Shifting patterns of disparities in unintentional injury mortality rates in the United States, 1999-2016 / Tendencias cambiantes en las disparidades en las tasas de mortalidad por traumatismo no intencional en Estados Unidos entre 1999 y 2016 / Mudança nos padrões de disparidade nas taxas de mortalidade por lesões acidentais nos Estados Unidos, 1999-2016

ABSTRACT Objectives. To analyze changes in racial/ethnic disparities for unintentional injury mortality from 1999-2016. Methods. Mortality data are from the National Center for Health Statistics (NCHS) for all unintentional injuries, analyzed separately by injury cause (motor vehicle accidents [MVA], poisonings, other unintentional) for white,black, and Hispanic populations within four age groups: 15-19, 20-34, 35-54, 55-74 for males and for females. Results. Rates across race/ethnic groups varied by gender, age and cause of injury. Unintentional injury mortality showed a recent increase for both males and females, which was more marked among males and for poisoning in all race/ethnic groups of both genders. Whites showed highest rates of poisoning mortality and the steepest increase for both genders, except for black males aged 55-74. MVA mortality also showed an increase for all race/ethnic groups, with a sharper rise among blacks, while Hispanics had lower rates than either whites or blacks. Rates for other unintentional injury mortality were similar across groups except for white women over 55, for whom rates were elevated. Conclusions. Data suggest while mortality from unintentional injury related to MVA and poisoning is on the rise for both genders and in most age groups, blacks compared to whites and Hispanics may be suffering a disproportionate burden of mortality related to MVAs and to poisonings among those over 55, which may be related to substance use.

RESUMEN Objetivos. Analizar cambios en las disparidades por raza y grupo étnico en materia de mortalidad por traumatismos no intencionales de 1999 al 2016. Métodos. Los datos de mortalidad de todos los traumatismos no intencionales provienen del Centro Nacional de Estadísticas Sanitarias y se han analizado por separado por causa de traumatismo (colisiones automovilísticas, intoxicaciones y otras causas no intencionales) y por población blanca, negra e hispana, tanto en hombres como en mujeres, en cuatro grupos etarios: de 15 a 19, de 20 a 34, de 35 a 54 y de 55 a 74. Resultados. Las tasas en todos los grupos raciales y étnicos variaron según el sexo, la edad y la causa del traumatismo. La mortalidad por traumatismo no intencional mostró un aumento reciente tanto en hombres como en mujeres, que fue más marcado en el caso de los hombres, y por intoxicación en todos los grupos raciales y étnicos de ambos sexos. La población blanca mostró las tasas más elevadas de mortalidad por intoxicación y el incremento más acentuado en ambos sexos, con excepción de los hombres negros entre 55 y 74 años de edad. La mortalidad por colisión automovilística también registró un aumento en todos los grupos raciales y étnicos, con un incremento mayor en la población negra, mientras que la población hispana mostró tasas inferiores que la blanca o la negra. Las tasas de mortalidad por otros traumatismos no intencionales fueron similares en todos grupos salvo en el caso de las mujeres blancas de más de 55 años, cuyas tasas mostraron un incremento. Conclusiones. Los datos indican que, si bien la mortalidad por traumatismo no intencional relacionada con colisiones automovilísticas e intoxicación está en alza en ambos sexos y en la mayoría de los grupos etarios, la población negra en comparación con la blanca y la hispana puede estar presentando una carga desproporcionada de mortalidad relacionada con colisiones automovilísticas e intoxicación en personas mayores de 55, que podrían estar relacionado con el consumo de sustancias psicoactivas.

