients with environment-related injuries 3 (33.33%) each had good, fair, and poor visual outcomes. CONCLUSIONS: Agent and environment-related injuries had a far worse outcome than host-related injuries. This epidemiological classification directly suggests practical preventive measures that can be adopted at home or at school to reduce the incidence and severity of ocular injuries. The other predictors of the final visual outcome were the severity of the injury at presentation and the necessity for a secondary surgical procedure.     

Eye injuries among children in Kuwait: pattern and outcome

One hundred and ninety four children with ocular injuries were admitted to the Eye Department at Ibn Sina Hospital, Kuwait during a 1-year period (1983). They represented 8.7% of total admissions and 56% of all ocular injuries admitted in the same period. These figures are higher than any previously reported figures in comparable series. The risk of severe ocular injury to children was found to be 0.35% per 1000 per year. There were 47 (24%) perforating injuries and 111 (57%) concussion injuries. Catapulted missiles were the commonest cause of injury (26%). Early presentation to hospital accounted for a low rate of secondary infection. Visual outcome of 6/12 or better was achieved in 78.5% of concussion injuries and 27.3% of perforating injuries. Education in organized school programmes has been recommended to reduce the incidence of ocular injuries in children.     

The evaluation of ocular trauma in children between ages 0-12

Ocular trauma is the leading cause of noncongenital unilateral blindness in children under 20 years old. In this study, 138 patients (36 female, 102 male) with ocular trauma between November 1983 and October 1996 were reviewed retrospectively at the Department of Ophthalmology, Ondokuz Mayis University Faculty of Medicine. Twenty-four of these patients were blunt trauma and 114 were perforating eye injury. The mean age of the patients was 6.96+/-3.01 years. Mean post-treatment follow-up was 10.7 months (range 1 to 121 months). Forty-five patients were admitted to the eye clinic within the first 24 hours after trauma. The most frequent finding was hyphema in blunt injury, and corneal laceration in perforating injury. The most frequent cause of injury was wood and stone in blunt trauma and glass and knife in perforating trauma. While the ratio of visual acuities equal to or better than finger counting was 37.5 percent (9 eyes) in blunt trauma cases and 20.2 percent (23 eyes) in perforating trauma cases prior to treatment, it was 79.2 percent (19 eyes) and 55.3 percent (63 eyes), respectively, at last visit examination post-treatment. The most frequent complication was traumatic cataract in blunt trauma and corneal leukoma and anterior synechia in perforating trauma. The results obtained suggested that socioeconomic and sociocultural status and family negligence are important factors in eye injuries in children that occur during games.     

Ocular injuries in children after major trauma

OBJECTIVE: To determine the variety of ocular injuries sustained by children during major trauma. SUBJECTS AND METHODS: The pediatric trauma registry of The Children's Hospital in Denver, Colorado, was surveyed for children with ocular injuries and an Injury Severity Score higher than 15. The injuries were tabulated and correlated with mechanisms of injury to determine identifiable injury patterns. RESULTS: In a pediatric trauma center, ocular injuries were nearly twice as frequent among children with major trauma (Injury Severity Score > 15). Two-thirds of the children with an Injury Severity Score higher than 15 had been involved in a mishap with a motorized or a nonmotorized vehicle. Ocular injuries in children with an Injury Severity Score higher than 15 were characterized by fracture of the surrounding bony structures and contusions. Children with an Injury Severity Score higher than 15 had 50% to 80% fewer open wounds of the ocular adnexa and eyeball than did children with an Injury Severity Score of 15 or lower. The one optic nerve injury and two-thirds of the other ocular cranial nerve injuries occurred in children with an Injury Severity Score higher than 15. CONCLUSIONS: Serious ocular injury should be suspected in children involved in a motor vehicle accident who have an Injury Severity Score higher than 15 and fractures of the surrounding bony structures, contusions, or both. Absence of an open wound of the ocular adnexa or eyeball does not eliminate the possibility of serious ocular injury.     

Self-inflicted ocular mutilation in the pediatric age group

Three mentally retarded children with severe self-inflicted ocular injuries are presented. All three suffered from severe ocular injuries including retinal detachment resulting in progressive visual loss and even blindness. Self-inflicted injuries to the eyes, including self enucleation, is an extremely uncommon form of behavior, rarely encountered by pediatricians. The risk of ocular morbidity is high if the diagnosis is overlooked. Technical advances in ophthalmology permit much improvement in some formerly hopeless cases of ocular self-mutilation, but there is still no accurate method to repair destroyed retinal or nervous tissue. Early identification of patients at risk of ocular self-mutilation is essential in order to prevent or minimize such severe ocular injuries.     

