Executive Management, Groote Schuur Hospital, Cape Town; Health Impact Assessment Unit, Western Cape Government: Health, Cape Town; and School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2020 Nov 27;110(12):1218-1225. doi: 10.7196/SAMJ.2020.v110i12.14546.
Injury remains a leading cause of childhood morbidity and mortality in the developing world. The probability of injury occurrence is influenced by agent, host and environmental factors. Studies of repeat injuries in childhood therefore provide insight into factors in the epidemiological triad predisposing children to injury.
To determine the proportion of children and the factors associated with repeat presentations to the Red Cross War Memorial Children's Hospital Trauma Unit (RCWMCH TU) in Cape Town, South Africa, for all non-transport-related injuries in childhood.
This was a retrospective cohort study using data from the RCWMCH TU. We included children aged 0 - 10 years with first presentation from January 1997 to June 2013 and followed up until the earlier of age 13 years or June 2016. We assessed individual and population-level factors associated with repeat injury using multilevel Poisson regression analysis. Child dependency ratios were derived from the 2011 National Census.
Between 1997 and 2013, 72 490 children aged <10 years (59% male) presented to the RCWMCH TU for the first time with injuries. After the initial injury, 9 417 (13%) presented with a repeat injury by 2016 and before age 13 years. After adjusting for health subdistrict, distance from RCWMCH TU and age at first presentation, factors associated with reduced repeat presentation were injury identified as due to abuse (adjusted incidence rate ratio (aIRR) 0.6; 95% confidence interval (CI) 0.4 - 0.7), fluid burn (aIRR 0.6; 95% CI 0.6 - 0.7), foreign body ingestion (aIRR 0.7; 95% CI 0.7 - 0.9), and moderate and severe (v. minor) initial injury (aIRR 0.9; 95% CI 0.8 - 0.9 and aIRR 0.7; 95% CI 0.6 - 0.8, respectively), while boys were more likely to have repeat injury presentations (aIRR 1.4; 95% CI 1.4 - 1.5).
Repeat presentations were substantial and associated with male gender. They occurred less commonly after fluid burn injuries, foreign body ingestion and moderate to severe injuries. Children with intentional injuries were also less likely to have a repeat presentation. Further research is indicated for childhood injuries with greater propensity to repeat, including non-height falls and sport-related injuries. Secondary injury prevention education should not neglect patients with unintentional and minor injuries. These results strengthen the hypothesis that injuries arise as a result of sustained exposure to agent, host and environmental risk factors.
在发展中国家，伤害仍然是儿童发病和死亡的主要原因。伤害发生的概率受致伤因素、宿主因素和环境因素的影响。因此，对儿童重复伤害的研究可以深入了解导致儿童易受伤的流行病学三角中的因素。
确定南非开普敦红十字会战争纪念儿童医院创伤科（RCWMCH TU）因所有非交通相关伤害而再次就诊的儿童比例，以及与再次就诊相关的因素。
这是一项回顾性队列研究，使用了 RCWMCH TU 的数据。我们纳入了 1997 年 1 月至 2013 年 6 月期间首次就诊的年龄在 0-10 岁的儿童，并随访至 13 岁或 2016 年 6 月。我们使用多水平泊松回归分析评估与重复伤害相关的个体和人群水平因素。儿童抚养比源自 2011 年全国人口普查。
1997 年至 2013 年间，RCWMCH TU 首次收治了 72490 名年龄小于 10 岁（59%为男性）的儿童。在初次受伤后，到 2016 年且在 13 岁之前，有 9417 名（13%）儿童再次受伤。在调整卫生分区、距 RCWMCH TU 的距离和初次就诊年龄后，与重复就诊减少相关的因素包括：被认为是虐待所致的伤害（校正发病率比（aIRR）0.6；95%置信区间（CI）0.4-0.7）、液体烧伤（aIRR 0.6；95%CI 0.6-0.7）、异物吞食（aIRR 0.7；95%CI 0.7-0.9）以及中等和重度（与轻度相比）初次损伤（aIRR 0.9；95%CI 0.8-0.9 和 aIRR 0.7；95%CI 0.6-0.8），而男孩更有可能再次就诊（aIRR 1.4；95%CI 1.4-1.5）。
重复就诊的情况较为普遍，与男性有关。液体烧伤、异物吞食和中重度损伤后，重复就诊的可能性较小。被认为是故意伤害的儿童也不太可能再次就诊。需要进一步研究更易重复受伤的儿童伤害，包括非高处坠落伤和与运动相关的伤害。二级伤害预防教育不应忽视非故意伤害和轻度伤害的患者。这些结果进一步证实了这样一种假设，即伤害是由于持续暴露于致伤因素、宿主因素和环境因素所致。
