• No results found

ARE HOME ACCIDENTS IN CHILDREN PREVENTABLE?

N/A
N/A
Protected

Academic year: 2020

Share "ARE HOME ACCIDENTS IN CHILDREN PREVENTABLE?"

Copied!
10
0
0

Loading.... (view fulltext now)

Full text

(1)

ARE HOME ACCIDENTS IN CHILDREN PREVENTABLE?

Study

of 491 Cases

By JAMEs M. DENNIS, M.D.,* AND ALBERT D. KAISER, M.D.

Rochester, N.Y.

I

N THIS age of antibiotics and improved

public health practices, when a number

of infectious diseases have been reduced as

causes of illness and death in children and

adults alike, it is difficult to

overempha-size the importance of accidents in the

pedi-atric age range. Accidents have become the

leading cause of death in the age group of

1 through 14 years, killing more children

than the next six leading causes of death

combined. About two million child

acci-dents requiring medical aid occur in the

United States yearly.1

Home accidents in general are an

im-portant part of the total accident situation.

They are responsible for more than 30,000

deaths annually, and injure about 5 million

persons; the ratio of fatal to nonfatal

acci-dents being about 1 to 150.2

This survey was undertaken by the

Roch-ester Health Bureau in recognition of the

need for further study of nonfatal childhood

accidents in the home, an area with which

the Health Bureau, through the Public

Health Nurses and its health education

pro-gram, is intimately concerned. One purpose

was to determine and analyze the factors

involved in these accidents. A further

ob-jective was to attempt to decide what

pro-portion might have been prevented, and

what measures of prevention are most

ap-plicable and would yield the best results.

Studies by Prothro in Kalamazoo and

Rob-erts in Massachusetts have demonstrated

that local health bureaus can be effective

From the Rochester Health Bureau, in

coopera-tion with the Department of Pediatrics of the

Uni-versity of Rochester School of Medicine and

Dentistry, Rochester, N.Y.

(Received for publication Dec. 19, 1953.)

#{176}Rotating Inteme, Genesee Hospital, Rochester,

N.Y.

not only in the study of accidents in the

community, but also in their

METHOD

The period covered in this report is from

July 1, 1952 to May 1, 1953. The cooperation

of the 7 Rochester hospitals-Strong Memorial,

Municipal, Genesee, General, St. Mary’s,

Highland and Park Avenue-was obtained.

Small accident report cards were distributed

to the Emergency Rooms of the hospitals, to

be completed on all nonfatal accident cases

admitted, with the exception of traffic and

in-dustnial accidents. These cards gave brief

per-sonal information on the person injured, along

with the place, time, and nature of injury, and

a brief description of the accident.

Those cases involving persons under 19 yr.,

which occurred in the home or yard, and which

appeared likely to meet the definition of an

accident described by the National Safety

Council; that is, “any injury which causes an

interruption of normal activity for a period of

at least 24 hours,” were given to the Public

Health Nurses of the Bureau for further

in-vestigation. The nurses, and in some cases the

authors, went into the individual homes, and

using a longer form prepared for the purpose,

completed the information on each accident.

This form had 2 main parts; a written

descrip-tion of the accident, and a check list

subdi-vided under 8 headings, to insure uniformity

and completeness of recording. These

sub-divisions included location of the accident,

action of injured, type of accident, objects

in-volved, nature of injury, part of body injured,

and mechanical and personal factors involved.

Those cases which did not appear to constitute

an accident were then discarded.

Before tabulation, each case was evaluated

as to its preventability, using a group of

arbitrary criteria which will be discussed later.

The 2 groups, preventable and nonpreventable,

were then analyzed separately, to bring out

(2)

0-4

CHART 1. Age-Sex Relationship in Childhood Home Accidents in Series of 491 Nonfatal Cases

in Rochester, N.Y., in 1952-53. YEARS

15-18 \SSISIN

5-14

FEMALE

MALE

+ I I I

25 50 75 100 125

NUMBER OF ACCIDENTS

I-150 175

were made of age, sex, time of day and week,

significant factors present in the household,

and of the 8 subdivisions mentioned above.