RESUMO Objetivos. Analisar as mudanças nas disparidades étnico-raciais da mortalidade por lesões acidentais no período 1999-2016. Métodos. Os dados de mortalidade foram obtidos do Centro Nacional de Estatísticas de Saúde (NCHS) dos Estados Unidos para todos os tipos de lesões acidentais e analisados em separado por causa de lesão (acidentes de trânsito de veículos a motor, envenenamento/intoxicação e outros tipos de acidentes) em grupos populacionais de brancos, negros e hispânicos de ambos os sexos divididos em quatro faixas etárias: 15-19, 20-34, 35-54 e 55-74 anos. Resultados. As taxas de mortalidade nos grupos étnico-raciais variaram segundo sexo, idade e causa de lesão. Houve um aumento recente na mortalidade por lesões acidentais nos sexos masculino e feminino, sendo mais acentuado no sexo masculino e por envenenamento/intoxicação em todos os grupos étnicos-raciais de ambos os sexos. A população branca apresentou as maiores taxas de mortalidade por envenenamento/intoxicação e o aumento mais acentuado na mortalidade em ambos os sexos, exceto por homens negros de 55-74 anos. Ocorreu também um aumento da mortalidade por acidentes de trânsito de veículos a motor em todos os grupos étnico-raciais, sendo mais acentuado em negros, e a mortalidade na população hispânica foi menor que em brancos ou negros. As taxas de mortalidade por outros tipos de acidentes foram semelhantes em todos os grupos, exceto em mulheres brancas acima de 55 anos que apresentaram taxas elevadas. Conclusões. Os dados analisados indicam que, apesar de a mortalidade por lesões acidentais por acidentes de trânsito de veículos a motor e envenenamento/intoxicação estar aumentando em ambos os sexos e na maioria das faixas etárias, em comparação a brancos e hispânicos, os negros possivelmente sofrem um ônus desproporcional de mortalidade por acidentes de trânsito e envenenamento/intoxicação no grupo acima de 55 anos que pode estar associada ao uso de substâncias químicas.

Why do some trauma patients die while others survive? A matched-pair analysis based on data from Trauma Register DGU®.

PURPOSE: The mortality rate for severely injured patients with the injury severity score (ISS) ≥16 has decreased in Germany. There is robust evidence that mortality is influenced not only by the acute trauma itself but also by physical health, age and sex. The aim of this study was to identify other possible influences on the mortality of severely injured patients. METHODS: In a matched-pair analysis of data from Trauma Register DGU®, non-surviving patients from Germany between 2009 and 2014 with an ISS≥16 were compared with surviving matching partners. Matching was performed on the basis of age, sex, physical health, injury pattern, trauma mechanism, conscious state at the scene of the accident based on the Glasgow coma scale, and the presence of shock on arrival at the emergency room. RESULTS: We matched two homogeneous groups, each of which consisted of 657 patients (535 male, average age 37 years). There was no significant difference in the vital parameters at the scene of the accident, the length of the pre-hospital phase, the type of transport (ground or air), pre-hospital fluid management and amounts, ISS, initial care level, the length of the emergency room stay, the care received at night or from on-call personnel during the weekend, the use of abdominal sonographic imaging, the type of X-ray imaging used, and the percentage of patients who developed sepsis. We found a significant difference in the new injury severity score, the frequency of multi-organ failure, hemoglobine at admission, base excess and international normalized ratio in the emergency room, the type of accident (fall or road traffic accident), the pre-hospital intubation rate, reanimation, in-hospital fluid management, the frequency of transfusion, tomography (whole-body computed tomography), and the necessity of emergency intervention. CONCLUSION: Previously postulated factors such as the level of care and the length of the emergency room stay did not appear to have a significant influence in this study. Further studies should be conducted to analyse the identified factors with a view to optimising the treatment of severely injured patients. Our study shows that there are significant factors that can predict or influence the mortality of severely injured patients.

Acute stressors and clinical characteristics differentiate death by suicide, accident, or natural causes among illicit and prescription opiate users.

BACKGROUND: Opiate misuse has reached epidemic levels. Prevention efforts depend on distinguishing opiate users from abusers. The current study compared opioid users who died by natural cases, accidents, and suicide using psychological autopsy methods. Groups were compared on substance use characteristics, treatment history, experiences of negative life events, and circumstances at the time of death. METHODS: Substance use and suicide risk were evaluated using psychological autopsy methods in 63 decedents with positive toxicology for opiates at death divided into three groups: adults dying by suicide (n = 19), accident (n = 19), and natural causes (n = 25). Groups were compared on several dependent measures, using chi-square analyses to examine categorical variables and one-way analyses of variance (ANOVA) to examine continuous variables. RESULTS: Individuals who died by suicide were similar in many ways to adults who died by an accidental overdose. However, suicide completers were more likely to have struggled with severe depression, and previously attempted suicide, whereas the accidental overdose sample was more likely to display a chronic pattern of severe drug abuse. CONCLUSIONS: The current study helps to distinguish between opiate users who are at risk for death by an accidental or intentional overdose. In the ongoing opiate crisis, clinicians must understand the risk of overdose and the nuances of accidental behaviors compared to purposeful ones. Signs of suicidal planning, relevant psychopathology, and ongoing life stress may be useful points of intervention for stopping the increasing number of deaths among opiate users.

