Epidemiology of Accidental Injuries at Home and Related Risk Factors for Mortality among Older Adults in South Korea: A Retrospective Cohort Study.

Background and Objectives: Accidental home injuries among older adults are increasing globally, but reporting is limited. This study aims to establish foundational data for program development and policies to prevent accidental injuries at home in older adults by using data on the occurrence of accidental injuries at home and analyzing the risk factors of mortality due to accidental injuries among adults aged 65 years and older. Materials and Methods: This retrospective study used data from the community-based Severe Trauma Survey in South Korea. This study identified general, injury-related, and treatment-related characteristics of older adults who were transported to the emergency department with accidental injuries at home. Single-variable and multiple logistic regression analyses were used to identify risk factors for mortality after injury. Results: The majority of older adults in this study who experienced accidental injuries at home were aged 75 to 84 (42.8%) and female (52.8%), with 1465 injured from falls and slips (68.0%). Risk factors for mortality included older age (≥85 years) (ORs 2.25, 95% CI 1.47-3.45), male sex (ORs 1.60, 95% CI 1.15-2.20), mechanism of injury (falls or slips vs. contact injury, ORs 6.76, 95% CI 3.39-13.47; airway obstruction vs. contact injury, ORs 13.96, 95% CI 6.35-30.71), higher severity (moderate vs. mild, ORs 2.56, 95% CI 1.45-4.54; severe vs. mild, ORs 12.24, 95% CI 6.48-23.12; very severe vs. mild, ORs 67.95, 95% CI 38.86-118.81), and receiving a blood transfusion (ORs 2.14, 95% CI 1.24-3.67). Conclusions: Based on these findings, the home and community environments where older adults live should be inspected and monitored, and in-home accidental injury prevention strategies should be developed tailored to the characteristics of older adults' risk factors and their injury-related characteristics.

Accidental Infant Suffocation and Strangulation in Bed: Disparities and Opportunities.

Objectives (a) Update previous descriptions of trends in ASSB; (b) determine if factors previously associated with ASSB are replicated by updated data; and (c) generate new hypotheses about the occurrence of ASSB and racial inequalities in ASSB mortality. Methods National Center for Health Statistics files (International Classification of Diseases, Tenth Edition) Code W75 to describe race-ethnicity-specific ASSB occurrence. Results (a) ASSB mortality continues to increase significantly; for 1999-2016, 4.4-fold for NHB girls (45.8 per 100,000 in 2016), 3.5-fold for NHB boys (53.8), 2.7-fold for NHW girls (15.8) and 4.0-fold for NHW boys (25.9); (b) F actors previously associated with ASSB (unmarried mothers and mothers with low educational attainment, low infant birth weight, low gestational age, lack of prenatal care, male infant, multiple birth, high birth order) continue to be associated with both overall ASSB and inequalities adversely affecting NHB; (c) (1) geographic differences and similarities in ASSB occurrence support hypotheses related to positive deviance; (2) lower ASSB mortality for births attended by midwives as contrasted to physicians generate hypotheses related to both medical infrastructure and maternal engagement; (3) high rates of ASSB among infants born to teenage mothers generate hypotheses related to the possibility that poor maternal health may be a barrier to ASSB prevention based on education, culture and tradition. Conclusions for Practice These descriptive data may generate new hypotheses and targets for interventions for reducing both ASSB mortality and racial inequalities. Analytic epidemiologic studies designed a priori to do so are required to address these hypotheses.

Trauma in elderly patients: a study of prevalence, comorbidities and gender differences.

