Age-related trends in unintentional injuries among children and adolescents in an urban Danish population 1980-2021. A cohort study of 292,737 children and adolescents.

OBJECTIVE: This study describes the age-related trends in unintentional injuries in children and adolescents in an urban population 1980-2021. A retrospective study of all children and adolescents aged 0-17 years treated for unintentional injuries at Odense University Hospital, Denmark 1980-2021. METHODS: Information about age, gender, place of injury, and diagnoses from the emergency department register. We estimated gender specific annual incidence rates (IRs) in different age groups (0-4, 5-9, 10-14, and 15-17 years) per 1000 population/years. The severity was classified by mild or severe injuries. RESULTS: Overall, 292,737 unintentionally injured children and adolescents were included. The median age was 10 years and 57.4 % were boys. The overall IR was 241 (CI: 240-242) for boys and 188 (CI: 187-188) for girls per 1000 population/years. In the study period, the overall incidence decreased by 44 % in boys and by 38 % in girls. The overall IR for severe injuries did not change in the study period, whereas the IR of mild injuries decreased significantly in all age groups in both gender. The upper limbs were the most frequently injured in all age groups for both gender, except for children aged 0-4 years, where lesions mostly occurred in the head or neck. In the youngest age groups 0-4 years and 5-9 years wounds were the most common type of lesion, while bruises were the most common type of lesion in the oldest age groups. Fractures accounted for 14.5 % of the lesions with the highest proportions in the 5-9 years and 10-14 years age group. CONCLUSION: The study provides information, which is useful when coordinating the resources at emergency departments and for planning preventive campaigns targeting different age groups.

The completeness of routine registration of the counterpart in deliberate interpersonal violence in an urban emergency department.

Most studies of violence from the health care system lack reliable information about the counterpart, which is important for distinguishing between different types of violence. Since 2014, the emergency department at Odense University Hospital in Denmark has routinely registered information about the counterpart. The purpose of this study was to evaluate the completeness of registering information about the counterpart during routine registration of victims of interpersonal violence in the emergency department. We included 11,200 victims treated at the emergency department 2014-2021. Using the patient registration data, we estimated the proportion of missing information on the counterpart, stratified by age group and gender of the victim as well as type of incident and severity of injury. Information about the counterpart was registered in 91.5 % of all cases. In 43.1 % (CI: 42.2-44.0) of the cases, the counterpart was unknown to the victim, in 24.3 % (CI: 23.5-25.1) the counterpart was an acquaintance, in 10.5 % (CI: 10.0-11.1) the counterpart was a partner, and in 4.2 % (CI: 3.8-4.5) the counterpart was another family member. The proportion of cases with no information about the counterpart varied with gender, age group, time of violence, place of violence, weapon use, and severity of injury. Half of the victims injured with firearms (46.2 %, CI: 30.1-62.8) and one-fourth of the victims injured with knives (25.9 %, CI: 21.9-30.2) did not reveal information about the counterpart. The majority of the victims revealed information about the counterpart, making it possible to analyse different types of violence separately.

Predictors of physical activity levels in children and adolescents with cerebral palsy: clinical cohort study protocol.

INTRODUCTION: Children and adolescents with cerebral palsy may be trapped in a vicious circle of low physical fitness, resulting in deconditioning that causes a further decrease in physical activity (PA), a lower quality of life and an increased risk of developing non-communicable diseases. Therefore, establishing a healthy and active lifestyle during childhood is even more important for individuals with a disability. However, the factors that influence habitual PA in children and adolescents with cerebral palsy remain unknown.The present protocol outlines a prospective cohort study with the aim of investigating potential predictors of habitual PA in children and adolescents with cerebral palsy in order to provide evidence for optimising PA levels and associated overall health. METHODS AND ANALYSIS: This prospective cohort study will enrol participants with cerebral palsy between the ages of 8 and 15 years at Gross Motor Function Classification System levels I-III. Using a modified version of the International Classification of Functioning, Disability and Health model as a conceptual analytical framework, the analysis will be divided into six components and will provide predictors for habitual PA measured by accelerometry. The potential predictive variables are registry data on physical function (Danish Cerebral Palsy Follow-Up Programme); validated proxy-reported questionnaires on quality of life (Paediatric Quality of Life Inventory), overall health, pain and participation in daily activities (Paediatric Outcomes Data Collection Instrument) and supplementary questions regarding sleep, screen time and socioeconomic status. ETHICS AND DISSEMINATION: The project is approved by the Danish Data Protection Agency (19/16396) and has been declared not notifiable by the Regional Committee on Health Research Ethics, cf. Committee Act Art. 14, paragraph 1 (S-20192000-23). The study results will be published in international peer-reviewed journals, presented at international conferences, and published in a PhD dissertation. TRIAL REGISTRATION NUMBER: NCT04614207.

