Regional trauma patterns during the COVID-19 pandemic.

BACKGROUND: The current pandemic has impacted heavily on health systems, making unprecedented demands on resources, and forcing reconfiguration of services. Trauma and orthopaedic units have cancelled elective surgery, moved to virtual based clinics and have been forced to reconsider the provision of trauma. Our national elective orthopaedic centre has been re-designated as a trauma centre to allow tertiary centres re-direct triaged trauma. Many governments, as part of their COVID-19 management, have significantly restricted activity of the general population. We proposed that trauma patterns would change alongside these changes and maintaining existing standards of treatment would require dedicated planning and structures. METHODS: Referrals over a six-week period (March 15th to April 30th) were retrospectively reviewed. Data was collected directly from our referral database and a database populated. Analysis was performed to assess trauma volume, aetiology, and changes in trends. RESULTS: There were one hundred and fifty-nine referrals from three individual hospitals within the timeframe. Mean age of patient's referred was 55 (range17-92). Males accounted for 45% of cases. F&A injuries were the most common (32%), followed by H&W (28%), UL (17%), H&F (16%) and K&T (7%). In comparison to the corresponding time-period in 2019, trauma theatre activity reduced by almost one half (45.3%) CONCLUSION: The majority of trauma referred to our Dublin based centre during COVID-19 related population restrictions appears to be home based and trauma volumes have decreased. Significant reductions are apparent in work and sport related injuries suggestive of compliance with COVID-19 activity guidelines. Maintaining existing standards of treatment requires dedicated planning.

Mechanism and epidemiology of paediatric finger injuries at Prince of Wales Hospital in Hong Kong.

OBJECTIVES: To determine the mechanism and epidemiology of paediatric finger injuries in Hong Kong during 2003-2005 and 2010-2012. DESIGN: Comparison of two case series. SETTING: University-affiliated teaching hospital, Hong Kong. PATIENTS: This was a retrospective study of two cohorts of children (age, 0 to 16 years) admitted to Prince of Wales Hospital with finger injuries during two 3-year periods. Comparisons were made between the two groups for age, involved finger(s), mechanism of injury, treatment, and outcome. Telephone interviews were conducted for parents of children who sustained a crushing injury of finger(s) by door. RESULTS: A total of 137 children (group A) were admitted from 1 January 2003 to 31 December 2005, and 109 children (group B) were admitted from 1 January 2010 to 31 December 2012. Overall, the mechanisms and epidemiology of paediatric finger injuries were similar between groups A and B. Most finger injuries occurred in children younger than 5 years (group A, 56%; group B, 76%) and in their home (group A, 67%; group B, 69%). The most common mechanism was crushing injury of finger by door (group A, 33%; group B, 41%) on the hinge side (group A, 63%; group B, 64%). The right hand was most commonly involved. The door was often closed by another child (group A, 37%; group B, 23%) and the injury often occurred in the presence of adults (group A, 60%; group B, 56%). Nailbed injury was the commonest type of injury (group A, 31%; group B, 39%). Fractures occurred in 24% and 23% in groups A and B, respectively. Traumatic finger amputation requiring replantation or revascularisation occurred in 12% and 10% in groups A and B, respectively. CONCLUSIONS: Crushing injury of finger by door is the most common mechanism of injury among younger children and accounts for a large number of hospital admissions. Serious injuries, such as amputations leading to considerable morbidity, can result. Crushing injury of finger by door occurs even in the presence of adults. There has been no significant decrease in the number of crushing injuries of finger by door in the 5 years between the two studies despite easily available and affordable preventive measures. It is the authors' view that measures aimed at promoting public awareness and education, and safety precautions are needed.

Craniofacial injuries from television tip-over.

BACKGROUND: Craniofacial injuries caused by television (TV) sets falling on small children are becoming a frequent event seen in emergency departments. Injuries occur primarily to the head and neck regions and range from contusions to intracerebral hemorrhage, which at times can be fatal. OBJECTIVES: Epidemiology and potential complications from TV tip-over injuries are presented. CASE: Three cases of craniofacial injuries are described from blunt trauma incurred from TV tip-over events. CONCLUSIONS: It is important to teach parents about the dangers of the new large slim TV sets and the occurrence of injuries when these are not secured properly or placed away from the reach of the child.

