Independent Risk Factors for Injury in Pre-School Children: Three Population-Based Nested Case-Control Studies Using Routine Primary Care Data

Abstract

BackgroundInjuries in childhood are largely preventable yet an estimated 2,400 children die every day because of injury and violence. Despite this, the factors that contribute to injury occurrence have not been quantified at the population scale using primary care data. We used The Health Improvement Network (THIN) database to identify risk factors for thermal injury, fractures and poisoning in pre-school children in order to inform the optimal delivery of preventative strategies.MethodsWe used a matched, nested case-control study design. Cases were children under 5 with a first medically recorded injury, comprising 3,649 thermal injury cases, 4,050 fracture cases and 2,193 poisoning cases, matched on general practice to 94,620 control children.ResultsYounger maternal age and higher birth order increased the odds of all injuries. Children’s age of highest injury risk varied by injury type; compared with children under 1 year, thermal injuries were highest in those age 1-2 (OR = 2.43, 95%CI 2.23–2.65), poisonings in those age 2-3 (OR = 7.32, 95%CI 6.26–8.58) and fractures in those age 3-5 (OR = 3.80, 95%CI 3.42–4.23). Increasing deprivation was an important modifiable risk factor for poisonings and thermal injuries (tests for trend p≤0.001) as were hazardous/harmful alcohol consumption by a household adult (OR = 1.73, 95%CI 1.26–2.38 and OR = 1.39, 95%CI 1.07–1.81 respectively) and maternal diagnosis of depression (OR = 1.45, 95%CI 1.24–1.70 and OR = 1.16, 95%CI 1.02–1.32 respectively). Fracture was not associated with these factors, however, not living in single-adult household reduced the odds of fracture (OR = 0.88, 95%CI 0.82–0.95).ConclusionsMaternal depression, hazardous/harmful adult alcohol consumption and socioeconomic deprivation represent important modifiable risk factors for thermal injury and poisoning but not fractures in preschool children. Since these risk factors can be ascertained from routine primary care records, pre-school children’s frequent visits to primary care present an opportunity to reduce injury risk by implementing effective preventative interventions from existing national guidelines.

Predisposing Factors for Traumatic Dental Injury in Primary Teeth and Seeking of Post-trauma Care

“…One might expect that older children in the family would have a higher frequency of dental trauma (20). However, this variable did not remain in the final model, suggesting that birth order exerts no influence on the occurrence of TDI.…”

Alti yas ve altindaki çocuklarda ve alti yasindan büyük çocuklarda karsilasilan zehirlenmelerin arastirilmasi

“…Literatürde bu konuyu ele alan çeşitli araştırmalar mevcuttur (19,30). Bu araştırmada retrospektif olarak hastaların tıbbi kayıtlarından yararlanıldığı için konunun ailelerin sosyodemografik ve sosyokültürel özelliklerinin incelenmesi mümkün olmamıştır.…”

“…Çocuklardaki zehirlenmelerin cinsiyete göre dağılımlarının eşit olduğu, buna karşın zehirlenmelerin oluş nedenleriyle iliş-kilendirildiğinde kazaların erkek, özkıyım girişimlerinin ise kız çocuklarında anlamlı derecede daha sık rastlandığı tespit edildi. Özkıyım girişimi ile karşılaşma oranının kız çocukla-rında, bilhassa da BÇ'lerde daha sık olduğu Türkiye'de ve diğer ülkelerde yapılmış pek çok araştırmada iddia edilmektedir (5)(6)(7)(8)(9)(10)15,(17)(18)(19)(20)(23)(24)(25)(26). Bu durum, özkıyım girişiminde bulunma riskini bilhassa kız çocuklarında azaltıcı önlemlerin gerekliliğine ve özkıyım girişimlerin nedenlerini ortaya koyacak ileri araştırmaların gerekliliğine duyulan ihtiyaca işaret etmektedir.…”

“…Çocuklarda zehirlenme önemli bir mortalite ve morbidite nedenidir. Bu sorun giderek azalmakla birlikte hala ölüm nedenleri arasında sayılmaktadır (17)(18)(19)(20). Örneğin Hindistan'da yapılmış bir araştırmada bu oranın %7.7 olduğu bildirilmiştir (21).…”

Risk of Fracture in Urolithiasis

“…The Health Improvement Network (THIN) database has been used to characterize the risk of fracture associated with several chronic conditions and drug exposures in adults and children (19)(20)(21)(22)(23)(24)(25)(26). The objectives of this large population-based study were to determine whether urolithiasis is associated with a higher risk of incident fracture and to delineate age and sex effects.…”