Non-fatal injuries among boys and girls presenting to Red Cross War Memorial Children's Hospital, Cape Town, South Africa.

BACKGROUND: In South Africa (SA), road traffic injuries, homicides and burns are the leading causes of injury-related deaths among children. Injury-related deaths are well documented for SA, but this is not the case for non-fatal injuries. OBJECTIVES: To describe the non-fatal injuries sustained among children aged 0 - 13 years, to identify any significant sex differences by age group, cause of injury, admission status and injury severity. METHODS: The trauma unit database from 1997 to 2016 at Red Cross War Memorial Children's Hospital, Cape Town, was utilised for this analysis. The prevalence of injuries and the boy/girl ratios with 95% confidence intervals (CIs) were reported. RESULTS: Analysis indicated significant differences by sex for individual injury causes (transport, assault, burns, falls and other injuries), age group, injury severity and admission status. Moderately severe injuries were largely caused by burns, while severe injuries were mostly transport related. Boys had significantly higher proportions of all injury causes. The boy/girl ratio was lowest for assault (1:18), where significantly more girls aged 1 - 3 and 4 - 6 years were injured. Rape/sexual assault was 5.5 times higher for girls, with a significantly higher proportion of moderate-severity injuries (87%; 95% CI 84.7 - 89.4). CONCLUSION: The study findings call for a more targeted prevention response for boy and girl children. Interventions should be targeted at the prevention of burns, traffic collisions and interpersonal violence, in particular sexual assaults against girls.

The epidemiology of drowning worldwide.

The purpose of this analysis was to quantify the magnitude of death and disability from drowning and near-drowning worldwide and to provide epidemiological data on which to base prevention efforts. All data are from the Global Burden of Disease 2000 (Version 1) estimates in which deaths and disabilities are based on the WHO International Classification of Diseases. Extrapolations were made by age, sex, and WHO region. The six WHO regions of the world were further divided into high-income, and low- and middle-income based on the 1998 World Development indicators. According to the GBD 2000 data, an estimated 449,000 people drowned worldwide (7.4 per 100,000 population) and a further 1.3 million Disability Adjusted Life Years (DALYs) were lost as a result of premature death or disability from drowning. 97% of drownings occurred in low- and middle-income countries. Although 38% of drownings occurred in the Western Pacific Region, Africa had the highest drowning mortality rate (13.1 per 100,000 population). Males had higher drowning mortality rates than females for all ages and in all regions. Children under the age of 5 years had the highest drowning mortality rate for both sexes in all of the WHO regions except for Africa, where children aged 5 to 14 years had the highest mortality rate. Worldwide, for children under the age of 15 years, drowning accounted for a higher mortality rate than any other cause of injury. Drowning is a significant problem worldwide particularly for children under the age of 15 years. Low- and middle-income countries have the highest rates of drowning and account for more than 90% of such fatalities. Primary prevention efforts should thus be focused on these countries where many children who cannot swim drown in large bodies of water.

Conservative management of abdominal injuries: audit of criteria for discharge.

This prospective study was conducted to audit the discharge criteria of patients admitted for the conservative management of abdominal trauma. A total of 184 patients who were admitted to Groote Schuur Hospital (GSH) with penetrating or blunt abdominal injuries and who were conservatively managed according to the GSH protocol were assessed. The study concluded that patients with abdominal trauma who do not require emergency laparotomy can be safely discharged after a period of conservative management provided they are pain-free, hungry and passing flatus.

Evaluation of a small trauma team for major resuscitation.