Influence of agents and mechanisms of injury on anatomical burn locations in children <5 years old with a scald.

OBJECTIVE: To demonstrate how the mechanism and agent of injury can influence the anatomical location of a scald. DESIGN: Prospective multicentre cross-sectional study. SETTING: 20 hospital sites across England and Wales including emergency departments, minor injury units and regional burns units. PATIENTS: Children aged 5 years and younger who attended hospital with a scald. MAIN OUTCOME MEASURES: Primary outcome: a descriptive analysis of the mechanism, agent and anatomical location of accidental scalds. Secondary outcome: a comparison of these factors between children with and without child protection (CP) referral. RESULTS: Of 1041 cases of accidental scalds, the most common narrative leading to this injury was a cup or mug of hot beverage being pulled down and scalding the head or trunk (132/1041; 32.9% of cases). Accidental scalds in baths/showers were rare (1.4% of cases). Accidental immersion injuries were mainly distributed on hands and feet (76.7%). There were differences in the presentation between children with accidental scalds and the 103 who were referred for CP assessment; children with scalds caused by hot water in baths/showers were more likely to get referred for CP assessment (p<0.0001), as were those with symmetrically distributed (p<0.0001) and unwitnessed (p=0.007) scalds. CONCLUSIONS: An understanding of the distributions of scalds and its relationship to different mechanisms of injury and causative agents will help clinicians assess scalds in young children, particularly those new to the emergency department who may be unfamiliar with expected scald patterns or with the importance of using appropriate terminology when describing scalds.

Association of Increased Safe Household Firearm Storage With Firearm Suicide and Unintentional Death Among US Youths.

Importance: Firearm injury is the second leading cause of death in the United States for children and young adults. The risk of unintentional and self-inflicted firearm injury is lower when all household firearms are stored locked. Objective: To estimate the reduction in youth firearm suicide and unintentional firearm mortality that would result if more adults in households with youth stored household guns locked. Design, Setting, and Participants: A modeling study using Monte Carlo simulation of youth firearm suicide and unintentional firearm mortality in 2015. A simulated US national sample of firearm-owning households where youth reside was derived using nationally representative rates of firearm ownership and storage and population data from the US Census to test a hypothetical intervention, safe storage of firearms in the home, on youth accidental death and suicide. Data analyses were performed from August 3, 2017, to January 9, 2018. Exposures: Observed and counterfactual household-level safe firearm storage (ie, storing all firearms locked), the latter estimated by varying the probability that a hypothetical intervention increased safe firearm storage beyond that observed in 2015. Main Outcomes and Measures: Observed and counterfactual counts of firearm suicide and unintentional firearm mortality among youth aged 0 to 19 years, the latter estimated by incorporating an empirically based estimate of the mortality benefit expected from additional safe storage (beyond that observed in 2015). Results: A hypothetical intervention among firearm owners residing with children with a 20% probability of motivating these owners to lock all household firearms was significantly associated with a projected reduction in youth firearm mortality (median incidence rate ratio = 0.90; interquartile range, 0.87-0.93). In the overall model, 6% to 32% of deaths were estimated to be preventable depending on the probability of motivating safer storage. Conclusions and Relevance: Results of this modeling study suggest that a relatively modest uptake of a straightforward safe storage recommendation-lock all household firearms-could result in meaningful reductions in firearm suicide and unintentional firearm fatalities among youth. Approaches that will motivate additional parents to store firearms safely are needed.

Causes and characteristics of injury in paediatric major trauma and trends over time.

