"Injury-prone areas" Repeat Presentations for Injuries in Childhood

Master Thesis


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Background: Injury remains a leading cause of childhood morbidity and mortality in the developing world. Probability of injury occurrence is influenced by agent, host and environmental factors. Studies of repeat injuries in childhood thus provide insight into factors in the epidemiological triad predisposing children to injury. Objectives: The study objectives were to determine the proportion of children and the factors associated with repeat presentations to Red Cross War Memorial Children’s Hospital Trauma Unit (RCWMCH TU) for all non-transport related injuries in childhood. Methods: This was a retrospective cohort study using data from RCWMCH TU. We included children aged 0-10 years with first presentation from January 1997 to June 2013, and followed up until the earliest of age 13 years or June 2016. We assessed individual and population-level factors associated with repeat injury using multilevel Poisson regression. Child Dependency Ratios were derived from the 2011 national census. Results: Between 1997 and 2013, 72 490 children under 10 years of age (59% male) presented to RCWMCH TU for the first time with injuries. After the initial injury, 9 417 (13%) presented with a repeat injury by 2016 and before age 13 years. After adjusting for health Sub-District, distance from RCWMCH TU and age at first presentation, factors associated with reduced repeat presentation were: injury identified as due to abuse (adjusted incidence rate ratio [aIRR] 0.6; 95% confidence interval [CI]: 0.4 - 0.7), fluid burn (aIRR 0.6; 95% CI: 0.6 - 0.7), foreign body ingestion (aIRR 0.7; 95% CI: 0.7 - 0.9), moderate and severe (vs minor) initial injury (aIRR 0.9; 95% CI: 0.8 - 0.9) and (aIRR 0.7; 95% CI: 0.6 - 0.8 respectively), whilst boys were more likely to have repeat injury presentations (aIRR 1.4; 95% CI: 1.4 - 1.5). Conclusion: Repeat presentations constituted a substantial proportion of disease burden. Factors associated with repeat presentations were identified, strengthening the argument that injuries arise due to sustained exposure to host, agent and environmental risk factors. While it is reassuring that children with initial injuries due to abuse and severe initial injuries are less likely to present again, injury prevention education should not neglect patients with minor and unintentional injuries. The findings of this study suggest that post-injury health promotion activities should not exclude patients who present with minor injuries, and that targeted education and further research is indicated for specific injuries, including those due to non-height falls and injuries sustained whilst playing sport.