Vessel traffic safety in busy waterways: A case study of accidents in western shenzhen port.

Throughout the world, busy waterways near large ports witness heavy vessel traffic in recent decades. The waterways are characterized by high risk in terms of loss of life, property, and pollution to environment. To facilitate maritime safety management with satisfactory efficiency and efficacy, the authors propose a framework of safety indexes to evaluate the risk level in busy waterways according to the accident severity, fatality rate and special indicators of maritime transportation. The safety indexes consist of Safety Evaluation Index (SEI) and Safety Warning Index (SWI), and are derived from the proposed risk criteria of Chinese vessel traffic. As a case study, data on vessel traffic accidents reported in the Western Shenzhen Port, South China from 1995 to 2015 are analyzed. The actual risk level of this area during the period is calculated under the framework. The implementation of the safety indexes indicate that the risk criteria and safety indexes are practicable and effective for the vessel traffic management. The methodology based on long-term accident data can significantly support the risk analysis in the macroscopic perspective for busy ports and waterways, such that SWI can act as threshold to trigger actions, while SEI can act as an indicator to measure safety status.

Risk factors for extremely serious road accidents: Results from national Road Accident Statistical Annual Report of China.

BACKGROUND: In the past decades, extremely serious road accidents with a death toll over ten in each have become a severe public health problem in China. This study investigates risk factors contributing to extremely serious road accidents, which will be crucial for accident prevention. METHODS: Collecting data from The Road Accident Statistical Annual Report openly issued by China's Traffic Management Bureau of the Public Security Ministry for the time period 2004-2015, we used the monthly case number of extreme serious road accidents as the dependent variable. We then selected ten risk factors as primary independent variables: professional driver, driving under influence (alcohol or drug), fatigue, vehicle type, overload, brake problem, weather, road classification, terrain, and region. The method of negative binominal regression was implemented to investigate the association between these risk factors and extremely serious road accidents. RESULTS: A total of 346 extremely serious road accidents were included in our analysis. On a national scale, we found that professional driver [incidence rate ratio (IRR): 1.10, 95% CI: 1.02-1.19], fatigue (IRR: 1.15, 95% CI: 1.03-1.29), large vehicle type (IRR: 1.11, 95% CI: 1.03-1.21), overload (IRR: 1.09, 95% CI: 1.03-1.16), and terrain (IRR: 1.09, 95% CI: 1.01-1.18) were significantly associated with extremely serious road accidents. Besides, separate analyses on western and non-western region indicated that both regions had shared risk factors as well as distinct factors. CONCLUSIONS: Our study identifies professional driver, fatigue, large vehicle type, overload, and terrain as significant risk factors of extremely serious road accidents in China, and targeted and preventative measures could be taken based on our findings.

Drowning mortality by intent: a population-based cross-sectional study of 32 OECD countries, 2012-2014.

OBJECTIVE: To compare the drowning mortality rates and proportion of deaths of each intent among all drowning deaths in Organisation for Economic Co-operation and Development (OECD) countries in 2012-2014. DESIGN: A population-based cross-sectional study. SETTING: 32 OECD countries. PARTICIPANTS: Individuals in OECD countries who died from drowning. MAIN OUTCOME MEASURES: Drowning mortality rates (deaths per 100 000 population) and proportion (%) of deaths of each intent (ie, unintentional intent, intentional self-harm, assault, undetermined intent and all intents combined) among all drowning deaths. RESULTS: Countries with the highest drowning mortality rates (deaths per 100 000 population) were Estonia (3.53), Japan (3.49) and Greece (2.40) for unintentional intent; Ireland (0.96), Belgium (0.96) and Korea (0.89) for intentional self-harm; Austria (0.57), Korea (0.56) and Hungary (0.44) for undetermined intent and Japan (4.35), Estonia (3.70) and Korea (2.73) for all intents combined. Korea ranked 12th and 3rd for unintentional intent and all intents combined, respectively. By contrast, Belgium ranked 2nd and 15th for intentional self-harm and all intents combined, respectively. The proportion of deaths of each intent among all drowning deaths in each country varied greatly: from 26.2% in Belgium to 96.8% in Chile for unintentional intent; 0.7% in Mexico to 57.4% in Belgium for intentional self-harm; 0.0% in nine countries to 4.9% in Mexico for assault and 0.0% in Israel and Turkey to 38.3% in Austria for undetermined intent. CONCLUSIONS: A large variation in the practice of classifying undetermined intent in drowning deaths across countries was noted and this variation hinders valid international comparisons of intent-specific (unintentional and intentional self-harm) drowning mortality rates.

