Examining the impact of a paediatric trauma family support service on the quality of life of injured children: A longitudinal cohort study.

PURPOSE: We describe and evaluate the introduction of a trauma family support service (TFSS) in an Australian tertiary paediatric hospital. DESIGN AND METHODS: A longitudinal mixed-methods cohort study evaluated the effectiveness of the TFSS on quality of life. PedsQL4.0 and EuroQol 5D-Y scores were collected at 6 and 12 months at intervention and non-intervention sites and outcomes were compared using a two-sample t-test. Qualitative data from field notes collected during the administration of the quality-of-life measures were analysed using inductive content analysis. Data were integrated during the interpretation of results to expand and strengthen findings. RESULTS: Data from 192 children were collected (intervention site: 104, control site: 88). Significant increases were seen in the PedsQL and EQ-5D-Y scores at the intervention site compared to the control site at both timepoints, indicating an increase in overall health related quality of life. Two main categories were generated from the qualitative analysis: "Psychosocial impact of trauma" and "Access to psychosocial services." CONCLUSIONS: The introduction of a dedicated family support service after paediatric injury improved well-being up to 12 months post injury. PRACTICE IMPLICATIONS: Healthcare providers should emphasise dedicated family support services for paediatric trauma patients, focusing on their psychosocial needs and ensuring access to suitable resources. Paediatric nurses are a major part of this service and should contribute to future research, co-designing and implementing these improved family support services to better serve families affected by paediatric trauma.

Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn care in Australia: A mixed method study.

PURPOSE: Pediatric burn injuries are a global clinical issue causing significant morbidity. Early adjunctive negative pressure wound therapy improves re-epithelialization rates in children with burns, yet adoption in acute burn care is inconsistent. This investigation aimed to determine barriers to the implementation of adjunctive negative pressure wound therapy for the acute management of pediatric burns and co-design targeted implementation strategies. METHODS: A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes. RESULTS: Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning. CONCLUSION: Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.

The modulation of the burn wound environment by negative pressure wound therapy: Insights from the proteome.

Negative pressure wound therapy has been used to promote wound healing in a variety of settings, including as an adjunct to silver-impregnated dressings in the acute management of paediatric burns. Fluid aspirated by the negative pressure wound therapy system represents a potentially insightful research matrix for understanding the burn wound microenvironment and the intervention's biochemical mechanisms of action. The aim of this study was to characterize the proteome of wound fluid collected using negative pressure wound therapy from children with small-area thermal burns. Samples were obtained as part of a randomized controlled trial investigating the clinical efficacy of adjunctive negative pressure wound therapy. They were compared with blister fluid specimens from paediatric burn patients matched according to demographic and injury characteristics. Protein identification and quantification were performed via liquid chromatography tandem mass spectrometry and sequential window acquisition of all theoretical mass spectra data-independent acquisition. Proteins and biological pathways that were unique to or enriched in negative pressure wound therapy fluid samples were evaluated using principal components, partial least squares-discriminant, and gene ontology enrichment analyses. Eight viable samples of negative pressure wound therapy fluid were collected and analyzed with eight matched blister fluid samples. A total of 502 proteins were quantitatively profiled in the negative pressure wound therapy fluid, of which 444 (88.4%) were shared with blister fluid. Several proteins exhibited significant abundance differences between fluid types, with negative pressure wound therapy fluid showing a higher abundance of matrix metalloproteinase-9, arginase-1, low affinity immunoglobulin gamma Fc region receptor III-A, filamin-A, alpha-2-macroglobulin, and hemoglobin subunit alpha. The results lend support to the hypothesis that negative pressure wound therapy augments wound healing through the modulation of factors involved in the inflammatory response, granulation tissue synthesis, and extracellular matrix maintenance. Data are available via ProteomeXchange with identifier PXD023168.

Surgeon's practices and beliefs in Australia and New Zealand regarding the donor site wound for paediatric skin grafts.

