Arjan Bastiaan van As

Inhaled foreign bodies in children: A global perspective on their epidemiological, clinical, and preventive aspects†

While several articles describe clinical management of Foreign Bodies injuries in the upper air tract, little epidemiological evidence is available from injury databases.

Violence, violence prevention, and safety: A research agenda for South Africa

Violence is a serious problem in South Africa with many effects on health services; it presents complex research problems and requires interdisciplinary collaboration. Two key meta-questions emerge: (i) violence must be understood better to develop effective interventions; and (ii) intervention research (evaluating interventions, assessing efficacy and effectiveness, how best to scale up interventions in resource-poor settings) is necessary. A research agenda to address violence is proposed.

Patterns of pediatric injury in South Africa: an analysis of hospital data between 1997 and 2006.

BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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. LEVEL OF EVIDENCE Prognostic study, level II.

The use of the Statscan digital X-ray unit in paediatric polytrauma

We present a 3-year review of clinical paediatric experience with the Statscan (Lodox Systems, Johannesburg, South Africa), a low-dose, digital, whole-body, slit-scanning X-ray machine. While focusing on the role of the unit in paediatric polytrauma, insight into its applications in other paediatric settings is provided.

Pediatric burn injuries in South Africa: A 15-year analysis of hospital data

INTRODUCTION Burns are a significant burden of pediatric injuries, particularly in low and middle-income countries, were more than 90% of burn-related pediatric deaths occur. This study explores pediatric burn-related injuries over a fifteen year time period in South Africa through an analysis of a pediatric trauma surveillance system. METHODS This retrospective observational study used data collected by Childsafe South Africa from the Red Cross War Memorial Childrens Hospital (RCH) trauma registry in Cape Town, South Africa between 1995 and 2009 for children less than 13 years of age who presented with burn injuries to the hospitals casualty department. Demographic data and Abbreviated Injury Scores (AISs) were first assessed, followed by an analysis of time trends using Poisson regression. Logistic regression models were used to analyse factors related to hospital admissions. RESULTS Between 1995 and 2009, 9438 children with burn-related injuries presented to RCH, of which nearly three-quarters resulted from scalds (73%; n=7024). The mean age of the injured children was 3.1 ± 2.9 years 58% were male. 11 deaths occurred in the hospitals casualty department. 39% of injuries were minor, 56% were moderate, and 5% were severe. During the 15-year study period, moderate burn injuries increased by 3%, while minor injuries decreased by 10% (p<0.05). 49% of all children were admitted to the hospital. Hospital admissions increased by 3% (p<0.05) during the study period. CONCLUSIONS Pediatric burn injuries are a significant contributor to the burden of child diseases in developing county hospitals. Pediatric surveillance systems, such as Childsafe South Africas, are important to study epidemiologic changes in burn injuries. Findings suggest the need for targeted interventions to address the prevention of specific burn-related injuries.

Digital radiographic measurement of the atlantodental interval in children

The atlantodental interval (ADI) is assessed after trauma to the head and neck region to determine whether the transverse ligament of the atlas is intact. Atlantodental interval measurement from conventional screen-film radiographs is characterized by the need for magnification correction and by low reliability. Assessment of normal ADI values using digital radiography with computer-assisted measurement has not been reported. We compared with published values the digital radiographic measurements of ADI in children, examined the reliability of measurements, and examined the interaction between age, sex and ADI. Computer-assisted digital measurements of ADI in 101 children, aged 1 to 12 years, were obtained from lateral supine head-neutral radiographs. We found intraobserver reliability of 0.72 and 0.85, interobserver reliability of 0.50, a maximum ADI value of 3.5 mm, no effect of sex and age, and weak evidence for an interaction between sex and age. Computer-assisted digital ADI measurement provides higher intraobserver reliability than what has previously been reported, and interobserver reliability and a maximum ADI value similar to that found in the literature.

Tension pneumocranium in childhood trauma

BackgroundTo report a case of fatal tension pneumocephalus in a 9-year-old boy following a severe motor vehicle accident.MethodsA young boy with a serious closed head injury was resuscitated in the emergency room and underwent CT scan of the head and orbits.ResultsThe CT-scan revealed a fracture of the orbital roof with extensive bilateral pneumocephalus.ConclusionsA 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.

Child road traffic crash injuries at the Red Cross war memorial children’s hospital in Cape Town South Africa in 1992, 2002 and 2012

Road traffic crashes are a significant cause of the disease burden among children, with the highest mortality in low- and middle-income countries. This observational study explores such injuries in Cape Town, South Africa through an analysis of data for cases in 1992, 2002 and 2012 at the Red Cross War Memorial Childrens Hospital, a referral paediatric hospital for children younger than 13 years. Descriptive and time trend analysis of demographic data as well as of the causes, severity and place of injury was conducted. Logistic regression and generalised linear models described factors influencing hospital admission. In the years 1992, 2002 and 2012, a total of 4690 patients presented with injuries sustained as a result of a road traffic crash. Nearly 50% (n = 2201) of them were between five and nine years of age, with 1.7 males for every female. Three-quarters of those who got injured were pedestrians while the second most commonly injured ones were unrestrained passengers. The majority had minor injuries (58%), but with notably higher proportions with moderate to severe injuries in the years 2002 and 2012. Forty per cent were admitted for inpatient treatment, with the highest proportion (50%) in 2002. Admission was related to mechanism and severity. The epidemiological factors assessed remain largely unchanged over the assessment points calling into question the impact of local safety strategies.

Childhood unintentional injuries: Supervision and first aid provided

Background : The aim of this study was to investigate the circumstances surrounding unintentional injuries of children and the appropriateness of the first aid provided by caregivers. Materials and Methods : This prospective study included children with aged range 0-12 years, who presented with an unintentional injury at the Trauma Unit of a hospital in Cape Town, South Africa, over a 3 month period. Caregivers were interviewed about the circumstances of the injury and the first aid provided. Experts classified the first aid as appropriate, appropriate but incomplete, or inappropriate. Results: A total of 313 children were included with a median age of 3.75 years. The most common causes of injury were falls (39.6%, n = 124), burns (23.9%, n = 75) and motor vehicle crashes (10.5%, n = 33). More than a quarter of the children (27.2%, n = 81) had been left under the supervision of another child below the age of 12. When the injury occurred, 7.1% (n = 22) of the children were unattended. First aid was provided in 43.1% (n = 134) of the cases. More than half of these interventions (53%, n = 72) were inappropriate or appropriate but incomplete. Conclusions: Especially young children are at risk for unintentional injuries. Lack of appropriate supervision increases this risk. Prevention education of parents and children may help to protect children from injuries. First-aid training should also be more accessible to civilians as both the providing of as well as the quality of first-aid provided lacked in the majority of cases.

Increased Morbidity Associated with Weekend Paediatric Road Traffic Injuries: 10-year Analysis of Trauma Registry Data

BACKGROUND Road traffic injuries (RTIs) are a significant cause of paediatric 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 paediatric RTI presentations using hospital-based trauma surveillance data in Cape Town, South Africa. METHODS Data was analysed from Childsafe South Africas prospectively collected trauma registry for injured children below 13 years of age presenting to a tertiary paediatric 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, paediatric 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 paediatric RTIs. These findings highlight the importance of trauma surveillance data to inform targeted community prevention strategies for improving child road safety.