Paediatric trauma epidemiology in an urban scenario in India

Journal of Orthopaedic Surgery, Apr 2007 by Tandon, T, Shaik, M, Modi, N

ABSTRACT

Purposes. To identify the epidemiology of paediatric trauma in an urban scenario of India and compare results with studies from developed countries, and to formulate preventive measures to decrease such traumas.

Methods. Between January 2004 and 2005 inclusive, 500 paediatric, orthopaedic trauma patients presenting to our hospital were prospectively studied. Information was recorded in a prescribed proforma.

Results. The children's ages ranged from 0 to 16 years; 274 were males. Most fractures occurred in children aged 7 to 12 years and decreased in older children. The ratio of fractures in left versus right upper extremity was 2:1. In children aged 0 to 6 years, the most common injured site was the elbow, whereas in children aged 7 to 16 years it was the distal radius. In descending order, most injuries were sustained at home (47%), in school (21%), due to sports (17%), and due to vehicular accidents (13%).

Conclusion. An effective accident prevention programme in developing countries requires changes in lifestyle and environment, and overcoming obstacles such as ignorance, illiteracy, and inadequate resources.

Key words: environment and public health; epidemiology; traumatology; wounds and injuries

INTRODUCTION

In the USA, trauma is the leading cause of death in children after the first year of life, accounting for 50% of mortality, with an injury occurring every 4 minutes and death every 6 minutes.1 Fractures are among the most common adverse events in their lives. Moreover, the urban scenario is associated with overcrowding and is fraught with risks to the lives of children. Yet there have been few epidemiological studies on paediatric fractures in an urban environment of a developing country.2-4

We aimed to identify how, when, and why fractures occur in children in an urban scenario of India and compare results with previous studies from developed countries, and to formulate preventive measures to decrease such traumas.

MATERIALS AND METHODS

Between January 2004 and 2005 inclusive, 500 trauma patients aged 0 to 16 years presented to the accident and emergency or orthopaedic out-patient departments of our hospital in Mumbai, India. The hospital is a tertiary level-4 trauma centre, with a catchment area for approximately one third of the city population. It handles almost 75 to 80% of paediatric trauma cases, from minor damage to severe highvelocity injuries. Resident doctors on duty recorded the characteristics of all patients and their fracture patterns in a prescribed proforma. Based on clinical and radiological findings, the duty orthopaedic registrar made the diagnosis.

RESULTS

Table 1 shows the numbers and percentages of various fracture patterns in each age-group. Of the 500 patients aged 0 to 16 years, 274 were male. The number of patients presenting with fractures increased with age until 12 years and decreased in older children. Fractures occurred more commonly in boys. In children aged 0 to 6 years, the most commonly encountered injured site was the elbow, whereas in those aged 7 to 16 years it was the distal radius. The association was statistically significant (Chi squared test, p

180 children had been treated by traditional modalities prior to hospital presentation (all within 10 days of the injury) [Table 2]. This reflects a high level of ignorance among people in developing countries. The numbers of physeal fractures, open fractures, multiple fractures, non-accidental factures, amputations, and neurovascular injuries encountered are shown in Table 3. The environmental aetiology of fractures among infants, toddlers, and school-age children is shown in Table 4; 47% occurred at home, 21% at school, 17% due to sports, 25% due to vehicular accidents, and 2% under other circumstances. In the home environment, among infants and toddlers, most fractures were related to falls from cots, beds, tripping over furniture, or from heights. Injuries from playground fixtures near the house (peridomestic) or scuffles/fights among siblings/friends were more commonly seen in older children. In the school environment, fractures were mainly due to athletic/sporting activities or scuffles/fights. Child abuse by teachers was occasionally seen. In sports, athletic activities and field/contact sports contributed equally to the causes of fracture. Among vehicular accidents, 52% involved school-age children; bicycle accident being the most common and none of the victims wore a helmet. Train accidents were more common in school-age children when boarding or alighting local suburban trains. Among vehicular accidents in school-age children, vehicle versus pedestrian contributed to 56% of the injuries, compared to 44% due to vehicle versus passenger.

DISCUSSION

The knowledge base of fracture healing in children was developed in the 40s and 50s.5,6 The effects of cultural differences on fracture among Indian, Malay, and Swedish children were compared.4 The epidemiological data on limb fracture patterns were analysed and preventive programmes set up.7,8