Belinda Wallis

An Audit of First-Aid Treatment of Pediatric Burns Patients and Their Clinical Outcome

This study describes the first aid used and clinical outcomes of all patients who presented to the Royal Children’s Hospital, Brisbane, Australia in 2005 with an acute burn injury. A retrospective audit was performed with the charts of 459 patients and information concerning burn injury, first-aid treatment, and clinical outcomes was collected. First aid was used on 86.1% of patients, with 8.7% receiving no first aid and unknown treatment in 5.2% of cases. A majority of patients had cold water as first aid (80.2%), however, only 12.1% applied the cold water for the recommended 20 minutes or longer. Recommended first aid (cold water for ≥20 minutes) was associated with significantly reduced reepithelialization time for children with contact injuries (P = .011). Superficial depth burns were significantly more likely to be associated with the use of recommended first aid (P = .03). Suboptimal treatment was more common for children younger than 3.5 years (P < .001) and for children with friction burns. This report is one of the few publications to relate first-aid treatment to clinical outcomes. Some positive clinical outcomes were associated with recommended first-aid use; however, wound outcomes were more strongly associated with burn depth and mechanism of injury. There is also a need for more public awareness of recommended first-aid treatment.

Interventions associated with drowning prevention in children and adolescents: systematic literature review

Introduction Drowning remains a leading cause of preventable death in children across the world. This systematic review identifies and critically analyses studies of interventions designed to reduce fatal and non-fatal drowning events among children and adolescents or reduce the injury severity incurred by such incidents. Methods A systematic search was undertaken on literature published between 1980 and 2010 relating to interventions around fatal and non-fatal drowning prevention in children and adolescents 0–19 years of age. Search methods and protocols developed and used by the WHO Global Burden of Disease Injury Expert Group were applied. Results Seven studies fulfilled the inclusion criteria. Interventions were categorised into three themes of Education, Swimming Lessons and Water Safety, and Pool Fencing. All are possible effective strategies to prevent children from drowning, particularly young children aged 2–4 years, but very little evidence exists for interventions to reduce drowning in older children and adolescents. There were methodological limitations associated with all studies, so results need to be interpreted in the context of these. Conclusions Relatively few studies employ rigorous methods and high levels of evidence to assess the impact of interventions designed to reduce drowning. Studies are also limited by lack of consistency in measured outcomes and drowning terminology. Further work is required to establish efficacy of interventions for older children and adolescents. There is a need for rigorous, well-designed studies that use consistent terminology to demonstrate effective prevention solutions.

Safety legislation, public health policy and drowning prevention

The article presents a study on drowning as the major cause of mortality and morbidity of the children in Brisbane, Queensland. It states that the drowning death rates of young children, aging 0-4 years old, had decreased after the introduction of safety legislation. The study has shown that the drowning incidents of young children will continue to reduce with the introduction of safety legislation and enforced compliance, in combination with education for safety and ongoing advocacy.

Injury and frequency of use of playground equipment in public schools and parks in Brisbane, Australia

Objective: The purpose of this study was to determine the frequency of use of play equipment in public schools and parks in Brisbane, Australia, and to estimate an annual rate of injury per use of equipment, overall and for particular types of equipment. Methods: Injury data on all children injured from playground equipment and seeking medical attention at the emergency department of either of the two children’s hospitals in the City of Brisbane were obtained for the years 1996 and 1997. Children were observed at play on five different pieces of play equipment in a random sample of 16 parks and 16 schools in the City of Brisbane. Children injured in the 16 parks and schools were counted, and rates of injury and use were calculated. Results: The ranked order for equipment use in the 16 schools was climbing equipment (3762 uses), horizontal ladders (2309 uses), and slides (856 uses). Each horizontal ladder was used 2.6 times more often than each piece of climbing equipment. Each horizontal ladder was used 7.8 times more than each piece of climbing equipment in the sample of public parks. Slides were used 4.6 times more than climbing equipment in parks and 1.2 times more in public schools. The annual injury rate for the 16 schools and 16 parks under observation was 0.59/100 000 and 0.26/100 000 uses of equipment, respectively. Conclusions: This study shows that annual number of injuries per standardized number of uses could be used to determine the relative risk of particular pieces of playground equipment. The low overall rate of injuries/100 000 uses of equipment in this study suggests that the benefit of further reduction of injury in this community may be marginal and outweigh the economic costs in addition to reducing challenging play opportunities.

