Application of data for prevention of foreign body injury in children.

BACKGROUND: To develop design criteria for consumer products, based on foreign body injury and fatality data, to prevent airway obstruction injuries to children. METHOD: Beginning in 1988, RAM Consulting has created a worldwide database of foreign body injuries. This ongoing project now includes approximately 7000 data points from 51 children's hospitals in 15 countries located on five continents. Statistical analysis of these data, especially in terms of size, shape and consistency of the object and obstruction location and severity of injury for the patient has allowed the creation of an injury prevention criterion. RESULTS: Analysis of these data reveals that adoption of an injury prevention criteria based on the use of a 1.50 in. (38.10 mm) diameter gauge for non-spherical objects and a 1.75 in. (44.50 mm) diameter gauge for spherical objects would greatly reduce airway obstruction injuries to children. Furthermore, the data show that this criterion is independent of country and culture. However, the data suggest that a child's exposure to the "mix" of objects that may cause airway obstruction varies with the country and culture of the child. For example, coins are well represented in the database, however, some countries make more coins than other countries and the exposure level may have made the difference in the occurrence of incidents. CONCLUSIONS: Airway obstruction injuries from consumer products could be greatly decreased by the adoption of the presented injury prevention criteria that is founded in a statistical analysis of known objects that have caused injury. This criteria is dependent on object characteristics and is independent of the country or culture of the child.

Prevention of accidental childhood strangulation. A clinical study.

Accidental strangulation is a preventable problem, and there is limited scientific understanding of its mechanism in children. If the amount of external pressure that occludes the airway can be determined, design changes may be made to allow for production of household objects that would break apart at safe pressure levels. A force gauge was applied to the suprahyoid region in 90 children under standardized anesthesia. Three blinded observers performed the study. The anesthesiologist maintained the airway and used a stethoscope to auscultate for breath sounds and monitor the CO2 curves to evaluate obstruction. The recorder noted the numbers from the gauge. A single observer applied the force gauge. Age was the most significant variable in occluding the airway. Obstruction appears to occur at the level of the larynx. Increased knowledge regarding the external pressure required for airway occlusion would allow for the design and manufacture of products with a reduced potential for accidental strangulation.

Prevention of accidental childhood strangulation: where is the site of obstruction?

BACKGROUND: Accidental strangulation is a preventable problem with limited scientific understanding in children. Children's clothing and household furniture have the potential to cause strangulation. Localizing the site of obstruction would provide understanding and insight to preventing this unfortunate event. METHODS: While undergoing the application of pressure to the submental and suprahyoid region in eight patients flexible endoscopy was performed to evaluate the location of obstruction. RESULTS: Submental pressure occluded the nasopharynx and oropharynx. Suprahyoid pressure occluded the larynx. CONCLUSIONS: In suspension strangulation, airway obstruction appears to occur at the level of the larynx involving the epiglottis and the arytenoids. Increased knowledge regarding site of airway occlusion may help to decrease the hazard of accidental strangulation.