Patient-accident-fracture (PAF) classification of acute distal radius fractures in adults.

There is not enough evidence in the literature to support the use of any classification system for distal radius fractures (DRF) in adults. However, there is a need for identification of more homogeneous groups of patients with DRF so that the extent of preoperative workup and sophistication of treatment would best match the needs of the patient. The authors propose an innovative method to analyse and stratify acute DRF in adults. A one-page chart includes criteria related to the patient (P), the energy of the accident (A) and the pathology of the fracture (F). Analysis of the pathology includes not only the distal radius itself but also the associated ulnar and carpal lesions. Radiological suspicion of associated carpal of distal radio-ulnar joint ligamentous injuries is included in the analysis. The preliminary results of the use of this chart in 1610 consecutive adult patients (16-102 years) with unilateral acute DRF are presented. A total of six homogeneous groups of patients are described, and the relevance of this classification regarding the therapeutic options is discussed.

An analysis of international traveller deaths at the Cliffs of Moher in Ireland, 1993-2017.

Background: Traumatic deaths, and more particularly suicides, during international travel receive a disproportionately low level of attention in the travel medicine literature. We describe the demographic profile of international travellers whose death occurred at the Cliffs of Moher along the Atlantic seaboard in Ireland. Methods: Coroners' files for the 25 years between 1993 and 2017 were interrogated. All cases of death on or at the cliffs were examined, and demographic data were extracted, including date of death, gender, age, nationality, whether the victims were alone at the cliffs prior to their death, whether the fall was witnessed, prevailing weather conditions, post-mortem examinations, toxicology reports and inquest verdicts. Results: Overall, 66 deaths occurred on or at the base of the Cliffs of Moher during the period 1993 through August 2017. In total, 18 (27.3%) of the victims were international visitors to Ireland, including 11 males (61.1%). The mean age of travellers (n = 17) was 34.2 years. Victims were nationals of 12 different countries, with 13 being European nationals. Most deaths occurred in summer (n = 7) or spring (n = 6), with eight deaths (44%) reported at weekends. In total, 15 victims (83.3%) had walked along the cliff path alone. A jump or fall from the cliffs was witnessed in only two cases (11.1%). Post-mortem examinations revealed multiple traumatic injuries consistent with a fall from a height. Four cases had evidence of alcohol intoxication. Suicide or open verdicts were returned in 50% (n = 9) of the cases. Conclusions: Travelling alone to the site, purchasing one-way tickets, or depositing belongings on the clifftop support the possibility of suicidal intent, while being intoxicated could be a co-factor in suicidal jumps or support the possibility of an accidental fall. This knowledge could help to identify travellers at the greatest risk of death at cliffs.

Lesiones deportivas versus accidentes deportivos. Documento de consenso. Grupo de prevención en el deporte de la Sociedad Española de Medicina del Deporte (SEMED-FEMEDE) / Sports injuries versus sports accidents. Consensus document. Group of prevention in the sport of the Spanish Society of Sports Medicine (SEMED-FEMEDE)

