Demographic and injury trends for car crash casualties hospitalized in Level I Trauma centers over two decades: data from the National Trauma Registry.

BACKGROUND: During the past two decades, there have been many changes in automotive and medical technologies, road infrastructure, trauma systems, and demographic changes which may have influenced injury outcomes. The aim of this study was to examine injury trends among traffic casualties, specifically private car occupants, hospitalized in Level I Trauma Centers (TC). METHODS: A retrospective cohort study was performed based on data from the Israel National Trauma Registry. The data included occupants of private cars hospitalized in all six Level I TC due to a traffic collision related injury between January 1, 1998 and December 31, 2019. Demographic, injury and hospitalization characteristics and in-hospital mortality were analyzed. Chi-squared (X2) test, multivariable logistic regression models and Spearman's rank correlation were used to analyze injury data and trends. RESULTS: During the study period, 21,173 private car occupants (14,078 drivers, 4,527 front passengers, and 2,568 rear passengers) were hospitalized due to a traffic crash. The percentage of females hospitalized due to a car crash increased from 37.7% in 1998 to 53.7% in 2019. Over a twofold increase in hospitalizations among older adult drivers (ages 65+) was observed, from 6.5% in 1998 to 15.7% in 2018 and 12.6% in 2019. While no increase was observed for severe traumatic brain injury, a statistically significant increase in severe abdominal and thoracic injuries was observed among the non-Jewish population along with a constant decrease in in-hospital mortality. CONCLUSIONS: This study provides interesting findings regarding injury and demographic trends among car occupants during the past two decades. Mortality among private car occupant casualties decreased during the study period, however an increase in serious abdominal and thoracic injuries was identified. The results should be used to design and implement policies and interventions for reducing injury and disability among car occupants.

Dental and maxillofacial injuries associated with domestic violence against women in Israel: A report for 2011-2021.

BACKGROUND/AIM: The WHO, in its 2002 report, indicated the dramatic worldwide increase in the incidence of intentional injuries affecting people of all ages and both sexes, but especially children, women, and the elderly. The aim of this study was to analyze dental and maxillofacial injuries associated with domestic violence against women in Israel between the years 2011-2021. METHODS: This was a retrospective cohort study based on data from the Israeli National Trauma Registry (INTR). The INTR provides comprehensive data on hospitalized patients from all six Level I trauma centers (TC) and 15 of the 20 Level II TCs in Israel. Women, ages 14 and older, injured and hospitalized due to domestic violence between 2011 and 2021 were identified. RESULTS: Between 2011 and 2021, there were 1818 cases of women ages 14 + that were hospitalized due to violence, excluding terror, occupational trauma, and attempted suicide. Out of these injuries, 753 cases were attributed to domestic violence, 537 were defined as non-domestic violence and 528 were a result of a brawl/fight. Of the domestic violence cases, 5% (38) exhibited maxillofacial injuries compared to the non-domestic violence cases where 6.2% (33) exhibited maxillofacial injuries and the brawl group where 5.7% (30) exhibited maxillofacial injuries. The most injured areas in domestic violence cases were the maxilla followed by the zygomatic bone and the mandible. Almost half of the domestic violence cases (47.7%) required surgical intervention during their hospitalization. The spouse was the perpetrator responsible for the domestic violence in the majority of the cases. CONCLUSIONS: Dental professionals might be able, in some cases, to identify and report domestic violence signs and thus, better understanding of the specific characteristics of domestic violence related to traumatic injuries is important.

Outcomes of basic versus advanced prehospital life support in severe pediatric trauma.

