Complicated head trauma from machete wounds: the experience from a tertiary referral hospital in Jamaica

There have been limited reports on machete wounds to the cranium. This study was carried out to document the injury profile in a series of patients who have sustained cranial injuries from machete wounds in this setting. Between 1 January 1998 and 1 January 2008, demographic and clinical data were retrospectively collected from all patients treated with complicated head injuries from machete wounds with at least one of the following clinical or radiological features: a recorded Glasgow Coma Score < 8 at any point during admission; compound skull fractures; protruding brain matter; cerebrospinal fluid (CSF) leaks; intra-cranial bleeding; parenchymal contusions; lacerations and/or oedema. The data were analysed using the SPSS version 12.0. Of the 40 patients with complex injuries to the cranium, there was a 6:1 male preponderance with a mean age of 32.5 ± 13.7 years (Mean ± SD). The injuries included open skull fractures in all the 40 (100%) patients, depressed skull fractures in 20 (50%) patients, CSF leaks in 4 (10%) patients, protruding brain matter in 4 (10%) patients, cerebral contusions in 3 (7.5%) patients and extra cranial injuries in 16 (40%) patients. Tetanus prophylaxis and intravenous antibiotics were administered to all patients, and phenytoin was required in 16 (40%) cases. There were 37 (92%) patients requiring operative intervention at a mean of 10.4 h after presentation (SD ± 18.1; Median 6). The operative procedures included elevation of depressed fractures in 20 (54.1%) patients, dural repair in 10 (27.0%) patients and intra-cranial debridement in 7 (18.9%) patients. There were three deaths (7.5%), and seizures were recorded in 5 (12.5%) cases with no reports of infectious morbidity. Eighty percent of patients had a normal Glasgow outcome score on discharge. Complicated machete head trauma is uncommon at this health care facility in Jamaica. We achieved a satisfactory outcome with aggressive management consisting of prompt assessment of the extent of injury, appropriate antibiotics, anticonvulsants for those with seizures or cortical injury and early operation to decrease the risk of complications.     

Incidence and characteristics of unintentional injuries among children in a resource limited setting in Kampala,Uganda

ABSTRACT

Given that little is known about the epidemiology of unintentional injuries in children in low-income countries, this study sought to determine the incidence and characteristics of unintentional injuries among children aged ≤18 years in a slum community in Uganda. From a household survey, the incidence and odds ratios for factors associated with unintentional injury characteristics were calculated. Of 1583 children, 706 had suffered 787 unintentional injuries yielding an annual incidence rate of 497 injuries per 1000 children. Commonest injuries were cuts, bites or open wounds (30.6%) and bruises or superficial injuries (28.6%) with majority (75.5%) occurring at home. Boys were more likely to be injured at school (AOR 4.34; 95% CI 1.22–15.54) and to be injured from falls (AOR 1.41; 95% CI 1.01–1.96). Older children (12–18 years) were more likely to suffer from fractures (AOR 2.37; 95% CI 1.26–4.43), concussions and organ system injuries (AOR 3.58; 95% CI 1.03–12.39) and cuts, bites or open wounds (AOR 2.05; 95% CI 1.21–3.48). Older children were less likely to suffer burns or scalds as compared to the young children (AOR: 0.23; 95% CI 0.11–0.50). Unintentional injury incidence rate was high among children with most occurring in the homes.     

Costs of unintentional injuries among children in an urban slum community in Kampala city,Uganda

Abstract

Unintentional injuries cause deaths, disabilities, productivity and financial losses and disproportionately affect children in low-income settings yet their cost remains under studied. This study determined the household out-of-pocket expenditure and missed school attendance due to unintentional childhood injuries in a Ugandan slum. We used a cross-sectional household survey design. Data were collected on occurrence and associated costs of unintentional injuries during a one-year period from July 2014 to June 2015. A total of 706 (44.7%) children who had suffered from injuries were reported in the one year period. More male children (N?=?415, 58.7%) suffered injuries than females (N?=?291, 41.2%). The average out-of-pocket expenditure on treating an injury was US $24.1 [standard deviation (SD)?=?±$62.8] and mean school days lost were 25 days (SD?=?±51.8). Road traffic injuries (RTIs) resulted in higher costs [mean difference was US $51.1 (95% CI: $11.4–$90.8)] compared to injuries that, for example, occurred at school. In a Ugandan slum community, unintentional childhood injuries resulted in high out-of-pocket expenditures and missed school attendance. The costs varied widely depending on external causes of the injury. These findings highlight the need to invest in population level injury prevention interventions to reduce injury costs by households.     

