Falls in young children with minor head injury: A prospective analysis of injury mechanisms

IntroductionThe COVID-19 pandemic has reduced pediatric emergency department (ED) visits and surgeries. This study evaluates the incidence of pediatric trauma ED visits and surgeries in Finland during the first and second waves of the pandemic.MethodsThree large Finnish hospitals, covering one-sixth of the Finnish pediatric population, participated. Data on all ED visits and trauma surgeries between January 2017 and December 2020 were collected from hospital discharge registers. Monthly incidences with 95% CI were calculated per 100 000 person-months by Poisson exact method and compared by incidence rate ratio (IRR).ResultsDuring the lockdown the incidence of head injuries (IRR 0.19, 95% CI 0.04 to 0.87), sprains (IRR 0.25, 95% CI 0.14 to 0.46), and fractures (IRR 0.36, 95% CI 0.25 to 0.51) decreased in the 13–17 years age group. In the 4–12 years age group a 55% decrease (IRR 0.45, 95% CI 0.22 to 0.96) in head injuries was observed. During the period of regional restrictions a subtle decrease in head injuries was seen in the 13–17 years age group (IRR 0.26, 95% CI 0.09 to 0.78). During the lockdown in March 2020 the incidence of fractures decreased in the oldest age group (13–17 years) (IRR 0.62, 95% CI 0.46 to 0.85), while a rebound in incidence was seen at the end of the lockdown period in June.ConclusionThe nationwide lockdown and the cancellation of sports and other hobbies markedly decreased the injuries among children aged 13–17 years, while the decrease was lower among children aged 4–12 years. Cancellation of sports and hobbies did not affect patients under 4 years of age.

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“…This is an interesting finding because fall is a common injury mechanism for minor blunt head trauma patients in the pediatric population. 18 …”

Section: Discussionmentioning

confidence: 99%

Incidence of pediatric injury visits decreased while trauma surgeries remained stable during the first and second waves of the COVID-19 pandemic in Finland: a register-based study

Kuorikoski

Kuitunen

Uimonen

et al. 2021

World Jnl Ped Surgery

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“…Research showed that young children having minor head injuries had low risk to coincide with clinically significant traumatic brain injury. 28 …”

Section: Discussionmentioning

confidence: 99%

Fall-related attendance and associated hospitalisation of children and adolescents in Hong Kong: a 12-year retrospective study

Lee

Tung

et al. 2017

BMJ Open

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ObjectivesThe present study aimed to examine the trends and characteristics of fall-related attendance in accident and emergency department (AED) by injury type and the trend in associated average length of stay (LOS) among children and adolescents in Hong Kong.DesignA retrospective approach was adopted.SettingAED, involving all local public emergency departments from 2001 to 2012.Participants63 557 subjects aged 0–19 years with fall injury record were included in the analysis.Primary outcome measuresFall-related injury number and rates were calculated and reported. Poisson and negative binomial regression models were used to study the trends of injury incidence rate at different body regions.ResultsAED fall-related attendance rate increased significantly with an annual percentage change of 4.45 (95% CI 3.43 to 5.47%, p<0.0001). The attendance number of male subjects was persistently higher than female subjects. The standardised rate of fracture injury increased by 1.31% (95% CI 0.56 to 2.05%, p<0.0001) and that of non-fracture injury increased by 9.23% (95% CI 7.07 to 11.43%, p<0.0001) annually. Upper limb was the most frequently fractured location. It included forearm/elbow, shoulder/upper arm and wrist/hand with descending order of frequency. On the contrary, head was the most frequent non-fracture location, followed by forearm/elbow.ConclusionsThe rates of fall-related attendance have been increasing and still remain high. There were significant increases in non-fracture injuries. Fractures were most frequently found in the upper extremity of a child while the most common non-fracture location was head. It appears that more efforts should be made and preventive measures should be implemented for children and adolescents in Hong Kong.

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“…Falling during early childhood is common (e.g., down stairs, from a bed, from a changing table or furniture, from a playground device, etc.) and can cause serious injuries (132). In one epidemiological study of 0- to 4-year olds (133), the annual rate of injury hospitalization and death from falls was twice the rate of the next most common cause (poisoning).…”

Section: The Stress Acceleration Hypothesis Of Nightmaresmentioning

confidence: 99%

The Stress Acceleration Hypothesis of Nightmares

Nielsen

2017

Front. Neurol.

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Adverse childhood experiences can deleteriously affect future physical and mental health, increasing risk for many illnesses, including psychiatric problems, sleep disorders, and, according to the present hypothesis, idiopathic nightmares. Much like post-traumatic nightmares, which are triggered by trauma and lead to recurrent emotional dreaming about the trauma, idiopathic nightmares are hypothesized to originate in early adverse experiences that lead in later life to the expression of early memories and emotions in dream content. Accordingly, the objectives of this paper are to (1) review existing literature on sleep, dreaming and nightmares in relation to early adverse experiences, drawing upon both empirical studies of dreaming and nightmares and books and chapters by recognized nightmare experts and (2) propose a new approach to explaining nightmares that is based upon the Stress Acceleration Hypothesis of mental illness. The latter stipulates that susceptibility to mental illness is increased by adversity occurring during a developmentally sensitive window for emotional maturation—the infantile amnesia period—that ends around age 3½. Early adversity accelerates the neural and behavioral maturation of emotional systems governing the expression, learning, and extinction of fear memories and may afford short-term adaptive value. But it also engenders long-term dysfunctional consequences including an increased risk for nightmares. Two mechanisms are proposed: (1) disruption of infantile amnesia allows normally forgotten early childhood memories to influence later emotions, cognitions and behavior, including the common expression of threats in nightmares; (2) alterations of normal emotion regulation processes of both waking and sleep lead to increased fear sensitivity and less effective fear extinction. These changes influence an affect network previously hypothesized to regulate fear extinction during REM sleep, disruption of which leads to nightmares. This network consists of a fear circuit that includes amygdala, hippocampus, and medial prefrontal cortex and whose substantial overlap with the stress acceleration findings allows the latter to be incorporated into a wider, more developmentally coherent framework.

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Falls in young children with minor head injury: A prospective analysis of injury mechanisms

Abstract: The risk for csTBI was low and no association was found between MOI and injury severity.

Cited by 17 publications

References 10 publications

Incidence of pediatric injury visits decreased while trauma surgeries remained stable during the first and second waves of the COVID-19 pandemic in Finland: a register-based study

Incidence of pediatric injury visits decreased while trauma surgeries remained stable during the first and second waves of the COVID-19 pandemic in Finland: a register-based study

Fall-related attendance and associated hospitalisation of children and adolescents in Hong Kong: a 12-year retrospective study

The Stress Acceleration Hypothesis of Nightmares

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