OBJECTIVE: The role of basic life support (BLS) vs. advanced life support (ALS) in pediatric trauma is controversial. Although ALS is widely accepted as the gold standard, previous studies have found no advantage of ALS over BLS care in adult trauma. The objective of this study was to evaluate whether ALS transport confers a survival advantage over BLS among severely injured children. METHODS: A retrospective cohort study of data included in the Israeli National Trauma Registry from January 1, 2011, through December 31, 2020 was conducted. All the severely injured children (age < 18 years and injury severity score [ISS] ≥16) were included. Patient survival by mode of transport was analyzed using logistic regression. RESULTS: Of 3167 patients included in the study, 65.1% were transported by ALS and 34.9% by BLS. Significantly more patients transported by ALS had ISS ≥25 as well as abnormal vital signs at admission. The ALS and BLS cohorts were comparable in age, gender, mechanism of injury, and prehospital time. Children transported by ALS had higher in-hospital mortality (9.2% vs. 0.9%, p < 0.001). Following risk adjustment, patients transported by ALS teams were significantly more likely to die than patients transported by BLS (adjusted OR 2.27, 95% CI 1.05-5.41, p = 0.04). Patients with ISS ≥50 had comparable mortality rates in both groups (45.9% vs. 55.6%, p = 0.837) while patients with GCS <9 transported by ALS had higher mortality (25.9% vs. 11.5%, p = 0.019). Admission to a level II trauma center vs. a level I hospital was also associated with increased mortality (adjusted OR 2.78 (95% CI 1.75-4.55, p < 0.001). CONCLUSIONS: Among severely injured children, prehospital ALS care was not associated with lower mortality rates relative to BLS care. Because of potential confounding by severity in this retrospective analysis, further studies are warranted to validate these results.

Do direct admissions to trauma centers have a survival benefit compared to inter-hospital transfers in severe trauma?

PURPOSE: To compare mortality among severe and critically injured patients who were directly admitted (DA) to level I trauma center (TCI) or level II trauma center (TCII) with those who were transferred to a TCI after being initially admitted to a TCII. METHODS: A cohort study of severe and critically injured patients (Injury Severity Score 16-75) hospitalized between 2010 and 2019 using data from the National Program for Trauma Registration. Multivariate logistic regression models estimated mortality risk, including stratified analyses. RESULTS: Of the 27,131 hospitalizations, 9.5% were transfers, 60.1% were DA to TCI and 30.4% were DA to TCII. Children ages ≤ 17 years, Non-Jews (minority), critical injuries (ISS 25-75), head injuries (AIS ≥ 3) and fall injuries were significantly more frequent among transfers, compared with the DA groups. Evacuation by emergency medical services was less frequent among transfers. After accounting for possible confounders, transfers had a greater risk of in-hospital mortality [DA to TCI vs transfer, OR (95% CI) 0.61 (0.52-0.72); DA to TCII vs transfer, OR (95% CI) 0.78 (0.65-0.94)]. In stratified analyses, these mortality differences persisted among the sub-group of patients who sustained critical injuries, among the patients with non-penetrating injuries, among the elderly ages ≥ 65 year and during the first 2 weeks of hospitalization. CONCLUSION: This study has intervention implications that should be directed primarily at prehospital triage and the inter-hospital transfer processes. In addition, there may be a need to optimize the capabilities of regional trauma systems along with continuous performance evaluations and actions as required.

Burns in Israel: Etiologic, Demographic, and Clinical trends-A 9-Year Updated Comprehensive Study, 2004-2010 versus 2011-2019.

Based on the Israeli National Trauma Registry (INTR) data, this study reports etiological, demographic, and clinical trends and includes all admissions to burn and trauma centers across Israel from 2011 to 2019 and compares these with 2004 to 2010 rates. From 2011 to 2019, 5,710 patients were admitted to burn centers across Israel. Children aged 0 to 1 years (25.9%), non-Jews (40.7%), and males (67.2%) remain the main groups of the burn casualties. Most of the casualties sustained 1 to 9% total body surface area (TBSA) burns with various depths. Scalds were less fatal than fire/flame-related casualties (<1 vs. 11.5%). Fewer surgical procedures were conducted for burns under 9% TBSA compared with greater TBSA. The percentage of TBSA and burn depth were found to be the most significant predictor of mortality among all age groups (>200 times increased risk with full-thickness burns >30% TBSA burn) and correlated with prolonged length of stay (>7 days).

Gunshot casualties in Israel: A decade of violence.