La práctica deportiva tiene numerosos efectos beneficiosos sobre la salud y el bienestar de las personas, pero también puede tener efectos negativos, entre los que se encuentran los accidentes y las lesiones. Establecer las diferencias entre lesión y accidente deportivo es de vital importancia desde el punto de vista médico-legal y ayudará a clarificar la regulación jurídica del deporte en estos aspectos. Por ello, el objetivo de este documento es establecer un consenso sobre lo que entendemos por lesión deportiva y sobre qué tipos de lesiones pueden calificarse como accidente deportivo. Se vienen utilizando diferentes criterios, muy dispares, para definir las lesiones deportivas, así como para clasificarlas, lo que lleva a que los datos epidemiológicos no puedan extrapolarse de unos a otros. Así, para unos son todas aquellas que requieren asistencia médica; otros consideran que existe una lesión cuando hay daño corporal que obliga al deportista a abandonar o modificar una o más sesiones de entrenamiento o competición; otros autores entienden que una lesión deportiva debe combinar la necesidad de asistencia médica con la pérdida de tiempo de las actividades deportivas; y finalmente algunos estiman que una lesión deportiva es cualquier problema físico sufrido por un deportista durante el entrenamiento o la competición, independientemente de la necesidad de atención médica y de la pérdida de tiempo de actividades deportivas. Bajo el punto de vista de este consenso, una lesión deportiva es un problema físico debido a una alteración de la integridad de los tejidos que se produce como resultado de la práctica de actividad física o deporte, y que altera la capacidad absoluta o relativa de practicar deporte, independientemente de que requiera atención de personal sanitario o que conlleve ausencias o modificaciones en las sesiones de entrenamiento o en las competiciones. Puede aparecer de forma súbita, en el caso de las lesiones agudas, o tener un comienzo lento y progresivo, en el caso de lesiones por sobrecarga o sobreuso. Un accidente deportivo es una lesión corporal, no intencionada por parte del accidentado, de inicio repentino, provocada por un traumatismo o una carga que supere los límites fisiológicos, y que acontece durante una actividad deportiva identificable. Las causas de los accidentes varían en función de la modalidad deportiva, del terreno donde se practica el deporte, del material deportivo, etc. Todas las lesiones agudas (por traumatismos, malos gestos técnicos o cargas que superen los límites fisiológicos y provoquen un daño tisular) deben ser consideradas como accidentes deportivos, y aquellas en las que el daño tisular aparece en un determinado momento y es progresivo, pudiendo manifestarse clínicamente o no (sobrecargas de repetición), quedan excluidas de lo que entendemos por accidente deportivo

Sports practice has many beneficial effects on the health and well-being of people, but it can also have negative effects between those tha are accidents and injuries. Establishing the differences between injury and sports accident is of vital importance from the medical-legal point of view and will help to clarify the legal regulation of sport in these aspects. Therefore, the purpose of this document is to establish a consensus on what we understand as sports injury and what kind of injuries can be classified as sports accidents. Different criteria have been used, very differente, to define sports injuries, and to classify them, so that epidemiological data cannot be extrapolated from some study to other. Thus, for some are all those that require medical assistance; Others consider that there is an injury when there is bodily injury that forces the athlete to leave or modify one or more training session or competition; another group of authors understand that a sports injury must combine the need for medical assistance with the loss of time from sports activities; finally, others estimate that a sports injury is any physical problem suffered by an athlete during training or competition, regardless of the need for medical attention and loss of time from sports activities. From our point of view, a sports injury is a physical problem due to an alteration of the integrity of the tissues that occurs as a result of the practice of physical activity or sport, and that alters the absolute or relative capacity to practice sport, independently of the fact that it requires attention of sanitary personnel or that it involves absences or modifications in training sessions or competitions. It can appear suddenly, in the case of acute injuries or have a slow and progressive onset, in the case of overload or overuse injuries. A sports accident is a bodily injury, unintentional by the injured person, of sudden onset, caused by trauma or a load that exceeds physiological limits and that occurs during an identifiable sports activity. The causes of accidents depend on the sport modality, sports playground, sports equipment, etc. All acute injuries (due to trauma, incorrect sport technique or loads that exceed physiological limits and cause tissue damage) should be considered as sports accidents and those in which the tissue damage appears at a certain time and is progressive, being able to manifest itself clinically or not (repeated overloads), are excluded from what we understand by sports accidents

Application of classification principles to improve the reliability of incident classification systems: A test case using HFACS-ADF.

