Variability in pediatric injury patterns by age and ethnic groups in Israel.

BACKGROUND: . In Israel, nearly 10,000 children are hospitalized due to injury every year. OBJECTIVES: To define injury patterns in subgroups of the pediatric population, in order to focus prevention programs on vulnerable groups. METHODS: A retrospective study of Israel's National Trauma Registry (ITR) data on patients aged 0-17 years hospitalized between 1 January 1998 and 31 December 2002 due to trauma. Data includes patient demographic details, information on the injury, hospital resource utilization, length of stay and outcome. Descriptive statistics were used to characterize injury patterns and bivariate and multivariate analysis was used to compare injury severity and cause between population groups. RESULTS: A total of 32,009 children were included. Falls were the cause of injury for 51% of the population, 6% of falls sustaining severe injuries (ISS 16+). Road traffic accidents (RTA) injured 23%, of which 14% were severe injuries. Burns (7%) accounted for long hospitalizations -- nearly 20% stayed for over 14 days. Crude data showed that the proportion of severe injuries and inpatient death rate among non-Jewish children was double that of Jewish children (12% vs 6% and 1% vs 0.5%, respectively (chi2, p<0.0001)). When looking at children from low socio-economic status (SES) townships, the difference in proportion of severe injuries between Jewish and non-Jewish children is reduced, yet it remains higher in non-Jewish than among Jewish children (7% vs 5%) (chi2, p=0.0001). These results were verified by multivariate logistic regression analysis adjusting for SES, age, gender and external injury cause. Non-Jewish children had a significantly higher rate of burns (10% vs 6%), falls from heights above 2.5 meters (16% vs 6% of all falls) and pedestrian injuries (51% vs 37% of all injured in RTA). When SES is taken into account, the only outstanding injury among non-Jewish children is fall from height: 13%, n=376 among non-Jewish children vs 8%, n=85 among Jewish children, living in townships with low SES cluster (1-4) (chi2, p<0.0001). CONCLUSIONS: The findings of this study show that there is variability in external cause of injury and severity by age and ethnic group. Falls were most frequent among young children and burns among non-Jews. Non-Jewish children in SES clusters 1-4 are at high risk for falls from height, suggesting intervention and prevention activities should be directed in this direction.

Maxillofacial trauma resulting from terror in Israel.

During a 33 month period, maxillofacial injuries resulting from terrorist attacks in Israel were compared with non-terror trauma maxillofacial injuries. Files of patients hospitalized from October 1, 2000 to June 30, 2003 were obtained from the Israel National Trauma Registry. Data were evaluated and compared with a hospitalized non-terror related trauma population within the same period. A literature survey was also conducted. Terror casualties totaled 1,811. In 493 patients with facial injuries, 322 had soft facial tissue injuries (excluding eyes and ears), and 104 had hard tissue injuries of the maxillofacial complex. A significantly higher prevalence was found in terror casualties (explosions and gunshots) compared with non-terror related casualties. Most suffered multiple injuries. Maxillofacial terror casualties experience a unique epidemiology, with more severe injuries and higher prevalence of soft and hard tissue injuries. Preparedness and awareness to the unique pattern of injuries are needed when terrorists strike.

Different AIS triplets: Different mortality predictions in identical ISS and NISS.

BACKGROUND: Previous studies demonstrated different mortality predictions for identical Injury Severity Scores (ISS) from different Abbreviated Injury Scale (AIS) triplets. This study elaborates in both scope and volume producing results of a larger magnitude, applicable to specific injury subgroups of blunt or penetrating, traumatic brain injury, various age groups, and replicated on NISS. METHODS: All patients hospitalized after trauma at 10 hospitals, with ISS/NISS (new ISS) generated by two AIS triplets, excluding patients with isolated minor or moderate injuries to a single body region were studied. Patients were separated into two groups based on the different triplets. Inpatient-mortality rates were calculated for each triplet group. Odds ratios were calculated to estimate the risk of dying in one triplet group as compared with the other. The chi test determined whether the difference in mortality rate between the two groups was significantly different. Differences were further explored for various subgroups. RESULTS: There were 35,827 patients who had ISS/NISS scores generated by two different AIS triplets. Significant differences in death rates were noted between triplet groups forming identical ISS/NISS. Odds ratio for being in the second group (always containing the higher AIS score) ranged from 2.3 to 7.4. CONCLUSIONS: ISS and NISS that are formed by different AIS triplets have significantly different inpatient-mortality rates. The triplet with the higher AIS score has higher inpatient-mortality rates, overall and in several sub-populations of varying vulnerability. The comparison of populations and the interpretation of ISS/NISS based outcome data should take this important information into account and the components of AIS triplets creating each ISS and NISS should be reported.