OBJECTIVE: To investigate causes, characteristics and temporal trends of paediatric major trauma. DESIGN: A retrospective review of paediatric major trauma (<16 years of age) was conducted using data from the population-based Victorian State Trauma Registry from 2006 to 2016. Temporal trends in population-based incidence rates were evaluated using Poisson regression. SETTING: Victoria, Australia. RESULTS: Of the 1511 paediatric major trauma patients, most were male (68%), had sustained blunt trauma (87%) and had injuries resulting from unintentional events (91%). Motor vehicle collisions (15%), struck by/collisions with an object or person (14%) and low falls (13%) were the leading mechanisms of injury. Compared with those aged 1-15 years, a greater proportion of non-accidental injury events were observed in infants (<1 year) (32%). For all patients, isolated head injury (29%), other/multitrauma (27%) and head and other injuries (24%) were the most prevalent injury groups. The incidence of paediatric major trauma did not change over the study period (incidence rate ratio (IRR)=0.97; 95% CI 0.92 to 1.02; p=0.27), which was consistent in all age groups. There was a 3% per year decline in the incidence of transport events (IRR=0.97; 95% CI 0.94 to 0.99; p=0.005), but no change in the incidence of falls of any type (IRR=1.01; 95% CI 0.97 to 1.04; p=0.70) or other events (IRR=1.00; 95% CI 0.97 to 1.02; p=0.79). The overall in-hospital mortality rate was 7.2%. CONCLUSIONS: This study demonstrated no change in the incidence of paediatric major trauma over an 11-year period. Given the potential lifelong impacts of serious injury in children, additional investment and coordination of injury prevention activities are required.

Television Tip-Over Related Head Injuries: A Particular Type of Child Neglect.

AIM: To identify, report, and raise awareness of the risk factors for television (TV) tip-over. MATERIAL AND METHODS: In total, 86 children who were brought to the emergency service and hospitalized at the neurosurgery clinic because of TV tip-over-related head trauma between August 2011 and August 2016 were included in the study. RESULTS: The 86 patients consisted of 47 males and 39 females. The mean age was 38.8 ± 19.5 (9â€"102) months. Low education level of the mother was a risk factor for this type of accident (p=0.009). In all the patients, injuries were caused by the tip-over of a cathode ray tube (CRT) TV. In 66 patients (77%), only the TV tipped over onto the child, whereas in 20 cases (23%), the TV tipped over with the TV stand. The TVs were not fixed to the stand or the wall in any of the homes. According to computerized tomography findings, 12 patients (13.9%) had intracranial hemorrhage and 19 patients (22%) had skull fractures. Five patients underwent neurosurgical intervention. Eighty-four patients (97.6%) were discharged with a GCS level of 15. One patient was discharged with a GCS level of 9/15 with a tracheostomy and nasogastric tube. One patient died. CONCLUSION: TV tip-over causes physical injury that may result in serious neurological damage and even death. It is becoming more common and may be prevented by taking simple precautions.

Population-based case-control study of risk factors for unintentional mortality from carbon monoxide poisoning in Taiwan.

We carried out a population-based case-control study to identify people in Taiwan who are at increased risk of unintentional mortality from carbon monoxide (CO) poisoning (ICD-9 CM: 986 or E868). The study included all 439 deaths from unintentional CO poisoning registered in Taiwan's National Mortality Registry during 1997-2003, whereas 878 control subjects were randomly selected, with a control/case ratio of 2, from all deceased individuals from other causes during the same period. The annual mortality rate of CO poisoning significantly increased in Taiwan over the 7-yr period from 1.6 to 3.5 per 10(6) person-years. Thirty-six percent (n = 160) of the deaths occurred at home, and 21% (n = 93) were registered as in-hospital mortalities. A multivariate logistic regression analysis indicated that married people had a significantly reduced mortality odds ratio (MOR) of 0.50 (95% CI = 0.30-0.82) compared to single individuals. Additionally, residents of northern Taiwan (which is relatively urban) had a notably higher MOR of CO poisoning (MOR = 3.44, 95% CI = 1.40-8.44) than people residing in eastern Taiwan (which is relatively rural). Moreover, the MOR peaked in cold periods. A daily maximum temperature of < 18.4 degrees C was associated with a 2.15-fold increase in the MOR compared to a daily maximum temperature of > or = 27.1 degrees C. This study demonstrates an alarming increase in the unintentional death rate from CO poisoning in Taiwan between 1997 and 2003. Certain demographic and geographic characteristics were significant predictors for CO poisoning, suggesting a need for preventive strategies targeting these high-risk populations. Precautions should also be taken during periods of low temperatures.

