|Year : 2018 | Volume
| Issue : 2 | Page : 247-251
Epidemiology of pediatric trauma at a tertiary hospital in Riyadh, Saudi Arabia
Abdulrhman Alnasser1, Ahmad Othman2, Osama Mobaireek1, Nesrin Alharthy2, Nawfal Aljerian3, Heythem Al Zamel4, Shoeb Qureshi5, Mohammed Al-Mutairi2
1 College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
2 Department of Paediatric Emergency, King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia
3 Department of Emergency Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
4 Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
5 Department of Research, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
|Date of Web Publication||20-Jun-2018|
College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objective: To evaluate the pattern of pediatric traumas at a tertiary hospital in Riyadh, Saudi Arabia, based on gender, age groups, mechanisms of injury, and anatomical regions. Methods: This retrospective observational study used the trauma registry of King Abdulaziz Medical City Trauma Center to review the data of all pediatric patients aged <14 years who were admitted to the hospital following trauma from January 2009 to April 2014. Demographic characteristics, date and time of admission, injury type and mechanism, body area involved, and the mortality rates were analyzed. Results: A total of 1762 patients were included, 68% of who were males. The most common mechanism of injury was blunt trauma (73%), followed by burns (17%) and penetrating injuries (10%). Road traffic injuries were the most common cause (50%) of blunt trauma, followed by fall (40%) and those caused by a physical object (10%). During the study, 305 patients with burns were treated with scalds accounting for the highest proportion (68%) of burn injuries. Sharp objects (79%) were the most frequent cause of penetrating injuries. A total of 50 mortality cases were recorded, which most commonly occurred among the school-aged group (40%) and male patients (78%). The leading cause of deaths among patients was blunt injury (92%). Conclusion: This study has shown the patterns of pediatric trauma injuries in a tertiary hospital in Riyadh, Saudi Arabia, illustrating the local variability across genders, age groups, injury types, and injury mechanisms. Such demographic data will be valuable for optimally resourcing health-care system locally.
Keywords: Anticipatory guidance, pediatric trauma, trauma registry
|How to cite this article:|
Alnasser A, Othman A, Mobaireek O, Alharthy N, Aljerian N, Al Zamel H, Qureshi S, Al-Mutairi M. Epidemiology of pediatric trauma at a tertiary hospital in Riyadh, Saudi Arabia. J Nat Sc Biol Med 2018;9:247-51
|How to cite this URL:|
Alnasser A, Othman A, Mobaireek O, Alharthy N, Aljerian N, Al Zamel H, Qureshi S, Al-Mutairi M. Epidemiology of pediatric trauma at a tertiary hospital in Riyadh, Saudi Arabia. J Nat Sc Biol Med [serial online] 2018 [cited 2019 Jun 16];9:247-51. Available from: http://www.jnsbm.org/text.asp?2018/9/2/247/234716
| Introduction|| |
The incidence of traumatic injuries is predicted to exceed that of any other causes of disability-adjusted life year (DALY) and become the leading cause of DALY by 2020. Traumatic injuries are already recognized as the leading cause of death among children in many countries worldwide.,
Moreover, the rising hospital admission rates among children were also found to be related to trauma., These findings were also confirmed locally in Saudi Arabia by previous studies.,
Road traffic injury (RTI) is the major mechanism of trauma and also the leading cause of traumatic deaths in Saudi Arabia,, which accounted for over 5000 deaths in Saudi Arabia in 2005 alone. However, penetrating injuries are considered to be a global health problem, which are even more common than RTI in some European countries.
The use of trauma registries has been shown to play a crucial role in the reduction of death and disability rates associated with injuries because it influences the evaluation, application, and planning of trauma care. Moreover, it is important for physicians to use these registry numbers to provide anticipatory guidance for parents and empower them to prevent morbidity and mortality associated with injuries. The change should come from every patient and their parents, and the physicians' role is to provide guidance to patients and parents visiting the clinic.
This study aimed to determine the common types of trauma, pattern and distribution among gender and age groups, and anatomical regions involved and provide anticipatory guidance by linking it to the numbers associated with trauma injuries.
| Methods|| |
This retrospective observational study utilized the trauma registry of King Abdulaziz Medical City (KAMC) Trauma Center in Riyadh, Saudi Arabia, which is considered as one of the biggest trauma centers in the country. Trauma is defined as any physical injury caused by disruptive or violent action or any substance introduced into the body. We used the data of all pediatric patients aged <14 years old who were admitted to the hospital following trauma from January 2009 to April 2014.