Paediatric treadmill friction injuries

Aim:  The aim of this study was to report on the severity and incidence of children injured by treadmills and to promote the implementation of safety standards.

Phytophotodermatitis: Case reports of children presenting with blistering after preparing lime juice

Letter to the Editor We read with interest the case report entitled ‘‘Contact with fig tree sap: An unusual cause of burn injury’’ by Mandalia et al. [1] and would like to report our similar experience with phytophotodermatitis caused by lime juice. Phototoxic dermatitis is understandably easily confused with a burn, particularly when a patient presents with large blisters of unknown mechanism. At the Royal Children’s Hospital Burns Centre, this injury was treated in the same manner as a burn and is described here...

Paediatric low speed vehicle run-over fatalities in Queensland

Introduction Child pedestrian fatalities associated with motor vehicles reversing or moving at low speed are difficult to identify in surveillance data. This study aims to determine the incidence of fatalities associated with what is thought to be an under-reported and preventable fatal injury mechanism. Methods The term low speed vehicle run-over (LSVRO) incidents encompasses pedestrian fatalities where vehicles run-over a child at low speed. Data were obtained for children aged 0–15 years in the Australian state of Queensland (January 2004–December 2008). Results There were 15 deaths (12 boys and 3 girls) during 2004–2008 (rate:1.67/100 000). Over half were aged 0 and 1 years of age (n=8; 53.3%, rate: 14.67/100 000), and one quarter were 2 and 3 years of age (n=4, 27%, rate 7.46/100 000). There were no LSVRO deaths recorded among 10–15 year olds. Most (13/15) of the incidents occurred on private property, and only two occurred on a street/road. Almost half of the fatalities were caused by a four wheel drive (4WD) vehicle; large family sedans were involved in four fatalities, and heavy vehicles were involved in three deaths. In 11 of the fatalities, parents were the drivers of the vehicle involved (mothers 5; fathers 6). In nine, the vehicle involved was reversing before it came in contact with the child. Fatalities occurred in each of the Socio-Economic Indexes For Areas (SEIFA) levels. Conclusion The unique data provided by the child death review team has signalled that LSVRO fatalities are a significant problem in Queensland. The Commission for Children and Young People and Child Guardian (CCYPCG) continue to collect data, which, when combined, will provide outcomes that will act as an impetus for promoting intervention and child advocacy.

Drowning Mortality and Morbidity Rates in Children and Adolescents 0-19yrs: A Population-Based Study in Queensland, Australia

Objective To redress the lack of Queensland population incidence mortality and morbidity data associated with drowning in those aged 0-19yrs, and to understand survival and patient care. Design, Setting and Participants Retrospective population-based study used data linkage to capture both fatal and non-fatal drowning cases (N = 1299) among children aged 0-19years in Queensland, from 2002-2008 inclusive. Patient data were accessed from pre-hospital, emergency department, hospital admission and death data, and linked manually to collate data across the continuum of care. Main Outcome Measures Incidence rates were calculated separately by age group and gender for events resulting in death, hospital admission, and non-admission. Trends over time were analysed. Results Drowning death to survival ratio was 1:10, and two out of three of those who survived were admitted to hospital. Incidence rates for fatal and non-fatal drowning increased over time, primarily due to an increase in non-fatal drowning. There were non-significant reductions in fatal and admission rates. Rates for non-fatal drowning that did not result in hospitalisation more than doubled over the seven years. Children aged 5-9yrs and 10-14yrs incurred the lowest incidence rates 6.38 and 4.62 (expressed as per 100,000), and the highest rates were among children aged 0-4yrs (all drowning events 43.90; fatal 4.04; non-fatal 39.85–comprising admission 26.69 and non-admission 13.16). Males were over-represented in all age groups except 10-14yrs. Total male drowning events increased 44% over the seven years (P<0.001). Conclusion This state-wide data collection has revealed previously unknown incidence and survival ratios. Increased trends in drowning survival rates may be viewed as both positive and challenging for drowning prevention and the health system. Males are over-represented, and although infants and toddlers did not have increased fatality rates, they had the greatest drowning burden demonstrating the need for continued drowning prevention efforts.