Changes in the pattern of paediatric bicycle injuries in relation to helmet use 1980-2014.

INTRODUCTION: This study aimed to describe long-term changes in injury pattern in bicycle accidents among children in relation to the increasing use of bicycle helmets. METHODS: This was a descriptive register study of all children aged 6-14 years with injuries from bicycle accidents who were treated at a Danish university hospital in the 1980-2014 period. Diagnoses and helmet use were analysed and stratified by gender and age group. Diagnoses were grouped into head injuries, severe head injuries, facial injuries, bone fractures, spinal injuries and internal injuries. We defined severe head injuries as skull fractures and intracranial injuries including concussions, haemorrhages and lacerations. RESULTS: We included 13,294 children, 58.7% were boys. From 1980-1984 to 2010-2014, the use of helmets increased from 0% to 49.9% in boys and from 0% to 57.1% in girls. The proportion of boys and girls with head injuries decreased from 31.3% to 17.4% and from 29.6% to 10.1%, respectively. A similar reduction was found in the proportion of children with severe head injuries. In the study period, the proportion of children with facial injuries, fractures, spinal injuries and internal injuries in trunk remained unchanged. Eighteen children died from their injuries, none of whom wore a helmet. CONCLUSIONS: In the study period, the proportion of head and severe head injuries decreased by 50% along with an increase from 0% to 50% in helmet use. The proportion of facial injuries, spinal injuries, bone fractures and injuries to the internal organs remained unchanged. FUNDING: none. TRIAL REGISTRATION: not relevant.

Improved functional outcome after hip fracture is associated with duration of rehabilitation, but not with waiting time for rehabilitation.

INTRODUCTION: The aim of this study was to explore the relationship between "waiting time to onset of municipal rehabilitation", "length of municipal rehabilitation" and the attained level of function four months after the hip fracture. METHODS: Among a consecutive series of 156 patients, the 116 patients who were recommended a municipal rehabilitation sequence after discharge were included. The expos-ures were waiting time in days and duration in hours of the municipal rehabilitation. The outcome was lower-extremity functional level as measured with the Short Physical Per-form-ance Battery. Effects were assessed with non-parametric gamma coefficients. RESULTS: The median waiting time to initiation of rehabilitation was ten days. A weak and insignificant correlation was observed between waiting time and outcome at four months, and a statistically significant correlation was recorded between duration of municipal rehabilitation and outcome, also at four months. No marked differences in these results were found when subgrouped by pre-fracture level of function as assessed with the Barthel-20 index. CONCLUSIONS: Waiting times from hospital discharge to initiation of municipal rehabilitation seems not to correlate with functional level four months after the hip fracture. In contrast, the amount of municipal rehabilitation time does correlate with a better functional level four months after the hip fracture. Furthermore, large-sample studies are warranted to clarify this relationship. FUNDING: none. TRIAL REGISTRATION: not relevant.

Children and adolescents admitted to a university-level trauma centre in Denmark 2002-2011.

