Kite String (Manjha) Injuries Among Children: Single Center Experience Over Four Years.

We reviewed hospital records for kite-string injuries among children over four years (2017-2022). Of 42 affected children, mortality was 9.5%. The mean (SD) Pediatric Trauma Score (PTS) was 8.02 (2.66), with passively involved children facing greater severity [mean (SD) PTS, 5.58 (2.23)]. Kite-string injuries, alarmingly, endanger even bystanders, urging stricter preventive strategies.

Trampoline Injuries in a Statewide Trauma System.

INTRODUCTION: It is well known that trampolines can be a particular source of danger, especially in children. We sought to examine the profile of those patients with trampoline injuries. We hypothesized there would be certain injury patterns predicative of trampoline injuries. METHODS: All patients submitted to Pennsylvania Trauma Outcome Study database from 2016 to 2018 were analyzed. Trampoline injury was determined by ICD-10 activity code. Injury patterns in the form of abbreviated injury scale body regions were examined. Patient demographics and clinical variables were compared between those with trampoline injury vs those without. RESULTS: There were 107 patients with a trampoline injury. All of these patients were discharged alive and had a blunt mechanism of injury. The most common injury type was injury to the extremities (n=90,[84.1%]) with 54(50.5%) upper extremity injuries and 36(33.6%) lower extremity injuries. Ten (9.35%) patients had injury to the spine and five (4.67%) had head injury. Those with trampoline injuries were significantly younger (13y vs. 48.6y) and more likely to be white or of Hispanic ethnicity. Almost half of the patients injured (49.5%) were under 10 years. Patients with trampoline injuries had significantly lower Injury Severity Scores and significantly higher shock index. DISCUSSION: The majority of patients with trampoline injuries had injury to an extremity. These results help better understand the demographic, physiologic, and anatomic patterns surrounding trampoline injuries. Current government standards recommend that no child under age six should use a full-sized trampoline; however, based of this study, we advise that this age be increased to ten.

Traumatic Brain Injury Caused by Toy: Abuse or Accidental?

A 9-month-old child presented with frequent crying and delayed developmental milestones. Computed tomography of the skull showed chronic subdural hematoma caused by playing with a rattle toy. Conservative treatment was decided with good results. The main differential diagnosis in these traumatic brain injuries is abuse, although in these cases subdural hematomas are usually multiple and have specific locations.

Reimagining spaces where children play: developing guidance for thermally comfortable playgrounds in Canada.

SETTING: Planning and designing thermally comfortable outdoor spaces is increasingly important in the context of climate change, particularly as children are more vulnerable than adults to environmental extremes. However, existing playground standards focus on equipment and surfacing to reduce acute injuries, with no mention of potential negative health consequences related to heat illness, sun exposure, and other thermal extremes. The goal of this project was to develop proposed guidelines for designing thermally comfortable playgrounds in Canada for inclusion within the CAN/CSA-Z614 Children's playground equipment and surfacing standard. INTERVENTION: The project to develop guidance for thermally comfortable playgrounds was initiated with a municipal project in Windsor, Ontario, to increase shade, vegetation, and water features at parks and playgrounds to provide more comfortable experiences amid the increased frequency of hot days (≥30°C). The lack of available information to best manage environmental conditions led to a collaborative effort to build resources and raise awareness of best practices in the design of thermally comfortable playgrounds. OUTCOMES: A group of multidisciplinary experts developed technical guidance for improving thermal comfort at playgrounds, including a six-page thermal comfort annex adopted within a national playground and equipment standard. The annex has been used by Canadian schools in a competition to design and implement green playgrounds. IMPLICATIONS: Both the technical report and the thermal comfort annex provide increased awareness and needed guidance for managing environmental conditions at playgrounds. Thermally safe and comfortable play spaces will help ensure that Canada's playgrounds are designed to minimize environmental health risks for children.

