Abstract
Background:
Trauma can be categorized based on the characteristics of its cause into penetrating, blunt, thermal, or compressive trauma. Another type of classification is based on anatomical location, as trauma may occur at any anatomical site of the body.Objectives:
This study aimed to determine the epidemiology of neurosurgical and orthopedic trauma among children in the city of Ilam.Methods:
In this retrospective study, the health records of all patients aged 6 to 18 years with orthopedic and neurosurgical trauma who were referred to the hospital in Ilam were investigated. Since Imam Khomeini Hospital is the only public hospital for trauma patients in this city, only the records of patients who were referred to this hospital were reviewed.Results:
Results showed that in the neurosurgical trauma group, out of 145 reviewed cases, 96 (66.2%) patients were male and 49 (33.8%) were female. In relation to orthopedic traumas, out of 570 investigated cases, 386 (67.7%) were male and 184 (32.2%) were female. Additionally, results showed that 224 (39.3%) patients had fractures in the right hand, 255 (44.7%) had fractures in the left hand, and 91 (16%) had fractures in both hands. Furthermore, 21 (14.5%) patients had cervical spine injuries, 35 (24.1%) had thoracic spine injuries, 54 (37.2%) had lumbar spine injuries, and 35 (24.1%) had brain trauma.Conclusions:
In the present study, the epidemiology of neurosurgical and orthopedic trauma in children was investigated. Given the prevalence of these types of trauma in Ilam, it is necessary to provide essential training to prevent or reduce their occurrence in the future.Keywords
1. Background
Human health is threatened by various factors, including acute and chronic diseases as well as trauma. Trauma is the most common cause of mortality globally, with consequences such as loss of labor force leading to significant economic costs (1, 2). In Iran, trauma is one of the most common causes of death and is the leading cause of mortality among adolescents, resulting in disability and health-related economic damages (3, 4). In the pediatric group, trauma occurs due to various reasons such as falls (e.g., from stairs, heights), direct hits (blunt trauma), sports injuries, and different types of accidents involving vehicles, pedestrians, motorcycles, and bicycles (5).
Trauma can be categorized based on the characteristics of its cause into penetrating, blunt, thermal, or compressive trauma. Another classification is based on anatomical location, as trauma can occur at any anatomical site of the body (6). For example, the prevalence of head trauma in children across five continents was reported by Dewan et al. in 30 peer-reviewed papers, with a prevalence ranging from 47 to 280 per 100,000 children (7). Additionally, a study by Eslami et al. found that the prevalence of blunt trauma was 57%, with 36.9% of injuries due to firearms and 34% due to accidents (8).
The hand is an organ with complex anatomy, used in everyday activities, communication, labor, relationships, and emotional expression (9). It is the primary organ in business, with many work-related injuries occurring in the hands or arms (10). The hand is essential for performing motor skills and activities of daily living, coordinating and controlling body movements, and interacting with the external environment (11-13).
Hand trauma involves injuries to the fingers, hand, and wrist, which can cause serious physical and psychological complications for a child. As children are considered the future labor force, traumatic injuries that reduce a child's performance can affect all aspects of their life, including mental, physical, and economic conditions. This imposes significant costs on society and hinders the economic progress of the country (14-16).
2. Objectives
Hand trauma is significant in all age groups, especially in children, as it can lead to various complications later in life. Therefore, this study aimed to determine the epidemiology of neurosurgical and orthopedic trauma among children in the city of Ilam.
3. Methods
In this retrospective study, the health records of all patients aged 6 to 18 years with orthopedic and neurosurgical trauma who were referred to the hospital in Ilam were investigated. Considering that Imam Khomeini Hospital is the only public hospital for trauma patients in this city, only the records of the patients referred to this hospital were reviewed.
The ethics code IR.MEDILAM.REC.1402.022 was obtained for this study. Researchers assessed the health records of the patients, and those who met the inclusion criteria were enrolled in the study. The inclusion criteria were ages between 6 and 18 years and a definitive diagnosis of orthopedic trauma and neurosurgery based on anatomical conditions caused by injury. Patients with incomplete records and insufficient information were excluded from the study.