Risk factors and geographical heterogeneity in unintentional home injuries incidence rate: new evidence based on Multiscopo survey in Italy.

Home injuries together, with road traffic accidents, are estimated to be the third cause of death in Italy (Arokiasamy and Krishnan 1994). However, as in most other countries, in Italy there is a lack of information on home injuries and on how differences in geographical patterns may influence the scope and magnitude of this phenomenon. By analysing a multipurpose large survey (Multiscopo) carried out annually, geographical heterogeneity in home injuries incidence rate can be investigated. The aim of this study is the assessment of possible differences in geographical patterns among the Italian regions making use of a re-analysis of Multiscopo home injury data. The study results show that Italian regions differ greatly in the number of home injuries. The geographical heterogeneity may be due to the unemployment rate and the incidence of poverty that is greater in the Southern and Insular regions than in other zones. Other socio-economic variables such as alcohol consumption can increase the risk of injury in the home. To prevent them it could be useful to organize campaigns aimed at increasing the awareness among people about this problem.

Outcomes from television sets toppling onto toddlers.

OBJECTIVE: To assess outcomes of trauma caused by television sets falling onto children. METHODS: Retrospective review of medical charts of 183 children aged 7 years and younger hospitalized for injuries caused by falling television sets. Descriptive statistics were applied. DATA SOURCES: Phase 2 (1988-1995) and phase 3 (1995-1999) of the National Pediatric Trauma Registry. OUTCOME MEASURES: Demographics, injured body region, injury severity measured by the Injury Severity Score, length of hospital stay, admission to the intensive care unit, surgical intervention, in-hospital death rate, disability resulting from the injury, and disposition at discharge from the hospital. RESULTS: The sample population represented 0.5% of all National Pediatric Trauma Registry admissions in this age group. More than half (57.4%) of the children were boys, and more than three quarters (76.0%) were 1 to 4 years of age. In most cases (95.1%), the injury occurred at home. Most children (68.3%) sustained head injury, and 43.7% sustained injuries to multiple body regions. More than a quarter (28.4%) of the children had injuries of moderate to critical severity (Injury Severity Score, 10-75), about a third (31.1%) required admission to the intensive care unit, and 20.2% needed 1 or more surgical interventions. The average length of hospitalization was 3.3 days. Five children (2.7%) died, and 48 (26.2%) developed functional limitations, which required discharge to a rehabilitation facility in 5 cases. Most (94.0%) of the children returned to their home. The proportion of television set-related injuries increased more than 100% during the study period. CONCLUSIONS: The injuries reported are not trivial. Not only did they require hospitalization, but they also resulted in an in-hospital death rate comparable to the 2.5% rate observed in children of the same age group injured by unintentional blunt trauma, inclusive of motor vehicle traffic-related injuries. Since virtually all American children are at risk for such injury, we suggest that television set designs be modified to reduce the incidence and severity of the problem.

Household oven doors: a burn hazard in children.

Contact with hot oven doors is an important cause of burns in pediatric patients. These burns are of particular concern because of their frequent localization to the hands, with the resulting negative implications for financial cost, long-term cosmesis, and hand function. A 5-year review of pediatric oven door burn cases admitted to a burn referral center was conducted. Of the 14 cases identified, the median age was 12 months. The median total body surface area (TBSA) was 1.75% (range, 0.5%-4.5%). Twelve of 14 cases involved 1 or both hands. The median length of hospital stay was 10 days. In 7 cases, burns were sustained from contact to an external surface of the oven. Based on the results obtained, we propose several prevention strategies.

Drug-related emergencies and drug-related deaths in Vienna, 1995-1997.

The demographics of drug-related emergencies and drug-related deaths that occurred in Vienna between January 1st, 1995 and December 31st, 1997 were compared to investigate whether they represent two different subgroups of the drug-taking community. Analysis indicated that drug-related emergencies were significantly younger and that the proportion of females was higher than amongst the fatalities. In addition, emergencies were more likely than fatalities to occur in private residences than public places. No significant association between the number of contacts with the Vienna Ambulance Service and the fatal outcome of drug use could be substantiated. The results of this study indicate that drug-related emergencies and drug-related deaths represent two different subpopulations of the drug-taking community. Therefore, different strategies of prevention are considered.

