Pediatric Unintentional Injuries Research Articles

Power outages and pediatric unintentional injury hospitalizations in New York State.

In the past decade, electrical power disruptions (outages) have increased in the United States, especially those attributable to weather events. These outages have a range of health impacts but are largely unstudied in children. Here, we investigated the association between outages and unintentional injury hospitalizations, a leading cause of childhood morbidity. The study setting was New York State (NYS) from 2017 to 2020. Outage exposure was defined as ≥10%, ≥20%, and ≥50% of customers from a power operating locality without power, ascertained from NYS Department of Public Service records and stratified by rural, urban non-New York City (NYC), and NYC regions. Outcome daily block group-level pediatric injury hospitalization data was from the Statewide Planning and Research Cooperative System (SPARCS). We leveraged a case-crossover study design with logistic conditional regression. We identified 23,093 unintentional injury hospitalizations in children <18 years with complete block group and exposure data. Most hospitalizations occurred in urban regions (90%), whereas outages were more likely in rural than urban areas. In urban non-NYC regions, outages ≥4 hours were associated with 30% increased odds of all-cause unintentional injury hospitalizations when ≥50% of customers were without power. Analyses by injury subtype revealed increasing point estimates as the proportion of customers exposed increased. These results, however, had wide confidence intervals. Outage exposure differed significantly across rural, urban non-NYC, and NYC regions across New York. Especially at the highest outage threshold, we observed an increased risk of pediatric unintentional injury hospitalizations.

Slicing Through the Layers of Pediatric Unintentional Injury With the Swiss Cheese Model: A Topical Review.

Pediatric unintentional injury significantly burdens children, families, and society. Behavioral researchers have examined the problem for decades, identifying many risk factors and greatly enhancing knowledge of the injury antecedent process. Approaches using theories and models to guide inquiry into etiology and prevention are still needed. We offer an approach borrowed from the field of human factors to enhance understanding and prevention. We focus our exploration on an error modeling and accident investigation tool called the Swiss Cheese Model. We first introduce the basic elements of the model. Next, we apply error modeling concepts to example scenarios drawn from real unintentional incidents and discuss the implications for understanding etiology and prevention. Finally, potential future directions are discussed to illustrate paths for the advancement of injury etiology and prevention.

Safe at home: prevention of pediatric unintentional injuries

BackgroundUnintentional injuries are the leading cause of death in children in the United States. Studies have shown that parent adherence to safety guidelines is improved when education is provided in conjunction with safety equipment.MethodsThis study surveyed parents about specific injury prevention behaviors regarding medication and firearm storage and provided education and safety equipment for safe practice of these behaviors. The project took place in a pediatric emergency department (PED) and partnered with the hospital foundation and the school of medicine. Inclusion criteria were families visiting a freestanding PED in a tertiary care center. Participants completed a survey conducted by a medical student approximately 5 min in length. The student then provided each family with a medication lock box (if children ≤ 5 years old lived in the home), firearm cable lock, and education for safe storage of medications and firearms in the home.ResultsThe medical student researcher spent a total of 20 h in the PED from June to August 2021. 106 families were approached to participate in the study, of which 99 agreed to participate (93.4%). A total of 199 children were reached with ages ranging from less than 1 year old to 18 years old. A total of 73 medication lockboxes and 95 firearm locks were distributed. The majority (79.8%) of survey participants were the mother of the patient and 97.0% of participants lived with the patient > 50% of the time. For medication storage, 12.1% of families store medications locked and 71.7% reported never receiving medication storage education from a healthcare professional. Regarding firearms, 65.2% of participants who reported having at least 1 firearm in the home stored firearms locked and unloaded with various methods of storage. 77.8% of firearm owners reported storing ammunition in a separate location from the firearm. Of all participants surveyed, 82.8% reported never receiving firearm storage education from a healthcare professional.ConclusionsThe pediatric ED is an excellent setting for injury prevention and education. Many families are not storing medications and firearms safely, demonstrating a clear opportunity to increase knowledge in families with young children.

PTSD Risk Factors and Acute Pain Intensity Predict Length of Hospital Stay in Youth after Unintentional Injury.