The study tools included a researcher-made checklist that collected data on the patient's age, living place (rural vs. urban), anatomical position of the injured hand, location of injury, medical imaging, product, season in which the injury occurred, presence or absence of fracture, whether the patient received emergency procedures, diagnosis, destination, and transfer mode of the patient. For neurosurgical trauma, factors such as the location of injury (cervical spine, thoracic spine, lumbar spine, brain) and CT scan results including intracerebral contusion, epidural hematoma (EDH), intraventricular hemorrhage (IVH), traumatic subarachnoid hemorrhage (TSAH), and traumatic acute subdural hematoma (ASDH) were investigated. The checklist was completed by studying the patients' health records.
When reviewing the patients' records, principles of research ethics including trustworthiness and protecting the confidentiality of the information in health records were maintained. Additionally, only the general aspects of the data were reported, and the guidelines of the university on ethics in research were observed. The data was analyzed using SPSS software version 16.
4. Results
Table 1 shows the demographic characteristics of the patients. According to the findings, in the neurosurgical trauma group, out of 145 reviewed cases, 96 (66.2%) of the patients were male and 49 (33.8%) were female. Regarding orthopedic traumas, out of 570 investigated cases, 386 (67.7%) were male and 184 (32.2%) were female (Table 1).
Demographic Characteristics of the Research Patients a
| Variables | Orthopedic Fractures | Neuroscience Fractures | ||||
|---|---|---|---|---|---|---|
| Boy | Girls | Total | Boy | Girls | Total | |
| Location | ||||||
| City | 290 (75.1) | 102 (55.4) | 386 (67.6) | 57 (59.4) | 31 (63.3) | 88 (60.7) |
| Village | 96 (24.9) | 82 (44.6) | 184 (31.2) | 39 (40.6) | 18 (36.7) | 57 (39.3) |
| Location | ||||||
| Sports | 167 (43.3) | 46 (25) | 213 (37.4) | 37 (38.5) | 24 (49) | 61 (42.1) |
| Home | 61 (15.8) | 33 (17.9) | 94 (16.5) | 14 (14.6) | 1 (2) | 15 (10.3) |
| School | 96 (24.9) | 56 (30.4) | 152 (26.7) | 12 (12.5) | 3 (6.1) | 15 (10.3) |
| Street or highway | 55 (14.2) | 36 (19.6) | 91 (16) | 31 (32.3) | 21 (42.9) | 52 (35.9) |
| Other public property | 7 (1.8) | 13 (7.1) | 20 (3.5) | 2 (2.1) | 0 (0) | 2 (1.4) |
| Medical imaging | ||||||
| X-ray | 253 (65.5) | 170 (92.4) | 423 (74.2) | 1 (1) | 2 (4.1) | 3 (2.1) |
| Computed tomography | 114 (29.5) | 7 (3.8) | 121 (21.2) | 80 (83.3) | 41 (83.7) | 121 (83.4) |
| Both | 19 (4.9) | 7 (3.8) | 26 (4.6) | 15 (15.6) | 6 (12.2) | 21 (14.5) |
| Product | ||||||
| Bicycles | 168 (43.5) | 31 (16.8) | 199 (34.9) | 22 (22.9) | 6 (12.2) | 28 (19.3) |
| Sport injuries | 60 (15.5) | 78 (42.4) | 138 (24.2) | 25 (26) | 16 (32.7) | 41 (28.3) |
