Division of Primary Care, University Park, University of Nottingham, Nottingham, United Kingdom.
PLoS One. 2012;7(4):e35193. doi: 10.1371/journal.pone.0035193. Epub 2012 Apr 5.
Injuries 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.
We 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.
Younger 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 = N 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).
Maternal 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.
儿童受伤在很大程度上是可以预防的，但据估计，每天仍有 2400 名儿童因受伤和暴力而死亡。尽管如此，利用初级保健数据在人群层面上量化导致伤害发生的因素尚未得到量化。我们使用 The Health Improvement Network (THIN) 数据库来确定学前儿童热伤、骨折和中毒的危险因素，以便为最佳预防策略的实施提供信息。
我们使用了匹配的嵌套病例对照研究设计。病例为首次经医学记录的损伤的 5 岁以下儿童，包括 3649 例热损伤病例、4050 例骨折病例和 2193 例中毒病例，在全科医生的匹配下，共 94620 名对照儿童。
母亲年龄较小和较高的出生顺序增加了所有伤害的几率。儿童受伤风险最高的年龄因伤害类型而异；与 1 岁以下的儿童相比，1-2 岁的儿童热伤风险最高（OR=2.43，95%CI 2.23-2.65），2-3 岁的儿童中毒风险最高（OR=7.32，95%CI 6.26-8.58），3-5 岁的儿童骨折风险最高（OR=3.80，95%CI 3.42-4.23）。日益增加的贫困是中毒和热伤的重要可改变危险因素（趋势检验 p≤0.001），家庭成人危险/有害饮酒（OR=1.73，95%CI 1.26-2.38 和 OR=1.39，95%CI 1.07-1.81）和母亲诊断为抑郁症（OR=1.45，95%CI 1.24-1.70 和 OR=1.16，95%CI 1.02-1.32）也是如此。然而，骨折与这些因素无关，但不住在单亲家庭会降低骨折的几率（OR=0.88，95%CI 0.82-0.95）。
母亲抑郁、危险/有害成人饮酒和社会经济贫困是学前儿童热伤和中毒的重要可改变危险因素，但不是骨折的危险因素。由于这些危险因素可以从常规初级保健记录中确定，因此学前儿童经常到初级保健就诊为实施现有国家指南中的有效预防干预措施提供了减少伤害风险的机会。