AIM: Children's burns care in Australasia is performed by paediatric surgeons and by plastic surgeons. The aim was to determine practices regarding the donor site wound (DSW), and to explore any differences by training scheme or nature of unit (paediatric vs. mixed). METHODS: Online survey of Australasian burns surgeons. RESULTS: Forty surgeons responded. 23/40 paediatric surgeons, 23/40 worked in a stand-alone children's burns unit. All used powered dermatomes. Alginates were the most common DSW dressing. Idealised dressings favour patient factors over cost. Plastic, and mixed-practice, surgeons use a broader range of dermatome settings in children >1 year. Mixed practice surgeons use thicker settings. All surgeons see pain as a common DSW problem. Paediatric surgeons recognise itch as a problem. CONCLUSIONS: While there are differences related to training scheme and the mix of patients being treated, there is a broader commonality of practice.

Preventive intervention for trauma reactions in young injured children: results of a multi-site randomised controlled trial.

BACKGROUND: Young children are at particular risk for injury. Ten per cent to twenty-five per cent develop posttraumatic stress disorder (PTSD). However, no empirically supported preventive interventions exist. Therefore, this study evaluated the efficacy of a standardised targeted preventive intervention for PTSD in young injured children. METHODS: Injured children (1-6 years) were enrolled in a multi-site parallel-group superiority prospective randomised controlled trial (RCT) in Australia and Switzerland. Screening for PTSD risk occurred 6-8 days postaccident. Parents of children who screened 'high-risk' were randomised to a 2-session CBT-based intervention or treatment-as-usual (TAU). Primary outcomes were PTSD symptom (PTSS) severity, and secondary outcomes were PTSD diagnosis, functional impairment and behavioural difficulties at 3 and 6 months postinjury using blinded assessments. Trials were registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000325606) and ClinicalTrials.gov (NCT02088814). Trial status is complete. RESULTS: One hundred and thirty-three children screened 'high-risk' were assigned to intervention (n = 62) or TAU (n = 71). Multilevel intention-to-treat analyses revealed a significant intervention effect on PTSS severity over time (b = 60.06, 95% CI: 21.30-98.56). At 3 months, intervention children (M = 11.02, SD = 10.42, range 0-47) showed an accelerated reduction in PTSS severity scores compared to control children (M = 17.30, SD = 13.94, range 0-52; mean difference -6.97, 95% CI: -14.02 to 0.08, p adj. = .055, d = 0.51). On secondary outcomes, multilevel analyses revealed significant treatment effects for PTSD diagnosis, functional impairment and behavioural difficulties. CONCLUSIONS: This multi-site RCT provides promising preliminary evidence for the efficacy of a targeted preventive intervention for accelerating recovery from PTSS in young injured children. This has important clinical implications for the psychological support provided to young children and parents during the acute period following a single-event trauma.

Cool Running Water First Aid Decreases Skin Grafting Requirements in Pediatric Burns: A Cohort Study of Two Thousand Four Hundred Ninety-five Children.

STUDY OBJECTIVE: First-aid guidelines recommend the administration of cool running water in the early management of thermal injury. Our objective is to analyze the associations between first aid and skin-grafting requirements in children with burns. METHODS: This cohort study used a prospectively collected registry of patients managed at a tertiary children's hospital. Multivariate logistic regression models were used to evaluate the relationship between first aid and the requirement for skin grafting. Secondary outcomes included time to re-epithelialization, wound depth, hospital admission and length of stay, and operating room interventions. Adequate first aid was defined as 20 minutes of cool running water within 3 hours of injury. RESULTS: In our cohort of 2,495 children, 2,259 (90.6%) received first aid involving running water, but only 1,780 (71.3%) were given the adequate duration. A total of 236 children (9.5%) required grafting. The odds of grafting were decreased in the adequate first aid group (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4 to 0.8). The provision of adequate running water was further associated with reductions in full-thickness depth (OR 0.4; 95% CI 0.2 to 0.6), hospital admission (OR 0.7; 95% CI 0.3 to 0.9), and operating room interventions (OR 0.7; 95% CI 0.5 to 0.9), but not hospital length of stay (hazard ratio=0.9; 95% CI 0.7 to 1.2; P=.48). CONCLUSION: Burn severity and clinical outcomes improved with the administration of cool running water. Adequate first aid must be prioritized by out-of-hospital and emergency medical services in the preliminary management of pediatric burns.