AIM: Trauma, in geriatric patients, increases with age, and is a leading cause of disability and institutionalization, resulting in morbidity and mortality. The aim of our study was to analyse the prevalence of trauma, the related risk factors, mortality and sex differences in the prevalence in a geriatric population. PATIENTS AND METHOD: We observed 4,554 patients (≥65 years) with home injuries or car accidents. Patients were evaluated with ISS (Injury Severity Score) and major trauma with ATLS (Advanced Trauma Life Support). The instrumental investigation was in the first instance, targeted X-Ray or whole-body CT. RESULTS: In over four years of study we treated 4,554 geriatric: 2,809 females and 1,745 Males. When the type of trauma was analysed the most common was head injury, followed by fractures of lower and upper limbs. In our experience hospitalization mainly involved patients over 80. In all patients mortality during assessment was 0.06%. DISCUSSION: The geriatric patient is often defined as a "frail elderly", for the presence of a greater "injury sensitivity". This is due to the simultaneous presence of comorbidity, progressive loss of full autonomy and exposure to a high risk of traumatic events. Optimal management of the trauma patient can considerable reduce mortality and morbidity. CONCLUSIONS: Falls and injuries in geriatric age are more frequent in women than in men. Among typical elder comorbidities, osteoporosis certainly causes a female preponderance in the prevalence of fractures. Our discharge data demonstrate that disability, which requires transfer to health care institutions, has a greater effect on women than men.

Risk factors associated with unintentional house fire incidents, injuries and deaths in high-income countries: a systematic review.

OBJECTIVE: To identify the distinguishing risk factors associated with unintentional house fire incidents, injuries and deaths. STUDY DESIGN: Systematic review. METHODS: A range of bibliographical databases and grey literature were searched from their earliest records to January 2016. To ensure the magnitude of risk could be quantified, only those study types which contained a control group, and undertook appropriate statistical analyses were included. A best evidence synthesis was conducted instead of a meta-analysis due to study heterogeneity. RESULTS: Eleven studies investigating a variety of risk factors and outcomes were identified. Studies ranged from medium to low quality with no high quality studies identified. Characteristics commonly associated with increased risk of house fire incidents, injuries and fatalities included: higher numbers of residents, male, children under the age of 5 years, non-working households, smoking, low income, non-privately owned properties, apartments and buildings in poor condition. Several risk factors were only associated with one outcome (eg, living alone was only associated with increased risk of injurious fires), and households with older residents were at increased risk of injurious fires, but significantly less likely to experience a house fire in the first place. CONCLUSIONS: This best evidence synthesis indicates that several resident and property characteristics are associated with risk of experiencing house fire incidents, injuries or death. These findings should be considered by the Fire and Rescue Services and others with a role in fire prevention. Future research should adopt robust, standardised study designs to permit meta-analyses and enable stronger conclusions to be drawn.

In Praise of NSC's Moonshot.

I applaud the NSC's chief executive and the council for setting this ambitious goal and keeping it on the front burner at every opportunity.

[Accidental ingestion of methadone by children and suggestions for better prevention]. / Akzidentelle Methadoneinnahme durch Kinder - Gedanken zur Verbesserung der Prävention.

Despite the medial attention attracted by the presented case in January 2012 and the determined measures taken to minimize the risk of accidental poisoning for children in the direct surroundings of substituted persons, we recently faced two more cases of methadone-intoxicated children in Hamburg. We believe that the most important step to increase awareness of the dangerous effects of methadone for children might be the storage of methadone in lockable boxes, which would make it safe from access by children and third parties. Moreover this way of storing reminds the patients of the risks resulting from their medication. Repeated and comprehensive instruction appears to be the best protection against cases like this to counteract careless handling of the substitution medication.

Unintentional home injuries across the life span: problems and solutions.

Home injuries cause more than 30,000 deaths and 12 million nonfatal injuries annually in the United States. They generate an estimated $222 billion in lifetime costs annually. Despite some data limitations in documenting home as the location of an injury, much progress has been made in identifying effective prevention strategies that reduce injury or mitigate risk behaviors. The current interest in public health in the role of housing in health offers unparalleled opportunities for injury prevention professionals concerned with home injuries. Sharing the science of injury prevention with the wide array of professionals-such as architects, home builders, home visitors, and fire and emergency medical services providers-who create home environments and interact with residents could be a useful approach. A collaborative national effort to reduce the burden of home injuries is needed.

