Peter Barss

Child and Youth Traffic-Related Injuries: Use of a Trauma Registry to Identify Priorities for Prevention in the United Arab Emirates

Objective: Traffic-related injuries are the main cause of death during childhood and youth in the United Arab Emirates (UAE), use of safety restraints by citizens is uncommon, rollovers are frequent, and current legislation does not protect rear-seat occupants. Because little was known about the circumstances of hospitalizations for traffic injuries to guide prevention, a trauma registry was used to assess causes and determinants for traffic-related injuries during childhood and youth (<19 years) and its value for prevention. Methods: One hundred ninety-three children and youth with traffic injuries were admitted for more than 24 h at surgical wards of the main trauma hospital in the Al-Ain region during a 36-month period (2003–2006). Injuries were analyzed by age, nationality, road user and vehicle types, severity, anatomical region, and the presence of head injury using Injury Severity Scores (ISS) and the Abbreviated Injury Scale (AIS). Results: Traffic injuries represented 40 percent (n = 193) of injuries to 0- to 19-year-olds, followed by falls (39 percent). Among 15- to 19-year-olds, who accounted for 46 percent of child and youth victims, the incidence was 150/100,000 person years, compared to an incidence of 15 to 51 for younger age groups. Overall, 53 percent were vehicle occupants, 23 percent were pedestrians, 14 percent were bicyclists, 6 percent were motorcyclists, with 4 percent other. The ratio of male-to-female victims was 6.7:1; for drivers it was 33:0; and for pedestrians, bicyclists, and motorcyclists it was between 10:1 and 12:1; injured females were mainly rear-seat passengers and the male: female ratio was 1.4:1. Seventy-one percent of pedestrians were ≤9 years old. Although the ratio of UAE children to foreign children was estimated at 0.7:1 in the community, 58 percent of the injured were UAE citizens. The ratio of injured UAE: non-UAE citizens was 1.4:1 overall but 5.6:1 for drivers and 4.5:1 for motorcyclists. Forty-one percent of citizens were injured in 4-wheel drive sport utility vehicles compared to 13 percent of non-citizens. Head injuries occurred in 68 percent of vehicle occupants and 51 percent of nonoccupants, with AIS ≥ 3 injuries in 23 percent of occupants and 26 percent of nonoccupants. Sixty-seven percent of rear occupants had head injuries. Conclusions: Male drivers and vulnerable road users were at an unusually high risk relative to females. A relatively high frequency of traffic-related head injuries among UAE children and youth, including rear-seat passengers and other vehicle occupants, suggests that considerable preventable morbidity is associated with nonuse of safety restraints and/or other factors such as excess speed and rollovers of 4-wheel drive vehicles. Trauma registries can be useful for prevention; inclusion of data on safety restraints and helmet use by road user type is essential.

Home and other nontraffic injuries among children and youth in a high-income Middle Eastern country: a trauma registry study.

A trauma registry in the United Arab Emirates was used to ascertain nontraffic injuries of 0- to 19-year-olds. The registry’s value for prevention was assessed. A total of 292 children and youth with nontraffic injuries were admitted for >24 hours at surgical wards of the main trauma hospital in Al Ain region during 36 months in 2003-2006. Injuries were analyzed by external cause, location, body part, and severity. Nontraffic represented 60% (n = 292) of child and youth injuries. Incidence/100 000 person-years was 91 for males, 43 for females. Unintentional included falls 65% (n = 191), burns 17% (n = 49), animal-related (mainly camel) 3% (n = 10), and others 10% (n = 29). Intentional accounted for 4% (n = 13). Falls affected all ages, burns mainly 1- to 4-year-olds. Of the injuries, 70% occurred at home. Most frequent and severe injuries measured by the Injury Severity Score and Abbreviated Injury Scale involved extremities. Prevention of home falls for all ages and burns of 1- to 4-year-olds are priorities. Registries should cover pediatric wards and include data on fall locations and hazardous products.