The most obvious limitation of this approach

is that the group is not necessarily

representa-tive. Injured children who were treated at

home or by a private physician were not

in-eluded, because of the difficulty of getting

re-ports in these cases. The use of hospital

emergency rooms as a source tends to include

more persons of a low economic level, but at

the same time acts as a screen to eliminate

many minor incidents.

RESULTS

During the 10 month period covered by

this survey, a total of 491 nonfatal home

accidents involving children was collected

from the emergency room admissions of the

Rochester hospitals, and each one

com-pletely investigated. These form the

sub-stance of this report.

The age distribution and the relationship

to sex are shown in chart 1. Over half of the

accidents occurred in children under 5

years, and most of the remainder under 15

years. Boys outnumbered girls consistently,

taking the lead in all age groups.

Table 1 shows the time of occurrence of

accidents by day and by period of the day.

The ratio of weekday to weekend

acci-dents is not very different from that of the

number of days involved, indicating only

a slight increase on weekends, when

logi-cally they might be expected to go up. The

afternoon was the most dangerous time of

day, followed by the waking hours of the

evening. The sleeping hours were quite but

not entirely safe, and morning was only a

moderately hazardous period.

While inside the house children got into

trouble most often in the kitchen, but the

porch and yard were a source of even more

accidents, these two localities accounting

for more than half of the cases (chart 2).

The remainder of the accidents were spread

quite widely, with such supposedly

dan-gerous areas as bathroom and stairs

appear-ing relatively harmless.

TABLE 1

OCCURRENCE OF HOME ACCIDENTS BY DAY OR WEEK

AND PERIODS OF DAY, IN SERIES OF 491

NoN-FATAL CASES INVOLVING CHILDREN

No. of

cases

Per cent of total

Weekday Weekend

347 144

71% 29

6-12 noon 93 19

12 noon-6 p.m. 201 41 6-10 p.m.

10 p.m.-6 am. Unknown

157 23

17

32 4.7

(3)

Cl)

I-z w 9 .150

0 U

KITCHEN

O .100 QbWRS OTHER

SLEEPING QUARTER%TJRS

IlK

STEPS

CHART 2. Location of Childhood Home Accidents in Series of 491 Nonfatal Cases

in Rochester, N.Y., in 1952-53.

OTHER

570 JAMES M. DENNIS AND ALBERT D. KAISER

CHART 3. Types of Childhood Home Accidents in Series of 491 Nonfatal Cases

in Rochester, N.Y., in 1952-53.

PORCH AND YARD

Table 2 shows the activity of the child at

the time of injury. As might be expected

from a group consisting largely of young

children, more than half were hurt at play.

A much lesser number were injured while

walking or running. The “other” category

includes a diversity of things, such as

house-work, sleeping, climbing, bike riding, etc.

The relative frequency of the different

types of accidents is shown in chart 3. Falls,

as is usually the case, led all the rest, almost

half of the cases being of this type.

Han-dling objects and being struck by objects

POISONING

BURN

were the next most common types, with

stepping on objects, burns and poisoning

fol-lowing iii that order. Accidents involving

stepping are of note in that in more than two

thirds of these cases the object was a nail,

something which can usually be readily

re-moved. Poisons included turpentine, aspirin,

mothballs, phenol, brake fluid, arsenic,

ex-lax#{174}and a number of others. Most of the

burns were scalds from hot liquids spilled on

or by the child, often coffee or tea.