Pediatric ocular trauma: Characteristics and outcomes among a French cohort (2007–2016)

Pediatric ocular trauma is a major cause of acquired monocular blindness. Post-traumatic visual impairment can lead to significant handicap. In France, recent data on the epidemiology of pediatric ocular trauma are lacking.AimTo describe the characteristics of a pediatric cohort with ocular trauma and to analyse patient outcomes.Material and methodsThis was a retrospective observational study of pediatric ocular trauma (age < 15 years) presenting to pediatric and ophthalmology emergency units of our tertiary university hospital between January 1, 2007 and December 31, 2016. Data were collected on: age, sex, time and circumstances of trauma, injury type and location, trauma mechanism, other associated injuries, hospitalisation rate and length of stay, treatment, and sequelae (visual impairment). Ocular traumas were classified according to the Birmingham Eye Trauma Terminology (BETT) system and the Ocular Trauma Score (OTS).ResultsA total of 337 children were included (247 males). The global mean age was 8.4 ± 4.1 years (range 6 months to 14.9 years). The trauma occurred at home (51%) or in a public area (21%). Blunt objects (22%) and direct trauma (17%) were the main mechanisms. According to the BETT, 23% of ocular traumas were open-globe traumas (OGT): penetrating (n = 39), perforating (n = 12), with intraocular foreign body (n = 24). Among closed-globe injuries (CGT), hyphema was the most frequent lesion (22%). Associated injuries were recorded in 32 patients. In all, 63% of patients had an OTS of 5 (good visual prognosis) while 39 children (12%) had an OTS of ≤ 3. In 47 patients, there was an initial surgery; 62% of children were hospitalised. By the end of the ophthalmic follow-up, 32 patients (9.5%) had sequelae. Children aged between 2 and 5 years had the greatest proportion of sequelae (15%). Compared with female patients, male patients were older (P = 0.0007) and were more frequently injured by projectiles (P = 0.036). Compared with CGT, OGT were more frequent among younger children (P = 0.0015). Ocular injuries secondary to a projectile and spring-summer accidents were associated more frequently with a poor visual prognosis (OTS ≤ 3; P = 0.036, OR = 2.5 [1.1–5.8] and P < 0.0001, OR = 5.8 [3.2–10.7] respectively).CommentsThe annual admission for pediatric ocular trauma was stable during the study period (200 cases per 100,000 annual trauma admissions in the first period [2007–2011] and 195 cases per 100,000 during the most recent period [2012–2016]). Projectiles such as Airsoft gun bullets and paintball are still the cause of severe injuries while reports on ocular injuries secondary to blaster or Nerf guns use are starting to be published.ConclusionThe great majority of ocular traumas could be prevented, especially by wearing protective goggles during at-risk activities. French legislation should be stricter about the sale of any Airsoft gun to children under 18 years old. Parents must repeat educational warnings to their children handling sharp objects. The social and psychological burden of relative visual impairment is of importance: One in ten children will have a permanent visual defect.     

Pediatric silicone oil surgery

PURPOSE: To evaluate clinical characteristics, surgical aspects, and visual outcomes of pediatric patients who underwent pars plana vitrectomy and silicone oil injection for complicated retinal detachment. PATIENTS AND METHODS: The records of 24 patients (25 eyes) younger than 18 years were retrospectively reviewed. All patients underwent pars plana vitrectomy and silicone oil injection for complicated retinal detachment between January 1995 and June 2004 in the Ophthalmology Department of Dokuz Eylul University, Izmir, Turkey. All patients had follow-up at or beyond 6 months. RESULTS: Nineteen (79.2%) boys and 5 (20.8%) girls were included. Mean age was 12.6 years (standard deviation, +/- 3.5; range, 5 to 17). Five eyes (20%) had blunt ocular trauma. Eleven eyes (44%) had penetrating trauma. Three eyes (12%) had high myopia. Four eyes (16%) had congenital cataract surgery. One eye (4%) had redetachment 1 month after vitreoretinal surgery performed at another clinic. One case had bilateral proliferative vitreoretinopathy with an undefined cause. The retina remained attached in 18 (72%) of 25 eyes at the final examination (17 were totally attached; 1 was partially attached). Mean follow-up was 23.4 months (standard deviation, +/- 20.5; range, 6 to 108). Postoperative visual acuity improved to 1/10 or better only in 6 eyes (24%) at the last examination. CONCLUSION: In pediatric patients with complicated retinal detachment, silicone oil injection for intraocular tamponade is an option for treatment, but visual outcome is poorer than for adults.     