Vehicle occupant restraint systems impact on eye injuries: A review

Vehicle occupant trauma to the eyes and associated facial structures has evolved rapidly in conjunction with safety-oriented vehicle design, including restraint systems. Trends vary worldwide with culture, personal factors, vehicle safety equipment, and the traffic environment-including physical, legislative, and enforcement. Wearing safety belts is essential to occupant protection. Airbags were designed as a supplement to protect the head from hard surfaces in frontal crashes, not as a primary countermeasure. Even where vehicle fleets are new with high airbag prevalence, but safety culture and knowledge of restraints is less than robust, injury attributable to not wearing seatbelts is frequent, especially in countries where high-powered vehicles are prevalent. Upper bodies of rapidly forward-moving unrestrained occupants collide with rearward-accelerating airbags. Airbag deployment produces injuries such as corneal abrasions, alkali burns, and the effects of globe compression.

Baby walker injury, disability, and death in a high-income middle eastern country, as reported by siblings

BackgroundBaby walkers (BWs) are frequent causes of infant injuries. Little research is reported from the Middle East and few population-based studies anywhere.MethodsUsing multistage random sampling in a city of the United Arab Emirates, 4 of 8 female Arab government high schools and 3 final-year classes each from science and arts tracks were selected. Structured self-administered questionnaires assessed prevalence, frequency, severity, and external causes of BW incidents and injuries, and residential hazards.ResultsResponse was 100 %, 696 students, 55 % (nu2009=u2009385) Emirati citizens. 87 % (nu2009=u2009605) of families used/had used BWs. Among 646 injuries were 118 ER (emergency) visits, 42 hospitalizations, 11 disabilities, and 3 deaths. Average risk was 1 incident/user, 1 injury/4 users, 1 ER visit/20, 1 hospitalization/55, 1 disability/200, 1 death/1000. Odds ratios for >1:1 floor levels were 2.3 (95 % confidence interval: 1.2, 4.3) for hospitalization, 16.8 (95 % CI: 2.1, 132.5) disability. Incidents included hitting objects 48 % (nu2009=u20091322), overturning 23 % (nu2009=u2009632), accessing hazardous objects 17 % (nu2009=u2009473), and falling down stairs 11 % (nu2009=u2009300); 1 % (nu2009=u200932) fell into swimming pools. In 49 % (nu2009=u2009297/605) of user families, ≥1 child had been injured.ConclusionsDespite causing many injuries including disabilities and fatalities, BWs were used by nearly all families. Governments should consider Canada’s lead in prohibiting importation, sales, and advertisingxa0of BWs.Background Baby walkers (BWs) are frequent causes of infant injuries. Little research is reported from the Middle East and few population-based studies anywhere. Methods Using multistage random sampling in a city of the United Arab Emirates, 4 of 8 female Arab government high schools and 3 final-year classes each from science and arts tracks were selected. Structured self-administered questionnaires assessed prevalence, frequency, severity, and external causes of BW incidents and injuries, and residential hazards. Results Response was 100 %, 696 students, 55 % (nu2009=u2009385) Emirati citizens. 87 % (nu2009=u2009605) of families used/had used BWs. Among 646 injuries were 118 ER (emergency) visits, 42 hospitalizations, 11 disabilities, and 3 deaths. Average risk was 1 incident/user, 1 injury/4 users, 1 ER visit/20, 1 hospitalization/55, 1 disability/200, 1 death/1000. Odds ratios for >1:1 floor levels were 2.3 (95 % confidence interval: 1.2, 4.3) for hospitalization, 16.8 (95 % CI: 2.1, 132.5) disability. Incidents included hitting objects 48 % (nu2009=u20091322), overturning 23 % (nu2009=u2009632), accessing hazardous objects 17 % (nu2009=u2009473), and falling down stairs 11 % (nu2009=u2009300); 1 % (nu2009=u200932) fell into swimming pools. In 49 % (nu2009=u2009297/605) of user families, ≥1 child had been injured. Conclusions Despite causing many injuries including disabilities and fatalities, BWs were used by nearly all families. Governments should consider Canada’s lead in prohibiting importation, sales, and advertising of BWs.