Knowledge of childhood burn risks and burn first aid: Cool Runnings.

AIM: The high incidence of hot beverage scalds among young children has not changed in the past 15 years, but preventive campaigns have been scarce. A novel approach was used to engage mothers of young children in an app-based hot beverage scald prevention campaign 'Cool Runnings'. This paper provides baseline data for this randomised controlled trial (RCT). METHOD: Queensland-based mothers aged 18+ years with at least one child aged 5-12 months were recruited via social media to Cool Runnings, which is a two-group, parallel, single-blinded RCT. RESULTS: In total, 498 participants from across Queensland completed the baseline questionnaire. The most common source of burn first aid information was the internet (79%). One-third (33%) correctly identified hot beverage scalds as the leading cause of childhood burns, 43% knew the age group most at risk. While 94% reported they would cool a burn with water, only 10% reported the recommended 20min duration. After adjusting for all relevant variables, there were two independent predictors of adequate burn first aid knowledge: first aid training in the past year (OR=3.32; 95% CI 1.8 to 6.1) and smoking status (OR=0.17; 95% CI 0.04 to 0.7). CONCLUSION: In this study, mothers of young children were largely unaware how frequently hot beverage scalds occur and the age group most susceptible to them. Inadequate burn first aid knowledge is prevalent across mothers of young children; there is an urgent and compelling need to improve burn first aid knowledge in this group. Given the high incidence of hot beverages scalds in children aged 6-24 months, it is important to target future burn prevention/first aid campaigns at parents of young children. TRIAL REGISTRATION NUMBER: ACTRN12616000019404; Pre-results.

Combining Technology and Research to Prevent Scald Injuries (the Cool Runnings Intervention): Randomized Controlled Trial.

BACKGROUND: New technologies, internet accessibility, social media, and increased smartphone ownership provide new opportunities for health researchers to communicate and engage target audiences. An innovative burn prevention intervention was developed using these channels. OBJECTIVE: The aim of this study was to evaluate the efficacy of Cool Runnings, an app-based intervention to increase knowledge of childhood burn risk (specifically hot beverage scalds) and correct burn first aid among mothers of young children. METHODS: This was a 2-group, parallel, single-blinded randomized controlled trial (RCT). Participants were women aged 18 years and above, living in Queensland, Australia, with at least 1 child aged 5-12 months at time of enrollment. The primary outcome measures were change in knowledge about risk of burns and correct burn first aid assessed via 2 methods: (1) overall score and (2) categorized as adequate (score=4) versus inadequate (score<4). Efficacy of gamification techniques was also assessed. RESULTS: In total, 498 participants were recruited via social media and enrolled. At the 6-month follow-up, 244 participants completed the posttest questionnaire. Attrition rates in both groups were similar. Participants who remained in the study did not differ from those lost to follow-up on any characteristics except education level. Although similar at baseline, intervention group participants achieved significantly greater improvement in overall knowledge posttest than control group participants on both primary outcome measures (overall knowledge intervention: mean [SD] of overall knowledge 2.68 [SD 1.00] for intervention vs 2.13 [SD 1.03] for control; 20.7% [25/121] adequate in intervention vs 7.3% [2/123] in control). Consequently, the number needed to treat was 7.46. Logistic regression showed participants exposed to the highest level of disadvantage had 7.3 times higher odds of improved overall knowledge scores than participants in other levels of disadvantage. There were also significant correlations between gamification techniques and knowledge change (P<.001). In addition, odds of knowledge improvement between baseline and 6-month follow-up was higher in participants with low-moderate app activity compared with no app activity (odds ratio [OR] 8.59, 95% CI 2.9-25.02) and much higher in participants with high app activity (OR 18.26, 95% CI 7.1-46.8). CONCLUSIONS: Despite substantial loss to follow-up, this RCT demonstrates the Cool Runnings app was an effective intervention for improving knowledge about risks of hot beverage scalds and burn first aid in mothers of young children. The benefits of combining gamification elements in the intervention were also highlighted. Given the low cost and large reach of smartphone apps to deliver content to and engage with targeted populations, the results from this RCT provide important information on how smartphone apps can be used for widespread injury prevention campaigns and public health campaigns generally. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12616000019404; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369745&showOriginal=true&isReview=true (Archived by WebCite at http://www.webcitation.org/72b1E8gTW).

