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CHAPTER 25

Paediatric Trauma: Epidemiology,

Prevention, and Control

Francis A. Abantanga
Charles N. Mock

Introduction injuries occur when a child is exposed to mechanical, electrical, or
Trauma is the leading cause of disability, death, and hospitalisation thermal energy. Childhood injuries can be penetrating or nonpenetrating,
among children and adolescents globally. It constitutes an enormous with blunt injuries predominating; but many penetrating injuries can be
financial burden on society in particular and governments in general. disturbing and life threatening.
The impact of injury in developing nations has not been as extensively Injuries should not be considered as random events or accidents.
studied as in industrialised countries, and therefore often is not fully They have an association with many predictable factors, such as age,
appreciated. Traditionally, infectious diseases and malnutrition have sex, geographic location, and socioeconomic status. Risk for serious
predominated as causes of morbidity and mortality in developing coun- injury is highly age-related. There are also developmental-related
tries. All the same, injury is a major health problem among children of vulnerabilities. Young infants are at higher risk of inflicted trauma
all ages worldwide. due to their small size and inability to protect themselves. Risks for
For most parts of the African subregion, there are no trauma registries, teenagers are higher as a result of increased exposure to hazards and
and as such, it is difficult to know how much trauma contributes to risk-taking behaviours. In other words, the range of causes of injury and
injuries and death. Accurate data on the extent and nature of injuries are the character of the injuries seen in children vary with age. For example,
required to formulate effective policies targeted at reducing the burden transport-related injuries are common in all age groups but are found
of injury and in particular to compare the contribution to morbidity to be more common in teenagers and adolescents, with resultant high
and mortality due to injuries with that due to infectious diseases and morbidity and mortality rates in these age groups. Also, burn injuries
malnutrition. Most of the studies on injuries in the subregion are are more rampant in children younger than 4 years of age than in older
hospital-based; given the limited access to hospital care and emergency children. In developing countries, falls are usually the most common
transport in low-income countries, these studies are unlikely to be truly cause of injury seen in hospitals, affecting the age group of 5–9 years
representative of what is happening in the communities. more than other age groups.
By the estimates of the World Health Organization (WHO) and the Overall, injury rates are higher in socioeconomically less-endowed
World Bank, injury is likely to account for 20% of all disability-adjusted communities than in more affluent societies. In addition, boys are more
life year (DALY) losses for the world’s population by 2020. Road traffic likely than girls to be harmed by unintentional injuries. Various research
injuries alone are the third leading cause of DALY losses. In spite of this, studies have demonstrated this fact and have concluded that male sex is
very little attention is paid to injury as a major health problem globally, a risk for all types of injury death, with the ratio of male deaths to female
particularly in the developing world. deaths varying by injury mechanism.
The care of trauma patients is a continuous process and involves Unintentional Injuries
the initial first aid, the in-hospital care for the acute phase, and finally The mechanisms of unintentional injuries in children include transporta-
rehabilitation. For this to be successful, a trauma system must be put in tion accidents, falls, burns, insect or animal stings and bites, agricultural
place involving hospitals, trained personnel, and public agencies such injuries, drownings and submersions, poisonings, suffocations, and gun-
as the ambulance services and the Red Cross, among others. Such a shot wounds.
trauma system will require communication capabilities to be able to Transport-related injuries
triage and rapidly transport injured children from the field of injury to a
suitable facility for immediate treatment and rehabilitation. Frankly, the Transport-related injuries are considered in many studies (mostly hospi-
focus in the African subregion should be on injury prevention because tal-based in the subregion) to be the leading cause of injuries, sometimes
treating injuries is very expensive and the costs of injuries to society fatal, in children. Transport-related mechanisms of injury include motor
are enormous. vehicle crashes, pedestrian knockdowns, motorcycle crashes, bicyclists
either falling off their bicycles or being hit by motorised vehicles, and
Epidemiology of Injury in Children injuries related to tractors, among others. Motor vehicle crashes predom-
Knowledge of the epidemiology of injury will help with prevention inate in low-income and middle-income countries. Road traffic injuries
methods. Epidemiology is the study of the factors determining and lead to serious head, chest, abdominal, and limb injuries with resultant
influencing the frequency and distribution of disease, injury, and other severe permanent disability or even death. From two hospital-based
health-related events, as well as their causes in a defined human popula- studies in Ghana and Nigeria, for example, road traffic crashes were
tion. Epidemiology of injury involves the collection of data concerning the most common cause of injuries to children; over 81% and 90% of
the time, the place, the mechanism, and the victim of injury. The purpose children, respectively, in the two reports were pedestrians knocked down
of studying injury and its causes is to establish programmes to prevent by automobiles and motorcycles. Table 25.1 illustrates the problem
and control its development and spread. Injury is known to be a lead- associated with pedestrian knockdowns, which is partly a result of rapid
ing threat to the health of children in Africa, with unintentional injuries urbanisation and increased motorisation all over Africa in recent years.
being the leading cause of morbidity and mortality. The table shows that a vast majority of road traffic injuries involve child
Injuries are subdivided into life threatening and non–life threatening. pedestrians who have been knocked down by moving vehicles. Any pre-
Life-threatening injuries may be intentional or unintentional. Such vention efforts should therefore target this mechanism of injury directly.