Elderly fall patients triaged to the trauma bay: age, injury patterns, and mortality risk.

BACKGROUND: Falls in the elderly are a significant cause of morbidity and mortality. We sought to better categorize this patient population and describe factors contributing to their falls. METHODS: This is a retrospective review of geriatric patients presenting to a level 1 community trauma center. We queried our trauma database for all patients 65 years and older presenting with fall and triaged to the trauma bay from 2008 to 2013. Researchers reviewed the patients' trauma intake paperwork to assess mechanism, injury, and location of fall, whereas discharge summaries were reviewed to determine disposition, morbidity, and mortality. RESULTS: A total of 650 encounters were analyzed. Five hundred thirty-nine resided at home (82.9%), 110 presented from nursing homes or assisted living (16.9%), and 1 came from hospice (0.15%). Ninety-five patients died or were placed on hospice as a result of their falls (14.7%), of which 88 came from home. Controlling for Injury Severity Score, living at home was an independent risk factor for fall-related mortality (odds ratio, 3.0). Comparing the elderly (age 65-79 years; n = 274) and the very elderly (age ≥80 years; n = 376), there were no differences in Injury Severity Score (P = .33), likelihood of death (P = .49), likelihood of C-spine injury (P = 1.0), or likelihood of other axial or long bone skeletal injury (P = .23-1.0). There was a trend for increased likelihood of head injury in very elderly patients (P = 0.06). CONCLUSION: Prevention measures to limit morbidity and mortality in elderly fall patients should be aimed at the home setting, where most severe injuries occur. Very elderly patients may be at increased risk for intracranial fall-related injuries.

Preventing deaths and injuries from house fires: an outcome evaluation of a community-based smoke alarm installation programme.

BACKGROUND: Few studies have examined the impact of community-based smoke alarm (SA) distribution programmes on the occurrence of house fire-related deaths and injuries (HF-D/I). OBJECTIVE: To determine whether the rate of HF-D/I differed for programme houses that had a SA installed through a community-based programme called Operation Installation, versus non-programme houses in the same census tracts that had not received such a SA. METHODS: Teams of volunteers and firefighters canvassed houses in 36 high-risk target census tracts in Dallas, TX, between April 2001 and April 2011, and installed lithium-powered SAs in houses where residents were present and gave permission. We then followed incidence of HF-D/I among residents of the 8134 programme houses versus the 24 346 non-programme houses. RESULTS: After a mean of 5.2 years of follow-up, the unadjusted HF-D/I rate was 68% lower among residents of programme houses versus non-programme houses (3.1 vs 9.6 per 100 000 population, respectively; rate ratio, 0.32; 95% CI 0.10 to 0.84). Multivariate analysis including several demographic variables showed that the adjusted HF-D/I rate in programme houses was 63% lower than non-programme houses. The programme was most effective in the first 5 years after SA installation, with declining difference in rates after the 6th year, probably due to SAs becoming non-functional during that time. CONCLUSIONS: This collaborative, community-based SA installation programme was effective at preventing deaths and injuries from house fires, but the duration of effectiveness was less than 10 years.

Sudden unexpected death in infancy (SUDI) in the early neonatal period: the role of bed-sharing.

The incidence of sudden infant death syndrome (SIDS) has declined substantially, but the proportion of sudden unexpected death in infancy (SUDI) in neonates, <7 days old, has increased among all SUDI cases in the first year of life. The aim of this study was to analyze circumstances and common features of SUDI cases during the first 7 days of life. Data have been gathered retrospectively from Departments of Legal Medicine in Germany and Austria by using a standardized questionnaire. 19 out of 46 children died within 24 h after birth. A possible reason for this could be a lack of awareness of the needs of the newborn on the part of an exhausted mother. Fifty-two percent of the incidents occurred while the mother and her newborn were still hospitalized in a birth clinic. Forty-eight percent of the infants had been sleeping in the parents' bed with mother and/or father. In 11 % of the cases, there was a sofa-sharing situation. Bed-sharing seems to increase the risk for SIDS in the newborn period as well as the risk for accidental suffocation/asphyxia of the baby. Therefore, mothers should not be instructed to bed-share. Particularly during the first 24 h after birth, it may be advisable to check mothers and infants regularly.