Accident classification systems are important tools for safety management. Unfortunately, many of the tools available have demonstrated poor reliability of coding, making their validity and usefulness questionable. This paper demonstrates the application of four strategies to improve the reliability of accident and incident classification systems. The strategies include creating a domain-specific system with limitations on system size and careful selection of codes, specifically the reduction of abstract concepts and bias-causing terminology. Using HFACS-ADF as a test case, the system was adapted using the strategies and validated using comprehension and comprehensiveness testing. The new system was then assessed for reliability. The reliability of the system increased by at least 20% at all levels of the classification system following the changes made. The results provide evidence that the application of theoretically and empirically-derived classification principles are effective for improving the reliability of accident and incident classification systems in high hazard industries.

An Examination of Potential Misclassification of Army Suicides: Results from the Army Study to Assess Risk and Resilience in Servicemembers.

Debate continues about the accuracy of military suicide reporting due to concerns that some suicides may be classified as accidents to minimize stigma and ensure survivor benefits. We systematically reviewed records for 998 active duty Army deaths (510 suicides; 488 accident, homicide, and undetermined deaths; 2005-2009) and, using research criteria, reclassified 8.2% of the nonsuicide cases to definite suicide (1), suicide probable (4), or suicide possible (35). The reclassification rate to definite suicide was only 0.2% (1/488). This low rate suggests that flagrant misclassification of Army deaths is uncommon and surveillance reports likely reflect the "true" population of Army suicides.

[Accident or maltreatment? Radiographic X­ray patterns in non­accidental trauma : The concept of sentinel injuries]. / Unfall oder Misshandlung? Radiologische Befunde beim nichtakzidentiellen Trauma : Das Konzept der "sentinel injuries".

The focus of this review article is on child abuse and the radiographic pattern of X­ray findings. The radiologist should be able to recognize typical injuries resulting from child abuse. In some cases the findings are highly specific for abuse and these include metaphyseal corner fractures of the long bones in children aged up to 24 months. In other cases the fractures are not specific but highly indicative of child abuse: rib fractures, for example can be associated with child abuse in more than 50 % of the cases; however, maltreatment is difficult to diagnose without taking the entire pattern of skeletal findings into consideration so that a radiological screening of the entire skeleton is often necessary. The concept of sentinel injuries might be helpful for deciding in which cases a complete skeletal screening should be performed. In the age group up to 24 months old a complete skeletal status (with some exceptions) is recommended if one of the three sentinel injuries of rib fractures, intracranial bleeding and abdominal trauma is present.

Circumstances of Trauma and Accidents in Children: A Thesaurus-based Survey / Circonstances des traumatismes et accidents de l'enfant : recensement par un thésaurus.

Introduction : Injuries and accidents are major causes of morbidity and mortality in children in France. Identification and description of the mechanisms of accidents are essential to develop adapted prevention methods. For this purpose, a specific thesaurus of ICD-10 codes relating to the circumstances of trauma and accidents in children was created in the French Loire department. The objective of this study was to evaluate the relevance and acceptability of the thesaurus in the pediatric emergency unit of Saint-Etienne university hospital.Material and Methods : This study was conducted in two phases. The first, longitudinal phase was conducted over three periods between May and October 2014 to compare codings by emergency room physicians before using the thesaurus with those defined on the basis of the thesaurus. The second phase retrospectively compared coding in July and August 2014 before introduction of the thesaurus with thesaurus-based coding in July and August 2015.Results : The first phase showed a loss of more than half of the information without the thesaurus. The circumstances of trauma can be described by an appropriate code in more than 90% of cases. The second phase showed a 13% increase in coding of the circumstances of trauma, which nevertheless remains insufficient.Discussion : The thesaurus facilitates coding and generally meets the coding physician's expectations and should be used in large-scale epidemiological surveys.

Trauma in children due to wheeled recreational devices.