OBJECTIVE: The purpose of this study was to identify and characterize casualties hospitalized with assault (non-terror) related gunshot wounds (GSW) in Israel as a basis for determining the incidence, trends and at-risk population groups. METHODS: This retrospective cohort study is based on data from the Israel National Trauma Registry. The data includes GSW casualties hospitalized between January 1, 2011 and December 31, 2020. Attempted suicide, unintentional injury, legal intervention, children (ages 0-9) and terror (Israeli-Arab conflict) related GSW were excluded. The remaining population was classified with an ICD-9-CM diagnosis code of 965.0-965.4. RESULTS: The study population included 2,763 GSW admissions. A noticeable increase in GSW casualties was reported, from 206 hospitalization in 2011 to 456 in 2020. The proportion of Arab casualties increased from 73.3% of all GSW casualties in 2011 to 90.8% in 2020, far more than their proportion in the population (∼20%). The majority of the GSW casualties were males (95.8%) and between the ages of 20 and 29 (42.2%). Among severe/critical casualties, 19% of Arabs and 9.9% of Jews arrived by private car. Severe thoracic and abdominal injuries were the prominent injuries among fatal casualties (47.6 and 40.8, respectively). While the all-severity mortality rate was 5.6% (n = 147), 24.4% (n = 135) of severe/critical (ISS16+) casualties died, with no significant differences between Jews and Arabs. Forty percent of deaths occurred in the emergency department. CONCLUSIONS: This study establishes that during the past decade in Israel, not only has there been a continuous increase in hospitalizations due to GSW, but also Arabs are at great risk of such related hospitalizations. Preventive strategies targeting at-risk groups are crucial for minimizing morbidity and mortality related to GSW in Israel.

The surfacing portion of the Iceberg of the Domestic Violence Phenomenon-data from the Israeli National Trauma Registry.

BACKGROUND: Domestic violence against women, which is an ancient phenomenon, is still thriving worldwide. The burden of domestic violence that is non-fatal on scene and its consequences in Israel are unknown. The purpose of this study was to provide evidence-based data regarding domestic violence-related hospitalizations among women in Israel. METHODS: The study is a retrospective cohort study of hospitalized patients included in the Israeli National Trauma Registry between January 1, 2011 and December 31, 2020. All women aged 14 and older, hospitalized due to a violence-related injury in one of the six-level I Trauma Centers or one of the 15 regional Trauma Centers in Israel were included (n = 676). RESULTS: Domestic violence contributes to moderate, severe, and critical injuries in a quarter of abused hospitalized women. Among these women, 20% underwent surgery, and in-hospital mortality was recorded for 2% of the patients. For most cases (53%), the spouse or ex-spouse caused the injury. The family relationship with the perpetrator was distributed differently between the population groups. The proportion of brothers who attacked sisters was greatest among Arabs (14.4%), while the phenomenon of attacking a mother was infrequent in the Arab sub-group. In contrast, among Jewish women, the proportion of those injured by a son was high, especially among the group of Jewish immigrants from the Former Soviet Union (FSU) (17%) and other countries (26%). In a multivariable logistic regression model with at least moderate injury as a dependent variable, in comparison to Israeli Arabs, Jews had a higher odds for sustaining at least moderate injuries, while the odds of Jewish immigrants not from FSU or Ethiopia were the highest (OR = 4.5, 95% CI 2.0-9.9). The annual hospitalization risk was 1.3/100,000 and 5.8/100,000, respectively for Jews and Arabs in 2020, almost fivefold higher among Arab women in comparison to Jewish women (RR = 4.6, 95% CI 2.9-7.3). CONCLUSIONS: Domestic violence prevention should pay special attention to populations at risk, such as Arab women and new immigrants, as those women are especially vulnerable and often without sufficient family support and lack of economic resources to exit the trap of domestic violence. The collaboration between social and health services, the police, and the local authorities is crucial.

Maxillofacial trauma following road accidents-An 11-year multi-center study in Israel.

BACKGROUND/AIM: Road traffic collisions (RTC) are known to be one of the major causes of maxillofacial trauma (MFT). The road user factor is of crucial importance in the prevalence, severity, and treatment of maxillofacial injuries. The aims of the study were to determine the prevalence of maxillofacial trauma among road users, to illustrate injury patterns and to identify road users at high risk. METHODS: This historical prospective multi-center study was based on Israel's Trauma Registry between 2008-2018, which included 4829 hospitalized patients following RTC with MFT. Data were analyzed according to six road user types (vehicle driver, passenger, bicyclist, motorcyclist, pedestrian, and e-bike/scooter), maxillofacial injury location, and maxillofacial treatment. RESULTS: MFT, which accounted for 5% of the hospitalized RTC injuries, was not equally distributed among road users, as bicyclists and e-bike/scooters were more prone to maxillofacial trauma (7.2% and 10.1%, respectively) than vehicle drivers (3.2%). Children (age 0-14 years) comprised almost half of the cyclists, 25% of the pedestrians and 20% of the passengers. Some MFT patients experienced multiple injuries, with the majority involving jaw and facial bones and to a lesser extent the mouth, teeth, gingivae, and alveolar bone (mouth and dento-alveolar (DA) trauma). Approximately 30% of hospitalized road casualties with MFT underwent MF surgery, with the need for surgery lowest among pedestrians. CONCLUSION: Hospitalized road casualties had different types of MFT in terms of prevalence, location, severity, and treatment, depending on the road user type.

