Abstract Background Road traffic injuries (RTIs) are a significant cause of pediatric morbidity and mortality worldwide, with a disproportionate number of these injuries occurring in low- and ...middle-income countries (LMICs). Adult data from LMICs suggest that weekends are particularly high-risk for RTIs, but whether children are at increased risk of RTI on weekends has not previously been investigated in any setting. This study sought to assess patterns in pediatric RTI presentations using hospital-based trauma surveillance data in Cape Town, South Africa. Methods Data was analyzed from Childsafe South Africa's prospectively collected trauma registry for injured children below 13 years of age presenting to a tertiary pediatric referral Trauma Department between 2004 and 2013. Results During the 10-year study period, a total of 71,180 patients presented with traumatic injuries, of which 8,815 (12.4%) resulted from RTIs. RTI patients had a mean age of 5.2 ± 3.6 years, and were predominantly males and pedestrians. RTIs were more common on weekends than weekdays (2.98 vs. 2.19 patients/day, p < 0.001), representing a greater proportion of daily all-cause trauma (15.5% vs. 11.2%, p < 0.001). Moreover, weekend RTI patients sustained more severe injuries than on weekdays, and compared to weekend all-cause trauma patients (injury score 1.66 vs. 1.46 and 1.43, both p < 0.001). RTI patients were more likely to require admission to both the trauma ward (1.14 vs. 0.79 patients/day, p < 0.001) and the PICU (0.10 vs. 0.07 patients/day, p < 0.05) on weekends than on weekdays. Weekend RTI patients most frequently required admission to the trauma ward (p < 0.001) and the PICU (p < 0.05) during the last annual quarter. Conclusions In a LMIC-setting, pediatric RTI patients are more frequently brought to medical attention, sustain more severe injuries and more frequently require hospital admission during the weekend. Weekends during the last annual quarter were particularly high-risk for pediatric RTIs. These findings highlight the importance of trauma surveillance data to inform targeted community prevention strategies for improving child road safety.
Introduction
Physical impairments following traumatic brain injury (TBI) may limit participation in daily living. Physiotherapy could assist in managing these limitations, however, there is a paucity ...of literature on the physiotherapy management of children in the acute phase of TBI.
Objectives
To describe the characteristics, course and outcome of children hospitalized with TBI, with specific reference to the role of physiotherapy.
Methods
A retrospective folder review of all children (n = 130, median 5.37 years IQR 1.88–7.88) admitted in 2016 with a primary diagnosis of TBI was conducted at a tertiary paediatric hospital.
Results
Most cases presented with mild TBI (66.2%). The most common cranial manifestation of the TBI was brain bleeds (80%) and most occurred as a result of road traffic accidents (50%, including both pedestrian and motor vehicle accidents).
Physiotherapy was administered in 35 cases (26.9%), with functional interventions, such as mobilizations out of bed, the most common form of therapy (71.4%). Children involved in road traffic accidents, presenting with severe diffuse TBI, resulting in altered tone and coordination problems, admitted to intensive care, monitored with an intracranial pressure or Licox monitor, and receiving occupational therapy and/or been followed up by dieticians, were more likely to receive physiotherapy.
The duration of hospitalization (median 4 days IQR 2–9) was associated with infections, severity of TBI, presence of an intracranial monitoring, and parietal lobe injury.
Conclusion
This is the first study in South Africa investigating standard physiotherapy care in children admitted with TBI. Physiotherapy was provided in a small portion of children and appeared to be well tolerated. However, due to the limited information recorded in the physiotherapy notes, results of this study need to be confirmed in larger, more well‐documented studies before generalizations can be made.
Background Pediatric injuries are associated with significant morbidity and mortality, especially in low- and middle-income countries. Data to characterize the cause and risk factors associated with ...childhood injuries in low- and middle-income countries are very scarce. The aim of this study is to describe the cause of pediatric injuries and their possible changes between 2007 and 2011 using hospital-based data in Cape Town, South Africa. Methods Data from injured children <13 years of age who presented to the Red Cross War Memorial Children's Hospital's emergency department in 2007 and 2011 were captured in Childsafe South Africa's trauma surveillance system. Poisson regression was used to assess changes in rates of injury between 2007 and 2011 in terms of demographics, geographic location of injury, type of injury mechanism, injury severity, and anatomic region of the sustained injury. Results In total, 14,915 injured children with 15,414 injuries presented to Red Cross War Memorial Children's Hospital in 2007 and 2011. The mean age was 5.01 ± 3.5 years and 60.3% were male. Common mechanisms of injury included falls ( n = 6,036; 40%), road traffic injuries ( n = 1,939; 13%), burns ( n = 1,885; 12.6%), and assault ( n = 640; 4.3%). Comparing 2011 to 2007, the incidence of road traffic injuries has decreased by 7% ( P < .05) while burn injuries increased 11% ( P < .05). Seventy-three percent (73%) of injuries that presented to Red Cross War Memorial Children's Hospital occurred in the Cape Flats area of Cape Town, where many informal settlements exist. Conclusion These epidemiologic findings suggest that while road traffic injuries decreased and burn injuries increased at Red Cross War Memorial Children's Hospital, there is a need for data that are population-based and not hospital based. If we could describe injuries accurately within the pediatric population of a city such as Cape Town, we could in turn use this data to strengthen the need for targeted interventions to address risk factors for pediatric injuries. Despite this, hospital-based data remain a powerful tool to study injuries in low and middle-income countries.