RéSUMé: CONTEXTE: À l'ère des changements climatiques, le confort thermique n'a jamais été si important pour la planification et l'aménagement d'espaces extérieurs, surtout car les enfants sont plus sensibles que les adultes aux chaleurs brûlantes. Cependant, les normes qui encadrent actuellement les aires de jeu s'articulent autour d'une logique de prévention de traumatismes. Elles portent donc principalement sur les équipements et leurs revêtements plutôt que sur les conséquences des canicules, des malaises liés à la chaleur et des insolations. L'objectif du présent projet est de rédiger un projet de directives pour favoriser le confort thermique des aires de jeu au Canada et d'intégrer ces directives à la norme CAN/CSA-Z614 Aires et équipements de jeu. INTERVENTION: Les origines du projet remontent à une action municipale à Windsor, en Ontario. Celle-ci avait pour but d'augmenter la quantité de zones d'ombres, de végétation et de jeux d'eau dans les parcs et les aires de jeu en vue de favoriser le confort thermique vu la fréquence croissante des canicules (≥30°C). Le constat de lacunes d'informations autour de la gestion des conditions écologiques a suscité une concertation pour créer des ressources et faire rayonner des pratiques d'aménagement optimales pour l'amélioration du confort thermique des aires de jeu. RéSULTATS: Une équipe transversale d'experts a rédigé des directives techniques pour améliorer le confort thermique des aires de jeu, ainsi qu'une annexe de six pages sur la question qui a été intégrée à une norme nationale. Dans le cadre d'un concours, des écoles canadiennes se sont servies de l'annexe comme référentiel pour penser et aménager des aires de jeu vertes. IMPLICATIONS: Le rapport technique et l'annexe mettent en valeur le besoin d'encadrer la gestion des facteurs environnementaux des aires de jeu. L'amélioration du confort thermique de ces espaces et la réduction des risques environnementaux permettent de protéger la santé des enfants au Canada.

Head and Neck Injuries and Electronic Scooter Use in the United States.

OBJECTIVE: To quantify electric scooter injuries encountered in United States emergency departments, focusing on the head and neck, to understand the safety impact of these scooters to improve safe usage. STUDY DESIGN: Retrospective cross-sectional study from January 2009 to December 2019 of patients presenting to United States emergency departments with electric scooter injuries collected from a national database. About 2,823 cases of injuries were related to electric scooter use from January 2009 to December 2019. Stratified weighted counts and incidence rates were estimated for injury characteristics. Piecewise linear regression quantified the yearly change in incidence of injuries before and after introduction of rideshare programs. RESULTS: The estimated national total of electric scooter cases from 2009 to 2019 was 103,943 (95% CI: 79,650-128,237). Incidence grew in 2019 to 8.63 cases per 100,000 person-years from 4.46 in 2018 to 2.42 in 2017. Head and neck injuries represented 28.5% of total injuries (weighted estimate = 29,610). The most common age group of head and neck injuries before 2018 was ≤17 years, but injuries in 18- to 44-year-olds grew significantly to become the most injured group in 2018 to 2019 (P < .001). From 2009 to 2017, incidence of head and neck injuries fell by 0.02 cases per 100,000 person-years, but cases grew by 1.22 cases per 100,000 person-years post-2017 (P < .001). CONCLUSION: Injuries following the launch of rideshare electric scooter programs increased significantly, especially in patients 18 to 44 years of age. Head and neck injuries represent many of these injuries. User safety education must be addressed to prevent injury as programs become more pervasive in the United States. LEVEL OF EVIDENCE: 2 Laryngoscope, 131:E2784-E2789, 2021.

Playground Equipment-related Genital Injuries in Children: An Analysis of United States Emergency Departments Visits, 2010-2019.