Socio-economic disparities and returning to work following an injury.

BACKGROUND: Traumatic injury is one of the main reasons for temporary and permanent occupational disability. The objective of this study was to define the role of socio-economic position on post-injury occupational absenteeism. METHODS: This was a nationwide retrospective cohort study, based on linking The Israeli National Trauma Registry (INTR) and the National Insurance Institute (NII) databases. The study population included 44,740 injured workers (residents of Israel, aged 21-67, hospitalized between 2008 and 2013 and employed prior to injury as salaried workers). Logistic-regression models tested the probability of not returning to work (RTW). RESULTS: The majority of the study population (61%) RTW within 1 month following the injury event. Income prior to injury was significantly associated with longer out of work stay, explaining 9% variance. A significant interaction (p value < 0.0001) was found between age and income on out of work stay more than 1 month, 1 year and 2 years. Logistic regression models of out of work stay were conducted separately for all age groups. Lower income was associated with greater chance for out of work stay for more than 1 month; and the gap between the lowest and highest income quartiles was greater among older workers (age 55+), where there was an elevenfold increase in probability of not RTW among casualties from the lowest vs. highest income quartile. In comparison to other population groups, Arabs were at greater odds of longer out of work stay following an injury. Among injured persons recognized by the NII as having occupational injuries, the odds for not RTW within a month, a year and 2 years were respectively 3.9, 2.5 and 2.2 times significantly greater in comparison to employees injured outside the workplace. CONCLUSIONS: This study identified population groups with a high probability of not RTW following an injury requiring hospitalization. Intervention programs for injured employees should promote early rehabilitation and aim to shorten out of work stay. These programs should be ethnically adapted and focus on underprivileged and disadvantaged populations.

Dental and maxillofacial injuries associated with electric-powered bikes and scooters in Israel: A report for 2014-2019.

BACKGROUND/AIMS: Electric-Powered Bikes and powered scooters present a new method of transportation and are becoming commonly used worldwide. However, the reports on traumatic dental injuries related to their use are scarce. The aim of this study was to report the frequency and severity of dental and maxillofacial injuries associated with electric-powered bikes and scooters in Israel between the years 2014 and 2019. METHODS: This was a retrospective cohort study based on data from the Israeli National Trauma Registry (INTR). The INTR provides comprehensive data on hospitalized patients from all six Level I trauma centers (TC) and 15 of the 20 Level II TCs in Israel. All injured patients who were hospitalized due to a traffic collision between 2014 and 2019 were identified. The data for those hospitalized due to an e-bike or motorized scooter accident were extracted as well as for pedestrians who were injured as a result of a crash with these vehicles. RESULTS: A total of 3,686 hospital admissions were related to electric-powered bikes and scooters. Of those, 378 (10.3%) were oral and maxillofacial injuries. Most of the oral and maxillofacial injuries were attributed to powered bikes (321 out of 378; 84.92%) and the rest to powered scooters. There was a constant increase in general as well as the oral and maxillofacial injuries during the study years. Almost 20% of the cases involved injuries to the teeth. Overall, 291 pedestrians were reported to be injured due to electric-powered bikes and scooters; 29 (9.97%) of them, suffered from oral and maxillofacial injuries. Most of those were children aged 0-15 years (41.38%) and elders older than 60 years (37.39%). CONCLUSIONS: Trauma related to electric-powered bikes and scooters is an increasing concern. Dental professionals should be actively involved in educational and legislative efforts focusing on the prevention of e-bike and scooter-related injuries, in general, and specifically maxillofacial injuries.

Returning to Work Following an Injury: Practical Usage of a Predictive Model Based on a Nationwide Study.