The objects involved were notable chiefly

by their variety (table 3). Household

fur-2

STEPPING ON OBJECT

STRUCK BY OBJECT

HANDLING OBJECT

FALL ON LEVEL

FALL FROM

(4)

TABLE 2

ACTIVITY AT TIME OF HOME ACCIDENTS, IN

SERIES OF 491 NONFATAL CASES INVOLVING CHILDREN

TABLE 3

OBJECTS INVOLVED IN hOME A(’CII)ENTS IN SERIES

OF 491 CASES IN CHILDREN

I

OTHER

No. of

cases

Per cent of

total

Playing 269 55%

Running 63 13

Walking 61 1

Other 98 0

nishings, actually a broad category, were

most often at fault, with broken glass

sec-ond but much less frequent. Drugs, nails,

tools, and hot liquids figured in a smaller

number of cases. Many other objects were

too varied to be grouped, and included such

things as fences, swings, golf clubs, stones,

ladders, etc.

The nature of the injuries sustained is

indicated in table 4. Cuts, lacerations and

abrasions were far and away the most

com-mon injury, occurring in half the accidents;

while fractures and dislocations were next

in incidence. Bruises and contusions, and

No. of cases

Per cent of total

Household furnishings and

equipment 108 22%

Broken glass 39 8

Drugs and chemicals 32 7

Nails 26 5

Tools and sharp objects 22 5

Hot liquids 18 4

Toys 13 3

Utensils 13 3

Slippery surface 13 3

Wheeled vehicles (bike,

strol-ler, etc.) 16 3

Other 116 23

None 75 14

burns were somewhat less common; with

poisoning, puncture wounds, and foreign

body making up most of the remainder.

The head was the part of the body most

often injured (37%), probably because of the

large number of falls and the awkwardness

DISORDER

I1M0R

USE

OF EQUIPMENT

I

IMPROPER EQUIPMENT

I

HOUSE NEEDING REPAIR

510 100 IO

2b0

2O

NUMBER

OF

ACCIDENTS

I

NONE

360

(5)

CHART 5. Personal Factors in Childhood Home Accidents in Series of 491 Nonfatal Cases in Rochester, N.Y., in 1952-53.

TABLE 4

NATURE OF INJURY IN HOME ACCIDENTS, IN SERIES

OF 491 CASES INVOLVING ChILDREN

No. of Per cent

occurrences of total

Cuts, lacerations and al)rasions 256 52%

Fracture and dislocation 72 15

Bruises and contusions 55 11

Burns 47 10

Poison 24 5

Puncture wounds 22 4

Foreign bo(ly 22 4

Other 13 3

of small children. Heads and arms were

each injured in about 17% of cases. Other

important areas were feet and toes, with

11%, and legs, with 8%. Injuries to the eye

occurred in only 15 cases.

Mechanical factors did not appear to be

involved in more than half of the accidents,

a surprising finding (chart 4). Disorder was

the most common factor, and usually meant

something out of place, as a nail on the

FATIGUE

EMOTIONAL

floor, broken glass in the yard, or poison

in an open drawer. Improper use of

equip-ment was a fairly common matter. Other

factors were of minor importance.

The personal factors at work are shown

in chart 5. An adult was thought to be at

fault in half of the cases, a critical factor in

prevention of childhood accidents. Hurry

and lack of knowledge were of secondary

importance, and other factors relatively

un-important. The emotional factor was the

most difficult to define, and was most

fre-quently applied to the “behavior problem”

-an unruly or disobedient child. No

per-sonal factor was apparent in a full third of

the cases.

Other factors which seemed to have a

bearing upon the accident were present in

about 13% of cases. Those were varied, and

included such things as: mother working

(15 cases), illness in family (9 cases), new

baby (7 cases), and a general upset of the

household occasioned by visitors or moving

to a new home (8 cases).

NONE

APPARENT

LACK

OF KNOWLEDGE

HURRY

CHILD

I

(6)

119 143

Ii 109

15 13 6

38 6 5 41%

51

4

4

TABLE 5

APPLICABILITY OF CRITERIA OF ACCIDENT PREVENTION, IN

SERIES OF 491 CASES INVOLVING ChILDREN

1. l)ue supervision by adult or older child 2. Use of reasonable precautions against accidents

a. Removal of dangerous objects b. Repair of home

d. Use of protective devices e. Other

3. Legal action on governmental level(as stricter dog laws)

4. Other (adequate housing, playgrounds or nurseries, medical therapy for illness

or disability, fire inspection, improved design of home or manufactured

product.) ii

No. of Per cent

cases of total

PREVENTABILITY

Each accident was evaluated as to its

preventability, on the basis of the criteria

listed in table 5. Two hundred and

eighty-four cases, or 58%, were considered to be

definitely preventable. This is far short of

the theoretic ideal of 100%, but is still

sub-stantial enough to be encouraging. It is

apparent that two methods-due

super-vision and reasonable precautions-were by

far the most pertinent, being applicable in

41% and 51% of the cases, respectively.

