Child drowning on farms in Canada and associated demographic and risk factors.

OBJECTIVES: This study aimed to examine the occurrence and characteristics of child drowning deaths on farms compared with other child injury deaths on farms. METHODS: This study uses cross-sectional data from the Canadian Agricultural Injury Reporting Program for the years 1990 through 2012. Using χ2 tests and regression, it compares the occurrence of demographics and potential risk factors between drowning deaths and all other injury deaths among children (< 19 years of age) on farms. RESULTS: There were 44 drowning deaths and 306 non-drowning deaths identified. Drowning deaths were at younger age (mean age of 5.4 versus 8.8 years old), non-work-related (25% versus 79%), and less likely to occur during adult supervision (36.4% versus 53.5%). CONCLUSIONS: Drowning disproportionately affects the very young. Improving supervision of young children may prevent some farm drowning deaths, but installing effective barriers to water hazards is likely more effective.

RéSUMé: OBJECTIFS: Examiner la survenue et les caractéristiques des décès d'enfants par noyade sur les fermes comparativement aux autres décès d'enfants attribuables aux blessures sur les fermes. MéTHODE: L'étude fait appel aux données transversales de 1990 à 2012 du programme de Surveillance des blessures dans le secteur agricole au Canada. À l'aide de tests du Χ2 et d'analyses de régression, elle compare l'existence de facteurs démographiques et de facteurs de risque potentiels entre les décès par noyade et les autres décès attribuables aux blessures chez les enfants (< 19 ans) survenus sur les fermes. RéSULTATS: Quarante-quatre décès par noyade et 306 décès autres que par noyade ont été répertoriés. Les décès par noyade ont touché des enfants plus jeunes (âge moyen de 5,4 ans contre 8,8 ans), n'étaient pas liés au travail (25 % contre 79 %) et étaient moins susceptibles de se produire sous la surveillance d'un adulte (36,4 % contre 53,5 %). CONCLUSIONS: Les noyades touchent démesurément les très jeunes enfants. Une meilleure surveillance des jeunes enfants pourrait prévenir certains décès par noyade sur les fermes, mais l'installation de barrières contre les risques aquatiques est probablement plus efficace.

Fatal farm injuries to Canadian children.

Children on Canadian farms are at high risk for fatal injury. Ongoing surveillance of these deaths is required to affirm recurrent patterns of injury, and to determine whether historical approaches to prevention have resulted in declines in the occurrence of these traumatic events. We analyzed epidemiological patterns and trends in the occurrence of fatal pediatric farm injuries over 23 years. Records of deaths were obtained from the Canadian Agricultural Injury Reporting system. To contrast more recent data with injury patterns described historically, cases were compared between two time periods. An intentional consensus process was used to finalize key patterns and their clinical or social importance. 374 fatal farm injuries to children in Canada were identified over the 23 years of study; 253 in period 1 and 121 in period 2. While machinery and non-machinery causes of death varied between the two study periods, mean annual rates of fatal injury (approximately 4 per 100,000 children) remained similar. Notably emergent types of injury in recent years included those caused by all-terrain vehicles, skid steer loaders, and drownings. Observed declines in the numbers of fatal farm injuries are most likely attributable to analogous declines in the number of registered farms in Canada. Our findings call into question the effectiveness of pediatric farm safety initiatives that primarily focus on education. Second, while CAIR fatality data are maintained, surveillance of hospitalized injuries has been disbanded and the fatality records require updating. Only by doing so will such surveillance findings provide comprehensive information to inform prevention.

Hockey-related emergency department visits after a change in minor hockey age groups.

OBJECTIVE: To examine ice hockey injury rates presenting to emergency departments (EDs) in 2 separate cohorts of players before and after a policy change for age groups in minor hockey. DESIGN: : Retrospective cross-sectional study. SETTING: Retrospective review of ice hockey injuries presenting to 2 tertiary care and 5 community care EDs in Edmonton, Alberta. PATIENTS: Two cohorts of minor ice hockey players were constructed. The pre-age change cohort consisted of 4215 registered male hockey players. The post-age change cohort consisted of 3811 registered male hockey players. ASSESSMENT OF RISK FACTORS: The risk of fracture, head and neck injury (intracranial and nonintracranial), and all other injuries presenting to EDs were compared between the pre-age change and post-age change cohorts. MAIN OUTCOME MEASURES: Presentation to an ED with an injury occurring in ice hockey between September 1 and April 31 for the years 1997 through 2010. RESULTS: Overall, significantly lower injury rates were observed in the post-age change cohort for players in the Peewee division; however, no significant differences were observed for the rate of fractures, and intracranial or nonintracranial head and neck injuries. There were no statistically significant differences observed between the pre-age change and post-age change cohorts in the Atom or Bantam divisions. CONCLUSIONS: Introducing body checking 1 year earlier than in a previous cohort (11 vs 12 years of age) neither significantly decreased nor increased the rate of serious ice hockey injuries occurring 2 years after the introduction of body checking. Further research is recommended to evaluate the claim that introducing body checking lowers injury rates in older divisions of hockey.

The epidemiology of hospitalized head injury in British Columbia, Canada.

OBJECTIVE: This descriptive study seeks to identify the incidence rates of head injuries in a large Canadian province, given incident cases for a ten year period. It describes cases in terms of age standardized rates, demographics, and health care utilization. METHODS: The analyses were done using descriptive statistics. Incidence rates were calculated using the direct method. The indicators of hospital resource utilization were: mean length of hospital stay, number of intensive care unit (ICU) stays, and mean length of stay in an ICU. RESULTS: In the ten year period, British Columbia saw 48,753 admissions due to an incident head injury. The most common head injury diagnosis was an "Intracranial" injury. The year with the highest total age standardized rate was 1991/92 (174.18/100,000). The mean length of hospital stay was 7.4 days. Ten percent had an ICU stay and the mean length of stay was 4.4 days (+/- 4.8). The diagnosis with the longest mean length of stay was a "Fractured Skull" while of the top five E-code categories; "Motor Vehicle Traffic" had the highest mean length of stay with 12.2 days. CONCLUSIONS: Our study provides a much needed analysis of the incidence of head injuries in British Columbia. These rates can be compared to other provinces using the 2001 Canadian population as the standardized population. Our results indicate that there are certain "at risk" groups that warrant attention, in particular, younger men with lower socioeconomic standing. Indicators of health care utilization presented in the study should generate policy discussions.