Suspected paediatric pesticide poisoning in the UK. I--Home Accident Surveillance System 1982-1988.

1. Between 1982 and 1988, 239,350 children under 10 years old attended 20 A & E Departments in England and Wales (22 departments throughout the UK in 1988) as a result of a home accident. 15,144 of 239,350 were suspected cases of poisoning and 514 attendances involved pesticides. 2. 501 of 514 children who attended hospital were under 6 years old and 41% were thought to have ingested a rodenticide, 37% an insecticide or other animal poison, 13% an herbicide or fungicide and 9% other pesticides. 3. Overall 189 of 514 children were admitted to hospital and of these 189 cases 35% were discharged home in less than one day; 94% left hospital within 2 days. 4. Using these data we estimate that over the period of study approximately 1,850 children annually attended an Accident and Emergency Department in the UK with suspected pesticide poisoning and that some 450 were admitted to hospital. However, the morbidity from this cause is low and no deaths from pesticide poisoning have been reported in children in England and Wales for more than two decades.

Suspected paediatric pesticide poisoning in the UK. II--Home Accident Surveillance System 1989-1991.

1. Between 1989 and 1991, 121,708 children less than 10 years old attended 22 Accident and Emergency (A & E) Departments in the UK as a result of an accident at home; 6,478 of these were cases of suspected poisoning. 2. Two hundred and fifty (124 boys and 126 girls) of 6,478 cases involved pesticides. Forty two per cent of these children were thought to have been poisoned by rodenticides, 33% by a different animal poison, 13% by an herbicide or fungicide, 7% by creosote and 5% by mothballs; a pattern similar to that observed in previous years. 3. Fifty-seven of 250 children (23%) were admitted to hospital. The proportion of children admitted to hospital between 1989 and 1991 is smaller than that observed between 1982-1988 (37%). Forty-six per cent of children were discharged home within one day and 95% within 2 days, whereas between 1982 and 1988 only 35% of children were discharged within one day. No child died during the study confirming the low morbidity. 4. Using these data we estimate that between 1989 and 1991 approximately 1,500 children annually attended an A & E Department in the UK with a diagnosis of suspected pesticide poisoning and that some 350 children were admitted each year.

Accidents involving adults in the home environment in Nairobi, Kenya.

Hospital records covering the period between 1986 and 1990 obtained from 10 major city hospitals and 12 City Council Health clinics were reviewed and information on age, sex, occupation, type and cause of injury and its management was extracted. Also extracted was information on outcome of treatment. This paper deals only with information related to persons aged 18 years and above. The results show that out of 9648 hospital records reviewed, 48% were adult cases, with a male to female ratio of 1.5:1. Age group 18-35 years constituted more than 70% of all the cases, declining markedly with increasing age. The slums and low income group residential areas contributed 63% of the cases. The main types of injuries attended to were open wounds (34%), burns (13%), swellings (7%), lacerations and bruises (6%), bites and limb injuries (5%), respectively. The results show that there is a clear case for a community operational research project with a strong accident prevention component.

[Fatal electric arc accidents due to high voltage]. / Tödliche Störlichtbogenunfälle im Hochspannungsbereich.

The frequency of electric arc accidents has been successfully reduced owing to preventive measures taken by the professional association. However, the risk of accidents has continued to exist in private setting. Three fatal electric arc accidents caused by high voltage are reported with reference to the autopsy findings.

[Scalding among children caused by electric kettles. An increasing problem]. / Skoldninger hos børn forårsaget af el-kedler. Et stigende problem.

The object of this work is briefly to draw attention to a new type of accident as the cause of scalding in children. The increasing use of electric kettles has resulted in an increased number of scalding accidents caused by these kettles. Within a period of six months, eight children under the age of five years were treated in the Department for Burns, Hvidovre Hospital on account of overturned electric kettles, a form of accident which had not previously been observed in this department. All of the children had pulled the cable. Seven out of eight children were admitted to hospital and transplantations proved necessary in three children.