OBJECTIVE: To evaluate the demographics, epidemiology, and common mechanisms associated with playground equipment-related genital injuries in children. METHODS: We examined the National Electronic Injury Surveillance System database to obtain playground-related genital injuries sustained in children ≤17 years from 2010 to 2019. Demographics of the patients and injury characteristics were analyzed using sample weights to produce national estimates. RESULTS: During the study period, an estimated 27,738 (95% confidence interval 18,602-36,874) emergency department visits with an average annual incidence of 3.8 (95% confidence interval 2.5-5) per 100,000 United States population ≤17 years were reported. The mean age was 6.6 (standard error 0.152) years with most injuries occurring in pre-school children (48.1%) and females (81.1%). Over ½ of genital injuries (55.2%) were associated with climbing apparatus. This was followed by slides (10.7%), swings (9%), and seesaws (4.8%). Most genital injuries occurred at public (41.4%) and school settings (36.3%). Straddling and/or falling was the most common mechanism leading to genital injuries (84.4%). The incidence of injuries remained constant during the 10-year study period (change = + 2.6%; r2 = 0.121, P = .326). Monthly variations in the number of injuries existed with peak injuries in April-May, and September-October. CONCLUSION: Despite current safety standards, genital injuries arising from playground equipment have remained stable since 2010. By defining common devices, mechanisms, and conditions associated with genital injuries, this study may help guide efforts aimed at the prevention of such injuries in various locations.

Shared electric scooter injuries admitted to Auckland City Hospital: a comparative review one year after their introduction.

AIM: E-scooters were introduced to New Zealand in 2018 as a means of city transport. Since their introduction, their use has resulted in high injury rates. No studies have directly compared e-scooters to other forms of transport. METHOD: The Auckland City Hospital trauma registry was retrospectively searched for patients admitted with an e-scooter injury. A comparison group of patients admitted with an injury secondary to cycling during the same period was collected. RESULTS: 178 patients were identified: 69 with e-scooter injuries and 109 with injuries sustained while cycling. The hospitalisation rate for e-scooter injuries was 326 hospitalisations per million hours. There was a significant difference found in blood ethanol levels (18.6 vs 6.4% positive, p-value=0.01), mechanism of injury (isolated falls: 87 vs 60.6%), time of injury (55.1 vs 40.4% between 5pm-8am) and protective gear use (worn in 10.1 vs 78.9%). No differences were found in injury severity, ICU admissions, length of stay or mortality. CONCLUSION: This study demonstrates a concerningly high e-scooter-related hospitalisation rate and suggests e-scooters are currently not as safe as cycling. Strategies to improve e-scooter safety are needed and could include zero tolerance for alcohol, mandatory protective gear, restricted operating times and changes in road laws.

TRAUMATIC RETINAL DETACHMENT CAUSED BY NERF GUN SHOT IN A PEDIATRIC PATIENT.

PURPOSE: To present a case of retinal detachment caused by a Nerf-gun shot in a pediatric patient. METHODS: Single case report. RESULTS: A 16-year-old white man presented with a nasal visual field deficit and floaters in his left eye for 1 month after being shot with a foam-ball Nerf gun by a friend. Fundus examination revealed a midperipheral retinal dialysis extending from 1 to 4:30 clock hours with a macula-on retinal detachment and superficial proliferative vitreoretinopathy. He underwent successful 25-gauge pars plana vitrectomy with membrane peel, retinectomy, injection of perfluoron, endolaser, and use of 1,000 centistoke silicone oil for tamponade. CONCLUSION: This is the first reported case of traumatic retinal detachment secondary to a Nerf-gun shot.

Reliability of the high-speed camera-based system (hsc-kinovea) for lower-limb explosive strength endurance assessment in athletes / Confiabilidade do sistema de câmera de alta velocidade (cav-kinovea) para avaliação da resistência de força explosiva de membros inferiores em atletas