Work absenteeism following an injury creates an economic burden on society and the individual. Programs encouraging return to work (RTW) should be implemented for high risk populations. The aim of this study was to identify the predictors for duration until RTW following an injury. The Israeli National Trauma Registry and the National Insurance Institute database (2008-2013) were linked. Logistic-regression models tested the probability not RTW within 1 month, 1 year and 2 years among 67% of the population and the quality of the model was examined among 33% of the population. The study population comprised 45,291 casualties (aged 21-67 and employed prior to injury as salaried workers). The majority of the study population (61%) RTW within 1 month from the injury event. Injury severity, multiple injuries, brain injury, traffic related injuries and fall injuries were significantly associated with work absenteeism. A dose-response relationship was found between income and not RTW: the lower the income the greater was the chance of not RTW. Among casualties with occupational injuries the odds for not RTW within a month, a year and 2 years were respectively, 3.7, 2.4 and 2 times significantly greater in comparison with casualties not injured at work. Underprivileged ethnic groups (Arabs and immigrants from Ethiopia) had a greater chance for long out of work stay following an injury. The outcomes of this study identified casualties at high risk for not RTW and enables health professionals to develop intervention programs focusing on returning to a productive lifestyle.

The impact of neighborhood socioeconomic disparities on injury.

OBJECTIVES: To examine the relationship between neighborhood socioeconomic level (NSEL) and injury-related hospitalization. METHODS: The National Trauma Registry (INTR) and the National Population Census (NPC), including NSEL, were linked by individual identity number. Age-adjusted logistic regression predicted injury hospitalization. Mantel-Haenszel X2 was used for linear trends. NSEL was divided into 20 clusters. RESULTS: The population comprised 7,412,592 residents, of which 125,829 (1.7%) were hospitalized due to injury. The injury hospitalization rate was at least 42 per 10,000 per year. Except for the very low SEL, an inverse relationship between NSEL and all-cause injury was found: 46.1/10,000 in cluster 3 compared to 22.9/10,000 in cluster 20. Hip fracture-related hospitalizations among ages 65 + decreased as SEL increased (2.19% o in cluster 2 compared to 0.95% in cluster 19). In comparison with Jews, non-Jews were 1.5 times more likely to have an injury-related hospitalization [OR 1.5 (95% CI 1.50-1.55)]. CONCLUSIONS: The INTR and the NPC were successfully linked providing individual and injury hospitalization data. The outcomes confirm the strong relationship between injury mechanism and NSEL.

The contribution of the Israeli trauma system to the survival of road traffic casualties.

BACKGROUND: According to the World Health Organization, over one million people die annually from traffic crashes, in which over half are pedestrians, bicycle riders and two-wheel motor vehicles. In Israel, during the last decade, mortality from traffic crashes has decreased from 636 in 1998 to 288 in 2011. Professionals attribute the decrease in mortality to enforcement, improved infrastructure and roads and behavioral changes among road users, while no credit is given to the trauma system. Trauma systems which care for severe and critical casualties improve the injury outcomes and reduce mortality among road casualties. GOALS: 1) To evaluate the contribution of the Israeli Health System, especially the trauma system, on the reduction in mortality among traffic casualties. 2) To evaluate the chance of survival among hospitalized traffic casualties, according to age, gender, injury severity and type of road user. METHODS: A retrospective study based on the National Trauma Registry, 1998-2011, including hospitalization data from eight hospitals. OUTCOMES: During the study period, the Trauma Registry included 262,947 hospitalized trauma patients, of which 25.3% were due to a road accident. During the study period, a 25% reduction in traffic related mortality was reported, from 3.6% in 1998 to 2.7% in 2011. Among severe and critical (ISS 16+) casualties the reduction in mortality rates was even more significant, 41%; from 18.6% in 1998 to 11.0% in 2011. Among severe and critical pedestrian injuries, a 44% decrease was reported (from 29.1% in 1998 to 16.2% in 2011) and a 65% reduction among bicycle injuries. During the study period, the risk of mortality decreased by over 50% from 1998 to 2011 (OR 0.44 95% 0.33-0.59. In addition, a simulation was conducted to determine the impact of the trauma system on mortality of hospitalized road casualties. Presuming that the mortality rate remained constant at 18.6% and without any improvement in the trauma system, in 2011 there would have been 182 in-hospital deaths compared to the actual 108 traffic related deaths. A 41% difference was noted between the actual number of deaths and the expected number. CONCLUSIONS: This study clearly shows that without any improvement in the health system, specifically the trauma system, the number of traffic deaths would be considerably greater. Although the health system has a significant contribution on reducing mortality, it does not receive the appropriate acknowledgment or resources for its proportion in the fight against traffic accidents.