Incidence and characteristics of low-speed vehicle run over events in rural and remote children aged 0-14 years in Queensland: an 11 year (1999-2009) retrospective analysis.

INTRODUCTION: The main objective of this study is to describe incidence rates of low-speed vehicle run-over (LSVRO) events among children aged 0-14 years residing in Queensland from 1999 to 2009. A second objective was to describe the associated patterns of injury, with respect to gender, age group, severity, characteristics (host, vehicle and environment), and trends over time in relation to geographical remoteness. Final results are hoped to inform prevention policies. METHODS: In this statewide, retrospective, population-based study, data were collected on LSVRO events that occurred among children aged 0-14 years in Queensland from 1999 to 2009 from all relevant data sources across the continuum of care, and manually linked to obtain the most comprehensive estimate possible of the magnitude and nature of LSVRO events to date. Crude incidence rates were calculated separately for males and females, for fatal events, non-fatal events (hospital admissions and non-admissions, respectively), and for all LSVRO events, for each area of geographical remoteness (major cities, inner regional, outer regional, remote/very remote). Relative risks and 95% confidence interval were calculated, and trends over time were examined. Data on host, injury and event characteristics were also obtained to investigate whether these characteristics varied between areas of remoteness. RESULTS: Incidence rates were lowest among children (0-14 years) living in major cities (13.8/100 000/annum, with the highest recorded incidence in outer regional areas (incidence rate =42.5/100 000/annum). Incidence rates were higher for children residing outside major cities for both males and females, for every age group, for each of the 11 years of the study, and consequences of LSVRO events were worse. Young children aged 0-4 years were identified as those most at risk for these events, regardless of geographical location. Differences were observed as a function of remoteness category in relation to injury characteristics (eg injury type), and host characteristics (eg sociodemographic status), but there were no observed differences in environmental characteristics (eg time of day, day of week). Heavy vehicles such as four-wheel drives, utilities, trucks and tractors were more frequently involved in LSVRO events that occurred outside major cities. CONCLUSION: The results confirmed that children of all ages and genders residing outside of major cities in Queensland are more at risk of being involved in an LSVRO incident, and experience more severe consequences compared to children in major cities. Future research should address the specific risk factors and focus on engaging rural communities to assist in the prevention of LSVRO incidents.

Evidence-based injury prediction data for the water temperature and duration of exposure for clinically relevant deep dermal scald injuries.

Deep dermal burn injuries require extensive medical care; however, the water temperatures and durations of exposure that result in a severe scald injury are unknown. This study used a porcine burn model to investigate the time and temperature threshold for clinically relevant deep dermal injuries for both immersion (long duration) and spill/splash (short duration) scald events. Scald wounds were created on the flanks of anaesthetized juvenile large White pigs (27 kg). Acute tissue injury evaluations performed at 1 hour and days 1, 3, and 7 postburn (16 pigs) included: wound examination, biopsies, and laser Doppler imaging. Up to 20 burn combinations were tested including: 50-60 °C water for 1-10 minutes (immersion); and 60-90 °C water for 5 seconds (spill/splash). Burn conditions demonstrating mid-to-deep dermal damage histologically were followed for 21 days to assess time to reepithelialize (eight pigs). Histologically, depth of damage increased until day 3 postburn. Damage to ≥75% of the depth of dermis was associated with burns taking longer than 3 weeks to fully reepithelialize. For spill/splash (5 seconds) scalds, water at ≥75 °C showed damage to mid-dermis or deeper by day 3; however, only burns from water ≥85 °C were not reepithelialized by day 21. For immersion scalds of equivalent duration, water at 55 °C caused significantly deeper dermal damage than 50 °C (p < 0.05) at day 3. Immersion scalds that were not fully reepithelialized by day 21 included 50 °C for >10 minutes, 55 °C for 5 minutes, 60 °C for 60 seconds, and 70 °C for > 15 seconds. This research provides valuable evidence-based injury prediction data, which can be used to inform future burn injury prevention guidelines/legislation to reduce the risk of severe scald injuries and support medicolegal opinions for cases where an inflicted mechanism of injury is alleged.

