An overview of the injury severity score and the new injury severity score.

OBJECTIVE: The research was undertaken to describe the injury severity score (ISS) and the new injury severity score (NISS) and to illustrate their statistical properties. DESIGN: Descriptive analysis and assessment of the distribution of these scales. METHODS: Three data sources--the National Pediatric Trauma Registry; the Massachusetts Uniform Hospital Discharge Data Set; and a trauma registry from an urban level I trauma center in Massachusetts--were used to describe the distribution of the ISS and NISS among injured patients. RESULTS: The ISS/NISS was found to have a positively skewed distribution and transformation did not improve their skewness. CONCLUSION: The findings suggest that for statistical or analytical purposes the ISS/ NISS should not be considered a continuous variable, particularly if ISS/NISS is treated as a continuous variable for correlation with an outcome measure.

Injuries to children with attention deficit hyperactivity disorder.

OBJECTIVES: To determine differences between hospital admitted injuries to children with preinjury attention deficit hyperactivity disorder (ADHD) and injuries to those with no preinjury conditions (NO). DESIGN: Comparative analysis, excluding fatalities, of ADHD patients (n = 240) to NO patients (n = 21 902), 5 through 14 years of age. OUTCOME MEASURES: Demographics, injury characteristics, length of stay, admission to the intensive care unit, surgical intervention, disability, and disposition at discharge. DATA SOURCE: Retrospective review of charts submitted by more than 70 hospitals participating in the National Pediatric Trauma Registry between October 1988 and April 1996. RESULTS: Compared with the NO children, the children with ADHD were more likely to be boys (87.9% vs 66.5%), to be injured as pedestrians (27.5% vs 18.3%) or bicyclists (17.1% vs 13.8%), and to inflict injury to themselves (1.3% vs 0.1%). They were more likely to sustain injuries to multiple body regions (57.1% vs 43%), to sustain head injuries (53% vs 41%), and to be severely injured as measured by the Injury Severity Score (12.5% vs 5.4%) and the Glasgow Coma Scale (7.5% vs 3.4%). The ADHD mean length of stay was 6.2 days versus 5.4 in the NO group. In both groups, 40% had surgery, but the ADHD children were admitted more frequently to the intensive care unit (37.1% vs 24.1%). The injury led to disability in 53% of the children with ADHD vs 48% of the NO children. Children with ADHD with any disability were twice as likely to be discharged to rehabilitation/extended care than were the NO children. CONCLUSIONS: Injured children with ADHD are more likely to sustain severe injuries than are children without ADHD. More research is needed to identify prevention efforts specifically targeted at this population.

Car restraints and seating position for prevention of motor vehicle injuries in Greece.

The protective effect of child restraint and the relative safety of front and rear seating in a population where children often travel unrestrained was assessed in a population based case-control study. The cases were all 129 children aged 0-11 years injured as car passengers in a motor vehicle accident who contacted, during 1996, one of the two major children's hospitals in Athens; emergency cases are accepted by the two hospitals on alternate days throughout the year, thus generating a random sample of children injured as car passengers. The prevalence of the studied exposures in the study base was estimated from an inspection survey comprising a random sample of 191 children of the same age who travelled in passenger cars. The survey was conducted by medical staff from our centre in collaboration with the road traffic police. Odds ratios (ORs) were calculated after adjustment for confounding factors through the Mantel-Haenszel procedure. The OR for injury was 3.3 among unrestrained children compared with restrained children (comparison essentially limited to children aged 0-4 years) and 5.0 for children seated in the front compared with those seated in the rear (comparison essentially limited among unrestrained children). Protective effect estimates derived from this analytical study suggest that in Greece about two thirds of all childhood injuries from car crashes could have been avoided through the regular use of a proper child restraint. The data also indicate that, in the absence of a child restraint system, a rear seating position conveys substantial protection and could explain the low mortality of children as car passengers in Greece, a country which is characterised by a high overall road traffic mortality as well as a high childhood accident mortality.

Blunt trauma in children: causes and outcomes of head versus extracranial injury.

A subset of the National Pediatric Trauma Registry was analyzed to describe causes and outcomes of blunt trauma among children younger than age 15 years. This subset, of 8639 children with blunt trauma, was divided into three groups according to the injured body region: a group with extracranial injury only (ECI) accounted for one half of the population, and the remainder were equally distributed between a group with head injury only (HI) and one with both conditions (ECI + HI). The three groups were compared with respect to demographic characteristics, external cause of injury, injury severity, and outcomes. Falls were the leading cause of injury in the HI group, where children were younger, whereas traffic-related injuries predominated in children with ECI or ECI + HI. Pedestrian injuries accounted for a significant share of poor outcomes. The highest proportions of deaths and severe injuries were observed in the mixed group (ECI +HI), and the lowest, in the ECI group. In contrast, functional impairments at discharge were most frequently noted in the ECI group, where 60% of the children were discharged with at least one impairment. While only 6% of children with HI were discharged with impairment, those affected exhibited more deficits in cognition and behavior, which are expected to persist longer than dysfunction in activities of daily living.

The epidemiology and prevention of child pedestrian injury.

Of pedestrian injuries that occur every year, approximately 50,000, including 1300 fatalities, are experienced by children between the ages of 1 and 14 years. Despite the importance of the problem, the pedestrian safety issue is often neglected in reports on vehicular injuries. Children between the ages of five and nine years, boys, and children in lower socioeconomic class are at higher risk of pedestrian injury than other children. Childhood pedestrian injuries take place predominantly in residential locations close to home and frequently occur while the child is at play. The risk of pedestrian injury to children is higher than that of other age groups when adjusted for traffic exposure, and a variety of developmental limitations may account for this fact. In spite of these limitations, children undertake collision avoidance maneuvers far more often than drivers do. Accident analyses have identified 15 different accident types, each reflecting a unique combination of human and environmental factors. Among children, the most frequently observed accident type is the midblock dart-out. Programs to modify pedestrian behavior, driver behavior, and vehicle design have met with modest success. In the United States, the cultural and political environments have not been favorable to the injury prevention effort. Urban designers and traffic engineers in Europe have undertaken a variety of modifications of the physical environment, and some of these have been successful in preventing pedestrian injuries to children.

Intentional injuries among children and adolescents in Massachusetts.

We estimated age-specific and sex-specific incidence rates of intentional injuries (assaults or suicide attempts) occurring between 1979 and 1982 in a population of 87,022 Massachusetts children and adolescents under 20 years of age in 14 communities with populations of 100,000 or less. The average annual incidence of intentional injuries treated at a hospital was estimated to be 76.2 per 10,000 person-years. Overall, 1 in 130 children was treated each year for an intentional injury. More than 85 percent of the injuries resulted from assaults, such as fights, rape, and child battering; 11.4 percent were self-inflicted. Intentional injuries were most common among adolescents. Each year, 1 in 42 teenage boys was treated for an assault-related injury, and 1 in 303 teenage girls was seen for a suicide attempt. Repeated episodes of intentional injury were identified in 4.3 percent of the children. In this population, intentional injuries accounted for 3.4 percent of all injuries but 9.8 percent of hospital admissions and 15.7 percent of deaths from injury. The rate of intentional injury was directly correlated with both the degree of urbanization and the poverty level of the community of residence. We conclude that intentional injuries are relatively common in this population and that attempts to prevent them must be directed to the children who are at greatest risk.