There has been a great improvement in the early management of trauma patients, encapsulated by ATLS. Initial in-hospital management of significant trauma is undertaken by a trauma team, the number and content of which varies. No study has demonstrated that large trauma teams per se improve patient survival, compared to smaller teams working in the same tertiary referral centre environment. This is a retrospective study of pedestrian road traffic accident patients, who were major resuscitation cases admitted over a 6-month period to this hospital, which is a Level I Trauma Centre. Most major trauma resuscitations are undertaken by a small trauma team, led by one doctor. The performance of the small trauma team was evaluated by applying TRISS methodology and comparing our patient group with MTOS (US). There were 77 patients. The majority (52 per cent) had polytrauma, 80 per cent required intubation, the median ISS was 27 and the median RTS was 5.03. Ten per cent required resuscitative procedures and 75 per cent required urgent surgery. Using TRISS methodology the Z statistic was +0.54 and the Unit's M statistic was 0.492. There were more unexpected survivors than deaths. Seventy-one per cent were initially treated by one doctor. Only two patients had three or more doctors at the initial resuscitation. The use of small trauma teams within this Level I Trauma Centre does not appear to give results that are any worse than those of units that routinely use larger teams. This could be evaluated in other centres and may have implications for training, manpower and costing.

Injured pedestrians in Cape Town--the role of alcohol.

OBJECTIVE: To establish a profile of injured adult pedestrians and attempt to define the role which alcohol plays in this regard. DESIGN: Prospective survey of injured pedestrians who presented consecutively over 9 weeks to Groote Schuur Hospital. Data on fatally injured pedestrians were retrospectively collected from the State Mortuary. SETTING: Hospital-based study conducted at the trauma unit, Groote Schuur Hospital. PARTICIPANTS: A total of 321 pedestrians--196 injured and 35 'dead on arrival'. MAIN OUTCOME MEASURES: Sociodemographics, blood alcohol concentration (BAC) and injury severity. RESULTS: Patients were predominantly male and, on average, 35.6 years old. They were most frequently injured at night and over weekends. The BAC was positive in 62.1% of pedestrians, and the mean BAC was 0.19 g/dl. Most pedestrians had at least one lower limb injury and nearly half had a head injury; however, BAC-positive pedestrians were 2.6 times more likely to have a head injury (P = 0.0009). Furthermore, BAC-positive pedestrians sustained more severe injuries, more frequently required admission to the ICU, had longer hospital admission and were more likely to die of their injuries. The overall case fatality rate was 19.5%. CONCLUSIONS: The influence of alcohol intoxication among injured adult pedestrians in Cape Town is high, suggesting that alcohol plays a major role in these accidents. Consequently, there should be some degree of culpability in those who cross the road while in an intoxicated state. However, equal attention should be given to safe and convenient crossing points, good lighting and education with regard to the wearing of reflective clothing after dark.

Patients who reattend after head injury: a high risk group.

OBJECTIVE: To assess risk factors for important neurosurgical effects in patients who reattend after head injury. DESIGN: Retrospective study. SUBJECTS: 606 patients who reattended a trauma unit after minor head injury. MAIN OUTCOME MEASURES: Intracranial abnormality detected on computed tomography or the need for neurosurgical intervention. RESULTS: Five patients died: two from unrelated causes and three from raised intracranial pressure. On multiple regression analysis the only significant predictor for both abnormality on computed tomography (14.4% of reattenders) and the need for operation (5% of reattenders) was vault fracture seen on the skull radiograph (P < 10(-6)); predictors for abnormal computed tomogram were a Glasgow coma scale score < 15 at either first or second attendance (P < 0.0001) and convulsion at second attendance (P < 0.05); predictive for operation only was penetrating injury of the skull (P < 10(-6)). On contingency table analysis these associations were confirmed. In addition significant associations with both abnormality on computed tomography and operation were focal neurological abnormality, weakness, or speech disturbance. Amnesia or loss of consciousness at the time of initial injury, personality change, and seizures were significantly associated only with abnormality on computed tomography. Headache, dizziness, nausea, and vomiting were common in reattenders but were found to have no independent significance. CONCLUSIONS: All patients who reattend after head injury should undergo computed tomography as at least 14% of scans can be expected to yield positive results. Where this facility is not available patients with predictors for operation should be urgently referred for neurosurgical opinion. Other patients can be readmitted and need referral only if symptoms persist despite symptomatic treatment or there is neurological deterioration while under observation. These patients are a high risk group and should be treated seriously.