Paediatric horse-related trauma.

AIM: This retrospective cohort study reported on the epidemiology of horse-related injuries for patients presenting to the only tertiary paediatric trauma hospital in Queensland. The secondary outcome was to examine the use of helmets and adult supervision. Traumatic brain injury (TBI) was examined in relation to helmet use. Morbidity and mortality were also recorded. METHODS: Included were all patients presenting with any horse-related trauma to the Royal Children's Hospital in Brisbane from January 2008 to August 2014. Data were retrospectively collected on patient demographics, hospital length of stay (LOS), mechanism of injury (MOI), safety precautions taken, diagnoses and surgical procedures performed. RESULTS: Included in the analysis were 187 incidents involving 171 patients. Most patients were aged 12-14 years (36.9%) and female (84.5%). The most common MOI were falls while riding horses (97.1%). Mild TBI (24.6%) and upper limb fractures (20.9%) were common injuries sustained. Patients who wore helmets had significantly reduced hospital LOS and severity of TBI when compared with those who did not wear helmets (P < 0.001 and P = 0.028, respectively). Morbidity was reported in 7.5% of patients. There were three deaths in Queensland. CONCLUSION: Helmet use is recommended for non-riders when handling horses, in addition to being a compulsory requirement whilst horse riding. Prompts in documentation may assist doctors to record the use of safety attire and adult supervision. This will allow future studies to further investigate these factors in relation to clinical outcomes.

Antenatal ultrasound features in fetuses with gastroschisis and its prediction in neonatal outcome.

BACKGROUND: Gastroschisis is the most common major congenital anomaly managed by paediatric surgeons. The significance of certain associated antenatal ultrasound features in determining fetal outcome is under discussion. AIM: The study aims to define if associated antenatal ultrasound features of gastroschisis are useful prognostic markers for fetal outcome. By establishing the significance of features, including extra- and intra-abdominal bowel dilatation, stomach herniation, stomach dilatation, bowel matting, growth restriction, abnormal umbilical artery (UA) Doppler ultrasounds, and abnormal amniotic fluid volume, it is hoped clinicians will have enhanced ability to counsel parents about the likely outcomes for their infant. MATERIALS AND METHODS: Retrospective analysis of ultrasound images, reports and medical records of 101 pregnancies affected by fetal gastroschisis managed by the Royal Brisbane and Women's Hospital Maternal and Fetal Medicine Department over a 13 and a half year period was performed. The presence of ultrasound features during antenatal surveillance corresponded to fetal outcome measures, including the diagnosis of postnatal complex gastroschisis, the number of operations required, length of parenteral feeding and length of stay in neonatal intensive care. RESULTS: The only statistically significant predictor of complex cases of gastroschisis was extra-abdominal bowel dilatation. Although a statistically significant feature, approximately three-quarters (44/59) of all infants with gastroschisis with associated extra-abdominal bowel dilatation had simple gastroschisis. CONCLUSIONS: Extra-abdominal bowel dilatation is a statistically significant marker of complex gastroschisis and associated morbidity. Its presence in infants who had uncomplicated outcomes, suggests that clinically, its usefulness in antenatal counselling is still debatable.

Giant congenital melanocytic nevi and malignant transformation: a case for early radical intervention.