The following variables were extracted: demographic characteristics, date and time of admission, type and mechanism of injury, body area involved, and mortality rate. Meanwhile, the participants were divided into five groups based on age and in accordance with the World Health Organization's age group classification: <1 (infant), 1–2 (toddler), 3–5 (preschool), 6–12 (school age), and >13 (adolescents) years. In addition, the mechanisms of injury were categorized as follows: Blunt trauma, including RTIs (motor vehicular and motorcycle accidents and pedestrian), fall and physical injuries, and drowning; penetrating injuries, including those caused by gunshot, stab wound, and other sharp objects (sharp objects, including nails, woods, broken glasses, or sewing needles); and burn trauma, including those caused by scalds, chemicals, electricity, and flames. The injuries were also classified into the following based on the body areas involved: Head and skull, facial and orbital, spine, thoracic, abdomen and pelvis, and extremity injuries. In cases where > 1 system is involved during trauma in patients, we categorized the condition as multisystem involvement.
All analyses of the data were performed using SPSS Statistics (version 22; IBM Corp., Armonk, NY, USA).
| Results|| |
During the study, the demographic characteristics of the 1762 patients with trauma who were admitted to the emergency department of KAMC due to injury were extracted. The majority of the patients were male (68.4%). School age was the most common age of presentation (38.9%) followed by preschool (24.6%) and least are neonate (0.7%) [Table 1].
The most common mechanism of injury observed among the patients was blunt trauma (72.8%), followed by burn (17.3%) and penetrating injuries (9.9%). All mechanisms of injury were more frequently observed among males than females [Table 2].
RTI was the most common cause of blunt trauma (44.9%), followed by fall (40.1%) and those caused by physical object (10%); no female patient with physical sport injury was documented [Table 3].
|Table 3: Classification of blunt, burn, and penetrating injuries based on gender|
Click here to view
A total of 305 patients with burn injuries were admitted to the KAMC center within the observed period, with scald burn accounting for the highest percentage of injuries (68.2%), followed by flame (22.3%) and chemical burns (5.2%), and electrical burns (4.3%). Patients with burn injuries were predominantly males, except in the cases of flame burns, where more females were affected than males [Table 3].
[Table 3] also shows the total number of penetrating injuries, which accounted for 9.9% of the total percentage of injuries. Penetration caused by sharp objects was the most frequent cause of penetrating injuries (79.3%), followed by gunshot (12.1%) and stab (8.6%). In this type of injury, the extremities were the most commonly involved area of the body (65%), followed by the facial and orbital areas (22.4%) [Table 4].
A total of 50 mortality cases were recorded, which most commonly occurred among the school-aged group (40%). More observed in male (78%) with leading cause of deaths among patients was blunt injury (92%) [Table 5].
| Discussion|| |
Trauma is considered as one of the most common causes of preventable morbidity and mortality.
Based on the results of a local study, 16% of the victims of motor vehicle accidents are <10 years old. Although the incidence of trauma is well documented in other countries, we found a significant lack of studies with regard to the general description of trauma epidemiology in Saudi Arabia. Thus, this study aimed to provide an up-to-date perspective on this topic based on the data obtained from one of the biggest trauma centers in Saudi Arabia.
The results of the present study showed that males were more commonly affected by trauma injuries than females. This finding is consistent with those of international studies,,, which we believe is associated with the tendency of males to engage in risky and dangerous activities. In addition, school age (6–12 years) was the most common age of presentation, accounting for 39% of the cases. This result is also consistent with those of similar studies.,
Blunt trauma was the most common mechanism of injury, which accounted for 72.8% of all the cases, and a male predominance pattern was observed among all types of injuries. In the present study, RTI was the most common cause of blunt trauma (44.9%), followed by fall (40.1%) and those caused by a physical object (10%). This finding is consistent with the pattern observed among adult patients in a previous study, where traffic-related injuries were the most common cause of blunt trauma.