The role of community in pediatric injury.

Cultural variations between communities may impact injury rates, especially among children. We conducted a retrospective study of three communities in Israel using data from the Israel National Trauma Registry (1998-2007). Pediatric injury hospitalization rates in urban communities with varied levels of socio-economic status (low, medium, and high) were compared for all injuries and cause-specific injuries. Age-standardized and age-specific rates were calculated. Age-standardized injury hospitalization rates were lowest for the low socio-economic status (SES) community (299.7, 95% confidence interval [CI] 289.8-309.6) compared to the medium SES (658.2, 95% CI 629.1-687.3) and high SES (443.7, 95% CI 422.2-465.3) communities. Similar rates were observed for injuries from falls, transportation, accidental striking and intentional causes. For example, rate ratios for falls were 149.1 (95% CI 142.0-156.2), 340.8 (95% CI 319.5-362.1) and 245.7 (229.9-261.5) in the low, medium and high SES communities, respectively. Deviations from these overall trends were noted, however, for pedestrian injuries and burns that were relatively higher in the low SES community and injuries from motorized vehicles that were greater among children living in the high SES community. These results suggest that strong social capital is associated with reduced pediatric injury risks regardless of community wealth. However, targeted interventions for reducing injuries in at-risk populations that rely solely on injury rates may omit culturally distinct communities and overlook their uneven burden to the trauma care system.

Pupil behaviour on school buses and potential risk factors for injury: an observational study.

OBJECTIVE: To observe pupil behaviour on school buses in Israel and identify hazards as a basis for improving school bus safety. METHODS: Data on student, bus driver and chaperone behaviours and on hazards associated with school buses, bus loading zones and bus stops were collected during an observational study conducted on school buses in rural communities in Israel. This report focuses on observations of student behaviour during school bus rides. Future reports will discuss the other findings. Student behaviours were assessed by means of chi(2) tests and logistic regression models. FINDINGS: Observations were made on 362 rides on 125 buses on which 11 000 pupils travelled to and from school. Seatbelt use among the pupils was limited: on 23% of the rides all pupils fastened seatbelts, while on 42% none did. Seatbelt use was more frequent among primary school pupils than among older pupils. Pupil behaviours, such as rowdiness, noisiness, conflicts between pupils and not remaining seated were observed. These and other unsafe behaviours were more frequent on afternoon bus rides (odds ratio, OR: 3.2, 95% confidence interval, CI: 2.1-5.3), on routes with 5+ bus stops (OR: 4.1; 95% CI: 2.5-6.5) and on rides with primary school pupils (OR: 1.8; 95% CI: 1.2-2.9). CONCLUSION: Without enforcement, government regulations and seatbelt availability on school buses are not enough to ensure seatbelt usage among pupils. Bus drivers cannot be expected to enforce seatbelt use and deal with pupil misconduct while also driving safely. Innovative strategies for improving pupil behaviour on school buses are needed to increase pupil safety.

Relationship between socio-economic position and general, maxillofacial and dental trauma: A National Trauma Registry Study.

Trauma, a major public health problem, has been extensively studied. However, characteristics of maxillofacial and dental injuries and their association with socio-economic position (SEP) have not been thoroughly documented. This study retrospectively investigated the occurrence of maxillofacial, dental and general trauma in Israel, and examined the relationship between socio-economic status and trauma-related hospitalizations. Records were obtained for all trauma patients hospitalized and recorded in the National Israel Trauma Registry (ITR) between January 1, 2003 and December 31, 2005. Maxillofacial and dental injuries were separated and further analyzed by residence locality and SEP. The socio-economic index, developed by the Israel Central Bureau of Statistics, was used to determine the socio-economic status of 50 selected localities. During the study period, 77 072 trauma patients were hospitalized, of whom 3972 (5%) were diagnosed with maxillofacial or dental injuries. Among the selected localities, 42 303 hospitalizations were recorded, of which 1886 (4.5%) involved maxillofacial or dental injuries. For all traumas, lower injury rates were found among residents living in high socio-economic localities. The difference in hospitalization rates for maxillofacial and dental injuries was not significant. The cause of injury differed by age, SEP and category of injury. A fall (35%) or road crash (33%) caused most of the maxillofacial injuries, with 50% of dental injuries because of a road crash. Intentional injuries constituted 22% of the maxillofacial-related hospitalizations and were more prevalent among adults living in low SEP localities. These data should be used to promote injury prevention programs with emphasis directed at high risk populations.