The epidemiology of head injuries in Sweden from 1987 to 2000

The purpose of the present study was to evaluate the variability in the annual head injury incidence rate in Sweden from 1987 to 2000. It was hypothesized that the annual incidence rate would decrease over time due to a variety of primary preventive strategies that have been introduced in Swedish society. We used the Hospital Discharge Register at the National Board for Health and Welfare and head injury codes 800-804, and 850-854 from ICD9 system and S2.0-S2.9, and S6.0-S6.9 codes from ICD-10 system. We evaluated the patterns of age, gender, external cause of injury (E-code), type of injury, length of hospital stay, and trends over time. Head injuries due to transportation collision were reduced over the 14-year period analysis. Falls persisted as the dominant cause of head injury. Overall, men had 2.1 times the incidence of head injury compared to women. There was a decline in younger ages experiencing a head injury over this interval, while the number of head injuries among elderly people increased over time. Concussion was about three times more frequent than fractures. Hematoma and diffuse or focal contusions had a much lower incidence rate than concussion. Concussions and fractures decreased over time. Diffuse or focal injuries showed a steady rate of occurrence over the study interval while hematoma increased. Although length of hospital stay varied widely from zero to more than 50 days, 73.6% of hospital days were confined to two days or less. The incidence rate is stable over this time frame. While head injuries attributable to transportation accidents decreased, falls made up an increasing proportion of head injuries. Since we observed an increase in head injuries among elderly, primary prevention strategies may need to be targeted at this age group, and at preventing falls.     

Unintentional child home injury incidence and patterns in six countries in Europe

This study investigates the incidence and patterns of child home injuries in six European Union countries. Emergency department and inpatient injury data on injuries to children aged 0-18 years in the home (n = 88,567) for the years 2003-2004 were extracted from the European Injury Database in Austria, Denmark, France, Netherlands, Portugal and Sweden. The incidence of child home injuries was 44.9/1000 inhabitants Six age-dependent injury patterns were identified using cluster analysis: 1) open wound head injuries; 2) hospital admissions for bruises, contusions, abrasions; 3) falls on stairs indoors; 4) fractures and sprains of the upper extremities; 5) crush/cut/piercing of the fingers; 6) miscellaneous injuries. Child home injuries are a considerable public health problem, particularly in the ages 0 to 4 years. The findings are useful for injury surveillance at the European level yet do not allow for designing testable countermeasures for prevention within home safety initiatives.     

Feasibility of routine collection of injured worker occupational information in hospital emergency departments

The aim of this study was to examine injury events and risk-factors among Swedish adult eventing athletes. A cross-sectional study design with retrospective recording of 1-year sports-specific exposure and injury data was used. The invited study population consisted of all members of the Swedish Equestrian Federation with eventing as their primary discipline (n = 513). The participation rate was 70.0%. The total 1-year injury prevalence was 26.6%; the specific 1-year prevalence of traumatic injury was 19.3% and of overuse injury 10.9%. The incidence of traumatic injury events was 0.54 injury events/1000 eventing hours (95% confidence interval (CI), 0.35–0.73 injury events/1000 eventing hours) for novices and 0.35 injury events/1000 eventing hours for qualified riders (95% CI, 0.21–0.49 injury events/1000 eventing hours). A total of 27.9% of the traumatic injury events led to severe injuries (causing more than 3 weeks absence from riding). Attitude to risk-taking was the only factor predicting an athlete becoming injured (p = 0.023), and qualification level was the only risk factor for additional injuries among injured riders (p = 0.003). Our results suggest that injury prevention programs in eventing should also give attention to overuse injuries and that care should be taken when eventing athletes are licensed into higher qualification groups.     