Background: Many hospitals have adopted screening tools to assess risk for posttraumatic stress disorder (PTSD) after pediatric unintentional injury in accordance with American College of Surgeons recommendations. The Screening Tool for Early Predictors of PTSD (STEPP) is a measure initially developed to identify youth and parents at high risk for meeting diagnostic criteria for PTSD after injury. Acute pain during hospitalization has also been examined as a potential predictor of maladaptive outcomes after injury, including PTSD. We investigated in a retrospective cohort study whether the STEPP, as well as acute pain intensity during hospitalization, would predict maladaptive outcomes during the peri-trauma in addition to the post-trauma period, specifically length of hospitalization. Methods: A total of 1123 youths aged 8–17 (61% male) and their parents were included. Patients and parents were administered the STEPP for clinical reasons while hospitalized. Acute pain intensity and length of stay were collected through retrospective chart review. Results: Adjusting for demographics and injury severity, child but not parent STEPP total predicted length of stay. Acute pain intensity, child threat to life appraisal, and child pulse rate predicted length of stay. Conclusions: Acute pain intensity and child PTSD risk factors, most notably child threat to life appraisal, predicted hospitalization length above and beyond multiple factors, including injury severity. Pain intensity and child appraisals may not only serve as early warning signs for maladaptive outcomes after injury but also indicate a more difficult trajectory during hospitalization. Additional assessment and treatment of these factors may be critical while youth are hospitalized. Utilizing psychology services to support youth and integrating trauma-informed care practices during hospitalization may support improved outcomes for youth experiencing unintentional injury.

Epidemiology and Prehospital Care of Pediatric Unintentional Injuries Among Countries with Different Economic Status in Asia: A Cross-National, Multi-Center Observational Study

Objective Injury is a major cause of morbidity and mortality in children. However, the epidemiology and prehospital care for pediatric unintentional injuries in Asia are still unclear. Methods A total of 9,737 pediatric patients aged <18 years with unintentional injuries cared for at participating centers of the Pan-Asian Trauma Outcome Study (PATOS) from October 2015 to December 2020 were reviewed retrospectively. Patients were divided into two groups: those <8 and those ≥8 years of age. Variables such as patient demographics, injury epidemiology, Injury Severity Score (ISS), and prehospital care were collected. Injury severity and administered prehospital care stratified by gross national income were also analyzed. Results Pediatric unintentional injuries accounted for 9.4% of EMS-transported trauma cases in the participating Asian centers, and the mortality rate was 0.88%. The leading cause of injury was traffic injuries in older children aged ≥8 years (56.5%), while falls at home were common among young children aged <8 years (43.9%). Compared with younger children, older children with similar ISS tended to receive more prehospital interventions. Uneven disease severity was found in that older children in lower-middle and upper-middle-income countries had higher ISS compared with those in high-income countries. The performance of prehospital interventions also differed among countries with different gross national incomes. Immobilizations were the most performed prehospital intervention followed by oxygen administration, airway management, and pain control; only one patient received prehospital thoracentesis. Procedures were performed more frequently in high-income countries than in upper-middle-income and lower-middle-income countries. Conclusions The major cause of injury was road traffic injuries in older children, while falls at home were common among young children. Prehospital care in pediatric unintentional injuries in Asian countries was not standardized and might be insufficient, and the economic status of countries may affect the implementation of prehospital care.

Racial and ethnic differences in pediatric unintentional injuries requiring hospitalization

This study aims to comprehensively examine racial and ethnic differences in pediatric unintentional injuries requiring hospitalization by age across injury mechanisms. This was a retrospective, nationally representative cross-sectional analysis of discharge data within the 2016 Kids' Inpatient Database for 98,611 children ≤19 years with unintentional injuries resulting in hospitalization. Injury categories included passengers and pedestrians injured in a motor vehicle crash, falls, drownings, burns, firearms, drug and nondrug poisonings, suffocations, and other injuries. Relative risk (RR) for injuries requiring hospitalization were calculated for children of Black, Hispanic, and Other races and ethnicities compared with White children, and then RR were further stratified by age. Excessive hospitalizations were calculated as the absolute number of hospitalizations for each race and ethnicity group that would have been avoided if each group had the same rate as White children. Black children were significantly more likely to be hospitalized compared with White children for all injury mechanisms except falls, and in nearly all age groups with the greatest RR for firearm injuries (RR 9.8 [95% confidence interval: 9.5-10.2]). Differences were associated with 6263 excessive hospitalizations among all racial and ethnic minority children compared with White children. Racial and ethnic minority children represent populations at persistent disproportionate risk for injuries resulting in hospitalization; risk that varies in important ways by injury mechanism and children's age. These findings suggest the importance of the environmental and societal exposures that may drive these differences, but other factors, such as provider bias, may also contribute.

Presentation of Pediatric Unintentional Injuries at Rural Hospitals in Rwanda: A Retrospective Study.