AIM: The aim of this study was to describe trauma in children secondary to the use of wheeled recreational devices (WRDs). METHODS: This study retrospectively described trauma secondary to use of WRDs sustained by children 16 years or younger over a period of 12 months at two tertiary paediatric hospitals in Brisbane, Queensland. Data were analysed from the Paediatric Trauma Registry at these two facilities. Data were also retrieved from The Commission for Children and Young People and Child Guardian to provide information regarding deaths in Queensland from the use of WRDs for the period January 2004 to September 2013. Outcome measures included age, gender, types of injuries, Injury Severity Scores, admission to Intensive Care, and length of hospital stay for all hospital admissions greater than 24 h. RESULTS: A total number of 45 children were admitted with trauma relating to WRDs during the 12 months, representing 5.3% of all trauma admissions of greater than 24 h during this time period. Of these, 34 were male with a median age of 11.0 years (IQR = 9-13). Limbs accounted for the majority (54.5%) of injuries, with other common injuries being spine/cranial fractures (14.5%), lacerations (12.7%), internal organ injuries (9.1%), and intracranial bleeds (9.1%). There were six admissions to the Paediatric Intensive Care Unit and one death. CONCLUSIONS: WRDs contribute significantly to injuries sustained by children. A large proportion of these injuries may be preventable, suggesting that mandating the use of protective equipment in Queensland may be of great benefit.

[Correspondence analysis of association between types of unintentional injuries and influential factors among rural rear pupils].

OBJECTIVE: To explore the association between types of unintentional injuries and influential factors among rural rear pupils. METHODS: The multistage stratified sampling method was used to select the study participant and thus 594 rural pupils were sampled, 292 rear pupils were confirmed and measured with unintentional injuries and influential factors of rural rear pupils scale. RESULTS: Binary logistic regression analysis indicate that the risk facts related to unintentional injury were left-behind status (OR = 2.68, 95% CI 1.06-6.79), gender (OR = 5.12, 95% C2.68-9.79) and surrounding environment (OR = 3.44, 95% CI 1.37-8.70). Correspondence analysis showed living with father, middle personality and low age were related possibly with traffic accident injury. Living with grandparents, extrovert personality and elder pupils were related possibly with unintentional falls injury. Living with mother, introvert personality and middle-age pupils were related possibly with animmal injury. CONCLUSION: The personality, ages and guardian types of rural rear pupils are correlated with types of unintentional injuries.

Evaluating the Reliability of the Human Factors Analysis and Classification System.

INTRODUCTION: This paper examines the reliability of the Human Factors Analysis and Classification System (HFACS) as tool for coding human error and contributing factors associated with accidents and incidents. METHODS: A systematic review of articles published across a 13-yr period between 2001 and 2014 revealed a total of 14 peer-reviewed manuscripts that reported data concerning the reliability of HFACS. RESULTS: Results revealed that the majority of these papers reported acceptable levels of interrater and intrarater reliability. CONCLUSION: Reliability levels were higher with increased training and sample sizes. Likewise, when deviations from the original framework were minimized, reliability levels increased. Future applications of the framework should consider these factors to ensure the reliability and utility of HFACS as an accident analysis and classification tool.

[Treatment of childhood injuries and violence in public emergency services]. / Atendimentos por acidentes e violências na infância em serviços de emergências públicas.

This study aimed to analyze the profile of treatment for accidents and violence involving children under 10 years of age in Brazil in the year 2011. This was a cross-sectional descriptive study in 71 emergency services in the Brazilian Unified National Health System (SUS), located in the national capital and 24 state capitals. Data were obtained from the Ministry of Health's system of sentinel surveillance services for Violence and Accidents (VIVA Survey). The highest proportion of injuries (67.4%) occurred inside the child's home. Among unintentional injuries, falls were the most frequent (52.4%), followed by running into objects or persons (21.8%) and traffic injuries (10.9%), especially as passengers (bicycles were an important means of transportation involved in the injuries). The vast majority of unintentional injuries are avoidable, and educational measures should be adopted, especially with parents, teachers, the community, and health workers, calling attention to the risks and the adoption of safe behaviors in the home, at school, and in leisure-time activities. Cases of violence are subject to mandatory reporting, and prompt measures should be taken to protect victims.

