Current Patterns of child injury

• Key ways of thinking about child injury
• Broad Patterns
• More detailed analysis

Key ways of thinking about child injury

This suggests that injury data should be looked at not only in terms of broad age groups but also in narrow ranges that reveal these developmental patterns. There are clear differences between the injury patterns of males and females. These emerge as early as the first year of life, and are accentuated during late childhood with a rapid increase in risk emerging for both sexes at adolescence. These gender differences cannot be considered in detail here but are worthy of further exploration.

Broad Patterns

Table 5 Child injury hospitalisation (excluding medical misadventure) Australia (excl NT) 1992-93 financial year. Counts and rates per 100,000 persons by major cause group ⁺

	0-4 yrs		5-9 yrs		10-14 yrs
	count	rate	count	rate	count	rate
Motor vehicle driver	6	0.5	7	0.6	51	4.1
Motor vehicle passenger or unspec occ	391	30.8	398	31.5	443	35.7
Motor cycle driver	13	1.0	146	11.6	600	48.3
Motor cycle passenger or unspecified	20	1.6	56	4.4	80	6.4
Pedal cyclist or passenger	299	23.6	1169	92.7	1681	135.3
Pedestrian	367	28.9	465	36.9	435	35.0
Animal related	987	77.8	1035	82.0	1422	114.5
Other transport	271	21.4	540	42.8	1242	100.0
Fall	6442	507.7	8927	707.5	6391	514.4
Drowning, incl. pool, quenching tank	163	12.8	17	1.4	4	0.3
Drowning other	117	9.2	31	2.5	28	2.3
Other threat to breathing	594	46.8	110	8.7	75	6.0
Fire flames smoke	232	18.3	140	11.1	194	15.6
Hot drink food steam etc	1228	96.8	166	13.2	104	8.4
Hot object or substance	289	22.8	42	3.3	34	2.7
Poisoning drugs and medicinals	2460	193.9	133	10.5	679	54.7
Poisoning other or unspecified substance	1107	87.2	113	9.0	183	14.7
Firearms	2	.	7	0.6	40	3.2
Cutting, piercing object	1069	84.3	1030	81.6	1074	86.5
Strike/struck by object or person	1749	137.8	1519	120.4	2269	182.6
Machinery in operation	131	10.3	76	6.0	133	10.7
Electricity	37	2.9	22	1.7	51	4.1
Hot conditions	5	0.4	5	0.4	4	0.3
Cold conditions	1	.	1	.	3	.
Other specified external cause	1741	137.2	1204	95.4	2208	177.7
Unspecified external cause	677	53.4	552	43.8	724	58.3
All causes excluding medical misadventure	20398	1607.5	17911	1419.7	20152	1622.3
Note: Rates are suppressed where number of cases on which they are based is less than 4. + See Data Issues section for definition of major cause groups.

More detailed analysis

In terms of death, the priority areas are motor vehicle traffic causes and drowning. Mechanical asphyxiation of children before their first birthday also ranks in the top 20 combinations. The priority for drowning is focussed on one and two year olds, while the motor vehicle traffic causes are important across a wider age span, with older children being more likely to die. For deaths, the top 20 combinations cover 53 per cent of death.

Priorities based on hospitalisation show more diversity. More causes are involved. Falls emerge as a common issue for the under fives with falls from playground equipment featuring for older groups. The top 20 combinations only account for 18 per cent of hospitalisations and 24 per cent of bed days. The influence of severity of injury can be seen by comparing numbers of hospitalisations, numbers of bed days and average number of bed days per hospitalisation (LOS). Motor vehicle traffic related injuries are much more important in terms of bed days than they are in terms of numbers of hospitalisations. Playground falls on the other hand are relatively frequent but do not rank highly on bed-days or average length of stay. Relatively rare injuries such as water transport accidents, firearm missile incidents and clothing ignition rank high in terms of average length of stay. Hospitalisation data shows the importance of burns and scalds, and recreation and leisure based injuries.

The priorities within each single year age group have also been considered in . It can be seen that the most frequent three causes with each age group account for a significant proportion of the injury for that group. This reflects the way in which important risks change from age to age, and that at each age, a relatively smaller subset of causes is of importance

Prevention planning needs to take into account the specific hazards for each age group in order to anticipate the need for prevention as children develop.

In order to move toward preventive strategies, there is a need for further analysis. During our analysis of the death and hospitalisation data, we noted the importance of motor vehicle related injury to very young children. A review at the finest level of the data, individual Ecodes, and study of more detailed descriptions of cases presenting to emergency departments, revealed that the issues were different for children under one year and their one year old counterparts. In the first year of life, injuries occur as passengers, whereas among the one year olds, a significant part of the problem is related to the children becoming mobile in and near vehicles, commonly classified as pedestrian injuries, although this does not properly describe the activity.

The literature focuses on pedestrian injuries among older children, usually omitting the study of the youngest age groups because their role is not that of a formal pedestrian. In order to illustrate the value of the more in-depth qualitative information to understand the patterns shown above, we have explored our emergency department data base to obtain more detail about the type of pedestrian injury experienced by one year old children.