The road traffic crash injury burden significantly impacts the lives of South African children. This study aimed to assess the fatal and non-fatal pattern of road traffic crash injury of children ...under 13 years old from Metro West, City of Cape Town, from 1 January until 31 December 2014. The data were stratified by age, sex and mechanism of road traffic crash. The overall mortality rate was 8.7 per 100 000 population and pedestrians contributed the most to this burden (72.5%). There were more male children involved in a road traffic crash (p = 0.0001). The greatest proportion of fatal and non-fatal road traffic crash injuries was observed in children aged 5-9 years. Fractures contributed to the greatest rate of years lived with disability (3.0 years of life lived with disability per 100 000). Our study found that the burden of road traffic crashes primarily affects male pedestrians aged 5-9 years old.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, GIS, IJS, IZUM, KILJ, KISLJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Thoracic injuries continue to be a leading cause of childhood trauma, despite the government's efforts to curb the scourge of this problem. Our review focuses on the incidence, etiology, and ...management of thoracic trauma in the pediatric population with reference to the recent experience at our institution in a developing country.
For the literature review, the National Library of Medicine's PubMed database was searched for the following terms: "pediatric," "chest trauma," "hemothorax," "hemopneumothorax," "pneumothorax," "diaphragmatic," "esophageal," and "mediastinal injury." For the hospital data analysis, data of all 378 pediatric patients treated with thoracic injuries under the age of 13 years from 2008 to 2012 (a 5-year period), at the Red Cross War Memorial Children's Hospital, were retrospectively analyzed.
The male to female ratio was 2.1:1 (255 males and 123 females). The mean age was 6.9 ± 2.3 years. Blunt chest trauma was responsible for chest injuries in 90.5%, while penetrating trauma caused 9.5% of the injuries. Road traffic crashes were the mean cause (48.9%) with pedestrian injuries in 72.4% and passenger injuries in 27.6%, respectively. Sports injuries were the cause in 4% and falls from a height in 22%. Most injuries occurred at home: inside one's own home (5%), outside one's own home (52%); inside someone else's home (44%); outside someone else's home (2%). Public space injuries occurred at schools or crèches in 77%, pavement or roads in 6%, and were not specified in 17%. Overall 74% presented with injuries of the thoracic cage; rib fractures occurred in 13%, chest wall contusions in 40%, and abrasions in 31%. Respiratory system injuries occurred in 22%; hemothoraces in 23%, pneumothoraces in 45%, and hemopneumothoraces in 29%. Cardiovascular injuries occurred in 16% of cases with vascular injuries in five patients (two firearms injuries and three motor vehicle crashes). Management was nonoperative in 79.4%, tube thoracotomy in 17.2%, and open surgery in 3.4%. The mortality rate was 1.3%, all contributed by firearm-related injuries and polytrauma.
Thoracic trauma has remained a significant cause of morbidity and mortality in the pediatric population. Concerted effort from governments, civil societies, and the medical profession are needed to address this challenge.
An unusual cause of sudden child death van der Heyde, Yolande; van As, Arjan Bastiaan Sebastian
The American journal of forensic medicine and pathology
29, Številka:
3
Journal Article
Recenzirano
Since the rise of HIV/AIDS in Sub-Saharan Africa, there has been a massive promotion of condom use. Unfortunately, this promotion has not always been accompanied with instructions for safe use. In ...this case report, we describe a small child who aspirated a condom and subsequently died.
Children, and in particular young children under the age of three, are the most vulnerable for aspiration and ingestion of foreign bodies (FBs). The Red Cross War Memorial Children's Hospital in Cape ...Town is the only children's hospital in South Africa and is unique in having a dedicated trauma unit for children under the age of 13 as part of its institution. Core activities of Childsafe South Africa (CSA), located at the hospital, are data accumulation and interpretation, development of educational programmes, health inculcation and advising in legislation involving child health. To achieve this task, CSA works in close co-operation with government, industry, non-governmental and community predicated organisations, community groups and individuals. A database of all children treated for trauma at CSA has been maintained since 1991; it currently contains detailed information of over 170,000 injuries in children under the age of 13. This review consists of a literature review combined with data from our database and aims to provide information on our experiences with tracheobronchial aspiration of FBs in children.
