Child Injury Risk Research Articles

Extreme heat and heatwaves are linked to the risk of unintentional child injuries in Guangzhou city

With unintentional injuries being the leading mortality cause among children, the comprehensive evaluation of the unintentional injury burden concerning heat exposure remains unknown. Here we quantified the years lived with disability (YLD) due to unintentional child injuries in Guangzhou from 2016–2020 using the injury surveillance data. A Poisson regression model was employed to explore how various magnitudes of heat exposure could increase the injury burden in different children’s subgroups. Our findings suggest a positive link between heat exposure and childhood injuries. The successive heatwave led to a 16.8–23.8% higher risk of childhood injuries. Girls and preschoolers exhibited higher vulnerability to heat. Furthermore, heat exposure increased the road injury burden for preschoolers aged 3–6 years but not for adolescents. Our study links heat exposure to childhood unintentional injuries, providing insights into the demographic features and injury causes. This evidence can be used to inform healthy childhood development.

Firearm-Related Unintentional Childhood Injury in Israel.

The rise in demand for firearm licenses in Israel due to the ongoing 2023-2024 Israel-Gaza War, coupled with the easing of regulations for issuing weapons, is expected to lead to a significant increase in the incidence of firearms among civilians. This situation calls for a special awareness of civilian populations of the dangers posed to children by the high prevalence of firearms. We therefore present trends in firearm-related incidents resulting in unintentional mortality and morbidity of children ages 0-17 between the years 2008-2023 in Israel. In total, 202 accidents involving firearms were reported, with an average age of 12.2 (median: 13), and with the youngest child being 2 years old. Of these, 24 cases resulted in fatalities18 of which of children of Arab descent. We provide several recommendations concerning changes and additions to current bylaws concerning firearms licensing and storage in Israel, in order to decrease the risk of child injury due to irresponsible firearm handling.

Development of an Internet-based Product-related Child Injury Textual Data Platform (IPCITDP) in China.

Internet-based media stories provide valuable information for emerging risks of product-related child injury prevention and control, but critical methodological challenges and high costs of data acquisition and processing restrict practical use by stakeholders. We constructed a data platform through literature reviews and multi-round research group discussions. Developed components included standard search strategies, filtering criteria, textual document classification, information extraction standards and a keyword dictionary. We used ten thousand manually labelled media stories to validate the textual document classification model, which was established using the Bidirectional Encoder Representation from Transformers (BERT). Multiple information extraction methods based on natural language processing algorithms were adopted to extract data for 29 structured variables from media stories. They were evaluated through manual validation of 1000 media stories about product-related child injury. We mapped the geographic distribution of media sources and media-reported product-related child injury events. We developed an internet-based product-related child injury textual data platform, IPCITDP, consisting of four layers - automatic data search and acquisition, data processing, data storage, and data application - concerning product-related child injury online media stories in China. Each layer occurred daily. External validation demonstrated high performance for the BERT classification model we established (accuracy = 0.9703) and the combined information extraction strategies (accuracy >0.70 for 25 variables). As of 31 December 2023, IPCITDP collected 35 275 eligible product-related child injury reports from 13 261 news media websites or social media platform accounts which were geographically located across all 31 mainland Chinese provinces and covered over 97% of prefecture-level cities. The injury cases in IPCITDP were typically reported several months or years earlier than official announcements about the product-related child injury risks. Our data platform added data concerning 15 supplementary variables that the national product-related injury surveillance system lacks. Two examples demonstrate the value of IPCITDP in supplementing existing data and providing early epidemiological detection of emerging signals concerning product-related child injury: magnetic beads and electric self-balancing scooters. Our data platform provides injury data that can support early detection of new product-related child injury characteristics and supplement existing data sources to reduce the burden of product-related injury among Chinese children.