The purpose of this paper is to highlight the risk of early malignant transformation in infants with giant congenital melanocytic nevi (GN) and demonstrate the potential for earlier intervention with aggressive surgery. We describe the case of a child born with a GN who developed a metastatic melanoma early in life, despite early commencement of resection of the nevus. This is contrasted against a second case of a child in which a more radical management was conducted. Despite early commencement of serial resection of the GN, the first child in this series died of metastatic melanoma prior to complete excision of the nevus. With the second child, radical excision combined with the use of Integra™ and negative pressure wound therapy allowed total removal of the GN within the first 6 months of life.

A Prospective Randomized Controlled Trial of Nonpharmacological Pain Management During Intravenous Cannulation in a Pediatric Emergency Department.

OBJECTIVES: Intravenous (IV) cannulation is commonly performed in pediatric emergency departments (EDs). The busy ED environment is often not conducive to conventional nonpharmacological pain management. This study assessed the use of Ditto (Diversionary Therapy Technologies, Brisbane, Australia), a handheld electronic device which provides procedural preparation and distraction, as a means of managing pain and distress during IV cannulation performed in the pediatric ED. METHODS: A randomized controlled trial with 98 participants, aged 3 to 12 years, was conducted in a pediatric ED. Participants were recruited and randomized into 5 intervention groups as follows: (1) Standard Distraction, (2) PlayStation Portable Distraction, (3) Ditto Distraction, (4) Ditto Procedural Preparation, and (5) Ditto Preparation and Distraction. Children's pain and distress levels were assessed via self-reports and observational reports by caregivers and nursing staff across the following 3 time points: (1) before, (2) during, and (3) after IV cannulation. RESULTS: Caregivers and nursing staff reported significantly reduced pain and distress levels in children accessing the combined preparation and distraction Ditto protocol, as compared to standard distraction (P ≤ 0.01). This intervention also saw the greatest reduction in pain and distress as reported by the child. CONCLUSIONS: Caregiver reports indicate that using the combined Ditto protocol was most effective in reducing children's pain experiences while undergoing IV cannulation in the ED. The use of Ditto offers a promising opportunity to negotiate barriers to the provision of nonpharmacological approaches encountered in the busy ED environment, and provide nonpharmacological pain-management interventions in pediatric EDs.

Cost-Effectiveness of a Nonpharmacological Intervention in Pediatric Burn Care.

OBJECTIVE: To report the cost-effectiveness of a tailored handheld computerized procedural preparation and distraction intervention (Ditto) used during pediatric burn wound care in comparison to standard practice. METHODS: An economic evaluation was performed alongside a randomized controlled trial of 75 children aged 4 to 13 years who presented with a burn to the Royal Children's Hospital, Brisbane, Australia. Participants were randomized to either the Ditto intervention (n = 35) or standard practice (n = 40) to measure the effect of the intervention on days taken for burns to re-epithelialize. Direct medical, direct nonmedical, and indirect cost data during burn re-epithelialization were extracted from the randomized controlled trial data and combined with scar management cost data obtained retrospectively from medical charts. Nonparametric bootstrapping was used to estimate statistical uncertainty in cost and effect differences and cost-effectiveness ratios. RESULTS: On average, the Ditto intervention reduced the time to re-epithelialize by 3 days at AU$194 less cost for each patient compared with standard practice. The incremental cost-effectiveness plane showed that 78% of the simulated results were within the more effective and less costly quadrant and 22% were in the more effective and more costly quadrant, suggesting a 78% probability that the Ditto intervention dominates standard practice (i.e., cost-saving). At a willingness-to-pay threshold of AU$120, there is a 95% probability that the Ditto intervention is cost-effective (or cost-saving) against standard care. CONCLUSIONS: This economic evaluation showed the Ditto intervention to be highly cost-effective against standard practice at a minimal cost for the significant benefits gained, supporting the implementation of the Ditto intervention during burn wound care.

Interventions associated with drowning prevention in children and adolescents: systematic literature review.

