Sleep Deprivation Is Associated with Bicycle Accidents and Slip and Fall Injuries in Korean Adolescents

Objective

This study sought to evaluate associations between sleep time and bicycle accidents, falls under various circumstances, and dental injuries in adolescents.

Methods

A total of 61,696 participants ranging from 12 to 18 years of age who completed the Korea Youth Risk Behavior Web-based Survey (KYRBWS) in 2013 were enrolled in this study. Bicycle riding accidents were analyzed for 17,232 bicycle-riding participants. Data were collected regarding the weekday sleep duration for the most recent 7 days, which was categorized as < 5.5 h, 5.5–6.5 h, 6.5–7.5 h, or ≥ 7.5 h per day, and the incidence of bicycle accidents, slips and falls under various circumstances, and dental injuries in the most recent 12 months. Adjusted odds ratios (aORs) were calculated among sleep groups for bicycle accidents, slips and falls, and dental injuries using simple and multiple logistic regression analyses with complex sampling.

Results

Bicycle riding accidents and slips and falls in classrooms, corridors, the ground, toilets, stairs, and other unspecified situations showed positive correlations with sleep deprivation. Comparisons of groups with ≥ 7.5 h sleep, < 5.5 h, 5.5–6.5 h sleep, and 6.5–7.5 h sleep revealed increased associations with slips and falls under various circumstances. In particular, the aORs were higher in the groups with less sleep (aOR of the 5.5 h group > the 5.5–6.5 h group > the 6.5–7.5 h group). There was no significant relationship between sleep deprivation and dental injury.

Conclusions

This study demonstrated that sleep deprivation among Korean adolescents was associated with bicycle accidents and falls at home and school. Thus, adequate sleep may be needed to prevent accidents and falls.     

Home Accidents to Children under 15 Years: Survey of 910 Cases

Out of 910 accidents sustained by children under 15 seen at the casualty department of a local hospital 678 (74·5%) were to children under 5 years of age. Boys were more prone to accidents than girls, and in preschool children the highest incidence of accidents was among the 2-to 3-year-olds of both sexes. Social class had no significant bearing on the accident rate. The fact that the average size of families with children under 5 was higher among families living in council houses than among those living in private houses appeared to have some bearing on the higher incidence of accidents among children under 5 living in council houses. There appeared to be no peak month when accidents were more frequent and the incidence of accidents was not significantly high on any particular weekday. In 95% of the cases one or both parents were in charge of the child at the time of the accident.Cuts were the most common types of accident followed by falls and poisoning. Among other accidents crushed fingers were as frequent as burns. A total of 62 patients (6·8% of all cases) were admitted as inpatients. Of the actual causes of the cuts and falls playing, fighting, and misbehaving were the most common followed by falling from beds, chairs, etc. While there is a need for health education programmes to draw attention to the specific dangers evidenced there clearly will always be home accidents.     

Risk of fatal accidents occurring other than at sea among Icelandic seamen.

OBJECTIVE--To study mortality among seamen, particularly from fatal accidents that occurred other than at sea. DESIGN--Cohort study. SETTING--Iceland. SUBJECTS--27,884 seamen, both fishermen and sailors from the merchant fleet, who had been members of a pension fund from 1958 to 1986. MAIN OUTCOME MEASURES--Cause of death (ICD seventh revision), standardised mortality ratio. RESULTS--Most standardised mortality ratios were greater than 1, being 1.26 for all causes and 1.83 for all external causes. There was no healthy worker effect. The excess of deaths from all external causes included all subcategories of death from accidents, poisonings, and violence and not just accidents at sea (water transport accidents, ICD codes E850-E858). A significant trend was found for length of employment and mortality from all accidents at sea, drowning at sea, accidental poisoning, other accidents, and accidental drowning; correlation coefficients for all causes, all accidents, suicide, and injuries undetermined whether accidentally or purposely inflicted were 0.7-0.8. Compared with seamen who started work during 1968-77, those who started work in 1978 or later had higher mortality from all causes, road traffic accidents, poisoning, other accidents, homicide, and injuries unknown whether accidentally or purposely inflicted, but not from all accidents at sea and accidental drowning. CONCLUSION--Seamen seem to be a special group with a high risk of fatal accidents occurring not only at sea. The association between fatal accidents other than at sea and length of employment as seamen indicates that seamen are modified by their occupation towards hazardous behaviour or a risky lifestyle.     