Congruency of Crash- and Hospital- Reported Injuries Among Child Passengers

Introduction: Prior work has found incongruencies in injury information reported by crash and hospital records. However, no work has focused on child passengers. The objective of this study was to compare crash scene and hospital-reported injury information for crash-involved child passengers. This study also explored injury location and severity by child age and restraint type. Methods: Utilizing linked New Jersey data from 2017 through 2019, the authors identified crash-involved child passengers <13 years old and their injuries in crash and hospital reports. Then, they characterized the congruency of injury frequency, severity, and location, as well as the frequency of injuries by child age and restraint type. Analyses were conducted from December 2023 through February 2024. Results: Of 84,060 crash-involved child passengers, crash reports documented 7,858 (9%) children with at least “possible” injuries, while 2,577 (3%) had at least one injury in hospital events. Crash report and hospital data were incongruent for both body region of injury and injury severity. The proportion of children injured increased as children's ages increased and as restraint type progressed. Conclusions: Crash reports overestimated the number of injured child passengers and misrepresented injury severity and locations. Child restraint systems mitigated a child's injury risk. Importantly, injury information documented on crash reports currently informs the allocation of traffic safety resources. These results highlight the importance of improving these reports’ accuracy and underscore calls to link administrative datasets for public health efforts.

Acute kidney injury induced by beta-lactam antibiotics in children: A scoping review

Antibiotics are the agents that cause Acute Kidney Injuries (AKI) in children. A recent study has shown the incidence of nephrotoxicity by antibiotics reaches 16% in children. Beta-lactam types are not widely known for their nephrotoxic effect. This study aims to examine beta-lactam antibiotics' role in inducing children's renal failure. This search for a scoping review on the effect of beta-lactam antibiotics in children was carried out in December-January 2022-2023. We used some search engines with the year of publication 2012-2022 then extracted. The keyword combinations used are: “beta-lactams” OR “β-lactams” AND “acute renal failure” OR “acute renal injury” OR “nephrotoxic” OR “nephrotoxicity” AND “children” OR “pediatric” OR “neonate” NOT “adult”. Studies were excluded if the: (i) adult; (ii) were a review, systematic review, or meta-analysis; (iii) written in a language other than English; (iv) not available in full text; (v) have kidney disease before (vi) in vitro or in vivo. The article selection process was based on PRISMA-ScR. From 4032 articles that met the search criteria, 3 studies met the inclusion criteria. The result shows that beta-lactam increases the risk of acute renal injury in children. This review emphasizes the importance of choosing kidney-safe antibiotics for children.

The Relationship Between Perioperative Blood Product Use and the Incidence of Postoperative Renal Injury in Infants Undergoing Cardiac Surgery

Cardiac Surgery Associated Acute Kidney Injury (CS-AKI) is a serious complication that occurs in patients following cardiac surgery. It is characterized by the rapid decline in kidney function, leading to potential long-term kidney damage or even kidney failure. CS-AKI is a significant health concern, as it not only prolongs hospital stays and recovery time but also increases the risk of mortality. This study, conducted as a prospective observational study, aimed to investigate the relationship between perioperative blood product use and the incidence of postoperative acute kidney injury (AKI) in infants and young children undergoing cardiac surgery. It examined the perioperative use of these blood products and its association with the occurrence of AKI. The findings of this study revealed a significant association between the use of red blood cell suspension and platelets and the development of postoperative AKI. This suggests that the administration of these blood products during cardiac surgery may increase the risk of kidney injury in infants and young children. However, it is important to note that the study did not find a statistically significant association between plasma transfusion volume and the incidence of AKI. This suggests that while the use of certain blood products may contribute to the risk of AKI, the volume of plasma transfused does not seem to have a significant impact. The findings of this study provide valuable insights into the perioperative management of infants and young children undergoing cardiac surgery. It underscores the importance of carefully considering the use of blood products during surgery and taking necessary measures to minimize the risk of AKI.