Under “Precautions,” the removal of a

dangerous object from the reach of a child

would have been most effective, and repair

of the home and the installation of

pro-tective devices considerably less so.

The comparative tabulation of

prevent-able and nonpreventable accidents revealed

a number of differences in the two groups.

The children who had nonpreventable

ac-cidents tended to be older, since more than

half of these were over 5 years; while more

than half of the other group were under 5

years. As to type of accident, burns,

poison-ing and stepping on objects were much

more common in the preventable group, as

were the corresponding types of injury;

while falls were appreciably more frequent

in nonpreventable accidents, and fractures

and dislocations a more common injury.

Similarly, glass, nails, hot liquids and

poi-sons were objects much more in evidence

in preventable accidents. This group was

also much more prone to involve mechanical

and personal factors, with disorder and

adult fault outstanding.

DIscussIoN

It might appear that in theory most

acci-dents are preventable, that the phrase, “It

was just an accident,” is self-contradictory. But the practical considerations of everyday

living in the home are such that children

cannot always be adequately supervised,

that not all potentially dangerous situations

anticipated; nor can all actions of an

ac-tively curious child be predicted. However,

much can readily be done to reduce home

accidents, and some of the findings of this

survey deserve consideration from this point

of view.

The age of a child has much to do with

the likelihood of his having an accident.

The younger the child, the more vulnerable

he is. Dietrich, in his discussion of a clinical

theory of accident prevention, emphasized

the need for total protection under one year,

with increasing use of education by the

parent as the child grows older.1 It also

seems that boys would bear watching more

than girls, since in both this and a recent

study by DeCrosse, boys were more prone

(7)

The importance of degree of activity and fatigue are reflected in the greater incidence

of accidents in the afternoon and evening, a

finding also confirmed by DeCrosse.5

Regu-lar rest periods for children may help them

to be safer.

The kitchen, where mother is usually

busy and dangerous objects abound; and

the yard, where close supervision is

diffi-cult, may be pinpointed as two particularlj

dangerous areas. Precautions with objects

and better supervision would make these

areas less hazardous.

There seems little to be gained from

re-vising the activities of children, since so

much of it is play. But the predominance of

falls, especially from a height, as a type of

accident, indicates the need for better

pro-tection in such places as bed, stairs and

steps, chairs and other furniture.

Although a wide variety of objects was

involved in this series, it is evident that

chil-dren can be protected from exposure to

several things which were responsible for

a considerable number of

accidents-namely, broken glass, nails, hot liquids and

poisons. Small children tend to gulp down

any substance which comes to hand, no

matter how distasteful it might seem to an

adult palate, and absolute protection seems

to be the only answer to the problem of

poisoning in this age group. This should

usually mean a lock and key-the lengths

to which a child will go to reach a

poison-ous substance are sometimes incredible.

The large number of cases in which an

adult was found to be at fault is a severe

indictment of the quality of parental care

-perhaps too severe, since this finding was

often a matter of judgment. It does

indi-cate, however, as DietricW has pointed out,

that the prevention of accidents in children

is largely an adult responsibility, not only of

parents but of physicians, health

depart-ments and other health agencies. It also

indicates the importance of education of

adults in furthering child safety. The

pin-pointing of dangerous locations, activities,

objects, types of accidents, and other

me-chanical and personal factors, as brought

out in this survey, enables the physician and

the nurse to give specific instruction in

ac-cident prevention to parents.