Nonfatal childhood injuries: a survey at the Children's Hospital of eastern Ontario.

OBJECTIVE: To examine the types and severity of injuries seen in the Emergency Department of the Children''s Hospital of Eastern Ontario and the circumstances surrounding the events. DESIGN: Chart review. SETTING: A tertiary care hospital that serves a child population of 600,000 in eastern Ontario and western Quebec. PARTICIPANTS: Every sixth day''s charts of children up to 17 years of age who visited the Emergency Department because of injuries between Sept. 1, 1984, and Aug. 31, 1985, were examined retrospectively. RESULTS: A total of 2886 charts were reviewed. There were more boys than girls. Most (1354 [46.9%]) of the accidents had occurred at home. Falls and sports-related accidents were the leading causes of injury (in 1088 [37.7%] and 560 [19.4%] of the cases respectively). Most of the visits were for minor injuries (bumps, swellings, cuts, bruises and scrapes), and only 114 (4.0%) of the children were admitted to the hospital. Injuries from motor vehicle accidents accounted for the highest admission rate (17.4%). Important information regarding the circumstances surrounding the events (e.g., whether a seat belt or car seat was used) was frequently missing from the charts. CONCLUSIONS: Nonfatal injuries are common, especially in or around the home, and remain a significant problem in our society in terms of radiographic and consulting fees, time off from school or work and pain. Given the difficulties in obtaining information on the circumstances surrounding the events prospective studies are needed. Factors related to the occurrence and severity of childhood injury and whether these factors can be altered remain a high priority for research.     

Mortality from unintentional injuries in California, 1985.

In 1985 unintentional injuries were the fourth leading cause of death among California residents, causing 10,380 deaths. They were the leading cause of potential life lost, accounting for 278,109 years lost. This was more than twice the number of years lost due to heart disease and 1 1/2 times the number lost due to cancer. Motor vehicle traffic accidents were the leading cause of unintentional injury deaths, accounting for half (5,158) the deaths. The next two leading causes were poisoning (especially for men aged 25 to 44 years) and falls (especially among persons aged 75 and older). Drowning was second to motor vehicle accidents as a cause of death in children aged 1 to 14 years. California''s age-adjusted injury mortality rates in 1985 were lower in coastal and urban counties than in inland and rural counties, and these rates were generally lower in counties having organized systems of trauma care.     

A comparison of the characteristics of injuries between obese and non-obese inpatients

Objective: The objective was to compare characteristics of injuries between a sample of U.S. obese and non‐obese inpatients. Methods: Discharge records from the 2002 Nationwide Inpatient Sample of the Healthcare Cost and Use Project were analyzed to identify records including an International Classification of Diseases, Ninth Revision, Clinical Modification injury diagnosis code (ICD‐9‐CM). Records with an exclusive obesity comorbidity were isolated, and proportionate injury ratios with 95% confidence intervals were calculated to compare the demographics and injury characteristics between obese and non‐obese persons hospitalized for an injury. Results: A total of 160,707 discharge records were analyzed. Type and cause of injury that required hospitalization were significantly associated with obesity status (p < 0.001). Sprains, strains, and dislocations represented significantly higher proportions of injury‐related hospitalizations among obese persons compared with non‐obese persons. By cause of injury, injuries among obese persons were more frequently due to falls, overexertion, and poisonings compared with non‐obese persons. Discussion: Injuries that required hospitalization among obese persons may have injury characteristics distinct from injuries among non‐obese persons.     