Pattern of road traffic injuries: one year hospital-based study in Western Nepal

Road traffic injuries and deaths caused by motor vehicles is a growing public health problem all over the world. Inter-country or regional differences in the pattern of injury by road users have significant implications in determining prevention policies. The present study was conducted to evaluate the pattern of injuries in 217 hospitalized trauma patients admitted during 1 year, 2003. The majority of the injuries (54%) involved motorcycles. The highest incidence amongst the male population was in the age group of 16 – 30 years. Head and face injuries and injuries to the lower limbs comprised 58.1% and 50.7% of all injuries respectively. The bones of the lower limbs were most commonly fractured. To conclude, the traffic casualties of motorcyclists and pedestrians are considered a major problem and the preventive measures to reduce these transport-related injuries are discussed in this study.     

Childhood and adolescent injuries in elementary schools in north-western Uganda: extent,risk and associated factors

Childhood injuries remain understudied in Uganda. The objective of this study was to determine the extent, nature and determinants of school-related childhood injury risk in north-western Uganda. A cohort of 1000 grade fives from 13 elementary schools was followed-up for one term. Survival and multi-level modelling techniques compared the risk rates across gender, schools and locations. Childhood injuries are common in north-western Uganda. Most of them occur during travel, breaks, practical classes and gardening, while walking, playing, learning and digging. Most injuries result from collisions with objects, sports and falls. Two-thirds of children receive first aid and hospital care. Times to injury were 72.1 and 192.9 person days (p = 0.0000). Gender differences in time to event were significant (p = 0.0091). Girls had better survival rates: cumulative prevalence of childhood injury was 36.1%; with significant gender differences (p = 0.007). Injury rate was 12.3/1000 person days, with a hazard ratio of 1.4. Compared to girls, boys had a 37% higher injury rate (p = 0.004). Rates varied among schools. Associated factors include sex and school. Rural–urban location and school differences do influence childhood injury risk. Childhood injuries are common: the risk is high, gender- and school-specific. Determinants include gender and school. Location and school contexts influence injury risk.     

Clothing-related motorcycle injuries in Pakistan: findings from a surveillance study

This study aims to assess the burden and patterns of clothing-related motorcycle injuries in Karachi, Pakistan. Data were extracted from an ongoing traffic injury surveillance system. In three years (2007–2009), out of 99155 road traffic injury cases there were 986 (0.9%) cases of clothing-related motorcycle injuries. Most cases were females (73.9%) and pillion riders (80.6%). The crashes involving clothing-related injuries were mostly single vehicle (98.5%), and largely resulted in injuries to the external body (60.3%), limbs (51.0%), head (41.5%) and face (35.9%). One-third of injuries were either moderate (26.7%) or severe (10.2%) while 10 (1.01%) deaths were reported. Female gender (11.4%), age ≥ 45 years (19.4%), pillion riding (11.3%) and crashes occurring at intersections (12.3%) were more likely to result in moderate or severe injury as compared to other users (P < 0.001). Injuries due to entanglement of loose fitting clothing in motorcycles are not uncommon in Karachi. Awareness campaigns for prevention of such injuries may involve promotion of appropriate dressing for motorcycle riding including close wrapping of clothes and encouraging installations of covers on the rear wheels and drive chains.     