ABSTRACT The present study verified the reliability of the high-speed camera-based system (HSC-Kinovea) in the lower-limb explosive strength endurance assessment in athletes. Eleven male volleyball players (21.8 ± 2.9 years; 186.3 ± 6.2 cm and 82.3 ± 11.0 kg) participated in the intermittent vertical jumping test in two days. The test was filmed and later analyzed using Kinovea 0.8.15 software to obtain the mean and peak power variables. Regarding reliability, the intra-class correlation coefficient, the typical error of measurements, and Bland-Altman plots were used. The method presented satisfactory values for inter and intra-class correlations (˃ 0.88). The typical values error of measurement presented in the inter-rater analysis was 0.95 W.kg-1 and 0.59 W.kg-1 for the peak and the mean power, respectively. In the intra-assessment analyses, the typical measurement error values were 7.02 W.kg-1 and 5.66 W.kg-1 (test-retest) and 1.59 W.kg-1 and 0.24 W.kg-1 (duplicates videos) for peak and average power, respectively. The HSC-Kinovea system is reliable for assessing the variables of the explosive strength endurance in athletes.

RESUMO O presente estudo verificou a confiabilidade do sistema baseado em câmeras de alta velocidade (CAV-Kinovea) na avaliação da resistência de força explosiva de membros inferiores em atletas. Onze atletas masculinos de voleibol (21.8 ± 2.9 anos de idade; 186.3 ± 6.2 cm and 82.3 ± 11.0 kg) participaram do teste de saltos verticais de contexto intermitente em dois dias. O teste foi filmado e posteriormente analisado no software Kinovea 0.8.15 para obter as variáveis ​​de potência pico e média. Para determinar a confiabilidade, utilizou-se o coeficiente de correlação intraclasse, o erro típico de medidas e os gráficos de Bland-Altman. O método apresentou valores satisfatórios para as correlações inter e intra-classe (˃0,88). Os valores do erro típico de medida apresentados na análise interavaliadores foram 0,95 W.kg-1 e 0,59 W.kg-1 para potência pico e média, respectivamente. Nas análises intra-avaliação, os valores do erro típico de medida foram 7,02 W.kg-1 e 5,66 W.kg-1 (teste-reteste) e 1,59 W.kg-1 e 0,24 W.kg-1 (duplicados de vídeos ) para potência pico e média, respectivamente. O sistema CAV-Kinovea é confiável para avaliar as variáveis da resistência de força explosiva em atletas.

[Characterisation of the impact and features of trampoline park-related injuries]. / Die spezifischen Auswirkungen und Merkmale von Trampolinpark-assoziierten Verletzungen.

INTRODUCTION: Numerous studies have described indoor trampoline park (ITP)-related injury patterns, but they have shown heterogeneous results. No such study has been performed in Germany to date. The aim of this study was to analyse the specific trampoline-related injury patterns found in our population. METHODS: This retrospective study included patients suffering from ITP-related injuries between 1 October 2016 and 30 April 2018. 258 patients were included in the analysis. Patients were categorised depending on different variables including age, sex, site of injury, diagnosis, length of admission and treatment using SPSS. RESULTS: In the 19-month study period, 258 patients with ITP-related injuries were recruited. Single ITP-related injuries were diagnosed in 250 (96.9 %) patients. The median age of this group was 22 years (IQR 15-28). 126 (50.4 %) injuries were suffered by men and 124 (49.6 %) by women. 168 (67.2 %) injuries occurred in the lower extremity. Sprains (n = 114, 45.6 %) and fractures without joint dislocation (n = 59, 23.6 %) were the most common diagnoses. Males suffered significantly more often from injuries of the upper extremity (26.2 vs. 9.7 %; p = 0.010), while females most commonly suffered from injuries of the lower extremity (79.8 vs. 54.8 %; p < 0.001). 45 (18 %) patients required hospital admission and twenty-five (10.0 %) patients required surgery. Eight (3.1 %) patients suffered from injuries in more than one anatomic location. CONCLUSIONS: ITP-related injuries were more prevalent in adults compared with children. The lower limb was the most affected anatomic location in all ages. The pattern of the injuries was heterogeneous, and their respective treatment represents a major challenge for traumatology surgeons.

Combining measures of risk exposure with injury incidence estimates to estimate nursery product injury rates.