道路交通事故所致骨折特点、致伤机制及其与交通方式关系的研究

研究道路交通事故所致骨折的流行病学特点、骨折的特征及致伤机制;探讨交通方式与骨折的关系及其法医学意义,为预防、控制道路交通事故、交通伤骨折的急救及法医学的鉴定提供重要的依据.本文对2004年昆明市道路交通事故所致骨折518例临床法医鉴定及199例法医病理检验鉴定资料进行系统性分析研究.2005年及2006年.全国与云南省的交通事故数量下降趋势明显.交通事故所致骨折有以下特点:(1)多处、多发性骨折常见;(2)骨折部位呈"离心性分布";(3)暴力传导性骨折明显;(4)骨折刨伤严重,粉碎性及开放性骨折多见,多数需手术治疗;(5)下肢骨折常见,胫腓骨是下肢骨折最常见的部位;(6)四肢多发骨折常发生同侧肢体,摩托车、电动车、自行车驾驶员及乘员和行人发生四肢骨折时以同侧肢体多见,机动车驾驶员及机动车乘员以异侧肢体多见.骨折损伤方式以碰撞为主,其次是摔跌.     

Roentgenomorphological correlations in the diagnosis of pneumonias in patients with combined, craniocerebral, thermal injury and exogenous poisonings]

The clinical roentgenological and postmortem morphological data were analyzed and correlated in 219 patients with combined (60), craniocerebral (38), thermal (46) injury and exogenous poisonings (75), who developed pneumonias in the course of the treatment. All the patients underwent chest roentgenography in the anteroposterior projection and in the supine position. The rate of intravital identification of pneumonias accounted for 73.3% in combined, 63% in craniocerebral, 65.2% in thermal injury, and for 77.3% in exogenous poisonings. The roentgenological and morphological characteristics common to the development of pneumonias in different injuries were revealed and the causes of diagnostic discrepancies were analyzed.     

Occupational Injury Risk Assessment Using Injury Severity Odds Ratios: Male Falls from Heights in the Danish Construction Industry, 1993-1999

To allow for an improved targeted approach to occupational injury research and prevention, detailed risk analyses of fatal, serious, and minor occupational injuries were completed with a focus on male falls from heights in construction. Reported lost-time injuries in Denmark (1993 to 1999) were analyzed for proportions, relative rates, and an injury severity odds ratio to assess relative hazards and reporting. Different types of injury risks, such as elevation falls through surfaces, were identified by contrasting fatal, serious and minor injuries. Trade-specific analyses provided evidence that the carpentry-trade group merits increased attention, as this group has excessively high proportions, rates and hazards for falls from heights, compared to the entire construction industry. Age-specific analyses of workers aged 20 to 59 revealed that the rates of serious-injury falls from heights increase with increasing age. This relationship was inverted for elevation fall injuries from roof surfaces. A focus on construction and falls from heights is necessary not only in terms of fatal injuries, but also for serious injuries. The use of an injury severity odds ratio to assess relative hazards and reporting is a useful supplement to proportions and injury rates in contributing to more precise targeting of subgroups for primary injury prevention.     

Farm accidents in children.

OBJECTIVE--To examine the problem of accidental injury to children on farms. DESIGN--Prospective county based study of children presenting to accident and emergency departments over 12 months with injuries sustained in a farm setting and nationwide review of fatal childhood farm accidents over the four years April 1986 to March 1990. SETTING--Accident and emergency departments in Aberystwyth, Carmarthen, Haverfordwest, and Llanelli and fatal accidents in England, Scotland, and Wales notified to the Health and Safety Executive register. SUBJECTS--Children aged under 16. MAIN OUTCOME MEASURE--Death or injury after farm related accidents. RESULTS--65 accidents were recorded, including 18 fractures. Nine accidents necessitated admission to hospital for a mean of two (range one to four) days. 13 incidents were related to tractors and other machinery; 24 were due to falls. None of these incidents were reported under the statutory notification scheme. 33 deaths were notified, eight related to tractors and allied machinery and 10 related to falling objects. CONCLUSIONS--Although safety is improving, the farm remains a dangerous environment for children. Enforcement of existing safety legislation with significant penalties and targeting of safety education will help reduce accident rates further.     