Patterns of injuries and motor-vehicle traffic accidents in Athens

The extremely high cost of motor-vehicle accidents in public health leads to the necessity of a better injury data collection in the Accident and Emergency Hospital Departments. The ‘Asclepeion’ of Voula Hospital covers the southeastern suburban areas of the greater Athens area (1 000 000 population). The aim of this study is to present information on the pattern of injuries in Athens, in order to understand the magnitude of the problem and develop rational prevention programmes. Specially trained health visitors of the Emergency Department Injury Surveillance System (EDISS) interviewed in person every injured victim who was brought into the Emergency Service of the ‘Asclepeion’ of Voula Hospital. The study was performed during a 3-year period, from 1996 to 1998; 4564 persons were interviewed. Traffic accidents were more frequent on weekdays with a seasonal peak in July and among young Greeks (aged 25 – 34 years). The usual type of injuries seen in vehicle-accident victims were cerebral contusion and concussion, while in motorcycle-accident victims, head contusion and fractures. The most common reasons for the accident were excessive speed, poor condition of road, inattention, abstraction or drowsiness and drug effects. A total of 29.8% of motorcycle drivers and 5.7% of motorcycle passengers wore a helmet and 26.3% of car drivers and 14.1% of car passengers were using seatbelts. The identification of road traffic injury patterns can contribute to the development of injury prevention measures and guide rational preventive interventions that can reduce the incidence of these injuries. The EDISS system established at ‘Asclepeion’ of Voula Emergency Service can provide useful and accurate information about this serious and multidimensional problem of Greek Public Health.     

Socio-cultural predictors of injuries: life-course experience of hospitalised injuries during the past century in the Velestino study

Retrospective reviews provide unique opportunity to assess changing approaches to trauma in recent history and identify modifiable behaviours through the lessons of the past. The objective of this paper is to depict the nearly one-century long, life-course injury experience of seniors residing in Velestino, an agricultural Greek town, and comment on neglected determinants and transitional patterns following historical and socio-cultural events in the area. The life-course experience of non-fatal injuries, requiring hospitalisation, has been reported by N = 643 study participants, aged 65–102 years. Injuries were grouped and assessed in three ways: chronologically, by body part and by type. Overall, 124 injuries have been recorded over the past 70 years; the majority sustained by men (58.6%), and the highest number of injuries occurred during the recent decades, 1980s–1990s. For the age groups 26–45 and 46–65 years old, traffic (37.5% and 22.2%) and occupational (25.0% and 22.2%) events have been the commonest cause of injury, whereas injuries occurring at home were primary hazard (25.8%) for the elderly. Moreover, meaningful historical connections with warfare and migration movements were made. In retrospect, socio-cultural factors emerge as important predictors of certain injuries, pointing to the number of factors that should be taken into account when designing injury-prevention programmes.     

Injuries sustained during snow removal from roofs resulting in hospital care

Clearing snow from roofs causes serious injuries annually. The aim of this study was to describe injury mechanisms, injury panorama, and injury incidence in connection to this activity. A specific aim was to study the association between snow depth and injury incidence. A total of 95 people were injured during four study periods. The risk of injury is strongly associated with snow depth, and the incidence varied up to 10-fold between the studied winter seasons. The majority of injuries (91; 96%) occurred during leisure time and only four people were injured in the occupational setting. The most common injury mechanism was falling off roofs or ladders of residential homes. Nearly 60% sustained moderate or serious injuries (Maximum Abbreviated Injury Scale [MAIS] 2–3), and fractures accounted for almost half of all injuries. Because roofs of single-family homes in Sweden usually do not require snow removal for heavy snow loads, these injuries may have been both unnecessary and avoidable. Further education is required to advise the public on the risks associated with snow removal from roofs.     

Injury among migrant workers in Changning district,Shanghai, China

The objective of this study was to characterise the injury epidemic and injury prevention needs of migrant workers in Shanghai. Cluster random sampling was applied in selecting subjects in migrant gathering areas, and face-to-face interview survey was conducted in this study. In this survey, 1256 migrant workers were included, among which the injury incidence in last one year was 38.3%. The first four injuries were incised and penetrating injury (9.5%), falls (7.2%), traffic injury (6.3%) and burns (5.3%). The injury incidence of male workers was significantly higher than that of female workers (χ² = 22.7, P < 0.01). Electricians, safeguards and construction workers were at the highest risk of getting injured. About 60.7% of injury episodes happened at a residence. The longest period of absence from work was up to 3 months due to falls, while the highest medical expense was near 9999 CNY ($1464.2) caused by traffic injury. About 62.9% of migrant workers need services on injury prevention. It is concluded that compared with urban registered residents, migrant workers have significantly higher incidence of injury in Shanghai. Injury prevention services are in urgent demand among the migrant workers.     