Preventing injuries on horizontal ladders and track rides.

Objectives. This study examined the type of injury, fall heights and measures of impact attenuation of surfaces on which children fell from horizontal ladders and track rides. Method. All injured children who presented to two childrens hospitals and received medical attention following a fall from a horizontal ladder or track ride in a public school or park during 1996–1997 were interviewed and the playground visited. Results. The number of children who fell from horizontal ladders and track rides and presented to hospitals with injury was 118. Of those children, 105 were injured when they hit the ground and data were available on 102 of those playground undersurfaces. Fractures to the arm or wrist were the most common injury. The median height fallen by children was 1930 mm, 73% of injuries were from falls greater than 1800 mm. In 41% of sites, the surface was deficient in impact absorbing properties for the height of the equipment. Fractures were no more likely on loose surfaces than other surfaces, such as rubber matting (p = 0.556) but more prevalent on compliant than non-compliant surfaces. Relative to falls occurring on noncompliant surfaces, the odds of a fracture occurring on a compliant surface was 2.67 (95% CI 0.88–8.14). Conclusions. Modification of the height of horizontal ladders and track rides to 1800 mm is preferable to removal of such equipment. The prevalence of fractures on compliant surfaces suggests that the threshold of 200 g or 1000 head injury criteria (HIC) needs to be revisited, or additional test criteria added to take account of change in momentum that is not presently accounted for with either g-max on HIC calculations.

Systematic Literature Review of Incidence Rates of Low-Speed Vehicle Run-Over Incidents in Children

AIM To systematically review the literature investigating the incidence of fatal and or nonfatal low-speed vehicle run-over (LSVRO) incidents in children aged 0-15 years. METHODS The following databases were searched using specific search terms, from their date of conception up to June 2011: Cochrane Library, Medline, CINAHL, Embase, AMI, Sociological Abstracts, ERIC, PsycArticles, PsycInfo, Urban Studies and Planning; Australian Criminology Database; Dissertations and Thesis; Academic Research Library; Social Services Abstracts; Family and Society; Scopus; and Web of Science. A total of 128 articles were identified in the databases (33 found by hand searching). The title and abstract of these were read, and 102 were removed because they were not primary research articles relating to LSVRO-type injuries. Twenty-six articles were assessed against the inclusion (reporting population level incidence rates) and exclusion criteria, 19 of which were excluded, leaving a total of five articles for inclusion in the review. FINDINGS Five studies were identified that met the inclusion criteria. The incidence rate in nonfatal LSVRO events varied in the range of 7.09 to 14.79 per 100,000 and from 0.63 to 3.2 per 100,000 in fatal events. DISCUSSION Using International Classification of Diseases codes for classifying fatal or nonfatal LSVRO incidents is problematic as there is no specific code for LSVRO. The current body of research is void of a comprehensive secular population data analysis. Only with an improved spectrum of incidence rates will appropriate evaluation of this problem be possible, and this will inform nursing prevention interventions. The effect of LSVRO incidents is clearly understudied. More research is required to address incidence rates in relation to culture, environment, risk factors, car design, and injury characteristics. CONCLUSIONS The lack of nursing research or policy around this area of injury, most often to children, indicates a field of inquiry and policy development that needs attention.