Tension pneumocranium in childhood trauma Gill, Hardeep Singh; van As, Arjan Bastiaan
World journal of pediatrics : WJP,
08/2008, Letnik:
4, Številka:
3
Journal Article
Recenzirano
Background
To report a case of fatal tension pneumocephalus in a 9-year-old boy following a severe motor vehicle accident.
Methods
A young boy with a serious closed head injury was resuscitated in ...the emergency room and underwent CT scan of the head and orbits.
Results
The CT-scan revealed a fracture of the orbital roof with extensive bilateral pneumocephalus.
Conclusions
A high index of suspicion for tension pneumocephalus is required in patients with severe head injuries presenting with periorbital swelling and perioccular trauma. A prompt CT scan and neurosurgical intervention are indicated.
•The majority of the children walk to school, with only 12% accompanied by an adult.•More than half (53%) of self-reported pedestrian collisions involved a bicycle.•Older boys (10–15 years) were most ...likely to report a severe pedestrian collision.•Children who walk accompanied reported more severe pedestrian collisions.•Children who spend more time walking engage in safer Sight Behaviour.
Pedestrian injuries are a leading cause of death among South African children, and young children residing in low-income communities are more at risk, due to various factors such as inadequate road infrastructure, exposure to traffic due to reliance on walking as a means of transport, and lack of supervision. This study used a cross-sectional, non-randomized self-report survey to assess pedestrian safety knowledge, road-crossing behaviour and pedestrian injuries of primary school children in selected low-income settings in Cape Town. The survey focused on three primary schools that had joined the Safe Kids Worldwide Model School Zone Project and was administered to 536 children aged 6–15 years, in their home language of isiXhosa. Descriptive and bivariate analyses as well as multivariate regression analyses were conducted to investigate potential predictor variables for pedestrian collision severity and unsafe road-crossing behaviour. Walking was the sole form of travel for 81% of the children, with a large proportion regularly walking unsupervised. Children who walk to or from school alone were younger and reported riskier road-crossing behaviour, although children who walk accompanied tended to have higher pedestrian collision severity. “Negligent Behaviour” related to road-crossing was significantly associated with higher pedestrian collision severity, with predictors of “Negligent Behaviour” including the lack of pedestrian safety knowledge and greater exposure to traffic in terms of time spent walking. More than half of the reported pedestrian collisions involved a bicycle, and older boys (10–15 years) were most at risk of experiencing a severe pedestrian injury. The findings substantiate emerging evidence that children in low-income settings are at greater risk for child pedestrian injury, and emphasise the need for evidence-based safety promotion and injury prevention interventions in these settings.
Pediatric injuries are associated with significant morbidity and mortality, especially in low- and middle-income countries. Despite the magnitude of this burden, there is lack of data to characterize ...the etiology and risk factors associated with childhood injuries, especially in low- and middle-income countries. The aim of this article is to describe the demographics, mechanisms, and severity of injuries during a 10-year time period using hospital-based data in Cape Town, South Africa.
Data from Childsafe South Africa's registry were used to study injured children younger than 13 years who presented with either intentional or unintentional injuries to the Trauma Unit of the Red Cross War Memorial Children's Hospital's (RCH) Causality Department between 1996 and 2007. Univariate and bivariate analyses were performed for demographic characteristics and injury mechanisms. Poisson regression analysis was used to analyze the age-adjusted annual incidence of injury presenting to RCH.
Between 1997 and 2006, 62,782 children with a total of 68,883 injuries presented to RCH. The mean age was 5.4 years (standard deviation ± 3.5 years) and 61.7% were male. Mechanism of injury included falls (39.8%), road traffic injuries (15.7%), burns (8.8%), and assault (7.4%). The majority of injuries occurred in and around the home. Abbreviated injury severity scoring showed 60.2% of injuries were minor, 36.6% were moderate, and 3.2% were severe. Sixty-six deaths occurred in the trauma casualty department. Thirty-one percent of patients were admitted to the hospital; children who suffered burn and head injuries were more likely to require admission.
Age, gender, mechanism, and severity of injury in pediatric populations have not been described elsewhere in South African national or sub-Saharan regional data. This retrospective, observational study uses Level II evidence to suggest the need for targeted interventions to address risk factors for pediatric injuries, emphasizing the importance of pediatric surveillance systems as a tool to study injuries in developing countries.
Prognostic study, level II.
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