Children Domestic Accidents Profile in Jazan Region,a call for new policies to improve safety of home environment

High-frequency home accidents draw more attention to the protection of our home environment. WHO has reported that home deaths were among the first 20 causes of death in the 0–14 age group worldwide in 2012. This innovative research was designed to examine children under 15 years of age at home, in 2018 in the Jazan area of Saudi Arabia. Data were collected retrospectively from 19 hospitals in the Jazan area of southern Saudi Arabia during the period from September to December 2019. Data showed that, for the first time, the incidence rate of child home incidents in the Jazan area was 7.4 per 100 children in 2018. Falling, burning, swallowing foreign bodies, and domestic violence were among the most common types of injuries recorded. Home safety continued to be one of the main public health issues in the area with 29,812 home injuries in 1 year, 36.8% bone fractures, 31.6% body distortions, 9.2% distortion fractures and 5.3% child impairment. This study is a crucial step towards addressing the severity of home accidents in Saudi Arabia; troubling figures need further analysis, regular registry, informed policies and well-planned action to avoid these types of accidents.     

Livestock Vehicle Accidents in Spain: Causes,Consequences, and Effects on Animal Welfare

Livestock vehicle accidents are rare but involve significant economic, human, and nonhuman farm animal losses. This study obtained information on the characteristics of accidents, the animals involved, and injuries to humans from newspaper reports about livestock vehicle accidents in Spain from January 2000 to December 2008. Most accidents involved pig transport (57%), followed by bovine (30%), poultry (8%), and sheep (5%). Driver mortality was not high (6%), and most accidents (76%) involved only the livestock vehicle, which often was overturned (64%) on a straight road transect (51%). Multivariate analysis of the data suggests 2 types of accidents, depending on the species transported. In the first cluster, 95.3% of the cases involved pig transport with articulated vehicles (60.5%). In the second cluster, 94.4% of the accidents involved small vehicles used for cattle transport (44.4%). The results of this study indicate that the characteristics of livestock vehicle accidents vary according to species. One of the main causes of accidents appears to be driver fatigue, which may be due to several factors such as intense workdays, poorly designed route plans, or high levels of pressure from companies.     

Persistence of Health Inequalities in Childhood Injury in the UK; A Population-Based Cohort Study of Children under 5

BackgroundInjury is a significant cause of childhood death and can result in substantial long-term disability. Injuries are more common in children from socio-economically deprived families, contributing to health inequalities between the most and least affluent. However, little is known about how the relationship between injuries and deprivation has changed over time in the UK.MethodsWe conducted a cohort study of all children under 5 registered in one of 495 UK general practices that contributed medical data to The Health Improvement Network database between 1990–2009. We estimated the incidence of fractures, burns and poisonings by age, sex, socio-economic group and calendar period and adjusted incidence rate ratios (IRR) comparing the least and most socio-economically deprived areas over time. Estimates of the UK annual burden of injuries and the excess burden attributable to deprivation were derived from incidence rates.ResultsThe cohort of 979,383 children experienced 20,804 fractures, 15,880 burns and 10,155 poisonings, equating to an incidence of 75.8/10,000 person-years (95% confidence interval 74.8–76.9) for fractures, 57.9 (57.0–58.9) for burns and 37.3 (35.6–38.0) for poisonings. Incidence rates decreased over time for burns and poisonings and increased for fractures (p<0.001 test for trend for each injury). They were significantly higher in more deprived households (IRR test for trend p<0.001 for each injury type) and these gradients persisted over time. We estimate that 865 fractures, 3,763 burns and 3,043 poisonings could be prevented each year in the UK if incidence rates could be reduced to those of the most affluent areas.ConclusionsThe incidence of burns and poisonings declined between 1990 and 2009 but increased for fractures. Despite these changes, strong socio-economic inequalities persisted resulting in an estimated 9,000 additional medically-attended injuries per year in under-5s.     