Background:Injuries are a leading cause of mortality among children globally, with children in low- and middle-income countries more likely to die if injured compared to children in high-income countries. Timely and high-quality care are essential to reduce injury-related morbidity and mortality.Objectives:This study describes patterns, management, and outcomes of children 0–15 years presenting with unintentional injuries at three district hospitals in rural Rwanda between January 1 and December 31, 2017.Methods:Using a retrospective cross-sectional study design, we assessed the demographic and clinical characteristics, care provided, and outcomes of the children using data extracted from patient medical charts. We describe the patient population using frequencies and proportions as well as median and interquartile ranges.Findings:Of the 449 injured children who sought care at the three rural district hospitals, 66.2% (n = 297) were boys. The main causes of injury were falls (n = 261, 58.1%), burns (n = 101, 22.5%), and road traffic injuries (n = 67, 14.9%). Burns were the most common injury among children aged 0–5 years while falls were the leading injury type among the 5–15 years age group. Vital signs were inconsistently completed ranging between 23.8–89.1% of vital sign items. Of the injured children, 37.0% (n = 166) received surgery at the district hospital, general practitioners performed 80.9% (n = 114) of surgeries, 87.4% (n = 145) of operated patients received no anesthesia, and 69.3% (n = 311) were admitted to the district hospital, while 2.7% (n = 12) were transferred to tertiary facilities for higher-level care.Conclusions:The presentation of child injuries—namely falls, burns, and road traffic accidents—is similar to what has been reported in other sub-Saharan African countries. However, more needs to be done to improve the completion and documentation of vital signs and increase availability of surgical specialists. Finally, targeted strategies to prevent burns and motorcycle-related injuries are recommended prevention interventions for this rural population.

The impact of RISE Up! in promoting positive parenting and safety behaviors of parents with young children

The objective of this study was to examine the extent to which a brief tailored parenting program administered in a pediatric clinic can change high-risk parenting behaviors. Parents with a child five years old or younger presenting to a University-based primary care pediatric clinic in a large Midwestern children's hospital were invited to participate in the study. Parents completed RISE UP!, which included an assessment completed on a tablet computer and then received a tailored, printed report that provided recommendations to address the personal high-risk parenting practices identified by the assessment. A follow-up assessment was completed with 125 parents (58%) about six weeks after the pediatric visit. Overall, 75% of parents reported trying at least one of the recommendations included in the report. Analysis of parenting risk indicated that 53% of parents had different highest parenting risk areas after RISE Up! and 33% of identified parenting risk scores decreased after RISE Up! Of the 231 priority unintentional injury risk behaviors identified, 34% were reported as non-risk behaviors at follow-up. Race and education were significantly associated with program effects in bivariate analysis; program effects were also correlated with communication mediators in a strong dose-response relationship. Reducing both child abuse and neglect and pediatric unintentional injuries are global priorities. Several childhood injury prevention frameworks and evidence-based policy recommendations highlight shared etiologies and opportunities for intervention. RISE Up! shows promise for universal prevention to promote the adoption of parenting practices to reduce injury risk and positive parenting behaviors.

Parental Perceptions, Risks, and Incidence of Pediatric Unintentional Injuries

IntroductionMore than 9,000 children die annually from various causes of unintentional injury. Of all the pediatric unintentional injuries occurring in the United States, 8.7 million are treated in emergency departments, and 225,000 require hospitalization annually. Health education programs are available to address these injuries. The objective of this research was to examine the distribution of self-reported high priority injury risks in an urban Midwestern pediatric level 1 trauma center and investigate the relationship between parental perceptions and injury-prevention behaviors. Prevalence rates for 3 data sources are compared. MethodsMissouri Information for Community Assessment (MICA) was categorized to mirror variables corresponding with risks of injury presented in the Safe ‘n’ Sound (SNS) program. Level 1 trauma center data were examined to determine how the variables were distributed compared with MICA data and with the parent-reported levels. ResultsA total of 429 SNS surveys were compared with ED data and MICA data. For SNS users, car crashes were identified as the highest risk, specifically due to the use of incorrect car seats. The injuries seen most often in the emergency department were falls, and falls were also the most prevalent injury captured by MICA. Controlling for demographics, parental perceptions predicted several risks for injury. DiscussionBecause parental perceptions are significantly related to risks of injury, prevention programs aiming to decrease injuries could focus on the perceptions. Not only can perceptions be used to tailor health communication materials, these perceptions can be the targets of change. Further work might investigate the extent to which changes in perceptions result in increased adoption of safety practices.Image 1

Epidemiology and Regional Distribution of Pediatric Unintentional Emergency Injury in Korea from 2010 to 2011.