INTRODUCTION: Nursery product hazards have been a frequent topic in the published literature. However, because information on the exposure to nursery product risks has not been generally available, there has been little evaluation of exposure-adjusted injury rates. METHODS: A national survey of durable nursery product use, by nursery product type, was conducted in 2013. Two measures of risk exposure were developed for each nursery product type: the number used frequently (i.e., used every day or a few times a week) and the total number in use by households, regardless of usage frequency. These data were combined with national estimates of nursery product injuries treated in U.S. hospital emergency departments to determine exposure-adjusted injury rates. RESULTS: For the 13 nursery products examined, there were an estimated 79.9 million in use; 81.6% were reportedly used frequently. When combined with injury estimates, there were an average of 104.1 injuries per 100,000 frequently used nursery products and 85.0 injuries per 100,000 in use. The exposure-adjusted injury rate rankings for the 13 products, from highest to lowest, varied substantially from rankings based on injury incidence alone. Although the injury rate rankings for the two risk exposure measures were not identical, they were highly correlated. CONCLUSIONS: The use of exposure-adjusted injury rates provides an enhanced understanding of product-related injury patterns, and can play an important role in program development and evaluation. Estimates of frequently used products may be preferable to products in use as a measure of risk exposure, because such estimates may better reflect intensity of use; both, however, represent valid alternatives that can result in improved program and policy analysis. Practical Applications: Exposure-adjusted injury rates can provide for a more comprehensive evaluation of injury patterns than incidence estimates alone. Analysts should, when possible, take risk exposure into account when evaluating safety programs and policy options.

Categorizing mothers' and fathers' conceptualizations of children's serious play-related injuries: "You won't grow a finger back".

BACKGROUND: There is inconsistency across child development and care literature in operationalizing serious play-related injury and also a lack of understanding of how mothers and fathers conceptualize serious play-related injury. The current study explores parents' perspectives of their 2- to 7-year-old children's serious play-related injuries in urban and rural areas of British Columbia and Québec, Canada, and provides an urban/rural and gender analysis of the results. METHODS: We conducted semistructured interviews with 41 mothers and 63 fathers from 57 families, a total of 104 participants, in urban and rural locations in British Columbia and Québec, Canada. We used a social constructionist approach to the research and reflexive thematic analysis to construct themes from participant responses and to inform the consequent categorizations of serious play-related injury. RESULTS: The results indicate four categories of parents' conceptualizations of serious play-related injury: (a) injury requiring medical intervention, (b) injury resulting in head trauma, (c) injury resulting in debilitation, and (d) broken bones. CONCLUSIONS: Child development and care advocates can use these categories to strengthen their communications with parents and to improve understanding of parents' conceptualizations of children's serious play-related injury.

Toy Guns, Real Danger: An Update on Pediatric Injury Patterns Related to Nonpowder Weapons.

BACKGROUND: Design changes of nonpowder guns, including BB and air guns, have significantly increased their potential to injure. We sought to characterize the demographics of children injured with nonpowder weapons and the specific injuries suffered. METHODS: A cross-sectional analysis of the study years 2006, 2009, and 2012 was performed by combining the Kids' Inpatient Database into a single dataset. We identified cases (age < 21 years) of air gun injuries using external cause of injury codes. Patient characteristics and injuries were analyzed using ICD-9 codes, and national estimates were obtained using case weighting. RESULTS: There were 1028 pediatric admissions for nonpowder weapon related injuries. The victims were predominately male (87.0%), non-Hispanic white (52.3%), resided in the South (47.3%), and in the lowest income quartile (39.2%). Half required a major surgical procedure. The predominant injuries were open wounds to the head, neck, or trunk (40.3%), and contusion (22.5%). Notable other injuries were intracranial injury (9.1%) and blindness or vision defects (3.3%). CONCLUSIONS: The nonpowder weapons available to this generation can paralyze, blind, and cause lasting injury to children. Injuries frequently require surgical intervention, and these weapons should no longer be considered toys. Further research and legislation should be aimed at limiting children's access to these weapons. LEVEL OF EVIDENCE: III.

Safety of School Playgrounds: Field Analysis From a Randomized Sample.