The Epidemiology and Prevention of Traffic Accidents Involving Child Pedestrians

A study of 713 motor vehicle accidents involving 749 children in the city of Vancouver is reported. A control group of 110 children who did not have accidents was included in the concurrent study. Factors investigated were the driver, the vehicle, the weather, the time of day, the day of week, the month, the width of roadway, the location of the accident, the child''s age, sex, personality, school record, and family background, the type of injury, and the ambulance and hospital service received. Boys were more commonly involved than girls, and most accidents occurred in the 3 to 7 year age group. Head injuries prevailed in the younger age groups and decreased steadily with the age of the child. Specific epidemic areas in the city were identified and selective enforcement was suggested as a possible countermeasure. Hospital records seldom provided a detailed history of the events leading up to the accident. In order to apply the preventive techniques of education and enforcement it was suggested that in each pedestrian traffic accident the driver should be required to accompany the victim to the site of medical care.     

The Low Fall as a Surrogate Marker of Frailty Predicts Long-Term Mortality in Older Trauma Patients

Background

Frailty is associated with adverse outcomes including disability, mortality and risk of falls. Trauma registries capture a broad range of injuries. However, frail patients who fall comprise a large proportion of the injuries occurring in ageing populations and are likely to have different outcomes compared to non-frail injured patients. The effect of frail fallers on mortality is under-explored but potentially significant. Currently, many trauma registries define low falls as less than three metres, a height that is likely to include non-frailty falls. We hypothesized that the low fall from less than 0.5 metres, including same-level falls, is a surrogate marker of frailty and predicts long-term mortality in older trauma patients.

Methods

Using data from the Singapore National Trauma Registry, 2011–2013, matched till September 2014 to the death registry, we analysed adults aged over 45 admitted via the emergency department in public hospitals sustaining blunt injuries with an injury severity score (ISS) of 9 or more, excluding isolated hip fractures from same-level falls in the over 65. Patients injured by a low fall were compared to patients injured by high fall and other blunt mechanisms. Logistic regression was used to analyze 12-month mortality, controlling for mechanism of injury, ISS, revised trauma score (RTS), co-morbidities, gender, age and age-gender interaction. Different low fall height definitions, adjusting for injury regions, and analyzing the entire adult cohort were used in sensitivity analyses and did not change our findings.

Results

Of the 8111 adults in our cohort, patients who suffered low falls were more likely to die of causes unrelated to their injuries (p<0.001), compared to other blunt trauma and higher fall heights. They were at higher risk of 12-month mortality (OR 1.75, 95% CI 1.18–2.58, p = 0.005), independent of ISS, RTS, age, gender, age-gender interaction and co-morbidities. Falls that were higher than 0.5m did not show this pattern. Males were at higher risk of mortality after low falls. The effect of age on mortality started at age 55 for males, and age 70 for females, and the difference was attributable to the additional mortality in male low-fallers.

Conclusions

The low fall mechanism can optimize prediction of long-term mortality after moderate and severe injury, and may be a surrogate marker of frailty, complementing broader-based studies on aging.     

Accidents involving off-road motor vehicles in a northern community.

The increasing number of accidents associated with off-road motor vehicles used for recreational purposes prompted this prospective study. During 1985 the records of victims of all motor vehicle accidents who were seen at the Hudson Bay Union Hospital, Hudson Bay, Sask., were studied; patients involved in on-road vehicle accidents were included for comparison. Emphasis was placed on age, vehicle type, mechanism of accident, injury severity and the use of safety features. Almost half of the victims of off-road vehicle accidents were under 16 years of age. The poor adherence to government legislation and manufacturer recommendations was evident in the number of people who did not wear helmets or use headlights.     