SUMMARY

A series of 491 nonfatal home accidents

involving children, occurring in a 10 month

period in the City of Rochester, New York,

is presented. These accidents were obtained

from hospital emergency rooms and

investi-gated by the authors and Public Health

Nurses. Of these 491 cases, 284, or 58%, were

judged to be preventable. Reasonable

super-vision by an adult, and the use of ordinary

precautions against accidents, were

out-standing as means of prevention. The

sta-tistically typical accident involved a boy

under the age of 5 years, who was playing

in the porch and yard in the afternoon, who

fell from a height and cut his head. No

mechanical factors were involved, and an

adult was at fault. Methods of prevention

of accidents are discussed.

ACKNOWLEDGMENTS

The authors are indebted to the following

persons and organizations for their advice

and cooperation:

The Public Health Nurses and Nursing

Supervisors of the Rochester Health

Bureau; the directors and emergency room

personnel of the Rochester Hospitals; and

to Mrs. Mary Karpiak Foster, Public Health

Educator; and Mr. Henry Lieberwurst,

Reg-istrar of Vital Statistics for the Health

Bureau.

REFERENCES

1. Dietrich, H. F., Clinical application of

theory of accident prevention in

child-hood, Am. J. Pub. Health 42 : 849, 1952.

2. Armstrong, D. B., Accident prevention, Pub.

Health Rep. 64:355, 1949.

3. Prothro, W. B., Home accident prevention

-research program, Am.

J.

Pub. Health

41 :954, 1951.

4. Roberts, H. L., Community surveys its home

accidents, Am. J. Pub. Health 41:1118,

1951.

5. DeCrosse, J. J., Study of 212 home

acci-dents, New England J. Med. 248:837,

(8)

202 Brooks Avenue

SPANISH ABSTRACT

Son Prevenibles los Accidentes de los

Ni#{241}osen el Hogar ?

En esta #{233}pocade antibi#{243}ticos y de aplicaci#{243}n

de m#{233}todos de salubridad piblica que han

reducido los padecimientos infecciosos y las

causas de enfermedad en ni#{241}osy adultos,

re-salta ya la importancia de los accidentes en los

ninos, al grado de haber alcanzado el primer

lugar como causa de muerte en ni#{241}osde 1 a 14

aflos, COn cifras que sobrepasan Ia suma de las

siguientes seis causas de mortalidad infantil.

Los accidentes fatales a domicilio han llegado

en los Estado Unidos a ser 30,000 anualmente

y afectado a 5,000,000 de gentes, con una

relaci#{243}n de lo fatal a lo no fatal de 1 a 150. En

este artIculo los autores estudian y analizan los

factores de accidentes en Rochester, N.Y., y

tratan de investigar el porcentaje que pudo

prevenirse asI como los m#{233}todosaplicables para

evitarlos con los mejores resultados. El perlodo

abarc#{243}del lo. de julio de 1952 al lo. de mayo

de 1953 y reuni#{243}un total de 491 accidentes

a domicillio no fatales. Los datos se obtuvieron

de los servicios de emergencia de hospitales y

se investigaron por el autor y enfermeras

sani-tarias.

La mitad de los aeeidentes se presentaron

en ni#{241}osmenores de cinco a#{241}os,del sexo

mas-eulino pereferentemente, predominando

escasa-mente en los fines de semana y dentro del dIa

en Ia tarde y al principio de Ia noche. Dentro

del hogar los accidentes ocurrieron con mayor

frecuencia en la cocina, y ya afuera, en el

portal y el patio. Generalmente sucedieron

mientras jugaban los ni#{241}os,en la mayorIa de

las veces al caer bruscamente, manejar objetos,

golpearse con ellos, siendo las quemaduras y

las intoxicaciones de menor incidencia. Los

objetos caseros comprendidos fueron

funda-mentalmente muebles de la casa, vidrios rotos,

clavos y lIquidos calientes. El tipo de Ia lesion

que predomin#{243} fueron cortaduras, heridas,

raspones, en Ia mitad de los casos; las fracturas

y las dislocaciones en segundo lugar. La cabeza

ocupO el primer lugar en las partes del cuerpo

lesionadas y en seguida fueron los brazos. El

factor mec#{225}nico que predispuso m#{225}sde la mitad de los accidentes fue el desorden, a saber,

mala colocaciOn de objetos, como clavos sobre

el suelo y vidrios rotos en el patio. Los factores

personales dependieron fundamentalmente de

personas adultas, es decir, el error que llevO al accidente en el ni#{241}ofue en general culpa de