Atendimentos por acidentes e violências na infância em serviços de emergências públicas / Treatment of childhood injuries and violence in public emergency services / Atención por accidentes y violencia contra la infancia en servicios públicos de urgencias

O objetivo deste artigo foi analisar o perfil dos atendimentos de emergência por acidentes e violências envolvendo crianças menores de 10 anos no Brasil no ano de 2011. Foi realizado estudo transversal, descritivo, em 71 serviços de urgência e emergência no âmbito do SUS, localizados no Distrito Federal e em 24 capitais brasileiras. Os dados foram obtidos no sistema de serviços sentinelas de Vigilância de Violências e Acidentes (VIVA Inquérito), do Ministério da Saúde. A maior proporção das lesões (67,4%) ocorreu no ambiente domiciliar. Dentre as injúrias não intencionais, as quedas foram a ocorrência mais frequente (52,4%), seguidas de choque contra objetos/pessoas (21,8%) e lesões no trânsito (10,9%), destacando-se as vítimas na condição de passageiros, e dentre os meios de locomoção da vítima são destaque as bicicletas. As injúrias não intencionais na grande maioria são evitáveis e devem ser adotadas medidas educativas, em especial junto aos pais, educadores, comunidade, profissionais de saúde e educação, alertando para os riscos e adoção de comportamentos seguros em relação ao ambiente doméstico, escola e de lazer. As violências são objeto de notificação obrigatória, e as ações de proteção às vítimas devem ser instituídas prontamente.

This study aimed to analyze the profile of treatment for accidents and violence involving children under 10 years of age in Brazil in the year 2011. This was a cross-sectional descriptive study in 71 emergency services in the Brazilian Unified National Health System (SUS), located in the national capital and 24 state capitals. Data were obtained from the Ministry of Health’s system of sentinel surveillance services for Violence and Accidents (VIVA Survey). The highest proportion of injuries (67.4%) occurred inside the child’s home. Among unintentional injuries, falls were the most frequent (52.4%), followed by running into objects or persons (21.8%) and traffic injuries (10.9%), especially as passengers (bicycles were an important means of transportation involved in the injuries). The vast majority of unintentional injuries are avoidable, and educational measures should be adopted, especially with parents, teachers, the community, and health workers, calling attention to the risks and the adoption of safe behaviors in the home, at school, and in leisure-time activities. Cases of violence are subject to mandatory reporting, and prompt measures should be taken to protect victims.

El objetivo de este estudio fue analizar el perfil de las consultas de urgencia por causas externas que involucran a niños menores de 10 años en Brasil, 2011. Este estudio transversal, analizando datos de la Violencia de Vigilancia y Accidentes (VIVA), encuesta realizada en 71 servicios de urgencias y emergencias en el Sistema Único de Salud (SUS), con sede en el Distrito Federal y 24 capitales brasileñas. Como resultado de ello el 67,4 % se produjo en el entorno del hogar. Las caídas fueron las más frecuentes (52,4 %), seguidas por la colisión con objetos/personas (21,8%) y las lesiones de tráfico (10,9%). Las lesiones no intencionales en la gran mayoría son evitables y se producen en el hogar y se pueden prevenir. La violencia contra los niños más pequeños son más frecuentemente cometidas por miembros de la familia y están sujetas a notificación obligatoria, destinada a la implantación de medidas de protección a las víctimas.

Postmortem CT appearance of gas collections in fatal diving accidents.

OBJECTIVE. The purpose of our study was to define the postmortem CT semiology of gas collections linked to putrefaction, postmortem "off-gassing," and decompression illness after fatal diving accidents and to establish postmortem CT diagnostic criteria to distinguish the different causes of death in diving. SUBJECTS AND METHODS. A 4-year prospective study was conducted including cases of death during diving. A hyperbaric physician analyzed the circumstances of death and the dive profile, and an autopsy was performed. Subjects were divided into three groups according to the analysis from their dive profile: decompression illness, death after decompression dive without decompression illness, and death after nondecompression dive without decompression illness. Full-body postmortem CT was performed before autopsy. RESULTS. The presence of intraarterial gas associated with death by decompression illness had a negative predictive value (NPV) of 100%, but the positive predictive value (PPV) was only 54% because of postmortem off-gassing. The PPV reached 70% when considering pneumatization of the supraaortic trunks. Pneumothorax, subcutaneous emphysema, and intraarterial gas, all of which are classic criteria for decompression illness diagnosis, are not specific for decompression illness. CONCLUSION. This study is the first to show that pneumothorax, subcutaneous emphysema, and intraarterial gas, all of which are classic criteria for decompression illness diagnosis, are not specific for decompression illness. Complete pneumatization of supraaortic trunks is the best postmortem CT criteria to detect a fatal decompression illness when CT is performed within 24 hours after death.