Annual incidence of unintentional injury among 54,000 children.

OBJECTIVE: To enhance the case definition of unintentional injuries in childhood by applying an objective severity measure to fatal and non-fatal cases. DESIGN: A descriptive prospective epidemiological study of a defined resident childhood population (< 16 years of age) for a one year period, 1990. SETTING: Newcastle upon Tyne, England. Child population estimate for 1990 was 54,400. SUBJECTS: Resident children who died, were admitted to local hospitals, or attended local accident and emergency departments. OUTCOME MEASURES: Using recognised severity scoring systems (for example the injury severity score, trauma score) injuries were classified as severe, moderate, or mild. RESULTS: There were six deaths, 904 admissions, and 11,682 accident and emergency department attendances. All deaths, 25% of admissions, and 1% of accident and emergency attenders were classified as severe. The underlying determinants of severe injuries are different than those for all other injuries (for example age, social class). A comparison with a local survey in 1986 showed a 26% rise in hospital admissions, but no significant rise in the frequency of severe or moderately injured children. Comparisons with other international data showed higher rates of injury admissions and attendances for England, but no significant differences in the frequency of severe injuries. CONCLUSIONS: Objective severity scoring enhances the case definition of unintentional injuries in childhood by allowing for the identification, and, therefore, the more reliable ascertainment of severely injured children. This more completely ascertained set of population cases increases the accuracy of comparisons of injury frequency over time and by place, and, in addition, enhances our basic understanding about the epidemiological characteristics of childhood unintentional injury.

Measuring exposure to injury risk in schoolchildren aged 11-14.

OBJECTIVE: To apply a measure of exposure to injury risk for schoolchildren aged 11-14 across a population and to examine how risk factors vary with sex, age, and affluence. DESIGN: Self completion questionnaire survey administered in schools in May 1990. SETTING: 24 schools in Newcastle upon Tyne. SUBJECTS: 5334 pupils aged 11-14, of whom 4637 (87%) completed the questionnaire. RESULTS: Boys were exposed to greater risk than girls in journeys to places to play outdoors; they took longer trips and were more likely to ride bicycles (relative risk 5.30 (95% confidence interval 4.23 to 6.64)) and less likely to travel by public transport or car. Younger pupils (aged 11-12) were less exposed to traffic during journeys to and from school: their journeys were shorter, they were less likely to walk (trip to school, relative risk 0.88 (0.83 to 0.94)), and they were more likely to travel by car (trip to school, relative risk 1.33 (1.13 to 1.56)) or school bus (1.33 (1.10 to 1.62)). Poorer children were exposed to greater risk than affluent children (from families that owned a car and a telephone): they were less likely to travel to school by car (relative risk 0.26 (0.20 to 0.33)) or to be accompanied by an adult (0.39 (0.32 to 0.48)). CONCLUSION: Injury risk data can provide useful information on child injury prevention and can be used to identify priorities and target resources for injury prevention on a citywide scale or for an individual school.

Measuring the frequency of "severe" accidental injury in childhood.

STUDY OBJECTIVE: The aim was to improve the epidemiological information concerning child accidental injuries which can be extracted from routine inpatient and coroners' inquest data. DESIGN: This was a retrospective study of coroners' inquest reports and inpatient case notes to undertake objective severity scaling and to extract basic data. This material was related to denominators from OPCS mid-year population estimates, to 1981 census ward populations, and to sociodemographic data collected in a local census in 1986. SETTING: The study population was derived from three north east health districts and their corresponding census enumeration districts. PARTICIPANTS: A stratified sample of 500 children aged 0-16 years from among residents admitted to hospital with accidental injuries in 1986 was studied, together with all accidental injury child deaths between 1980 and 1986; 94% of the relevant case notes were localised and extracted. MAIN RESULTS: When differentiated by injury severity there are major systematic differences in the basic epidemiology of child accidental injury by age and place of residence of victims as well as in the nature and causes of injuries sustained. CONCLUSIONS: Injury severity scores can be used to define a "severity" threshold, within the spectrum of injuries, leading to hospital admission or death. By ensuring complete ascertainment this technique can provide a more accurate case definition than crude admission rates for estimating the frequency of injury in a population of children.

Validity and clinical scale comparisons between the MMPI and MMPI-2 with psychiatric inpatients.

This study was designed to investigate the comparability of the original MMPI (1950) and the MMPI-2 (1989) with a psychiatric patient population. 34 male and 3 female patients, shortly after admission to one of two acute psychiatry units, completed the old and revised versions of the MMPI. Paired t tests indicated but scant differences for raw scores, while many more differences were found among T scores for validity, clinical, and supplemental scales. Analyses, however, showed all scales on the two forms to be highly correlated. Analysis of the high-point and two-point codes across the two administrations also showed relative stability, although the proportion of Scales 2 (Depression) and 8 (Schizophrenia) decreased, while those for Scales 6 (Paranoia) and 7 (Psychasthenia) increased markedly in the MMPI-2 protocols. Examination of each version's discriminability among mood- and thought-disordered subsamples suggested that the MMPI provides slightly better delineation between diagnostic classes. Discriminant function analyses showed that there were essentially no differences between the two forms in the accurate classification of clinical and nonclinical groups. The findings reported here provide support for the MMPI-2; despite modification, the newer form retains the advantages of the original MMPI. Differences found here may be unique to psychiatric patients and their patterns of MMPI/MMPI-2 equivalence and may not generalize to other special populations.

Spontaneous passage of a submandibular salivary calculus in a child.

Inflammatory salivary disease in childhood is an infrequent clinical entity. That associated with sialolithiasis is rare. We report a case of a child with spontaneous passage of a submandibular calculus. We believe she represents the youngest patient documented to demonstrate the phenomenon.

Acute transient myositis due to Toxocara.

Two children presented with spontaneous, isolated swelling of the lower half of the left leg; this was diagnosed as acute myositis of unknown aetiology. Further investigations showed antibodies to Toxocara. The symptoms resolved within 72 hours and the children were discharged on no treatment.