Intraocular lens implantation in children and youth.

PURPOSE: To evaluate the safety and the effectiveness posterior chamber intraocular lenses (PCIOLs) in children and youth with cataract. METHODS: Retrospective study of operative and postoperative results was based on 146 eyes in 125 children ages 6 to 18 years (mean: 11.7 years) who underwent extracapsular cataract extraction with IOL implantation in the period from 1986 to 1996. Follow up was 1 to 10 years. OUTCOME MEASURE: Best corrected distance and near visual acuity, operative complications, and early and late postoperative complications. Exclusion criteria were uveitis, retinal detachment, prior glaucoma, and systemic diseases. RESULTS: Early postoperative complications were observed in 12.3% of cases including iritis in 7.5%, and transient corneal edema in 3.4% of eyes. Posterior capsule opacification requiring capsulotomy was needed in 81.5% of eyes after 8.5 years. YAG laser capsulotomy was performed in 68.1% and surgical intervention in 26.8% of cases. In 5.1% of the cases, both techniques were used. In 74.7% of patients, best corrected visual acuity of 0.5 or better was achieved. The mean postoperative spherical equivalent was +0.35 diopters (D, SD 1.35). Spectacle-corrected near visual acuity of 0.5 on the Snellen chart was obtained in 82.8% of eyes. CONCLUSION: IOL implantation in children older than 6 years appears to be an efficacious, satisfactory, and safe procedure in the management of pediatric cataract.     

Penetrating injuries in children: Is there a message?

OBJECTIVES: To determine the frequency, management and outcome of penetrating trauma in children. METHODS: A retrospective review of penetrating injuries in children under 16 years of age admitted to the Children's Hospital at Westmead (CHW), and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry, from January 1988 to December 2000. Patient details, circumstances of trauma, injuries identified, management and outcome were recorded. RESULTS: Thirty-four children were admitted to the CHW with penetrating injuries during the 13-year period. This represented 0.2% of all trauma admissions, but 3% of those children with major trauma. The injury typically involved a male, school-age child that fell onto a sharp object or was assaulted with a knife or firearm by a parent or person known to them. Twenty-five children (75%) required operative intervention for their injuries and 14 survivors (42%) suffered long-term morbidity. Thirty children were reported to the NPTD Registry over the same interval, accounting for 2.3% of all trauma deaths in New South Wales. Of these, a significant minority was injured by falls from a mower or a tractor towing a machine with blades. CONCLUSIONS: Penetrating injuries are uncommon, but cause serious injury in children. There are two clear groups: (i) those dead at the scene or moribund on arrival, in whom prevention must be the main aim; and (ii) those with stable vital signs. Penetrating wounds should be explored in the operating theatre to exclude major injury. Young children should not ride on mowers or tractors.     

Urethral trauma in children

We report our 12-year experience in the management of urethral injuries in nine children, six boys and three girls. The most common mechanisms of injury were motor vehicle accidents, followed by straddle injuries. All the injuries in boys involved the anterior urethra, and in girls the proximal or mid-urethra. There were associated injuries in five, including three pelvic fractures. All children were investigated with a retrograde urethrogram. Four were treated non-operatively with insertion of a urethral catheter. Of the remaining five, one had drainage of a penile haematoma, one cystourethroscopy, two insertion of urinary and suprapubic catheters, and one open cystotomy and passage of a guide wire with antegrade passage of a urethral catheter. Complications included one urinary tract infection, one urethral fistula, one urethrovaginal fistula, and two urethral strictures. Final outcome was satisfactory in all nine children. Accepted: 3 February 2000     

The surgery and results following traumatic cataracts in children.

Ninety eyes undergoing surgery for the removal of traumatic cataracts have been evaluated. In this group, the visual results relate to the coincident complications and amblyopia. Most commonly, they may be related to the extent of the preoperative trauma to the injured eye or to the age of the patient at the time of the injury. Forty-eight eyes (54%) achieved an acuity of 20/20 to 20/80 with 38 (42%) eyes achieving acuity of 20/20 to 20/30. A visual result of 20/80 or better was obtained in 12 eyes of the 29 patients six years of age or less.     