| Stairs | 81 (21) | 44 (23.9) | 125 (21.9) | 34 (35.4) | 15 (30.6) | 49 (33.8) |
| Driving accidents | 59 (15.3) | 29 (15.8) | 88 (15.4) | 12 (12.5) | 11 (22.4) | 23 (15.9) |
| other | 18 (4.7) | 2 (1.1) | 20 (3.5) | 3 (3.1) | 1 (2) | 4 (2.8) |
| Age (y) | ||||||
| 5 - 7 | 97 (25.1) | 56 (30.4) | 153 (26.8) | 20 (20.8) | 12 (24.5) | 32 (22.1) |
| 7 - 12 | 183 (47.4) | 82 (44.6) | 265 (46.5) | 24 (25) | 19 (38.8) | 43 (29.7) |
| 12 - 18 | 106 (27.5) | 46 (25) | 152 (26.7) | 52 (54.2) | 18 (36.7) | 70 (48.3) |
| Season | ||||||
| Spring | 74 (19.2) | 9 (4.9) | 83 (14.6) | 31 (32.3) | 13 (216.5) | 44 (30.3) |
| Summer | 160 (41.5) | 74 (40.2) | 234 (41.1) | 17 (17.7) | 13 (26.5) | 30 (20.7) |
| Autumn | 123 (31.9) | 74 (40.2) | 197 (34.6) | 27 (28.1) | 18 (36.7) | 45 (31) |
| Winter | 29 (7.5) | 27 (14.7) | 56 (9.8) | 21 (21.9) | 5 (10.2) | 26 (17.9) |
| Follow-up treatment post discharge | ||||||
| Yes | 132 (34.2) | 64 (34.8) | 196 (34.4) | 65 (67.7) | 25 (51) | 90 (62.1) |
| No | 254 (65.8) | 120 (65.2) | 374 (65.6) | 31 (32.3) | 24 (49) | 55 (37.9) |
| Destination | ||||||
| Discharge by personal consent | 253 (65.5) | 121 (65.8) | 374 (65.6) | 43 (44.8) | 28 (57.1) | 71 (49) |
| Dispatch to other centers | 68 (17.6) | 36 (19.6) | 104 (18.2) | 36 (37.5) | 13 (26.5) | 49 (33.8) |
| Hospitalization | 65 (16.8) | 27 (14.7) | 92 (16.1) | 17 (17.7) | 8 (16.3) | 25 (17.2) |
| How to transfer the patient | ||||||
| Ambulance (land or air) | 45 (11.7) | 31 (16.8) | 76 (13.3) | 84 (87.5) | 125 (86.2) | |
| Non-ambulance | 330 (85.5) | 153 (83.2) | 483 (84.7) | 0 (0) | 0 (0) | 0 (0) |
| Unknown | 11 (2.8) | 0 (0) | 11 (1.9) | 0 (0) | 0 (0) | 0 (0) |
The results in Table 2 showed that 224 (39.3%) patients had fractures in the right hand, 255 (44.7%) had fractures in the left hand, and 91 (16%) had fractures in both hands.
Prevalence of Orthopedic Traumas in Children According to Trauma Characteristics a
| Variables | Boy | Girls | Total |
|---|---|---|---|
| Injured hand | |||
| Right | 129 (33.4) | 95 (51.6) | 224 (39.3) |
| Left | 197 (51) | 58 (31.5) | 255 (44.7) |
| Both | 60 (15.5) | 31 (16.8) | 91 (16) |
| Diagnosis | |||
| Metacarpal fracture | 40 (10.4) | 33 (17.9) | 73 (12.8) |
| Long finger fracture | 65 (16.8) | 32 (17.4) | 97 (17) |
| Hand contusion | 93 (24.1) | 35 (19) | 128 (22.5) |
| Finger contusion | 82 (21.2) | 37 (20.1) | 119 (20.9) |
| Wrist sprain | 88 (22.8) | 25 (13.6) | 113 (19.8) |
| Wrist contusion | 14 (3.6) | 11 (6) | 25 (4.4) |
| Finger sprain | 4 (1) | 8 (4.3) | 12 (2.1) |
| Other diagnosis | 0 (0) | 3 (1.6) | 3 (0.5) |
The results in Table 3 showed that 21 (14.5%) patients had cervical spine injuries, 35 (24.1%) had thoracic spine injuries, 54 (37.2%) had lumbar spine injuries, and 35 (24.1%) had brain trauma.