This finding highlights the importance of establishing a multidisciplinary team to solve this issue and to primarily prevent RTIs by changing the behavior of the drivers in Saudi Arabia and by targeting the drivers through awareness campaigns like those done throughout social media. Besides that, efforts can be strengthened by a strict reinforcement of the traffic laws in Saudi Arabia. Moreover, physician's role in informing the parents and families of patients about these statistics and providing them with the necessary anticipatory guidance, such as wearing a helmet when riding a bicycle, or utilizing age-appropriate baby car seat. Likewise, avoiding the use a baby walker, using the stairs' gate when it comes to falls to reduce the likelihood of injuries and prevent their negative effects.,
In this study, no single case of a female patient who sustained an injury caused by physical sport activity had been reported. This finding is likely because girl's schools do not offer sport activities or no public places where females can participate in sports have been established in Saudi Arabia, which reflect the conservative view of the government. However, the government is advocating a new movement that is aimed toward the implementation of numerous sports where individuals from both genders can participate. Hence, providing parents with sport-related safety information is important.
Burn was the second most common cause of trauma, which accounted for 17% of all cases. Majority of the patients sustained scald burns (68.2%), followed by flame burns (23%). This result is consistent with those of similar studies.,, Although a male predominance pattern was observed in most types of burn injuries, more females suffered burns caused by fire or flames than males. However, this finding was not reflected in the results of similar studies , Although school age was the most common age of presentation in general, burn trauma is most commonly observed among the preschool-aged children (34%), followed by toddlers (28%). The number of deaths varied among different age groups. However, burn-associated mortality most commonly occurred in the school-aged group, followed by the preschool-aged group. The absence or malfunctioning of smoke alarms has been linked to deaths and injuries in residential fires. Therefore, ensuring the presence of a smoke alarm in every house is important regardless of social status, considering that financial difficulties might sometimes be the reason why individuals cannot afford to purchase a smoke alarm for their homes. In terms of scald injury prevention, safety tips, for example, adjusting the temperature of water heaters to 48°C, using hot water temperature limiters when installing a water system in the house, and using containers that are designed to reduce spillage of hot liquids, are recommended to decrease the likelihood of scald injuries.
Penetrating injuries accounted for 10% of all traumas. Sharp objects were the most common causes of penetrating injuries, followed by gunshot (12%) and stab (9%). Numerous international studies reported that gunshot and stab injuries had the highest mortality rates among all types of penetrating injuries.,, The extremities were the most commonly affected body area, followed by the facial and orbital areas (22%). Specifically, the head was the most commonly involved body area in gunshot injuries. Penetrating injuries can be prevented through several methods, for example, by not asking children to perform dangerous tasks that could put them at risk of getting injured. In addition, sharp objects at home should be placed away from the reach of the children. Windows and doors should also be made of shutter-proof glass. Finally, close supervision is crucial, especially in places around homes and playgrounds, where injuries most commonly occur.
| Conclusion|| |
Numerous diseases can be prevented and predicted even before they can occur. The same principle is also applicable to trauma. This discretional study provides information on the epidemiology of trauma among pediatric patients between the age of 0 and 14 years old who were admitted to a Tertiary Hospital in Riyadh, Saudi Arabia. The findings of this study revealed that the school-aged group (6–12 years) is the most commonly affected and has the highest overall number of deaths among all age groups. In general, males were more predominantly affected by injuries than females. The results also showed that blunt trauma was the most common mechanism of injury, with RTIs being the most frequent cause of blunt trauma. In this type of trauma, no single case of a female patient who sustained an injury due to a physical sport activity has been reposted. Moreover, burn was found to be the second most common cause of trauma, which accounted for 17.3% of all the cases. Although a male predominance pattern was observed in this type of injury, more females suffered from burns due to fire or flames than males. In addition, burn trauma was most commonly observed in the preschool-aged group, although the school-aged group had the highest mortality rate. Meanwhile, sharp objects were the most common causes of penetrating injuries.
The findings of this study highlight the need to develop an efficient multidisciplinary system to address the causes of trauma and establish a strategy to reduce the burden of this condition, especially in Saudi Arabia. In line with these results, physicians are also expected to provide anticipatory guidance to their patients as part of the solution to problems on trauma.
Ten cases of dead on arrival were not mentioned due to the lack of their demographical data in the trauma registry.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Haider AH, Hashmi ZG, Zafar SN, Castillo R, Haut ER, Schneider EB, et al.
Developing best practices to study trauma outcomes in large databases: An evidence-based approach to determine the best mortality risk adjustment model. J Trauma Acute Care Surg 2014;76:1061-9.
Manciaux M, Romer C. Accidents in Childhood and Adolescence: A Priority Problem Worldwide. Geneva: World Health Organization; 1991. p. 1-7.