INTRODUCTION: The epidemiology of children or adolescents admitted to a Scandinavian trauma centre is largely unknown. The aim of this paper was to describe the epi-demiology and severity of potentially severely injured children and adolescents admitted to a university hospital trauma centre. METHODS: This was a descriptive study of all children and adolescents aged 0-17 admitted to the university level trauma centre at Odense University Hospital, Denmark in the 2002-2011 period. Data were extracted from the Southern Danish Trauma Register and from medical records. RESULTS: A total of 950 children and adolescents were included. The median age was 13 (range: 0-17) years. Boys accounted for 60.6% of the cases. Accidents accounted for 97.2%, violence 1.4% and self-inflicted injuries 0.4%. More than three fourths of the injuries occurred either in traffic or at home. The occurrence was greatest in the summer (34.0%), during weekends (48.9%) and in the hours between 12.00 and 20.00 (59.2%). Overall, 58.5% of the in-juries were due to traffic. Of these injuries, 39.7% were in-juries suffered by passengers in motor vehicles, 27.5% drivers/passengers of a scooter/MC, 21.8% bicyclists and 10.3% pedestrians. The median Injury Severity Score (ISS) and Abbreviated Injury Scale was 4 (range: 1-75) and 2 (range: 1-6), respectively. Head/face injuries accounted for 36.5% and injuries to the extremities for 30.9% of all injuries. A total of 153 (16.1%) suffered from severe injuries (ISS > 15). Overall, 49 (5.2%) died due to their injuries. CONCLUSIONS: Based on a local trauma register, we described the epidemiology and severity of potentially se-verely injured children and adolescents admitted to a university trauma centre. FUNDING: none. TRIAL REGISTRATION: not relevant.

Trends in weapon-related injuries from violence in Odense Municipality, Denmark 1991-2009.

INTRODUCTION: The aim of this study was to examine the development in incidence rates and the severity of weapon-related physical interpersonal violence in Odense Municipality, Denmark from 1991 to 2009. METHODS: All victims of physical interpersonal violence with weapon-related injuries treated at the Emergency Department in the 1991-2009 period at Odense University Hospital, Denmark, and/or subjected to medico-legal autopsy at the Institute of Forensic Medicine in the 1991-2009 period at the University of Southern Denmark were included. Incidence rates were estimated following stratification by gender and age. The development in the incident rates was examined. RESULTS: Overall, 2,957 victims were included. The overall incidence rate was 8.5 per 10,000 population/year (14.6 and 2.7 for males and females, respectively). The rates did not change significantly in the study period. Most victims were injured with bottles/glass and blunt weapons (44.8% versus 28.2%), whereas 24% were injured with sharp weapons and 3% with firearms. Most lesions were sustained to the head/neck (56.1%) and to the upper limbs (26.2%). A total of 182 (6.1%) victims had lesions that were considered severe. The mortality rate was 4.8 per 1,000 victims in males and 29.1 per 1,000 victims in females. More than half (57%) of the homicides were caused by lesions due to sharp weapons. CONCLUSION: Weapon-related injuries are rare in the Odense Municipality. The incidence rate of weapon-related violence did not increase in the study period. Additionally, no evidence of an increased proportion of severe injuries was found. Women had a seven-fold higher mortality than males. FUNDING: none. TRIAL REGISTRATION: not relevant.

Violence- and alcohol-related acute healthcare visits in Greenland.

AIMS: The aim of this study was to describe emergency admissions in Greenland's healthcare system, and the extent to which admissions were associated with alcohol abuse or violence. Furthermore, we aimed to test whether data on emergencies in Greenland could be registered in a reliable way by simple means. METHODS: Registration of all emergencies presented in 15 out of 17 of Greenland's health districts in the period 21 May to 7 June 2010. RESULTS: In the 17-day registration period, 2403 emergencies were registered. In 10% of cases the patients were clinically alcohol intoxicated. When reason for presentation were mental or social problems, attempted suicide, accidents, or violence, 24, 50, 15, and 59% respectively were intoxicated. Alcohol intoxication was statistically significantly more often associated with advanced treatment (e.g. evacuation, hospitalisation, or follow up by doctor or nurse). CONCLUSIONS: This study confirms that violence- and alcohol-related emergencies put a considerable strain on Greenland's healthcare system. Due to the short observation period, we have not been able to describe the actual extent of the problem in detail, nor was it possible to estimate whether this problem is more pronounced in Greenland than in other countries, for example Denmark.