INTRODUCTION: Drowning remains a leading cause of preventable death in children across the world. This systematic review identifies and critically analyses studies of interventions designed to reduce fatal and non-fatal drowning events among children and adolescents or reduce the injury severity incurred by such incidents. METHODS: A systematic search was undertaken on literature published between 1980 and 2010 relating to interventions around fatal and non-fatal drowning prevention in children and adolescents 0-19 years of age. Search methods and protocols developed and used by the WHO Global Burden of Disease Injury Expert Group were applied. RESULTS: Seven studies fulfilled the inclusion criteria. Interventions were categorised into three themes of Education, Swimming Lessons and Water Safety, and Pool Fencing. All are possible effective strategies to prevent children from drowning, particularly young children aged 2-4 years, but very little evidence exists for interventions to reduce drowning in older children and adolescents. There were methodological limitations associated with all studies, so results need to be interpreted in the context of these. CONCLUSIONS: Relatively few studies employ rigorous methods and high levels of evidence to assess the impact of interventions designed to reduce drowning. Studies are also limited by lack of consistency in measured outcomes and drowning terminology. Further work is required to establish efficacy of interventions for older children and adolescents. There is a need for rigorous, well-designed studies that use consistent terminology to demonstrate effective prevention solutions.

Drowning in Aboriginal and Torres Strait Islander children and adolescents in Queensland (Australia).

BACKGROUND: Aboriginal and Torres Strait Islander (Indigenous) children are at greater risk of drowning than other children, however little is known about drowning of Indigenous children. This study identifies the previously unpublished incidence and characteristics of fatal and non-fatal drowning in Indigenous children and adolescents. METHODS: Retrospective data (Jan 2002-Dec 2008) on fatal and non-fatal drowning events among Indigenous and Non-Indigenous Queensland residents aged 0-19 years were obtained from multiple sources across the continuum of care (pre-hospital; emergency department; admitted patients; fatality) and manually linked. Crude incidence rates for fatal and non-fatal events were calculated using population data from the Australian Bureau of Statistics. RESULTS: There were 87 (6.7 % of all events) fatal and non-fatal (combined) Indigenous drowning events yielding a crude Incidence Rate of 16.8/100,000/annum. This is 44 % higher than the incidence rate for Non-Indigenous children. For every fatality, nine others were rescued and sought medical treatment (average 12 per year). There were no significant changes in Indigenous drowning incidents over the study period. Drowning rates were higher for Indigenous females than males. Overall incidence was higher among Indigenous children and adolescents than Non-Indigenous children for every calendar year and age-group (0-4 years; 5-9 years; 10-14 years) except those aged 15-19 years where no drowning events were recorded for males. Location of drowning sites was similar in both populations 0-19 years, however there were slight differences in frequency at each of the locations. The three leading drowning locations for Indigenous 0-19 years olds were pool (48 %), bath (21 %) and natural water (16 %), and for non-Indigenous 0-19 years the leading locations were pool (66 %), natural water (13 %) and bath (12 %) (p < .01). Except for pool drowning, Indigenous drowning occurred more often in geographic areas of relative disadvantage. Among Indigenous children drowning location varied with age (p < .001). Most frequent locations by age were: <1 year bath (71 %); 1-4 years pools (80 %); 5-9 years pools (75 %) and 10-19 years beach/ocean (36 %). Severity of event differed statistically with Indigenous status and by remoteness with all fatal drowning events occurring in Regional or Remote areas, and none in Major Cities. CONCLUSIONS: For every fatal drowning among Indigenous children in Queensland aged 0-19 years there are nine non-fatal events. This previously unreported survival ratio of 9:1 indicates the non-fatal injury burden in Indigenous children aged 0-19 years. Although higher Indigenous drowning rates prevailed, no significant changes over time are concerning. Equally the apparent over-representation of Indigenous adolescent females should be weighed against the absence of drowning among Indigenous male adolescents in the same age group in consecutive years of the study. Further investigation around behaviour and culture may highlight protective factors. Culturally specific prevention strategies which take into account social and demographic indicators identified in this study should be delivered to carers and peers of vulnerable age groups who frequent specific locations. Females, swimming ability, supervision and the young are areas which need to be incorporated into Indigenous-specific interventions for drowning prevention.

