Injuries to Children Methods
Data Source: The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP)
This report presents data for injuries to children aged between 0 and 6 years who were treated at the emergency departments of Kingston General Hospital (KGH) or Hotel Dieu Hospital (HDH) in Kingston, Ontario during the period from 2001 to 2005. These data were obtained from the database of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), at the Public Health Agency of Canada. CHIRPP is a computerized injury surveillance program that has operated since 1993 in emergency departments of 14 Canadian Hospitals, including KGH and HDH in Kingston.7 The time period 2001-2005 was chosen since a previous report presents CHIRPP injury data from 1994 to 2000,8 and because data from 2006 onwards were not available for extraction.
Data Collection
When an injured child presents to the emergency department of KGH or HDH, the caregiver accompanying the child is asked to complete a one-page questionnaire. Questions on the front side of the form cover the circumstances surrounding the injury: where did the injury happen (home or yard, on the road, or other place), what the person was doing at the time (participating in a sport, in a motorized vehicle, or other), how the injury happened (what went wrong and what actually caused the injury), the time and place the injury occurred, and the age and sex of the patient. The back page of the form is completed by staff in the emergency department. They provide details on the nature of the injury, body part injured and treatment received.7
In Kingston, the Emergency Medicine and Injury Research Group (EMIRG) administers CHIRPP. The Director (a physician in the emergency department) oversees the project, and the Research Program Manager and Data Control Assistant ensure CHIRPP forms are being handed out and completed. CHIRPP forms are sent to the Public Health Agency of Canada for entry into an electronic database. Data entry clerks code information on more than 40 variables and write a few lines of text describing "what happened" based on the account provided by the patient or caregiver. The cumulative national database resides in Ottawa at the Public Health Agency's Centre for Health Promotion.7
It is important to note that the results presented in this report do not represent all injuries among children aged 0-6 in Kingston. Injuries that are not included are those treated at a physician's office, community health centre, or at the Children's Outpatient Clinic (COPC) in Hotel Dieu Hospital. Also, fatal (and very serious) injuries are under-represented in the CHIRPP database, since the emergency department data do not capture information about children who died before they could be taken to hospital or those who died after being admitted to hospital.
Data Analysis
Descriptive data are presented in this report, including counts and percentages. Available descriptors included age and sex of patient; year, month, day and time of injury; and injury characteristics (external cause, location, context and type of injury). Data were analyzed using SPSS, version 18.
Ethical Considerations
The research proposal was reviewed in accordance with KFL&A Public Health's policy for the scientific and ethical review of research projects.
Injury Characteristics and Definitions
In this report, data are presented on four characteristics of injuries:
- external cause (e.g., a fall or motor vehicle accident),
- type of injury (e.g. wound).
- context or activity (e.g. running),
- location (e.g. home)
Figure 1 displays the flow chart of the descriptive terminology of injuries presented in this report. The first category, 'external cause of injury', is a combination of 'type of injury' and 'event leading to injury'. The latter two categories were present in the CHIRPP database, but by themselves do not provide a clear picture of how the child's injury occurred. We, therefore, created the 'external cause of injury' category, which includes falls, collisions, motor vehicle accidents, foreign body, burns and poisoning. The second important characteristic of an injury, 'type of injury', includes wounds, fractures, dislocations, head injuries and burns. The third category is the injury context, which includes sitting, standing, or being carried; walking, running or crawling; playing climbing or bicycling; or engaging in sports or recreation. The fourth category, 'injury location', includes own or other home, school/daycare, roads, or sports or recreation.
[figure 1]
Descriptions of the External Cause of Injury
Descriptions of each external cause of injury are presented in Table 1.
|
External cause of injury |
Examples |
|---|---|
|
Falls |
Child slips, trips or falls on floor, falls off structure or furniture, or falls down stairs. Includes falls from collisions with another person and being pushed or shoved by another person |
|
Collision with object |
Child collides with indoor items such as furniture or outdoor objects, such as playground items. If there is a collision involving two or more people, it is captured in 'Fall from collision, pushing or shoving by or with another person' |
|
Struck by another person or object |
Household item falls on the child, ball hits child, or child is stuck by another person |
|
Motor vehicle collision |
Child is inside a motor vehicle that is involved in a collision |
|
Road traffic accident |
Child is on a road, sidewalk or driveway and is injured by another car or bicycle |
|
Foreign body in mouth
|
Examples include coins, small toys, marbles, paper clips, cigarettes, buttons, nails, screws, safety pins, game pieces, batteries, candy
|
|
Foreign body in nose |
Examples include beads, rocks, peanuts, candy, beans, popcorn, peas, corn, raisins, toys, crayons |
|
Foreign body in ear |
Examples include Q-tips, beads, beans, popcorn |
|
Foreign body in eye |
Examples include pencils, pepper, sand, fingers, perfume, shampoo |
|
Foreign body in other |
Examples include slivers and stepping on tacks or nails |
|
Caught in or between object |
Mostly crushing injuries where fingers, hands or toes are caught in household doors, patio doors or car doors |
|
Cutting or piercing |
Child cuts self with a knife or scissors, or steps on or cuts self with glass or other sharp object |
|
Pulled arm/elbow |
Child sustains pulled arm or elbow as a result of being pulled up by arm, putting on clothing, or swung by parents |
|
Burns from hot objects
|
Includes burns from items on stove, fireplaces, wood stoves, lawn mowers, curling irons, light bulbs
|
|
Burns from hot liquids
|
Includes burns from water, tea, coffee, bath water, soup |
|
Burns from fire or flames
|
Burns from fires in home |
|
Burns from chemical burns in eye or skin
|
Includes burns from detergent, disinfectant, household or oven cleaner, mosquito repellent, other cleaners
|
|
Burns from sunburn
|
Excessive sun exposure causing skin burn |
|
Poisonings - medication |
Ingestion of Tylenol, vitamins, gravol, poison berries, prescription medication, cough syrups, ecstasy pills and other |
|
Poisonings- chemical/other |
Ingestion of cleaners (e.g., air fresheners, Drano), pet cleaners, shampoo, anti- freeze, paint thinner, furniture polish, lamp oil, bleach, toothpaste, zinc oxide |
|
Asphyxia |
Threats to breathing which includes choking, smoke inhalation, drowning |
|
Other |
Other types of injuries such as seizures, fainting, electrical shocks, and those injuries that do not fall into a category above. Also includes injuries with unknown cause |