Relationship between functional movement screening score and history of injury and identifying the predictive value of the FMS for injury

This study aimed to reveal the functional ability of functional movement screening (FMS) scores in determining an athlete's predisposition to injury. One hundred (50 females and 50 males) university level athletes, weight of 69.44 ± 5.84 kg, height of 172.69 ± 7.26 cm, age of 22.56 ± 2.99 years and Baecke score 21.66 ± 1.73, practised in football, handball and basketball sports (at least for 5 years), with no recent (<6 weeks) history of musculoskeletal injury were recruited. Of the 100 subjects, 35 of them suffered an acute, lower extremity (ankle = 20 and knee = 15 subjects) injury. An odds ratio was calculated at 4.70, meaning that an athlete has an approximately 4.7 times greater chance of suffering a lower extremity injury during a regular competitive season if they score less than 17 on the FMS. This study provides FMS reference values for university level athletes that will assist in the interpretation of individual scores when screening athletes for musculoskeletal injury and performance factors. More research is still necessary before implementing the FMS into a pre-participation physical examination for athletics, but due to the low cost and its simplicity to implement, it should be considered by clinicians and researchers in the future.     

Respondents’ recall of injury events: an investigation of recall bias in cross-sectional injury data from the Sudan Household Health Survey 2010

Recall bias is a well-documented limitation of population-based cross-sectional injury surveys. To fill some gaps in this area, we investigated the extent and nature of recall bias in Sudan Household Health Survey (SHHS 2010) injury data. The extent of incomplete recall was measured by comparing the total reported injuries over 12 months with the annualised number of injuries in the four weeks preceding the survey. Multivariable logistic regression was used to investigate the association of socio-demographic variables, injury attributes and interviewee characteristics with differential recall. Relevant interactions were tested. Overall, reported injuries were 33% of the expected. Injuries among children 1–4 years had lower odds of being reported to have occurred earlier than the four weeks preceding the survey than people aged 65 years and over (OR = 0.24, 95% CI 0.12–0.47). Injuries that received inpatient care in the first week were more likely to be recalled than those that did not receive care (OR = 2.07, 95% CI 1.14–3.75). Respondent's age was associated with differential recall. Differential injury recall should be considered when using SHHS 2010 to compare injury occurrence between children under five and older groups or at the level of health care received.     

A survey of inventions aimed at preventing drowning

To identify, describe and compare injuries among three water sport activities: kite surfing (KS), personal watercraft (PWC) and towed water sports (TWS). The study was a cross sectional, online survey. The setting was on Perth, Western Australia's popular beaches and riverbanks. Main outcome measures were number of injuries and level of severity; level of exposure and protection measures. Overall, 43% reported at least one injury in the past 12 months, a rate of 22.3 injuries per 100 h. Kite surfers were more likely to report an injury than PWC or TWS. One-half of injuries occurred while on the water. Most injuries were caused by landing awkwardly (56%) and/or trying new tricks (41%). Despite 90% of respondents having used at least one personal protective equipment (PPE) item, half (49%) reported always using a personal floatation device. This study provided information on KS, PWC and TWS injuries as well as a range of safety behaviours. It is recommended that these results form the basis of further research to reduce injury rates and encourage the use of PPE items.     

Neck injuries among the elderly in Sweden

Neck injuries are some of the most important injuries as they have the potential to influence the spinal cord. A previous national survey of neck injuries in Sweden revealed that injury incidence was increasing for the population over 65 years of age, although it was decreasing for the population as a whole. The aim of this study was therefore to further clarify the magnitude, severity, and external causes of neck injuries in the elderly people in Sweden. A national incidence study, with focus on the age group above 65 years, was undertaken with data from the injury surveillance program at the Swedish National Board of Health and Welfare. The investigation includes cervical vertebral fractures reported between 1987 and 1999, and cervical soft tissue injuries from 1997 to 1999. Data in the hospital discharge register were reported in ICD9 from 1987 to 1996, while data from 1997 to 1999 were reported in ICD10. During the study period 4168 cervical injuries occurred of which 341 were fatal. People above 65 years of age made up 17% of the population and sustained 30% of all cervical injuries and 43% of all fatal cervical injuries. Half of the cervical injuries were axis (C2) fractures. Lower vertebral fractures occurred in 16% of the cases and atlas (C1) fractures in 11%. The cervical soft tissue injuries amount to 19% of all injuries. Fall accidents account for the majority (71%) of the accidents. There is an increasing trend for fall accidents resulting in neck injuries. The male population has a higher incidence for neck fractures than females, disregarding the external cause of injury. The upper cervical injuries are the most common, have the longest hospital treatments, and seem to be caused mainly by low energy falls. Further research is needed to understand the mechanisms of these injuries and in this aspect engineering could contribute with valuable knowledge, through accident simulations with numerical models. The increasing incidence of fall injuries calls for further preventive actions. The public sector should implement preventive strategies to reduce the number of extrinsic accidents, while the health care sector should focus on preventing intrinsic accidents with individual actions for each patient.     