The effect of reclined seat-back angles on the LODC with and without a belt-positioning booster during far-side lateral-oblique impacts

Objective In frontal crashes belt-positioning boosters (BPB) may prevent submarining when the seatback is reclined. It is unclear if the BPB can also mitigate injuries in far-side lateral-oblique crashes in reclined conditions, where current restraints are less effective in reducing lateral excursion. This study aimed to understand reclined child injury risk during lateral-oblique impacts, with and without a booster seat, by using the Large Omni-Directional Child (LODC) test device. Methods The LODC was tested in nine lateral-oblique impact (80° from frontal) sled tests (target 31.3 km/h, duration 58 ms maximum, peak acceleration 21 g). Three seatback angles (25°, 45°, and 60°) with and without the BPB were compared on a production passenger seat with an integrated seatbelt. The LODC moved toward the buckle side during the far-side lateral-oblique impact. Abdominal pressure (left and right), seatbelt loads, anterior superioriliac spine (ASIS) forces, and pelvis lateral rotation were examined. The LODC head and knee excursions were extracted from a 3D-motion capture system. Results In the reclined noBPB condition, peak abdominal pressures on the buckle side reached up to 186 kPa and the ASIS forces demonstrated an early (∼ 50 ms) peak and a subsequent drop in the reclined noBPB conditions, suggesting that the belt slid into the abdomen. With the BPB, peak pelvis lateral rotation was greater than in the noBPB conditions but decreased with increasing reclined seatback angles (BPB: 31° to 36.5° vs no-BPB: −5° to −4.6°). Peak lap belt forces were greater in the reclined noBPB conditions (4.8-4.9 kN) compared to all conditions with the BPB (2.9-3.2 kN). The greatest lateral head excursion was observed in the BPB 25° condition (895 mm) and the lowest in the noBPB 45° condition (748 mm). Conclusions The BPB may prevent the lap belt intrusion into the abdomen in reclined configurations in far side lateral-oblique impacts. The greater pelvis lateral rotation and head displacement with the BPB may lead to contact with other rear-seated occupants and/or vehicle structures, although motion decreased with the BPB as the reclined seatback angle increased. This suggests that reclined seats may help reduce BPB-seated children’s lateral excursion in far-side lateral-oblique impacts.

C.4 Neurologic injury in pediatric patients cannulated for rescue extracorporeal life support

Background: Historical literature suggests the risk of neurologic injury in children supported by extracorporeal life support (ECLS) is between 10-20%, however recent studies suggest the incidence may be much higher. Methods: The Alberta Children’s Hospital (ACH) Rescue ECLS program cannulates patients who are then transferred to the partner program at Stollery Children’s Hospital. Data was systematically collected from all patients cannulated for Rescue ECLS at ACH October 2011 and May 2023. Neuroimaging (CT, MR) performed after cannulation was reviewed for evidence of ischemic and hemorrhagic strokes and hypoxic-ischemic brain injury. Results: Seventy-one patients were included in the Rescue ECLS cohort. Median age at cannulation was 1.74 years (range 0-17.6 years, 51% female). Survival to hospital discharge was 65%. Primary indication for ECLS included cardiac (42%), respiratory (33.3%), extracorporeal cardiopulmonary resuscitation (ECPR; 23.2%) and trauma (1.4%). Seventy four percent of the cohort underwent neuroimaging, of whom 67% had evidence of neurologic injury including stroke (ischemic 67%; hemorrhagic 50%) or hypoxic-ischemic injury (33%). Risk of neurologic injury did not differ by indication for ECLS. Conclusions: Neuroimaging abnormalities are present in most pediatric patients imaged post-cannulation for Rescue ECLS. Further research into modifiable risk factors for specific ECLS-related brain injuries may help to improve outcomes for survivors.

Elevated plasma solMER concentrations link ambient PM2.5 and PAHs to myocardial injury and reduced left ventricular systolic function in children