Bener A, el-Rufaie OE, al-Suweidi NE. Pediatric injuries in an Arabian Gulf country. Inj Prev 1997;3:224-6.
Hill AM. Trends in paediatric medical admissions. BMJ 1989;298:1479-83.
Phalp A. Child accidents: Common, serious and preventable. Practitioner 1994;238:766-9.
Evbuomwan I. Pediatric trauma admissions in the Sakaka Central Hospital, Al-Jour Province, Saudi Arabia. Saudi Med J 1994;15:435-7.
AH S. Trauma in a district general AH Hospital. Saudi Med J 1996;18:49-53.
Ansari S, Akhdar F, Mandoorah M, Moutaery K. Causes and effects of road traffic accidents in Saudi Arabia. Public Health 2000;114:37-9.
Mattox KL. Comment on the article, “Trauma care systems in Saudi Arabia: An agenda for action”. Ann Saudi Med 2010;30:329.
] [Full text]
Bhanderi DJ, Choudhary S. A study of occurrence of domestic accidents in semi-urban community. Indian J Community Med 2008;33:104-6.
] [Full text]
Nwomeh BC, Lowell W, Kable R, Haley K, Ameh EA. History and development of trauma registry: Lessons from developed to developing countries. World J Emerg Surg 2006;1:32.
Mizelle HL, Rothrock SG, Silvestri S, Pagane J. Preventable morbidity and mortality from prehospital paralytic assisted intubation: Can we expect outcomes comparable to hospital-based practice? Prehosp Emerg Care 2002;6:472-5.
Shanks NJ, Ansari M, al-Kalai D. Road traffic accidents in Saudi Arabia. Public Health 1994;108:27-34.
Chowdhury SM, Rahman A, Mashreky SR, Giashuddin SM, Svanström L, Hörte LG, et al.
The horizon of unintentional injuries among children in low-income setting: An overview from Bangladesh health and injury survey. J Environ Public Health 2009;2009:435403.
Karbakhsh M, Zargar M, Zarei MR, Khaji A. Childhood injuries in Tehran: A review of 1281 cases. Turk J Pediatr 2008;50:317-25.
Adesunkanmi AR, Oginni LM, Oyelami AO, Badru OS. Epidemiology of childhood injury. J Trauma 1998;44:506-12.
Alnasser M, AlSelaim N, Aldhukair S, Elbedah K, Tamim H, Alazzam S, et al
. Patterns of pediatric trauma in Ramadan. Ann Pediatr Surg 2012;8:9-11.
Alghnam S, Alkelya M, Al-Bedah K, Al-Enazi S. Burden of traumatic injuries in Saudi Arabia: Lessons from a major trauma registry in Riyadh, Saudi Arabia. Ann Saudi Med 2014;34:291-6.
Mack KA, Liller KD, Baldwin G, Sleet D. Preventing unintentional injuries in the home using the health impact pyramid. Health Educ Behav 2015;42:115S-22S.
Desapriya E, Scime G, Subzwari S, Pike I. Prevention of baby-walker-related injury. Lancet 2009;373:545.
Ahmad M. Pakistani experience of childhood burns in a private setup. Ann Burns Fire Disasters 2010;23:25-7.
Parbhoo A, Louw QA, Grimmer-Somers K. A profile of hospital-admitted paediatric burns patients in South Africa. BMC Res Notes 2010;3:165.
Sharma M, Lahoti BK, Khandelwal G, Mathur RK, Sharma SS, Laddha A, et al.
Epidemiological trends of pediatric trauma: A single-center study of 791 patients. J Indian Assoc Pediatr Surg 2011;16:88-92.
] [Full text]
Rafii MH, Saberi HR, Hosseinpour M, Fakharian E, Mohammadzadeh M. Epidemiology of pediatric burn injuries in Isfahan, Iran. Arch Trauma Res 2012;1:27-30.
Touloukian RJ, editor. Pediatric Trauma. 2nd
ed. St. Louis: Mosby Year Book; 1990.
DeMuth WE Jr. The mechanism of shotgun wounds. J Trauma 1971;11:219-29.
Christoffel KK. Pediatric firearm injuries: Time to target agrowing population. Pediatr Ann 1992;21:430-6.
Stringel G, Talutis S, Alemayehu H, Guertin L. Severe unintentional penetrating abdominal injuries of domestic origin in children. J Pediatr Surg Case Rep 2013;1:260-2.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]