Prevalence of Types of Neurosurgical Traumas in Children According to Trauma Characteristics a
| Variables | Boy | Girls | Total |
|---|---|---|---|
| Level of the injury | |||
| Cervical spine | 12 (12.5) | 9 (18.4) | 21 (14.5) |
| Thoracic spine | 20 (20.8) | 15 (30.6) | 35 (24.1) |
| Lumbar spine | 37 (38.5) | 17 (34.7) | 54 (37.2) |
| Brain | 27 (28.1) | 8 (16.3) | 35 (24.1) |
| CT findings for brain injury | |||
| Intracerebral contusion | 9 (33.3) | 2 (25) | 11 (31.4) |
| EDH epidural hematoma | 5 (18.5) | 1 (12.5) | 6 (17.1) |
| IVH Intraventricular hemorrhage OR tSAH Traumatic subarachnoid hemorrhage | 5 (18.5) | 0 (0) | 5 (14.3) |
| ASDH acute subdural hematoma | 8 (29.6) | 5 (62.5) | 13 (37.1) |
5. Discussion
Trauma injuries are among the most significant challenges for healthcare systems worldwide and are a major factor in reducing patients’ quality of life. Trauma is also considered one of the leading causes of death and social health problems (17). In childhood, injuries account for about 10% of all illnesses globally, with 84% being unintentional. The most prevalent type of injury in children is brain-associated injuries (18, 19).
In a retrospective study conducted by Nikdel et al. in the city of Urmia, trauma patients with an average age of 30 years were examined over a 6-month period. The prevalence of trauma in upper and lower extremities was 28.7% (5097 people), multiple injuries accounted for 27.3% (4863), spine injuries 21.2% (3778), head, face, and soft tissue of the neck injuries 13.8% (2451), and abdomen and pelvis injuries 9% (1602) (20).
Various studies have been conducted on trauma in patients aged 0 to 18 years in Iran. In a meta-analysis by Shokri et al., the prevalence of trauma at birth in Iran was 2.7% (95% CI [1.3 - 5.3]) (21). Other studies have focused on different age groups. For instance, Sadeghi and Mohammadi reported a prevalence of trauma at 26.2% (95% CI [14.4 - 29.2]) (22), and a meta-analysis by Maleki et al. in Iran found the prevalence of traumatic spinal cord injury (TSCI) to be 3 per 10,000 people, with a mean mortality rate of 3.9% (23).
In the study by Sharma et al., the prevalence of orthopedic trauma was 37.8% (299), head trauma 24.7% (192), burn-related trauma 15.17% (120), abdomen trauma 7.83% (62), and chest trauma 2.78% (22) (24). In the study by Singh et al., the prevalence of upper extremity injuries in the age group of 0 to 5 years was 50.9%, and in the age group of 6 to 15 years, it was 47.42%. The most common types of injuries in this study included pelvic and lower limb injuries. Complete spinal cord injuries were reported in a very small number of cases, with a rate of 2.9% for the age group of 0 to 5 years and 4.8% for the age group of 6 to 15 years (25).
5.1. Conclusions
In the present study, the epidemiology of neurosurgical and orthopedic trauma in children was investigated. Given the prevalence of these types of trauma in Ilam, it is necessary to provide essential training to prevent or reduce their occurrence in the future.
References
-
1.
Oakley LD, Kuo WC, Kowalkowski JA, Park W. Meta-Analysis of Cultural Influences in Trauma Exposure and PTSD Prevalence Rates. J Transcult Nurs. 2021;32(4):412-24. [PubMed ID: 33593236]. https://doi.org/10.1177/1043659621993909.
-
2.
Thumfart KM, Jawaid A, Bright K, Flachsmann M, Mansuy IM. Epigenetics of childhood trauma: Long term sequelae and potential for treatment. Neurosci Biobehav Rev. 2022;132:1049-66. [PubMed ID: 34742726]. https://doi.org/10.1016/j.neubiorev.2021.10.042.