Exposure to fine particulate matter (PM2.5) and polycyclic aromatic hydrocarbons (PAHs) is known to be associated with the polarization of pro-inflammatory macrophages and the development of various cardiovascular diseases. The pro-inflammatory polarization of resident cardiac macrophages (cMacs) enhances the cleavage of membrane-bound myeloid-epithelial-reproductive receptor tyrosine kinase (MerTK) and promotes the formation of soluble MerTK (solMER). This process influences the involvement of cMacs in cardiac repair, thus leading to an imbalance in cardiac homeostasis, myocardial injury, and reduced cardiac function. However, the relative impacts of PM2.5 and PAHs on human cMacs have yet to be elucidated. In this study, we aimed to investigate the effects of PM2.5 and PAH exposure on solMER in terms of myocardial injury and left ventricular (LV) systolic function in healthy children. A total of 258 children (aged three to six years) were recruited from Guiyu (an area exposed to e-waste) and Haojiang (a reference area). Mean daily PM2.5 concentration data were collected to calculate the individual chronic daily intake (CDI) of PM2.5. We determined concentrations of solMER and creatine kinase MB (CKMB) in plasma, and hydroxylated PAHs (OH-PAHs) in urine. LV systolic function was evaluated by stroke volume (SV). Higher CDI values and OH-PAH concentrations were detected in the exposed group. Plasma solMER and CKMB were higher in the exposed group and were associated with a reduced SV. Elevated CDI and 1-hydroxynaphthalene (1-OHNa) were associated with a higher solMER. Furthermore, increased solMER concentrations were associated with a lower SV and higher CKMB. CDI and 1-OHNa were positively associated with CKMB and mediated by solMER. In conclusion, exposure to PM2.5 and PAHs may lead to the pro-inflammatory polarization of cMacs and increase the risk of myocardial injury and systolic function impairment in children. Furthermore, the pro-inflammatory polarization of cMacs may mediate cardiotoxicity caused by PM2.5 and PAHs.

Social determinants of health and disparities in pediatric trauma care: protocol for a systematic review and meta-analysis

BackgroundSocial determinants of health (SDH), including “the conditions in which individuals are born, grow, work, live and age” affect child health and well-being. Several studies have synthesized evidence about the influence of SDH on childhood injury risks and outcomes. However, there is no systematic evidence about the impact of SDH on accessing care and quality of care once a child has suffered an injury. We aim to evaluate the extent to which access to care and quality of care after injury are affected by children and adolescents’ SDH.MethodsUsing Cochrane methodology, we will conduct a systematic review including observational and experimental studies evaluating the association between social/material elements contributing to health disparities, using the PROGRESS-Plus framework: place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital and care received by children and adolescents (≤ 19 years of age) after injury. We will consult published literature using PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, and Academic Search Premier and grey literature using Google Scholar from their inception to a maximum of 6 months prior to submission for publication. Two reviewers will independently perform study selection, data extraction, and risk of bias assessment for included studies. The risk of bias will be assessed using the ROBINS-E and ROB-2 tools respectively for observational and experimental study designs. We will analyze data to perform narrative syntheses, and if enough studies are identified, we will conduct a meta-analysis using random effects models.DiscussionThis systematic review will provide a synthesis of evidence on the association between SDH and pediatric trauma care (access to care and quality of care) that clinicians and policymakers can use to better tailor care systems and promote equitable access and quality of care for all children. We will share our findings through clinical rounds, conferences, and publication in a peer-reviewed journal.Systematic review registrationPROSPERO CRD42023408467

Clinical Effects of Nitric Oxide Added to the Oxygenator of Children on Extracorporeal Membrane Oxygenation: Pre-Post Cohort Study.

Nitric oxide (NO) can be safely delivered through the sweep gas to the oxygenator of an extracorporeal membrane oxygenation (ECMO) circuit. It has theoretical benefits such as preventing platelet adhesion to surfaces, mitigating inflammatory response and protection against ischemia-reperfusion injury. In this uncontrolled before-after study of children on ECMO, the outcomes of those who received NO were compared with those who did not. Among 393 ECMO runs (from 337 patients), 192 of 393 (49%) received NO and 201 of 393 (51%) did not. The use of NO was associated with a 37% reduction in circuit change (adjusted risk ratio [aRR]: 0.63, 95% confidence interval [CI]: 0.42-0.93). The aRR (95% CI) for risk of neurologic injury was 0.72 (0.47-1.11). We observed potential heterogeneity of treatment effect for the risk of neurologic injury in children who had cardiac surgery: the risk with NO was lower in those who had cardiac surgery (aRR: 0.50, 95% CI: 0.26-0.96). There was no difference in survival between the study groups. In children managed with NO delivered through the ECMO circuit, we report a reduction in observed rate of circuit change and lower risk of neurologic injury in children who underwent cardiac surgery. Nitric oxide therapy on ECMO warrants prospective evaluation in children.