Accidental mechanical asphyxia of children in Germany between 2000 and 2008.

Accidents constitute one of the greatest risks to children, yet there are few medical reports that discuss the subject of accidental asphyxia. However, a systematic analysis of all documented cases in Germany over the years 2000-2008 has now been conducted, aiming at identifying patterns of accidental asphyxia, deducing findings, defining avoidance measures and recommending ways of increasing product safety and taking possible precautions. The analysis is based on a detailed retrospective analysis of all 91 relevant autopsy reports from 24 different German forensic institutes. A variety of demographic and morphological data was systematically collected and analysed. In 84 of the 91 cases, the sex of the victim was reported, resulting in a total of 57 boys (68 %) and 27 girls (32 %). The age spread ranged between 1 day and 14 years, with an average of 5.9 years. Most accidents occurred in the first year of life (20 %) or between the ages of 1 and 2 years (13 %). In 46 % of cases, the cause of death was strangulation, with the majority occurring in the home environment. In 31 % of all cases, the cause of death was positional asphyxia, the majority resulting from chest compression. In 23 % of cases, the cause of death was aspiration, mainly of foreign bodies. Today, accidental asphyxiation is a rare cause of death in children in Germany. Nevertheless, the majority of cases could have been avoided. Future incidence can be reduced by implementing two major precautions: increasing product safety and educating parents of potentially fatal risks. Specific recommendations relate to children's beds, toys and food.

The impact of immersion protection requirements on hair dryer electrocutions in the USA.

OBJECTIVE: To evaluate the effectiveness of the immersion protection requirements of a voluntary safety standard for portable handheld hair dryers in preventing electrocution deaths in the USA. METHODS: The present work was an interrupted time series study design. Data on annual hair dryer-related electrocution deaths resulting from water contact were developed for the 1980-2007 study period. A multivariate Poisson regression model for rate data was used to evaluate the impact of the immersion protection requirements during the post-intervention period. The analysis controlled for the estimated number of hair dryers in use and the estimated number of US homes equipped with ground fault circuit interrupters, safety devices that would address hair dryer electrocutions even in the absence of the immersion protection requirements of the voluntary standard. The implementation of the 1987 and 1991 immersion protection requirements of the voluntary standard for portable handheld hair dryers was the intervention studied. The main outcome measure was the estimated reduction in the hair dryer electrocution rate associated with the immersion protection requirements of the voluntary standard. RESULTS: After controlling for covariates, the immersion protection requirements were estimated to reduce the rate of hair dryer immersion electrocution deaths by 96.6% (95% CI, 90.8% to 98.8%). This suggests the prevention of about 280 immersion electrocution deaths involving hair dryers during the post-intervention period (1987-2007). CONCLUSIONS: The immersion protection requirements of the voluntary safety standard for hair dryers have been highly effective in reducing hair dryer electrocutions.

Maternal and infant characteristics associated with accidental suffocation and strangulation in bed in US infants.