Injury is a leading cause of death and disability in children and adolescents worldwide. The purpose of the current study was to investigate the epidemiologic characteristics of the pediatric unintentional injuries presenting to the Korean emergency department (ED). We included unintentional injuries in patients aged < 20 yr. Data collected from January 2010 to December 2011 was extracted from the National Emergency Department Information System (NEDIS) of Korea. The NEDIS data included information on patient's age and gender, geographic location of the ED visits, mechanism of injuries; and clinical outcomes. Most (94.1%) injuries were unintentional while 5.9% were intentional. The rate of ED visit for pediatric unintentional injury was 6,097 per 100,000 and critical injury was 59.8 per 100,000 (< 20 yr habitants). The mortality rate was 5.4 per 100,000. The mortality rate of pediatric unintentional injuries was 0.1% including the prehospital death and ED death. Unintentional pediatric injuries occurred most commonly in those age 0-4 boys and girls and were predominantly caused by collisions. Male motorcyclists aged 15-19 yr formed a critical injury high-risk group. The rates of critical injury and mortality were highest in Jeju, Gangwon, Gwangju, and Jeonbuk than those in other regions. High-risk groups by age, gender, mechanism and region should be targeted to prevent pediatric injuries in Korea.

Saving Lives the Easy Way: Pediatric Injury Prevention Strategies for Emergency Nurses

Traumatic injury is the leading cause of death and disability in children after infancy (aged >1 year). 1 National Center for Injury Prevention and Control http://www.cdc.gov/ncipc/wisqars/ Google Scholar In fact, more children die each year from traumatic injuries than from all other causes of death combined. 2 Philippakis A Hemenway D Alexe DM Dessypris N Spyridopoulos T Petridou E A quantification of preventable unintentional childhood injury mortality in the United States. Inj Prev. 2004; 10: 79-82 Crossref PubMed Scopus (53) Google Scholar Far too often, emergency nurses treat injured children, adolescents, and young adults. Sometimes, the injuries are relatively minor; other times, they are fatal. Much of the time, traumatic injuries are preventable. 2 Philippakis A Hemenway D Alexe DM Dessypris N Spyridopoulos T Petridou E A quantification of preventable unintentional childhood injury mortality in the United States. Inj Prev. 2004; 10: 79-82 Crossref PubMed Scopus (53) Google Scholar , 3 Agran PF Winn D Anderson C Trent R Walton-Hayes L Rates of pediatric and adolescent injuries by year of age. Pediatrics. 2001; 108: 1-11 Crossref PubMed Scopus (122) Google Scholar , 4 Tamburro RF Shorr RI Bush AJ Kritchevsky SB Stidham GL Helms SA Association between the inception of a SAFE KIDS Coalition and changes in pediatric unintentional injury rates. Inj Prev. 2002; 8: 242-245 Crossref PubMed Scopus (11) Google Scholar , 5 Chen J Kresnow M Simon TR Dellinger A Injury-prevention counseling and behavior among US children: results from the second Injury Control and Risk Survey. Pediatrics. 2007; 119: e958-e965 Crossref PubMed Scopus (52) Google Scholar Emergency nurses can take steps to prevent injuries and decrease morbidity and mortality rates in children and adolescents. Anna Maria Valdez, Member, Sacramento Chapter 253, Director of Clinical Services, REACH Air Medical Services, Santa Rosa, CA.

Pediatric Unintentional Injury: Behavioral Risk Factors and Implications for Prevention

Unintentional injury is the leading cause of death for children and adolescents between the ages of 1 and 18 in the United States, accounting for more deaths than the next 20 causes of mortality combined. It is estimated that pediatric injury accounts for more than $50 billion in annual losses from medical care costs, future wages, and quality of life. Despite these numbers, much remains to be learned about the behavioral risks for pediatric unintentional injury. This article reviews behavioral risk factors for pediatric unintentional injury risk, with a particular focus on four broad areas. First, we discuss the effects of demographic risk factors, including gender, socioeconomic status, and ethnicity. Second, we present information about child-specific risk factors, including temperament, personality, psychopathology, and cognitive development. Third, we discuss the influence of parents and other primary caregivers on childhood injury risk, with a particular focus on the effects of supervision and parenting quality and style. Finally, we discuss the role of peers on child injury risk. We conclude with a discussion of the ways in which the material reviewed has been translated into injury prevention techniques, with a focus on how pediatricians might use knowledge about etiological risk to prioritize safety counseling topics. We also present thoughts on four priorities for future research: injury risk in diverse nations and cultures; developmental effects of injury; the influence of multiple risk factors together on injury risk; and translation of knowledge about risk for injury into intervention and prevention techniques.