Enhancing first aid knowledge for students at SDN Mojorejo 2 Sragen

Elementary education is a time when children actively interact with their friends. Play interactions sometimes carry a risk of injury for elementary school children. The national incidence of injuries at school is 5.4%. The highest prevalence rate of injury occurs in school children, namely 13%, and in the age range of 5-14 years. Inappropriate first aid can have detrimental effects on the victim. The aim of this community service activity is to increase students' knowledge of first aid for minor injuries. The method of implementing the service is through counseling using video media and training in treating minor injuries. After providing counseling and training on treating minor injuries to students at SDN Mojorejo II Sragen, they showed an increase in "good" knowledge of 74.0%, then the level of "sufficient" knowledge was 20.8%, and the level of "poor" knowledge was 5.2%. It can be concluded that the community service activities are going well, and it is hoped that students will be able to apply the knowledge about treating minor injuries obtained in the family and community environment.

Neurological abnormalities among pediatric patients with sickle cell disease in Saudi Arabia: a single-center retrospective study.

Sickle cell disease (SCD) is a common inherited blood disorder characterized by the production of abnormal sickle-shaped red blood cells. SCD can lead to various complications including neurological issues. Early detection and treatment are crucial for preventing these complications. This study aimed to describe the neurological manifestations, radiological findings, and neurological diagnosis related to SCD in Saudi children with the aim of contributing to the formulation of population-based guidelines for screening and treating SCD-related neurological complications. This descriptive retrospective study included pediatric patients aged < 14 years diagnosed with SCD who were regularly followed up at the hematology clinic in KAMC, Jeddah, Saudi Arabia, from January 2008 to January 2022. Demographic and clinical data were collected from the clinical charts of 101 participants. This study included 101 patients with SCD with a mean age of 23 months at diagnosis. Among these, 59% had SCD and high fetal hemoglobin (HbF) levels. Neurological sequelae, including seizures, stroke, and other abnormalities, were observed in 26.7% of patients. There were no significant differences in the onset of neurological issues between the patients with SCD-high HbF and those with other SCD phenotypes. This study highlights the increased risk of brain injury and neurocognitive deficits in children with SCD. The occurrence of neurological sequelae in many patients emphasizes the need for early detection and intervention. Some patients experience neurological complications despite having high HbF levels, suggesting that further interventions are needed. This study has some limitations, including its small sample size and retrospective nature. Early detection and intervention are crucial for neurological complications in patients with SCD. This study emphasizes the need for further research and effective treatment strategies considering the presence of neurological complications despite the presence of high HbF levels. Large-scale studies and population-specific guidelines are warranted for better understanding and management of SCD-related neurological complications in the Saudi population.

Maternal psychiatric and somatic illness, and the risk of unintentional injuries in children: variation by type of maternal illness, type of injury and child age

BackgroundMaternal mental illness appears to increase the risk of unintentional childhood injuries, which are a common cause of morbidity and mortality in early childhood. However, little is known about the...

Frequency of injuries in a voluntary program evaluating young children exposed to intimate partner violence

ObjectiveIntimate partner violence (IPV) affects 1 in 4 American women, and physical child abuse is reported to occur in 10–67 % of homes with IPV. Routine evaluation of physical abuse in IPV-exposed children is neither widespread nor informed by clinical guidelines. Thus, the true frequency of detectable injuries in IPV-exposed children remains unknown. The purpose of this study was to examine the frequency of injuries in children <3-years-old reported for IPV to a regional child protective services (CPS) office. MethodsIn this prospective observational study, we reviewed encounters of children whose caregivers agreed to an evaluation for injuries (physical exam and imaging, if indicated) from July 2019–June 2022. Children were included if: 1) a CPS investigator referred a child for evaluation for injuries (“non-acute” evaluation) or 2) a child presented immediately after an IPV incident (“acute” evaluation). ResultsOf 326 children <3-years-old reported to the CPS office after IPV exposure, 90 (27.6 %) were evaluated: 81(90 %) presented for a non-acute evaluation, and 21(23 %) were reported to have sustained trauma during the IPV event. Of the 90 children evaluated, 3 (3.3 %, 95 % CI 0.7–9.4) were found to have cutaneous injuries, fractures, and/or intracranial findings. Each was <6-months old and had an “acute” evaluation. ConclusionIn this study of children reported to CPS for IPV exposure, a small percentage was found to have injuries. A multi-center study that examines the frequency of and factors that increase the risk of abusive injuries in IPV-exposed children may ensure that testing targets children at highest risk.