Risk for motorcyclists in a busy metropolitan city: the example of Tel Aviv.

BACKGROUND: The proportion of motorcyclists injured in road accidents in Israel is larger than their proportion among road users. OBJECTIVES: To identify factors contributing to the risk of injury motorcyclists as compared to drivers of other motor vehicles. METHODS: We retrieved and analyzed National Trauma Registry data on drivers, aged 16 and above, who were involved in traffic accidents and hospitalized between 1 January 1997 and 30 June 2003. RESULTS: The study group comprised 10,967 patients: 3,055 (28%) were motorcyclists and 7,912 (72%) were drivers of other motor vehicles. A multiple logistic regression revealed that Tel Aviv, the busiest metropolitan city in Israel, is a risk for motorcycle injury as compared to other regions; males have an increased risk compared to females; and age is a protecting factor since the risk of injury as a motorcyclist decreases as age increases. Nevertheless, the population of injured motorcyclists in Tel Aviv was significantly older (mean age 32.5 years vs. 28.6 elsewhere; t-test P < 0.0001). Twenty percent (n = 156) of the injured motorcyclists in Tel Aviv were injured while working, compared to 9.5% (n = 217) in other regions (chi-square P < 0.0001). Motorcycle injuries in Tel Aviv were of lower severity (7.7% vs. 16.4% according to the Injury Severity Scale 16+, chi2 P < 0.0001), and had lower inpatient death rates (1.2% vs. 2.5%, chi2 P = 0.001). CONCLUSIONS: Tel Aviv is a risk for motorcycle injury compared to other regions, males have an increased risk compared to females, and age is a protecting factor. The proportion of motorcyclists in Tel Aviv injured while working is double that in other regions.

My home is my castle! Or is it? Hospitalizations following home injury in Israel, 1997-2001.

BACKGROUND: Although the home is perceived to be a safe haven, it is a scene of numerous injuries. OBJECTIVES: To characterize home injury in Israel, the victims, injury circumstances and outcomes, and to identify groups at high risk for injury in order to focus future interventions and thus effectively prevent these injuries and their associated hospitalizations. METHODS: We analyzed 5 year records (1997-2001) from the National Trauma Registry of all patients arriving at eight trauma centers following home injury and admitted to hospital, transferred to another medical center, or died in the emergency department. RESULTS: The study group included 26,921 patients, constituting 34% of all unintentional hospitalized trauma patients. Twenty-seven percent were children (0-4 years) and 37% were elderly (> or = 65 years), the two age groups whose home injury accounted for most of the trauma injuries. Among children more boys (59%) than girls (41%) were injured, but the opposite was true for the elderly (30% males and 70% females). The share of females among the home-injured increased with age. Falls caused 79% of all home injuries (97% among the elderly) and bums 9%, increasing to 18% among children (0-4 years). Among non-Jewish home-injured patients, infants predominated (50% compared to 20% among Jews). Moderate to critical injuries amounted for 42%, with 38% of the home-injured and 60% of the elderly requiring surgery. The clinical and economic consequences of home injuries differed according to the type of injury, with bums carrying the heaviest toll of prolonged intensive care and hospital stay. Overall, hospital stay averaged 6.2 days per patient (median 3 days). CONCLUSIONS: Falls among the elderly, bums among children, and a high prevalence of hospitalization among non-Jewish children define groups at high risk for home injuries. Prevention programs should be based on these findings and should focus on the more vulnerable groups.