-
3.
Raulli SJ, Schneider AB, Gallaher J, Motta F, Parodi E, Farber MA, et al. Trends and Outcomes in Management of Thoracic Aortic Injury in Children, Adolescent, and Mature Pediatric Patients Using Data from the National Trauma Data Bank. Ann Vasc Surg. 2023;89:190-9. [PubMed ID: 36210605]. https://doi.org/10.1016/j.avsg.2022.09.034.
-
4.
Blum B. Gender, Attachment Patterns, and Mental Representations of Gender, Attachment Patterns, and Mental Representations of Parents and Self as Predictors of Early Adolescents’ Trauma Symptoms [dissertation]. New York, USA: Long Island University; 2022.
-
5.
Aghakhani K, Ameri E, Ameri M, Mohtarami SA. [Epidemiology of orthopedic trauma in children and adolescent in a referral center in Tehran: a prospective study]. Tehran Uni Med J. 2015;73(1):40-8. Persian.
-
6.
Mobaleghi J, Yaghoobi Notash A, Yaghoobi Notash A, Ahmadi Amoli H, Borna L, Yaghoobi Notash A. [Evaluation of trauma patterns and their related factors in Besat Hospital in Sanandaj in 2012]. Sci J Kurdistan Univ Med Sci. 2014;19(1):99-107. Persian. https://doi.org/10.22102/19.1.99.
-
7.
Dewan MC, Mummareddy N, Wellons J3, Bonfield CM. Epidemiology of Global Pediatric Traumatic Brain Injury: Qualitative Review. World Neurosurg. 2016;91:497-509 e1. [PubMed ID: 27018009]. https://doi.org/10.1016/j.wneu.2016.03.045.
-
8.
Eslami MH, Saadeddin ZM, Rybin DV, Avgerinos ED, Eslami PW, Siracuse JJ, et al. Trends and Outcomes of Pediatric Vascular Injuries in the United States: An Analysis of the National Trauma Data Bank. Ann Vasc Surg. 2019;56:52-61. [PubMed ID: 30476614]. https://doi.org/10.1016/j.avsg.2018.09.006.
-
9.
Trybus M, Lorkowski J, Brongel L, Hladki W. Causes and consequences of hand injuries. Am J Surg. 2006;192(1):52-7. [PubMed ID: 16769275]. https://doi.org/10.1016/j.amjsurg.2005.10.055.
-
10.
Luria S, Talmud D, Volk I, Liebergall M, Calderon-Margalit R. The epidemiology of wrist and hand injury in two hospitals in Jerusalem: substantial differences between population subgroups. Isr J Health Policy Res. 2019;8(1):7. [PubMed ID: 30626435]. [PubMed Central ID: PMC6327559]. https://doi.org/10.1186/s13584-018-0278-0.
-
11.
Kus S, van de Ven-Stevens LA, Coenen M, Berno S, Kollerits B, Cieza A. What is our knowledge of functioning and disability in hand conditions based on? Arch Phys Med Rehabil. 2011;92(8):1326-32. [PubMed ID: 21658678]. https://doi.org/10.1016/j.apmr.2011.02.009.
-
12.
Alphonsus CK. Principles in the management of a mangled hand. Indian J Plast Surg. 2011;44(2):219-26. [PubMed ID: 22022032]. [PubMed Central ID: PMC3193634]. https://doi.org/10.4103/0970-0358.85343.
-
13.
Moellhoff N, Throner V, Frank K, Benne A, Coenen M, Giunta RE, et al. Epidemiology of hand injuries that presented to a tertiary care facility in Germany: a study including 435 patients. Arch Orthop Trauma Surg. 2023;143(3):1715-24. [PubMed ID: 36138241]. [PubMed Central ID: PMC9958136]. https://doi.org/10.1007/s00402-022-04617-9.