Quality of data entry using single entry, double entry and automated forms processing--an example based on a study of patient-reported outcomes.

BACKGROUND: The clinical and scientific usage of patient-reported outcome measures is increasing in the health services. Often paper forms are used. Manual double entry of data is defined as the definitive gold standard for transferring data to an electronic format, but the process is laborious. Automated forms processing may be an alternative, but further validation is warranted. METHODS: 200 patients were randomly selected from a cohort of 5777 patients who had previously answered two different questionnaires. The questionnaires were scanned using an automated forms processing technique, as well as processed by single and double manual data entry, using the EpiData Entry data entry program. The main outcome measure was the proportion of correctly entered numbers at question, form and study level. RESULTS: Manual double-key data entry (error proportion per 1000 fields = 0.046 (95% CI: 0.001-0.258)) performed better than single-key data entry (error proportion per 1000 fields = 0.370 (95% CI: 0.160-0.729), (p = 0.020)). There was no statistical difference between Optical Mark Recognition (error proportion per 1000 fields = 0.046 (95% CI: 0.001-0.258)) and double-key data entry (p = 1.000). With the Intelligent Character Recognition method, there was no statistical difference compared to single-key data entry (error proportion per 1000 fields = 6.734 (95% CI: 0.817-24.113), (p = 0.656)), as well as double-key data entry (error proportion per 1000 fields = 3.367 (95% CI: 0.085-18.616)), (p = 0.319)). CONCLUSIONS: Automated forms processing is a valid alternative to double manual data entry for highly structured forms containing only check boxes, numerical codes and no dates. Automated forms processing can be superior to single manual data entry through a data entry program, depending on the method chosen.

Demographic and socioeconomic risk factors of adult violent victimization from an accident and emergency department and forensic medicine perspective: a register-based case-control study.

OBJECTIVES: To describe demographic and socioeconomic risk factors of adult violent victimization leading to contact with an emergency department and/or an institute of forensic medicine based on a case-control study design. DESIGN: A register-based case-control study comparing demographic and socioeconomic characteristics of 10,799 adult victims of violence (cases) and 53,986 randomly selected population-based controls matched for age, gender, and date. DATA SOURCES: Cases were included from a Danish emergency department and a Danish institute of forensic medicine. Demographic and socioeconomic data for cases and controls were extracted from two national longitudinal registers. STATISTICS: Data were analysed using logistic regression in a semi-adjusted model adjusting for age, gender, and year, and a fully adjusted model including several variables. RESULTS: Factors positively associated with adult violent victimization were "being a pensioner" (OR: 4.71; 95% CI: 4.18-5.30), "being unemployed" (OR: 3.15; 95% CI: 2.85-3.48), and "not living with a partner" (OR: 2.93; 95% CI: 2.74-3.14), whereas the factors strongly negatively associated with adult violent victimization was "being a student" (OR: 0.72; 95% CI: 0.63-0.83). In the semi-adjusted analysis a foreign citizenship of a country outside Europe was significantly associated with adult violent victimization (OR: 1.79; 95% CI: 1.60-2.00), whereas in the fully adjusted analyses the association decreased to an insignificant level. CONCLUSIONS: Our findings emphasize the multifaceted nature of injuries from violence. The findings from this study indicated potential risk factors, which should be specifically addressed when planning preventive strategies.

[Development in violence in Odense City from 1991-2002]. / Udviklingen i forsaetlig vold i Odense 1991-2002.

The study included 14,316 consecutive victims of violence registered by Odense University Hospital and/or the Institute of Forensic Medicine, University of Southern Denmark from 1991-2002. The incidence rate was 9.9 and 3.4 per 1,000 population/year for males and females respectively. The incidence rate for males decreased during the period of the study. The proportion of less serious lesions increased and the proportion of potential severe lesions such as bone fractures and deep lesions decreased during the period of the study. The proportion of patients with injuries from knives or firearms did not change during the period of the study.