Research supports recess, however, playground injuries are prevalent with more than 200,000 cases per year requiring medical attention. School playgrounds are among the leading location for injury. The purpose was to identify the safety and risk factors of playground environments and impact attenuation characteristics of surfacing materials. Results demonstrated 46% playground spaces protected students from traffic. Results found 75% of playgrounds were exposed to full sun, and unitary surface materials were up to 49°F warmer than the air temperature. There was an increase in the probability of risk whether equipment height was over 9 ft for loose fill surfacing materials or over 6 ft for unitary surfaces. Loose strings or ropes looped over equipment were found on 23% of playgrounds. This study provides discussion and data pertaining to numerous aspects of playground safety. Strategies for school nurses are shared to shape policies and education for playground safety practices.

Trends in Trampoline Fractures: 2008-2017.

OBJECTIVES: In this study, we aim to evaluate the current trends in pediatric fractures related to trampolines. METHODS: The National Electronic Injury Surveillance System was queried for fractures occurring between 2008 and 2017 in individuals aged 0 to 17 years. Sex, anatomic region, locale of injury, admission status, and year of injury were recorded. Incidence rates were calculated by using national census data. Poisson regression analysis was used to test for changes in fracture incidence across the time period. Logistic regression analyses were used to test temporal trends in the odds of a fracture occurring at a place of recreation or sport and a patient with a fracture being admitted. RESULTS: Between 2008 and 2017, there was a 3.85% (95% confidence interval [CI]: 0.51-7.30) increase in the incidence of trampoline-related pediatric fractures per person-year. The incidence of pediatric trampoline-related fractures increased from 35.3 per 100 000 person-years in 2008 to 53.0 per 100 000 person-years in 2017. There was no change in the odds of a trampoline fracture requiring hospitalization (odds ratio per 1 year: 1.02; 95% CI: 0 6-1.07; P = .5431). There was a significant increase in the odds of a fracture occurring at a place of recreation or sport (odds ratio per year: 1.32; 95% CI: 1.21-1.43; P < .0001). CONCLUSIONS: Between 2008 and 2017, there was a significant increase in the national incidence of trampoline-related fractures. We identified a significant increase in the proportion of trampoline fractures that occurred at a place of recreation or sport. Advocacy campaigns should consider these sites in their prevention efforts.

Trampoline injuries compared with other child activities.

INTRODUCTION: Trampolines are responsible for specific injuries. We examined the severity of these injuries in children compared with those occurring in other activities. Our primary goal was to compare the injury severity between trampolining and other activities. Our secondary goal was to evaluate risk factors for severity in order to establish preventative measures and, third, to evaluate the increased prevalence of these injuries in our hospital from 2008 to 2016. MATERIAL AND METHODS: Our study was a retrospective, comparative, descriptive, and epidemiological research. Children aged 2-15 years admitted to our traumatology emergency services between June and October 2016 were included in the study. Non-sport-related injuries were excluded. Serious injuries were classified as fractures and admissions to the operating room. RESULTS: In total, 1106 children were admitted including 107 trampoline accidents. The fracture rate was similar in the two groups: 34 (31.78%) vs. 309 (30.93%), OR=1.039, 95% CI [0.65, 1.62] P=0.91. Surgical treatments were more frequent in the trampoline group: 4 (3.74%) vs. 18 (1.80%) OR=2.114, 95% CI [0.51, 6.58] P=0.156. Several people jumping simultaneously on the trampoline was a risk factor (OR=1.56, 95% CI [1.0908, 2.308], P=0.018). Parental supervision was a protective factor (OR=0.271, 95% CI [0.08, 0.80], P=0.023). Trampolining accidents were 9.7 times more common in our center in 2016 compared with 2008. DISCUSSION: To our knowledge, no study has compared trampoline injuries with those stemming from other activities. Awareness campaigns are needed as well as information from sellers, who have to be trained. CONCLUSION: Surgical treatments are twice as likely in trampoline accidents. Prevention is simple: Children should be alone on the trampoline and supervised by an adult.