-
14.
de Putter CE, Selles RW, Polinder S, Panneman MJ, Hovius SE, van Beeck EF. Economic impact of hand and wrist injuries: health-care costs and productivity costs in a population-based study. J Bone Joint Surg Am. 2012;94(9). e56. [PubMed ID: 22552678]. https://doi.org/10.2106/JBJS.K.00561.
-
15.
Nakaniida A, Sakuraba K, Hurwitz EL. Pediatric orthopaedic injuries requiring hospitalization: epidemiology and economics. J Orthop Trauma. 2014;28(3):167-72. [PubMed ID: 23681411]. https://doi.org/10.1097/BOT.0b013e318299cd20.
-
16.
de Jong JP, Nguyen JT, Sonnema AJ, Nguyen EC, Amadio PC, Moran SL. The incidence of acute traumatic tendon injuries in the hand and wrist: a 10-year population-based study. Clin Orthop Surg. 2014;6(2):196-202. [PubMed ID: 24900902]. [PubMed Central ID: PMC4040381]. https://doi.org/10.4055/cios.2014.6.2.196.
-
17.
Esmaeilzadeh MH, Mogharab M, Hosseini SMR, Bazeli J, Zamani A. [Effect of pre-hospital trauma management training program on the capability of clinical decision-making in emergency medical technicians]. Journal of Hayat. 2019;25(2):168-78. Persian.
-
18.
Barcenas LK, Appenteng R, Sakita F, O'Leary P, Rice H, Mmbaga BT, et al. The epidemiology of pediatric traumatic brain injury presenting at a referral center in Moshi, Tanzania. PLoS One. 2022;17(10). e0273991. [PubMed ID: 36197935]. [PubMed Central ID: PMC9534435]. https://doi.org/10.1371/journal.pone.0273991.
-
19.
World Health Organization. Children's health and the environment: a global perspective-a resource manual for the health sector. Geneva, Switzerland: World Health Organization; 2005.
-
20.
Nikdel R, Pakzad S, Mahmoudlo R. Examining the Frequency of Trauma Types in Patients Referred to Hospital Emergency Room. Studies in Medical Sciences. 2023;34(6):353-60. https://doi.org/10.61186/umj.34.6.353.
-
21.
Shokri M, Nayyeri S, Salimi N, Nourmohammadi A, Tarjoman A, Borji M, et al. Prevalence of Neonatal Birth Trauma in Iran: a Systematic Review and Meta-Analysis. Int J Pediatr. 2021;9(10):14520-31.
-
22.
Sadeghi S, Mohammadi HR. Prevalence of Head Trauma in Iran: A Systematic Review and Meta-analysis. Arch Neurosci. 2023;10(2). e134291. https://doi.org/10.5812/ans-134291.
-
23.
Saheban Maleki M, Khedri B, Ebrahimpour Roodposhti M, Askari Majdabadi H, Seyedrezaei SO, Amanat N, et al. Epidemiology of Traumatic Spinal Cord Injuries in Iran; a Systematic Review and Meta-Analysis. Arch Acad Emerg Med. 2022;10(1). e80. [PubMed ID: 36426164]. [PubMed Central ID: PMC9676708]. https://doi.org/10.22037/aaem.v10i1.1720.
-
24.
Sharma M, Lahoti BK, Khandelwal G, Mathur RK, Sharma SS, Laddha A. Epidemiological trends of pediatric trauma: A single-center study of 791 patients. J Indian Assoc Pediatr Surg. 2011;16(3):88-92. [PubMed ID: 21897566]. [PubMed Central ID: PMC3160060]. https://doi.org/10.4103/0971-9261.83484.
-
25.
Singh O, Gupta S, Din Darokhan MAU, Ahmad S, Charak SS, Sen A. Epidemiology of Pediatric Musculoskeletal Injuries and Their Pattern in a Tertiary Care Center of North India. Indian J Orthop. 2018;52(5):449-53. [PubMed ID: 30237601]. [PubMed Central ID: PMC6142803]. https://doi.org/10.4103/ortho.IJOrtho_516_17.