Outcome of hyperplastic persistent pupillary membrane

PURPOSE: To evaluate the long-term visual outcome of eyes with hyperplastic persistent pupillary membrane. PATIENTS AND METHODS: We adopted a retrospective approach involving 39 eyes of 24 Korean patients diagnosed as having hyperplastic persistent pupillary membrane, excluding patients who could not be observed beyond 3 years of age and eyes that had any other ocular anomalies that affect vision. Final best-corrected visual acuity and refractive status were compared according to treatment type and laterality. Mean visual acuity was transformed to the logarithm of the minimum angle of resolution (logMAR). RESULTS: The mean final best-corrected visual acuity was 0.32 (standard deviation, +/- 0.41). Five eyes had a best-corrected visual acuity less than 20/70 at the last follow-up. Four eyes were unilateral (deprivation amblyopia) and one eye was bilateral (anisometropic amblyopia). There were no significant differences in final best-corrected visual acuity according to treatment type or laterality. Significant anisometropia was found in 11 of the 24 patients. The mean absolute value of anisometropia was greater in the surgical treatment group than in the medical treatment and observation groups (P = .048). CONCLUSIONS: The visual prognoses for individuals with hyperplastic persistent pupillary membrane can be relatively good if the condition is appropriately managed. Unilaterality and poor initial visual acuity are indicators of a poor visual outcome. Surgery is effective when the opaque membrane retards visual maturation. Close follow-up with evaluation of visual acuity and refractive status is mandatory because this condition can lead to deprivation amblyopia and anisometropic amblyopia.     

Blunt abdominal trauma in children: epidemiology, management, and management problems in a developing country

Trauma is the leading cause of death in children in developed countries. In tropical Africa, it is only beginning to assume importance as infections and malnutrition are controlled. In developed countries, the availability of advanced imaging modalities has now reduced the necessity for laparotomy to less than 10% following blunt abdominal trauma (BAT) in children. This report reviews the epidemiology, management, and unnecessary laparotomies for pediatric BAT in a developing country in a retrospective review of 57 children aged 15 years or less at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria over 12 years. The average age was 9 years and the male-female ratio 3.8:1. Seventy-four percent (74%) of abdominal injuries in children were due to blunt trauma. The commonest causes of injury were road traffic accidents (RTA) (57%), 88% in pedestrians and 59% in children aged 5–9 years. Falls were the cause of trauma in 36%, 60% of them aged 10–15 years. Other causes of injury were sports in 5% and animals in 2%. Diagnosis was clinical, supported by diagnostic peritoneal lavage or paracentesis. Two patients had ultrasonography, and none had computed tomography. Fifty-three patients had a laparotomy, 2 died before surgery, 1 was managed nonoperatively, and in 1 surgery was declined. There were 34 splenic injuries, 20 treated by splenic preservation, splenectomy in 13, and non-operative in 1. Fourteen gastrointestinal injuries were treated in 12 patients. Of 9 hepatic injuries, 4 were minor and were left untreated, 3 were repaired, 1 was packed to arrest hemorhage, and a lacerated accesory liver was excised. Four injuries to the urinary tract (bladder contusion 2, bladder rupture 1, ruptured hydronephrotic kidney 1) were treated accordingly. There were 4 retroperitoneal hematomas associated with other intra-abdominal injuries and 2 pancreatic contusions. One lacerated gallbladder was treated by cholecystectomy and a ruptured left hemidiaphragm was repaired transperitoneally. In retrospect, 27 (51%) patients could have been managed by observation (splenic injury 20, liver injury 5, bladder contusion 2) using advanced imaging modalities. One patient developed an intra-abdominal abscess following splenorrhaphy. The average hospital stay was 17 days. Mortality was 8 (14.5%) from gastric perforation (3), liver injury (2), splenic injury (1), and 2 patients died before surgery. BAT in this population results predominantly from RTA in pedestrians. Laparotomy may be avoided in 51% of cases if advanced imaging modalities are readily available. Accepted: 28 October 1999     

Clinical symptoms and visual outcome in patients with presumed congenital cataract