Baby walker injury awareness among grade-12 girls in a high-prevalence Arab country in the Middle East

Baby walkers (BWs) are a consumer product frequently associated with infant injuries. With little research in the Middle East and few population studies anywhere, female students in grade 12 in the United Arab Emirates were surveyed, assessing the prevalence of use, perceived safety, and interventions. The study population included grade-12 students in a large UAE city. Multistage random sampling selected 4/8 female Arab government schools and 3 classes each from science and arts tracks for interview by self-administered questionnaire. Response was 100%, with a total of 696 students, 55% (n = 385) of whom were Emirati citizens; 90% (n = 619) of the families used/had used BWs. Among the reasons for use, 92% reported “keeping baby safe,” with 11% perceiving BWs as very safe and 74% as moderately safe. Only 16% perceived that BWs could cause injuries. Despite causing many injuries, including fatalities, BWs were perceived to be safe and used by nearly all families. Effective education of professionals, patients, the public, and decision makers is needed. Governments should consider countermeasures such as prohibiting importation, sales, and advertising, together with public education and provision of stationary activity centers.

PW 1000 Deaths by immersion in and around homes in canada, twenty-three years of epidemiology and failed policy: a built environment issue

Background National population-based data on home drownings are scarce. They represent 17% (1995/11280) of submersion fatalities in Canada. Objective Assess circumstances of drownings in/around homes, i.e., activities, personal, equipment, environment. Methods Using structured questionnaires, coroners’ data were collected prospectively in 1991–2013 during national surveillance of water-related injury deaths. Population averaged 30u2009million. Findings 11u2009915 deaths included 11u2009280 immersions with drowning and/or hypothermia, 584 trauma 39 other 12 unknown. 18% (n=1,995) occurred at home and 5% (n=515) at cottages/cabins. Activities Bathing accounted for 43%(n=864), aquatic 23%(n=466), falls into water 28%(n=565), other knowns 6%(n=111), unknown 2%(n=36). Personal factors Victims were 60% male. 61% of females and 32% of males drowned in bathtubs. 32% of males drowned in swimming pools, 22% of females. Infants<1u2009year-old accounted for 3%(n=57) of deaths, toddlers 1–4u2009years-old 17%(n=344), 5–14u2009year-olds 5%(n=107), 15–24u2009year-olds 7%(n=140), 25–74u2009year-olds 51%(n=1014), and ≥75, 17%(333). 3% were indigenous peoples. Medical conditions included seizures 17%(n=353), mental disabilities 5%, depression 7%, alcoholism 10%, schizophrenia 2%, physical disabilities 5%, diabetes 5%, and acute medical condition such as cardiac 3%. For ≥15u2009years-olds, 29% were alcohol associated, 22% above 80u2009mg%, 5% below, 2% suspected, 48% zero; Illegal drugs 5%. 14% were non-swimmers, 3% weak. Environment 77% (n=1567) involved person-made structures: bathtubs 56%(n=877), swimming pools 36% (n=557), hot tubs 8%(n=119), ornamental ponds 1%(n=14). Flatwater, i.e., lakes, ponds, reservoirs and dugouts accounted for 11%(n=228), moving water, i.e., rivers and streams 5%(n=96), oceans<1%(n=6). Supervision/accompaniment For children 1–14u2009years old, 68% were alone, 22% with minors, and 10% with adults. Resuscitation CPR and/or rescue breathing was done for 55%. Trends There was a mean 87 deaths/year, 0.28/100,000 population/year and no significant change. Conclusion and policy implications Nearly all fatalities involved consumer products in built environments and should be avertable by design, eliminating or modifying pools and adult bathtubs. Alcohol and seizures were other modifiable hazards.