Trends in deliberate interpersonal violence in the Odense Municipality, Denmark 1991-2002. The Odense study on deliberate interpersonal violence.

A 12-year study was carried out to investigate the development of interpersonal violence based on A and E department and/or forensic data from a Danish urban population. Included in the study were all victims of violence from the Odense municipality treated at the Odense University Hospital or subjected to medicolegal autopsy at the Institute of Forensic Medicine, University of Southern Denmark 1991-2002. Overall 14,316 victims of violence were included in the study. The incidence rates of violence were 9.9 and 3.4 per 1000 population/year for males and females. For males the incidence rate decreased in the study period whereas the incidence rate was unchanged among females. Less serious lesions and wounds were the most common type of lesions. The percentage of less serious lesions increased in the study period. The percentage of potential severe lesions such as bone fractures and deep lesions decreased in the study period. The percentage of patients stabbed or cut with knives, the percentage of gunshots, and the mortality rate did not change in the study period. The present study showed no evidence of an increased frequency or severity of interpersonal violence which contrasts with the increased public concern about violence.

Type I sensitization in adolescents: prevalence and association with atopic dermatitis. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis (TOACS).

The prevalence of Type I sensitization and its relationship to atopic dermatitis were assessed in a cohort of 1501 8th grade schoolchildren (aged 12-16) in Odense, Denmark. The protocol included a questionnaire, a clinical examination, IgE measurements and skin prick tests. A history of atopic dermatitis was found in 21.3%, allergic asthma in 6.9% and allergic rhinitis in 15.7% of the adolescents. One or more positive specific IgE measurements (CAP FEIA) were found in 29.6% of the schoolchildren (inhalant allergens 28.4%, food allergens 8.5%, pityrosporum ovale 1.5%) and a considerable proportion were sensitized without clinical relevance. The association between atopic dermatitis and Type I sensitization was related to concomitant inhalant allergy. A clear association with atopic dermatitis was indicated only for the allergen pityrosporum ovale.

Contact allergy and allergic contact dermatitis in adolescents: prevalence measures and associations. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis (TOACS).

The aims of this cross-sectional study were to establish the prevalence measures of contact allergy and allergic contact dermatitis in 8th grade schoolchildren (aged 12-16 years) in Odense, Denmark, and to examine the associations with atopic dermatitis, inhalant allergy and hand eczema. Contact allergy to a standard series allergen was found in 15.2% of schoolchildren. The point prevalence of allergic contact dermatitis was 0.7% and the lifetime prevalence 7.2%, predominantly in girls. The most common contact allergens were nickel (8.6%) and fragrance mix (1.8%). Nickel allergy was clinically relevant in 69% and fragrance allergy in 29% of cases. A significant association was found between contact allergy and hand eczema while no association was found between contact allergy and atopic dermatitis or inhalant allergy. In the future this cohort of schoolchildren will be followed with regard to the course and development of atopic diseases, hand eczema and contact dermatitis. Key words: school-

Nickel sensitization in adolescents and association with ear piercing, use of dental braces and hand eczema. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis (TOACS).

The prevalence of nickel allergy (sensitization) and the associations with ear piercing, use of dental braces and hand eczema were assessed in a cohort of 1,501 8th grade schoolchildren (aged 12-16 years) in Odense, Denmark. Nickel allergy was found in 8.6% and was clinically relevant in 69% of cases. Nickel allergy was found most frequently in girls and the association with ear piercing was confirmed. Application of dental braces (oral nickel exposure) prior to ear piercing (cutaneous nickel exposure) was associated with a significantly reduced prevalence of nickel allergy. In adolescents a significant association was found between hand eczema and nickel allergy. A follow-up study of this population is planned in order to assess the course and development of contact dermatitis, hand eczema and atopic diseases in adulthood and after choice of occupation.