Traffic Deaths—A Preliminary Study of Urban and Rural Fatalities in California

An analysis by the California Department of Public Health of California Highway Patrol reports for 1961 showed that traffic accidents injured one and one-half times as many people per 1,000 population in rural California counties (under 50,000 people) as in urban counties (over 500,000 people), also persons injured in rural counties were almost four times as likely to die of their injuries as those injured in urban counties.A death certificate study was undertaken of 782 traffic deaths (excluding pedestrians) occurring in rural and urban California counties during 1961. Accidents occurring in rural counties tended to be single vehicle accidents which resulted in less severe injuries, while those in urban counties tended to be two vehicle and multiple vehicle accidents resulting in more serious injuries. The anatomic distribution of injuries was the same for both urban and rural accidents. However, people dying in rural accidents more frequently died at the scene of the accident, died sooner after injury, and died of less serious injuries than did those injured in urban accidents. For injuries where theoretically few lives should be salvaged by prompt emergency care, the time between injury and death was about the same in urban as in rural counties. Where such care should delay or prevent death because the injury was possibly or probably salvageable, those injured in rural counties died more quickly.Thirty-two per cent of fatalities in rural counties happened to urban and out-of-state residents, while only 12 per cent of fatalities in urban counties were to rural or out-of-state residents, suggesting that traffic accidents to non-residents may place an excessive load upon medical care resources in rural areas.     

Falls from trees and tree associated injuries in rural Melanesians.

Falls from trees and other tree related injuries are the most common cause of trauma in some parts of rural Melanesia. A four year review of all admissions for trauma to the Provincial Hospital at Alotau, Milne Bay Province, Papua New Guinea, showed that 27% were due to falls from trees, and a further 10% were due to related injuries, such as being struck by a falling branch or a coconut. A questionnaire distributed to rural health centres showed that during the study period at least 28 villagers died from falls from trees before reaching hospital. Head and chest trauma were common causes of death. Many injured patients were boys. Forearm fractures were the most common injuries, but more serious injuries were also frequently encountered. Trees responsible for most deaths and injuries included the coconut palm, betel palm, mango, and breadfruit. There are many strategies for preventing such injuries; perhaps the most important is to stop small boys climbing tall trees. Such falls are a serious occupational hazard for many subsistence farmers.     

The use of accident reconstruction for the analysis of traumatic brain injury due to head impacts arising from falls

Brain injury is the leading cause of death in those aged under 45 years in both Europe and the USA. The objective of this research is to reconstruct and analyse real world cases of accidental head injury, thereby providing accurate data, which can be used subsequently to develop clinical tolerance levels associated with particular traumatic injuries and brain lesions. This paper looks at using numerical modelling techniques, namely multibody body dynamics and finite element methods, to reconstruct two real-life accident cases arising from falls. Preliminary results show the levels of acceleration of the head and deformation of brain tissue correspond well to those found by other researchers, suggesting that this method is suitable for modeling head-injury accidents.     

Effectiveness of bicycle helmets in preventing head injury in children: case-control study.

OBJECTIVE--To examine the risk of injury to the head and the effect of wearing helmets in bicycle accidents among children. DESIGN--Case-control study by questionnaire completed by the children and their carers. SETTING--Two large children''s hospitals in Brisbane, Australia. SUBJECT--445 children presenting with bicycle related injuries during 15 April 1991 to 30 June 1992. The cases comprised 102 children who had sustained injury to the upper head including the skull, forehead and scalp or loss of consciousness. The controls were 278 cyclists presenting with injuries other than to the head or face. A further 65 children with injuries to the face were considered as an extra comparison group. MAIN OUTCOME MEASURES--Cause and type of injury, wearing of helmet. RESULTS--Most children (230) were injured after losing control and falling from their bicycle. Only 31 had contact with another moving vehicle. Children with head injury were significantly more likely to have made contact with a moving vehicle than control children (19 (19%) v 12 (4%), P < 0.001). Head injuries were more likely to occur on paved surfaces than on grass, gravel, or dirt. Wearing a helmet reduced the risk of head injury by 63% (95% confidence interval 34% to 80%) and of loss of consciousness by 86% (62% to 95%). CONCLUSIONS--The risk of head injury in bicycle accidents is reduced among children wearing a helmet. Current helmet design maximises protection in the type of accident most commonly occurring in this study. Legislation enforcing helmet use among children should be considered.