829 Review of recreational and occupational pfd wearing legislation at provincial, state, and municipal levels in Canada and internationally

Background With a few notable exceptions, national legislation requiring wearing of a personal flotation device or lifejacket by boaters is uncommon. As a result some municipalities and provinces or states have introduced their own regulations. Methods Information was obtained by searching of Safety Lit and other sources, including by contacting instigators of national legislation Results Regulations for recreational and occupational boating were obtained for all 13 Canadian provinces and territories as well as one city. Canadian laws were diverse and are relatively weak, with the notable exception of the city of Calgary. Information was also obtained for Australia, Ireland, New Zealand, and the United States. In the United States, state laws supersede the national law, which appears mainly oriented towards children. The Irish legislation is more comprehensive than most. The most comprehensive state law in Australia is in Victoria State and has had remarkable success in improving outcomes as measured by boating drowning fatalities. In New Zealand, 18 regions and cities have regulations, some of which were comprehensive in requiring mandatory wearing. Many regulation featured opt out clauses at the discretion of the operator. Conclusions Current legislation on wearing of flotation devices is variable. If the weak regulations in many jurisdictions were to be replaced by those such as in Victoria, Ireland and certain regions and cities in New Zealand, it is probable that many boating fatalities could be averted. Since children are uncommon victims of boating immersion in many high income countries, legislation targeting children will not be expected to be effective in such countries, with certain exceptions such as indigenous peoples. Rather the focus should be adult males

210 Brain injuries and fractures from falls on stairs among children and youth in Canada: epidemiology and prevention

Background Stairs and steps have in some countries become the leading source of brain injury, with children and working age adults as the main populations at risk. Risk factors and trends were assessed for hospitalizations of children and youth ≤19 years in Canada. Methods Non-nominal hospital admission data were obtained from the Canadian Institute of Health Information for the years 1994–2009. Hospitalisations of children and youth 0–19 years of age due to falls on stairs and steps were extracted using appropriate ICD 9 and 10 codes. Trends by age group were analysed and hospitalizations cross classified using external cause and nature of injury codes. Statistical evaluation included χ2 for univariate and bivariate analysis and Poisson or negative binomial regression for trend analysis of hospitalizations and injuries. Results There were 13,500 hospitalisations from falls on stairs and steps among 0–19 year olds. Rate of hospitalisation decreased by 55% over the study period from 16.8/100,000 to 7.5/100,000. Infants less than <1 year old had the highest rate at 33.2/100,000, and the greatest improvement correlating in time with banning of baby walkers. Males represented 55% of patients. The home was the site of 60% of incidents, with 60% of falls resulting in a fracture and 30% in intracranial injury. For infants <1 year, 50% of stair falls resulted in an intracranial injury. Income quintiles were highly correlated (p < 0.001), especially for lowest, at 25% of total, versus highest 16%. Conclusions Home stairs present serious hazards, especially for infants and children. While rates of stair falls have declined in the last two decades, much work remains to make stairs safer and prevent injuries, especially of the brain. Home stairs can be made less steep by adopting the 7–11 configuration widely adopted for public places, and other building code measures to correct frequent design and constuction hazards.

828 Non-wearing of flotation devices and swimming ability of boating immersion victims in Canada

Background Boating is the most frequent activity for water-related immersion deaths in Canada. Central in immersion/drowning is non-wearing of personal flotation devices (PFDs). Anecdotal observation of frequent non-wearing among victims led to quantitive assessment using negative binomial and Poisson regression models. Methods Annual Red Cross collection of 1991–2010 Canadian coroner data was by structured questionnaire. Analysis included ten variables in the final model. Results There were 2678 recreational and daily living boating immersion deaths during 1991–2010. Certain variables significantly increased the odds of properly wearing a PFD and others decreased them. Controlling for all other variables, victims with average swimming ability had 1.93 times the odds of wearing compared with non and weak swimmers combined (95% CI: 1.29–2.87). Strong swimmers had 1.90 times the odds of wearing compared with non/weak swimmers (95% CI: 1.06–3.40). Conclusion It was surprising that boating victims with low swimming ability were less likely than swimmers to have worn a flotation device. It is possible, but remains to be established, that poor swimmers were less likely to have participated in a swimming course, which included the main elements of water safety for boating and other activities.