Characteristics of low-speed vehicle run-over events in children: an 11-year review.

OBJECTIVES: The purpose of this study was to investigate the characteristics associated with fatal and non-fatal low-speed vehicle run-over (LSVRO) events in relation to person, incident and injury characteristics, in order to identify appropriate points for intervention and injury prevention. METHODS: Data on all known LSVRO events in Queensland, Australia, over 11 calendar years (1999-2009) were extracted from five different databases representing the continuum of care (prehospital to fatality) and manually linked. Descriptive and multivariate analyses were used to analyse the sample characteristics in relation to demographics, health service usage, outcomes, incident characteristics, and injury characteristics. RESULTS: Of the 1641 LSVRO incidents, 98.4% (n=1615) were non-fatal, and 1.6% were fatal (n=26). Over half the children required admission to hospital (56%, n=921); mean length of stay was 3.4 days. Younger children aged 0-4 years were more frequently injured, and experienced more serious injuries with worse outcomes. Patterns of injury (injury type and severity), injury characteristics (eg, time of injury, vehicle type, driver of vehicle, incident location), and demographic characteristics (such as socioeconomic status, indigenous status, remoteness), varied according to age group. Almost half (45.6%; n=737) the events occurred outside major cities, and approximately 10% of events involved indigenous children. Parents were most commonly the vehicle drivers in fatal incidents. While larger vehicles such as four-wheel drives (4WD) were most frequently involved in LSVRO events resulting in fatalities, cars were most frequently involved in non-fatal events. CONCLUSIONS: This is the first study, to the authors' knowledge, to analyse the characteristics of fatal and non-fatal LSVRO events in children aged 0-15 years on a state-wide basis. Characteristics of LSVRO events varied with age, thus age-specific interventions are required. Children living outside major cities, and indigenous children, were over-represented in these data. Further research is required to identify the burden of injury in these groups.

Incidence of paediatric fatal and non-fatal low speed vehicle run over events in Queensland, Australia: eleven year analysis.

BACKGROUND: The purpose of this study was to estimate the incidence of fatal and non-fatal Low Speed Vehicle Run Over (LSVRO) events among children aged 0-15 years in Queensland, Australia, at a population level. METHODS: Fatal and non-fatal LSVRO events that occurred in children resident in Queensland over eleven calendar years (1999-2009) were identified using ICD codes, text description, word searches and medical notes clarification, obtained from five health related data bases across the continuum of care (pre-hospital to fatality). Data were manually linked. Population data provided by the Australian Bureau of Statistics were used to calculate crude incidence rates for fatal and non-fatal LSVRO events. RESULTS: There were 1611 LSVROs between 1999-2009 (IR=16.87/100,000/annum). Incidence of non-fatal events (IR=16.60/100,000/annum) was 61.5 times higher than fatal events (IR=0.27/100,000/annum). LSVRO events were more common in boys (IR=20.97/100,000/annum) than girls (IR=12.55/100,000/annum), and among younger children aged 0-4 years (IR=21.45/100000/annum; 39% or all events) than older children (5-9 years: IR=16.47/100,000/annum; 10-15 years IR=13.59/100,000/annum). A total of 896 (56.8%) children were admitted to hospital for 24 hours of more following an LSVRO event (IR=9.38/100,000/annum). Total LSVROs increased from 1999 (IR=14.79/100,000) to 2009 (IR=18.56/100,000), but not significantly. Over the 11 year period, there was a slight (non -significant) increase in fatalities (IR=0.37-0.42/100,000/annum); a significant decrease in admissions (IR=12.39-5.36/100,000/annum), and significant increase in non-admissions (IR=2.02-12.77/100,000/annum). Trends over time differed by age, gender and severity. CONCLUSION: This is the most comprehensive, population-based epidemiological study on fatal and non-fatal LSVRO events to date. Results from this study indicate that LSVROs incur a substantial burden. Further research is required on the characteristics and risk factors associated with these events, in order to adequately inform injury prevention. Strategies are urgently required in order to prevent these events, especially among young children aged 0-4 years.