To identify maternal and infant characteristics associated with accidental suffocation and strangulation in bed (ASSB) in US infants. Using 2000-2002 US linked infant birth and death certificate cohort files, we compared ASSB deaths to survivors. Adjusted odds ratios (aOR) from logistic regression were used to analyze associations between selected maternal and infant characteristics and ASSB mortality. During 2000-2002, 1,064 infants died from ASSB, resulting in an ASSB mortality rate of 9.2 per 100,000 live births. Most ASSB deaths (71%) occurred before an infant reached 4 months old. Maternal factors associated with an increased risk of ASSB were younger age (using maternal age of 25-29 years as reference aOR 2.6 for mothers <20 years old and 1.6 for mothers 20-24 years old), lower educational attainment (aOR 4.3 for <12 years and 3.3 for 12 years compared to ≥16 years), multiparity (aOR 1.7, 2.2, and 3.5 for parity 2, 3, and 4 or higher, respectively) and smoking during pregnancy (aOR 2.8). Compared to non-Hispanic whites, non-Hispanic blacks (aOR 1.8) and American Indians (aOR 1.8) were more likely to have an ASSB death. Being male and born preterm were also associated with a higher ASSB mortality risk. Younger, less educated, mulitparous, non-Hispanic black or American Indian women and their families who smoke during their pregnancy and deliver male or preterm infants, may need more intense safe sleeping education during the infant's first year of life, especially during the first 4 months of age.

Non fatal injuries among infants: a pilot study.

OBJECTIVE: To determine the incidence, nature and the extent of infant injuries in two suburban and rural communities of Pakistan. METHODS: The cross-sectional study was conducted on a cohort of 310 infants in suburban and rural communities of Pakistan in September 2007. The information was collected from primary care-givers based on any injury that had occurred to their infants during the preceding 3 months that required treatment at home or in a hospital. RESULT: The incidence of non-fatal injury for infants up to 1-year-old was found to be 19 injuries per 100 person (child) years of exposure (95% CI 9.90 - 27.21). In suburban area, the rate was 26 injuries/100 person (child) years (95 % CI 15.37 - 35.71), while in rural area, it was 13 injuries/100 person (child) years of exposure (95 % CI 4.79-18.39). Altogether, 13 episodes of injury were reported among infants in both the communities. The male to female infant ratio for injury was 1:2.2. Suburban area had more than double injuries compared to the rural area. CONCLUSION: The magnitude of infant injuries was quite significant, especially among suburban and female children. There is a dire need to develop community-based interventions creating awareness on the matter.

Child home injury mortality in Europe: a 16-country analysis.

BACKGROUND: Child injury mortality and morbidity are a public health concern in European countries and data are scarce. Cross-national efforts are needed to identify high-risk groups, follow trends and assist in establishing European-wide safety legislation. This study investigates fatal child injuries in the home, as compared to those in transport in European countries. METHODS: Injury mortality was extracted from the World Health Organization Mortality Database for the years 2002-04. The mortality rate per 100 000 population was calculated by age group for 16 contributing countries, grouped by their economic level of development. RESULTS: Fatal home injuries were highest in children under 5 years of age and then sharply decreased, as opposed to road traffic injuries, which increased with age. The majority of the upper-middle-economy countries tended to have higher home injury incidence rates compared to the high-income countries. The top five injury causes all countries aggregated were drowning/submersion, thermal injuries, poisoning, falls and homicide, all of which account for almost 90% of home injury deaths. CONCLUSION: Home injuries were the leading cause of injury death in children under 5 years of age in the countries under study and the inequalities found among the countries indicate potential for improvement. Evidence-based interventions exist to prevent these injuries and the barriers to their implementation ought to be determined and addressed.

Floor mattresses: another potentially dangerous infant sleeping environment.

AIM: To identify and characterise cases of infant deaths where the fatal episodes were considered to be because of positional asphyxia from wedging and/or suffocation associated with sleeping on or near a mattress that had been placed on a floor. METHODS: Retrospective review of autopsy cases from Forensic Science SA, Adelaide, Australia, was performed over a 10-year period from January 2001 to December 2009 to identify such cases. RESULTS: A total of five deaths were identified. In three cases, infants were wedged between the sides of mattresses and a wall or a sofa. In one case, the infant's head was wedged between a mattress side and a chest of drawers, and in the remaining case, the head was pressed into a plastic bag containing clothes. The age range was 2-10 months, with a male-to-female ratio of 3:2. CONCLUSIONS: Although such deaths are not common, they may be more prevalent when there is overcrowding and reduced sleeping space. While the ideal situation is to provide an infant with his or her own sleeping space, infants sleeping on or near floor mattresses can have the risk of asphyxiation reduced if such mattresses are not located close to furniture or walls, and are not near items such as soft materials or plastic sheeting that could cause airway obstruction.