Risk of concomitant traumatic brain injuries in children with traumatic dental injuries in a pediatric emergency department: A case-control study

BackgroundChildren with traumatic dental injuries (TDIs) may simultaneously sustain a traumatic brain injury (TBI). The aim of this study was to investigate the risk of concomitant TBI in children with TDIs. MethodsChildren (≤ 18 years) who sought treatment at the emergency department of a major children’s hospital for TDIs from 2010 through 2019 were identified. Children with a concomitant TBI were assigned as case patients (TDI and TBI). Two control patients (TDI only) were randomly age- and sex-matched with each case patient. Associations between variables of TDI and concomitant TBI were tested using 6 logistic regression models. ResultsOf 2,126 children with TDIs, 119 had concomitant TBIs (case patients). The control group consisted of 238 children with TDIs only who were age- and sex-matched with case patients. Mean (SD) age of children was 8.9 (4.8) years. Twenty-seven percent of case patients were female vs 32% of control patients. There was a statistically significant direct association between total number of injured teeth and concomitant TBIs (P = .01; odds ratio, 2.42; 95% CI, 1.22 to 4.79). For every tooth injured, the odds of concomitant TBI increased by 45% (P < .001; odds ratio, 1.45; 95% CI, 1.18 to 1.79). Number of displaced teeth, presence of avulsion or intrusion, number of fractured teeth, presence of complicated tooth fracture, and presence of alveolar fracture were not significantly associated with the odds of concomitant TBI. ConclusionsThe total number of injured teeth was positively associated with higher odds of concomitant TBI in this setting. Practical ImplicationsIn an emergency department setting, children with various types of TDIs sustained concomitant TBIs. For every tooth injured, the odds of concomitant TBI increased by 45%. Clinicians must systematically evaluate children with any TDI to rule out the possibility of concomitant TBI.

Use of lateral-exit crossed-pin fixation for pediatric supracondylar humeral fractures: a retrospective case series.

Surgeons have been reluctant to perform crossed-pin fixation for displaced pediatric supracondylar humeral (SCH) fractures because it carries a risk of iatrogenic ulnar nerve injury. This study aimed to introduce lateral-exit crossed-pin fixation for displaced pediatric SCH fractures and to evaluate its clinical and radiological outcomes, with a particular focus on iatrogenic ulnar nerve injuries. Children who underwent lateral-exit crossed-pin fixation for displaced SCH fractures between 2010 and 2015 were retrospectively reviewed. Lateral-exit crossed-pin fixation involved the introduction of a medial pin from the medial epicondyle, as in the conventional method, followed by pulling the pin through the lateral skin until the distal and medial aspects of the pin were just under the cortex of the medial epicondyle. The time to union and loss of fixation were assessed. Flynn's clinical criteria (cosmetic and functional factors) and complications including iatrogenic ulnar nerve injury were investigated. A total of 81 children with displaced SCH fractures were treated with lateral-exit crossed-pin fixation. All but one patient achieved union with good alignment, with an average time to union of 7.9 weeks (3.9-10.3 weeks). Only one patient exhibited cubitus varus deformity associated with loss of reduction. All patients recovered to almost their full range of motion. No case of iatrogenic ulnar nerve injury developed; however, iatrogenic radial nerve injury developed in one patient. Lateral-exit crossed-pin fixation provides sufficient stability with a lower risk of iatrogenic ulnar nerve injury in children with displaced SCH fractures. This method is an acceptable technique for crossed-pin fixation.

Pilot evaluation of a virtual training program for child injury prevention.

