Fatal Head Injuries in Children Under the Age of 5 Years in Pretoria

Abstract

The incidence of fatal injuries in children has been reported to be highest amongst children aged 1-4 years. Major causes of head injury include road traffic accidents, falls and intentional or inflicted injury (such as non-accidental injury syndrome). This study reviewed the profile of children (under five years of age) who had been admitted to a large urban medico-legal mortuary (in Pretoria, the capital city of South Africa), after having suffered fatal head injuries. This study was conducted over a 5 year period (from January 2004 through December 2008) and a total of 107 cases were identified for inclusion. These cases constituted nearly a 5 th of admissions in this age group. The male to female ratio was 56%:44% and the peak age of injury was less than 1 year. Most head injuries were sustained in road traffic accidents (70%) followed by falls (10%) and blunt force injuries (9%). Only 1 case of non-accidental injury syndrome (child abuse) was found. The great majority of deaths were deemed to have been accidental in nature (91%) with 6 (6%) homicides. Urgent review pertaining to the use of child restraint devices as well as the safety of pedestrians is required and the institution of childhood injury registers could aid in reducing childhood fatalities in South Africa.

Head Trauma–Related Deaths Among Preschool Children in Istanbul, Turkey

“…However, there were no data in 14 cases whether the deceased was passenger or pedestrian. A review of the literature revealed that a great number of studies reported traffic accident as the most common cause of head trauma-related childhood 3,4,6,[21][22][23][24] whereas similar to our findings, some other studies found traffic accident as the second most common cause of head trauma-related childhood deaths. 7,13,25 Of a total of 67 cases involving traffic accident, 40 (60%) were males and 27 (40%) were females, and victims were mostly in 13-to 36-month-age group with 32 cases (48%), in the present study.…”

“…It is expressed that pedestrian deaths are higher in low-middle income countries, whereas passenger deaths are higher in high-level income countries. 6 …”

“…7,13 It took the third place among deaths of children aged between 1 and 4 years in Chicago; however, a study conducted in Ohio between 1994 and 1996 showed that fall from a height was the fourth most common among causes of death in same age group. 6 Fall from a height contributes mortality rates; furthermore, this contribution is significant in children younger than 5 years, in particular. 14,15 In our series, 11 cases (11.30%) involved short falls (<150 cm), whereas 65 cases (67%) involved long falls (>150 cm).…”

“…In accordance to this, 2 studies from Africa and Norway revealed similar numbers and percentages of males (51, 56%) and females (40, 44%). 6,26 Less intensive parental supervision of boys is compared with that of girls, and higher frequency of involvement of boys into risky activities and physical activities might be considered as possible explanations for higher number of males involved in accidents.…”

“…5 A 5-year study by Isık et al 2 from Turkey showed that 851 children were admitted to emergency department because of head trauma, of which causes were mostly "fall from a height" (695, 80%) and "traffic accidents" (153, 18%). A 5-year study by du Toit-Prinsloo et al 6 from South Africa revealed that traffic accident (70%) was the most common cause of head trauma-related deaths among children younger than 5 years. However, a 4-year study from United Arab Emirates reported fall from a height as the most common cause of head trauma-related deaths in the same age group.…”