Pathology of deaths from carbon monoxide poisoning in Port Harcourt: an autopsy study of 75 cases.

BACKGROUND: Carbon monoxide (CO) poisoning is a notable cause of death at homes and industries that is posing public health problem worldwide that requires an elaborate study. OBJECTIVE: To study and characterize deaths resulting from the noxious gas (CO). DESIGN: A ten year (January 1st, 1995 December 31st 2004) autopsy study. SETTING: Port Harcourt, Nigeria. METHODOLOGY: Coroners and hospital autopsies performed by the authors at the University of Port Harcourt Teaching Hospital (UPTH), other hospitals and private mortuaries in Port Harcourt on deaths from carbon monoxide poisoning were studied over ten years. The circumstances of death reported by police were accidental, homicidal or suicidal; and other autopsy findings were used for the study. RESULTS: A total of seventy five autopsies were studied; out which 21 (28.0%) were females and 54 (72.0%) males giving a ratio 1:2.6 male dominance. The highest frequency of death 25 (33.3%) occurred in the age group 60 69 years; while the least 3 (4%) occurred in the age group 0 9 years. The youngest was an unborn 7 month old male fetus while the eldest was 85 years old female. The most common was accidental carbon monoxide poisoning which accounted for 48 (64%) cases. While Homicidal CO poisoning .was 24 (32%) and suicidal CO poisoning was 3 (4.0%). Body recovered from fumy electric generator rooms was 46 (61.3%) while least frequency was bodies recovered from naked flame 3 (4%). CONCLUSION: Carbon monoxide poisoning is posing a serious public health problem when ever it occurs. There is need for public enlightenment about this gas as it is related to fumes from generator, car exhausts, poorly ventilated rooms and enclosed chambers in order to reduce the carnage associated with it both at home and industries.

Fire-related deaths in India in 2001: a retrospective analysis of data.

BACKGROUND: Hospital-based studies have suggested that fire-related deaths might be a neglected public-health issue in India. However, no national estimates of these deaths exist and the only numbers reported in published literature come from the Indian police. We combined multiple health datasets to assess the extent of the problem. METHODS: We computed age-sex-specific fire-related mortality fractions nationally using a death registration system based on medically certified causes of death in urban areas and a verbal autopsy based sample survey for rural populations. We combined these data with all-cause mortality estimates based on the sample registration system and the population census. We adjusted for ill-defined injury categories that might contain misclassified fire-related deaths, and estimated the proportion of suicides due to self-immolation when deaths were reported by external causes. FINDINGS: We estimated over 163 000 fire-related deaths in 2001 in India, which is about 2% of all deaths. This number was six times that reported by police. About 106 000 of these deaths occurred in women, mostly between 15 and 34 years of age. This age-sex pattern was consistent across multiple local studies, and the average ratio of fire-related deaths of young women to young men was 3:1. INTERPRETATION: The high frequency of fire-related deaths in young women suggests that these deaths share common causes, including kitchen accidents, self-immolation, and different forms of domestic violence. Identification of populations at risk and description of structural determinants from existing data sources are urgently needed so that interventions can be rapidly implemented.

The epidemiology of domestic injurious falls in a community dwelling elderly population: an outgrowing economic burden.

In Italy, more than 3 million people annually sustain a domestic injury; the elderly experience it the most. From a healthcare perspective, elderly falls are a major clinical issue with an outgrowing socioeconomic burden. The aim of the study was to evaluate the epidemiology of injurious falls in a community dwelling population, admitted to the emergency room (ER) because of a domestic injury, to assess the socioeconomic burden. Seventy-four hospitalized patients among 227 were examined. Falls represented the main cause of admittance to the ER; the average cost for fall-related hospitalization was of €5479.09.