Lam Kai Yet, Sumanth Kumar Gera, Mahadev Arjandas
Department of Orthopaedic Surgery, KK Women's and Childrens Hospital (KKH), Singapore.
J Pediatr Orthop. 2013 Apr-May;33(3):221-6. doi: 10.1097/BPO.0b013e318288098d.
Despite the establishment of playground safety standards, playground-related injuries are still a significant cause of extremity fractures in Singapore. This prospective study evaluates the dimensions and characteristics of our playgrounds, and their effect on fracture severity in an Asian population. We aim to correlate various playground risk factors with severity of the fractures and give recommendations on future safety standards. Our data also allows us to compare the demographics of patients in our study group with that collected in our earlier study in 2004.
From June 2005 to 2006, children who presented with extremity fractures to KK Women's and Children's Hospital after a playground injury were enrolled. Their clinical data were collected prospectively. Relevant playground details were collected on-site independently by another investigator. For analysis of severity, fractures were "major" if they required reduction or operative fixation and were "minor" if they did not.
Supervision at time of injury, especially from the child's parents or siblings, resulted in a lower likelihood of "major" fractures (P=0.002, likelihood ratio=1.97). Conversely, supervision from grandparents or maids was found to result in a higher likelihood of "major" fractures. Increased weight of patients was directly related to severity of fractures (P=0.000), and a body mass index (BMI) of less than 19.8 kg/m resulted in lower likelihood of "major" fractures (P=0.010, likelihood ratio=2.22). Height of equipments and other playground-related factors were not linked to severity of fractures.
Supervision at the playground, preferably from the child's parents or siblings, and keeping a child's BMI within limits as guided by the BMI charts, may potentially reduce the occurrence of severe fractures.
Level I-prognostic study.
尽管已经制定了游乐场安全标准，但在新加坡，与游乐场相关的伤害仍是四肢骨折的一个重要原因。这项前瞻性研究评估了我们游乐场的尺寸和特征，以及它们对亚洲人群骨折严重程度的影响。我们旨在将各种游乐场风险因素与骨折严重程度相关联，并就未来的安全标准提出建议。我们的数据还使我们能够将研究组患者的人口统计学特征与我们在2004年早期研究中收集的数据进行比较。
从2005年6月至2006年，招募了在游乐场受伤后到KK妇女儿童医院就诊的四肢骨折儿童。前瞻性地收集他们的临床数据。相关的游乐场细节由另一名调查员在现场独立收集。为了分析严重程度，如果骨折需要复位或手术固定则为“严重”骨折，如果不需要则为“轻微”骨折。
受伤时的监护，尤其是来自孩子父母或兄弟姐妹的监护，会降低“严重”骨折的可能性（P = 0.002，似然比 = 1.97）。相反，发现来自祖父母或保姆的监护会导致“严重”骨折的可能性更高。患者体重增加与骨折严重程度直接相关（P = 0.000），体重指数（BMI）小于19.8 kg/m会降低“严重”骨折的可能性（P = 0.010，似然比 = 2.22）。设备高度和其他与游乐场相关的因素与骨折严重程度无关。
在游乐场进行监护，最好是由孩子的父母或兄弟姐妹进行监护，并按照BMI图表的指导将孩子的BMI保持在适当范围内，可能会降低严重骨折的发生率。
I级 - 预后研究。