Un sujeto maduro; la ignorancia y Ia

precipi-taci#{243}nen las personas fueron factores secun-darios, como lo fueron tambi#{233}nel que Ia madre

trabajara, que hubiera enfermedad en la

famiia, etc.

De los 491 casos analizados, 284, es decir

58%, fueron considerados francamente evitables

por una vigilancia correcta y precauciones

razonables de parte de la gente. Los accidentes no evitables fueron en ni#{241}osmayores, en m#{225}s de la mitad con m#{225}sde 5 aflos de edad; en cam-bio los evitables se presentaron en m#{225}sde Ia mitad de los casos en ni#{241}osmenores de 5 a#{241}os.

Del grupo evitable ocuparon el primer lugar

las quemaduras, las intoxicaciones y los

tropie-zos por objetos mal colocados; mientras que

las caIdas y sus concecuencias (fracturas y dis-locaciones) fueron apreciablemente m#{225}s fre-cuentes en accidentes no evitables.

De estas observaciones se deduce que la

frase “Fu#{233}un accidente,” no es aplicable en

todos los casos. Mucho puede hacerse para

re-ducir los accidentes caseros: debe considerarse

la edad de los ni#{241}ospues entre m#{225}sjdven m#{225}s

vulnerables se encuentran; el grado de

activi-dad y de fatiga para regularlos; vigilarse mejor las cocinas y los patios, proteger a los niflos de las caldas y de objetos vulnerables como vidrios rotos, clavos, alfileres, etc., y por iltimo, hacer

ver a los adultos que ellos son los responsables

(9)

1954;13;568

Pediatrics

JAMES M. DENNIS and ALBERT D. KAISER

ARE HOME ACCIDENTS IN CHILDREN PREVENTABLE?: Study of 491 Cases

Services

Updated Information &

http://pediatrics.aappublications.org/content/13/6/568

including high resolution figures, can be found at:

Permissions & Licensing

http://www.aappublications.org/site/misc/Permissions.xhtml

entirety can be found online at:

Information about reproducing this article in parts (figures, tables) or in its

Reprints

http://www.aappublications.org/site/misc/reprints.xhtml

(10)

1954;13;568

Pediatrics

JAMES M. DENNIS and ALBERT D. KAISER

ARE HOME ACCIDENTS IN CHILDREN PREVENTABLE?: Study of 491 Cases

http://pediatrics.aappublications.org/content/13/6/568

the World Wide Web at:

The online version of this article, along with updated information and services, is located on

American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

References

Related documents

In this spirit, the central objective of this study is to investigate the causal links between military expenditures and external debt for four emerging Northern

Test Execution Engine Formal Model Security Properties SUT Configuration Attack Trace Instrumentation Program Fragments Model Checking SUT Mapping Ad ap ter

dimensions (small business) and the sector of operations (high technology sector). A specific contribution was that the study was able to shed light on the

In addition, our analysis indicates that unemployment plays a statistically significant role in the increase in account utilization, i.e., an increase in the balance to line

The administration, intervention specialists, and teachers at the research site added an after-school and out-of-classroom intervention to serve the students receiving Tier 3 and

As school districts work within their professional development programs to move existing teachers toward 21 st century teaching and learning, similarly, pre-service teacher

Following the decomposition of the application architecture into TUs, application architects work with engineers and opera- tions experts to identify concrete components – or

These questions extend the current research as to how racial and gender diversity impacts governance, and allow this researcher to fill gaps in the existing literature by