International Study of the Epidemiology of Paediatric Trauma: PAPSA Research Study.

OBJECTIVES: Trauma is a significant cause of morbidity and mortality worldwide. The literature on paediatric trauma epidemiology in low- and middle-income countries (LMICs) is limited. This study aims to gather epidemiological data on paediatric trauma. METHODS: This is a multicentre prospective cohort study of paediatric trauma admissions, over 1 month, from 15 paediatric surgery centres in 11 countries. Epidemiology, mechanism of injury, injuries sustained, management, morbidity and mortality data were recorded. Statistical analysis compared LMICs and high-income countries (HICs). RESULTS: There were 1377 paediatric trauma admissions over 31 days; 1295 admissions across ten LMIC centres and 84 admissions across five HIC centres. Median number of admissions per centre was 15 in HICs and 43 in LMICs. Mean age was 7 years, and 62% were boys. Common mechanisms included road traffic accidents (41%), falls (41%) and interpersonal violence (11%). Frequent injuries were lacerations, fractures, head injuries and burns. Intra-abdominal and intra-thoracic injuries accounted for 3 and 2% of injuries. The mechanisms and injuries sustained differed significantly between HICs and LMICs. Median length of stay was 1 day and 19% required an operative intervention; this did not differ significantly between HICs and LMICs. No mortality and morbidity was reported from HICs. In LMICs, in-hospital morbidity was 4.0% and mortality was 0.8%. CONCLUSION: The spectrum of paediatric trauma varies significantly, with different injury mechanisms and patterns in LMICs. Healthcare structure, access to paediatric surgery and trauma prevention strategies may account for these differences. Trauma registries are needed in LMICs for future research and to inform local policy.

Epidemiology of isolated foot burns in children presenting to a Queensland paediatric burns centre- a two-year study in warmer climate.

BACKGROUND: European studies of paediatric foot burns report scalds as the leading cause. Mechanisms of injury are different in warmer climates. We sought to characterize the mechanisms and outcomes of isolated foot burns in our population. METHODS: Retrospective review of a prospectively collected database of all children aged 0-15 years presenting to a Queensland paediatric burns centre over a 26-month period. Non-parametric analyses such as the Mann-Whitney U and Pearson Chi-square were used. RESULTS: There were 218 children with foot burns treated over a period of 2 years and 2 months of which 214 had complete records. There were significantly more boys than girls (n = 134, 62.6% cf. n = 80, 37.4%, p < 0.0001). The leading mechanism of injury was a contact burn accounting for 63.1% (n = 135) followed by scalds (23.8%, n = 51). Friction, flame and chemical burns were a minority but were significantly deeper (p = 0.03) and significantly more likely to require grafting (p = 0.04) and scar management (p < 0.0001) compared to contact and scald burns. CONCLUSIONS: In our population, contact burns are the most common mechanism of injury causing burns to the feet. The leading aetiology is campfire burns, which account for one-third of all burns to the feet. Prevention campaigns targeted at this population could significantly reduce the burden of morbidity from these burns. Friction, flame and chemical burns constitute a minority of patients but are deeper and more likely to require skin grafting and scar management.