Swing accidents within the European region

Abstract

This study was conducted to gain greater awareness and understanding of the issues and events which lead to swing accidents; in particular, to provide indices for determining preventive measures concerning swing accidents by means of analyzing accident data. A secondary objective was to find out the potential use for data collected by means of the European Home and Leisure Accident Surveillance System (EHLASS)

All twelve Member States of the European Community in 1993 were asked for information on accidents involving swings recorded by EHLASS. Eight countries provided information on a total of more than 5,000 accidents. Based on this information it was concluded that every year in the European Community about 70,000 people have to be treated at an Accident and Emergency Department for an injury due to a swing, i.e. eleven victims per 10,000 children up to fifteen years of age. On average, half of the accidents involving playground equipment refer to swings. Swing accidents result in general in more severe injuries (based on the proportion of hospital admissions and fractures) than other home and leisure accidents recorded by EHLASS. Three quarters of the accidents refer to falls from a height. The location varies largely from country to country. The most common injuries are arm fractures and contusions of the head. The paper also goes into the differences noted for the countries included in the analyses. It is concluded that accidents involving swings result in severe injuries and form a serious problem, especially for children up to fifteen years of age. Many similarities between the countries were noted, except for the location of the accident. EHLASS has a considerable potential to make a substantial contribution to consumer safety in Europe     

Homeless in America: injuries treated in US emergency departments, 2007–2011

Despite being a high-risk population, epidemiological research about injuries among homeless individuals is limited. We sought to describe injury characteristics among individuals identified as homeless in the National Electronic Injury Surveillance System (NEISS), and to compare them to age- and sex-matched controls. We searched text narratives for all patients with product-related injuries who presented to NEISS emergency departments from 2007 to 2011 to identify homeless cases (N = 268). A random sample of 2680 age- and sex-matched controls was identified for the same time period. The incident location differed between groups, and the mention of substance use was significantly more common among homeless cases than controls. The body part injured differed significantly between cases and controls for all age groups, with the exception of older adults. Among homeless cases, injuries occurred most frequently to the lower extremities, and sprains/strains, contusions/abrasions and burns were most common. Additional research on injury among homeless individuals is warranted in order to identify meaningful preventive strategies for this at-risk population.     

Home injuries in Italy: patterns of injury and the most exposed people

Home injuries are a significant public health problem in developed and developing countries. To support future policies for reducing their occurrence and controlling their consequences, this study investigated the home injuries situation in Italy in 1999, using a nation-representative sample. The weighted correspondence analysis showed four different patterns of injury and seven profiles of the people most exposed to them. As results of this study falls were followed by bumps and cuts requiring specialist assistance then burns. Women were the most exposed to burn and fall risks and men to the risk of cuts and bumps. Among the elderly and children, falls and bumps leading to fractures, wounds or other consequences were frequent. The risks were highest for people with a lower level of education. Bumps and cuts were prevalent among unmarried and with the highest education level subjects. These injury risks were higher for young males. Cuts in adults doing do-it-yourself jobs had the worst consequences, while domestic work cuts generally did not need medical treatment. Burns occurred almost exclusively in the kitchen (90%) and did not need specialist assistance. Because home injuries are largely preventable, an efficient public health policy could promote and disseminate home safety culture.