Unintentional injuries are a leading cause of child death. The present study evaluated the effectiveness of a behavioral injury prevention program for children aged 3-18 years and their caregivers. To accommodate families during the Coronavirus-19 pandemic, training was modified to be delivered virtually. Forty-one children aged 3-18 years and 14 parents/caregivers of children aged 3-5 years attended one of several 4-hour online injury prevention training sessions directed toward residents of Washington state. Training was targeted to three different developmental stages (ages 3-5, 6-12 and 13-18 years). Study outcomes included knowledge about injury prevention strategies, perceived vulnerability for injury, self-efficacy to engage in safety behaviors and behavioral intentions to be safe. Following training, participants showed improved self-efficacy to stay safe, excellent knowledge about the learned material and increased behavioral intention to engage safely. There was minimal change in perceived vulnerability to injury among children; caregivers of young children felt their children were somewhat less vulnerable to injury following the training. Almost all participants said they would recommend the program to others. Results suggest that a virtual behavioral training program delivered remotely is feasible and may be effective to create behavior change and reduce child injury risk. Given its scalability and reach, such programs are recommended for further study, refinement and, if demonstrated effective in larger-scale controlled trials, dissemination to address the leading cause of child mortality in the United States, unintentional injury.

What is needed to reduce the risk of anterior cruciate ligament injuries in children? – Hearing from experts

ObjectiveAnterior cruciate ligament (ACL) injuries are an emerging health problem in children. Acknowledging considerable gaps in knowledge, the aim of this study was to examine the current knowledge on childhood ACL injury, and to explore risk assessment and reduction strategies, with experts in the research community. DesignQualitative study; semi-structured expert interviews. MethodsInterviews with seven international, multidisciplinary academic experts were conducted from February until June 2022. A thematic analysis approach organized verbatim quotes into themes using Nvivo Software. ResultsGaps in knowledge on the actual injury mechanism, and influence of physical activity behaviours, constrain targeted risk assessment and reduction strategies in childhood ACL injuries. Strategies to examine and reduce the risk of ACL injury included: examining an athletes' whole-body performance, moving from constraint (e.g., squat) to less constraint (e.g., single-leg) tasks, making assessments into children's context, building a movement repertoire at young age, performing risk reduction programs, multiple sports, and prioritising rest. ConclusionResearch is urgently warranted on the actual injury mechanism, reasons for ACL injuries in children, and potential risk factors to update risk assessment and reduction strategies. Further, educating stakeholders on risk reduction strategies could be essential to address the increasing occurrence of childhood ACL injuries.

Caregiver accounts of unintentional childhood injury events in rural Uganda

Objective: Complex environmental, social, and individual factors contribute to unintentional childhood injury events. Understanding context-specific antecedents and caregiver attributions of childhood injury events can inform the development of locally-targeted interventions to reduce injury risk in rural Uganda. Methods: Fifty-six Ugandan caregivers were recruited through primary schools and completed qualitative interviews regarding 86 unintentional childhood injury events. Descriptive statistics summarized injury characteristics, child location and activity, and supervision at time of injury. Qualitative analyses informed by grounded theory identified caregiver attributions of injury causes and caregiver actions to reduce injury risk. Results: Cuts, falls, and burns were the most common injuries reported. At the time of injury, the most common child activities were farming and playing and the most common child locations were the farm and kitchen. Most children were unsupervised. In cases where supervision was provided, the supervisor was typically distracted. Caregivers most often attributed injuries to child risk-taking but also identified social, environmental, and chance factors. Caregivers most often made efforts to reduce injury risk by teaching children safety rules, but also reported efforts to improve supervision, remove hazards, and implement environmental safeguards. Conclusion: Unintentional childhood injuries have a significant impact on injured children and their families, and caregivers are motivated to reduce child injury risk. Caregivers frequently perceive child decision-making a primary factor in injury events and respond by teaching children safety rules. Rural communities in Uganda and elsewhere may face unique hazards associated with agricultural labor, contributing to a high risk of cuts. Interventions to support caregiver efforts to reduce child injury risk are warranted.