[Pediatric injuries from mass casualty events in Israel: a ten-year summary].

BACKGROUND: Children are the most vulnerable sub-population in mass casualty events (MCEs), however, characteristics of MCE related injuries among children have not been well described. AIM: The aim of our study was to characterize childhood injuries resulting from MCEs in Israel including parameters such as magnitude, injury mechanism and severity and use of hospital resources. METHODS: We conducted a descriptive study of MCE related injuries among hospitalized children (0-17 years) between the years 1998-2007 and recorded in the Israel Trauma Registry (ITR). The main outcome measures included: body region, injury severity (ISS) and mortality rates. RESULTS: A total of 267 children (mean age 11.3 years, 52% girls) were hospitalized for injuries caused by 75 (47%) of the 158 MCEs recorded during the study period. The mechanisms of MCE related injury were as follows: terror-related (63%); motor vehicle collision (buses or train) (32%); a collapsed building (3%); and other mechanisms (2%). Injuries among teenagers (ages 10-17 years) were twice as high as those of younger children [ages 0-9 years), (67% and 33%, respectively (p < 0.05). Head and neck (67%) were the most common body regions to be injured, followed by upper and Lower extremities (62%). Most children sustained mild injuries (55% ISS 1-8), however, a significant percentage had severe to fatal injuries (29% ISS > or =16). Severe injuries were significantly more frequent among children injured in MCEs compared to non-MCE injuries: ISS 16 (29% vs. 8%, respectively p < 0.0001), in-hospital mortaLity (3.4% vs. 0.4%, respectively, p < 0.0001), underwent surgical procedures (50% vs. 20%, respectively, p < 0.05), ICU admission rate (31% vs. 6%, p < 0.0001), and longer hospital stay (median LOS 8.9 vs. 3.5 days, respectively p < 0.0001). CONCLUSIONS: Morbidity and mortality are significantly higher among children who are injured in MCEs than by other mechanisms. Improved pediatric pre-hospital care and hospital resources as well may enhance future pediatric MCE-related injury outcomes.

[Seatbelts on school buses: are they safe for our children?].

In Israel, 280,000 pupils travel daily to school and back home by means of school transportation. In an effort to increase school transportation safety, the installation of lap belts in school transportation vehicles is required since September 1, 2006. In Israel, laws are often passed with good intentions, but frequently without exploring the potential outcomes. Traffic regulation 364a states that "lap belts or other seatbelts" are required in all vehicles used for school transportation. The objective of this study is to review the world-wide literature regarding seatbelts on school buses with an emphasis to identify the risks associated with lap restraints. Over 50 studies, articles and position papers referring to the efficacy of seatbelts, with an emphasis on school transportation, were reviewed. According to the literature, this new traffic regulation could produce more devastating outcomes than previously. Seatbelts were designed to prevent passenger injuries during a motor vehicle crash. Researchers have not proven efficacy of seatbelts in school buses. Lap-only belts have shown to increase the risk of severe injury among children, even in mild crashes. Since young children are not adequately developed to take the force of a lap-only restraint, these belts have been associated with internal injuries, lumbar fracture-dislocations, abdominal contusions and head injuries. The National Highway Traffic Safety Administration (NHTSA) in the USA has reported that lap belts are not effective in preventing injury among children traveling by bus. Children have a two to three fold risk of severe injury when using lap only restraints. On the contrary, lap-shoulder belts may reduce the risk of abdominal injuries by up to 50% relative to lap-only belts. In conclusion, policy makers aimed to implement regulations which will reduce injuries and fatalities. However, neglecting to carry out an in-depth professional review has brought about a regulation requiring lap belts in school buses; a decision which, according to international research studies, can potentially increase the injury risks among pupils.