PURPOSE: To investigate clinical symptoms and visual outcome in patients who had presumed congenital cataract with visual acuity > or =20/200. METHODS: Twenty-nine patients (50 eyes) ranging in age from 5-28 years were included in this study. Congenital cataract was diagnosed by patients' past history, previous medical records, and typical findings of congenital cataract. Inclusion criteria were patients with visual acuity measured by Snellen chart, best corrected visual acuity > or =20/200, and no eye or systemic diseases influencing visual acuity. Seven patients had unilateral cataracts and 22 patients had bilateral cataracts. Cataracts were nuclear in 29 eyes, anterior or posterior subcapsular in 12 eyes, and polar in 7 eyes. All patients underwent lens aspiration or phacoemulsification combined with posterior chamber intraocular lens (PC-IOL) implantation without performing intentional posterior capsulotomy and anterior vitrectomy. RESULTS: The most common clinical symptom was visual disturbance followed by blurred vision, glare and knitting the brow, strabismus, and leukocoria. Comparison of calculated PC-IOL power showed a more significant myopic shift in unilateral cataract than in bilateral cataract. Postoperative best corrected visual acuity >20/25 was attained in 28 (65.1%) eyes with bilateral cataracts and 1 (14.3%) eye with a unilateral cataract. CONCLUSIONS: Cataract surgery is effective not only in improving visual acuity but also in eliminating clinical symptoms. Delaying cataract surgery in early infancy should be considered to avoid intentional operative procedures in patients with bilateral congenital cataract preserving visual acuity >20/200.     

Injuries to the head among children enrolled in special education

BACKGROUND: Injuries to the head comprise 20% to 39% of all school-related injuries. Head injuries among special education students have not been adequately described. OBJECTIVES: (1) To examine the incidence and characteristics of head injuries in children enrolled in special education and (2) to determine the factors that increase the risk of sustaining a head injury compared with an injury to another part of the body. METHODS: Pupil Accident Reports for 6769 students enrolled in 17 of 18 special education schools in 1 large urban school district during the academic years 1994-1998 were reviewed, and information on the nature of injury, external cause, and activity was abstracted. Head-injured and nonhead-injured cases were identified and compared by race, sex, age, characteristics of injury, and disability category. RESULTS: Six hundred ninety-seven injury events were reported during the 4-year study period. The overall injury rate was 4.7 injuries per 100 student-years. Two hundred five children (29.4%) sustained injuries to the head, and the rate of head injury was 1.3 injuries per 100 student-years. Falls were the leading cause of injury. Head injuries were most commonly associated with physical education and unstructured play and usually occurred on the playground. Disproportionately more head than nonhead injuries were sustained in the classroom (12% vs 8%) and the bathroom (9% vs 3%). Compared with children with emotional/mental disabilities, children with multiple disabilities had the highest risk of a head injury (incidence density ratio, 2.4 [95% confidence interval, 1.6-3.5]), followed by children with physical disabilities (incidence density ratio, 1.8 [95% confidence interval, 1.1-3.1]). There appeared to be no significant difference in the rate of head injury by sex and age. CONCLUSIONS: Modifications of the classroom, bathroom, and playground environments might reduce the risk of head injuries in children enrolled in special education. Special modifications and increased supervision may, in particular, reduce the risk of head injury for children with physical and multiple disabilities.     

Trends in childhood injury mortality in Canada, 1979–2002

OBJECTIVE: To examine national trends in mortality rates for injuries among Canadian children younger than 15 years in 1979-2002. METHODS: Data on injury deaths were obtained from the Canadian Vital Statistics system at Statistics Canada. Injuries were classified using the codes for external cause of injury and poisoning (E-codes) by intent and by mechanism. Mortality rates were age adjusted to the 1990 world standard population. Negative binomial regression was used to estimate the secular trends. RESULTS: Annual mortality rates for total and unintentional injuries declined substantially (from 23.8 and 21.7 in 1979 to 7.2 and 5.8 in 2002, respectively), whereas suicide deaths among children aged 10-14 showed an increasing trend. All Canadian provinces and territories showed a decreasing trend in mortality rates of total injuries. Motor vehicle related injuries were the most common cause of injury deaths (accounted for an average of 36.4% of total injury deaths), followed by suffocation (14.3%), drowning (13.5%), and burning (11.1%); however, suffocation was the leading cause for infants. The number of potential years of life lost due to injury before age 75 decreased from 89 343 in 1979 to 27 948 in 2002 for children aged 0-14 years. CONCLUSIONS: During the period 1979-2002, there were dramatic decreases in childhood mortality for total injuries and unintentional injuries as well as various degrees of reduction for all causes of injury except suffocation in children aged 10-14 years and drowning in infants. The reason for the reduction in injury mortality might be multifactoral.