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Inj Prev. 2007 August; 13(4): 288.
PMCID: PMC2598348

Splinters And Fragments

A recent study examined injury deaths by all causes to US children ages 4 and younger from 1981 through 2003. Although all racial groups showed improvements in unintentional injury rates, especially drowning, fire, motor vehicle occupant and pedestrian injuries, intentional injuries and unintentional suffocation rates did not show the same progress. Suffocation rates actually increased during the last 5 years of the study. Black and American Indian/Alaskan Native children continued to show higher mortality than white, Hispanic or Asian/Pacific Islander children. Pressley JC, Barlow B, Kendig T, et al. Twenty-year trends in fatal injuries to very young children: The persistence of racial disparities. Pediatrics 2007;119:e875–84.

Are US children receiving injury prevention counseling from their healthcare providers? A telephone survey (ICARIS‐2) of almost 10 000 households found that 42.4% of children had been counseled—unchanged from a similar survey in 1994, but now covering more topics. Children who had received counseling were also more likely to live in households where the poison control center telephone number was posted and were more likely to use bicycle helmets. It is not known whether the children who were counseled were being seen in the context of an injury‐related visit or a well child visit. Chen J, Kresnow M, Simon TR, et al. Injury-prevention counseling and behavior among US children: Results from the Second Injury Control and Risk Survey. Pediatrics 2007;119:e958–65.

Another article summarizing ICARIS‐2 data focuses on smoke detectors. Some 95% of the surveyed households reported at least one installed smoke alarm, and 52% had a plan in place to escape fires. But only 15% tested their alarms once a month, as recommended, and only 16% of homes with an escape plan reported practicing it every six months. Ballesteros MF, Kresnow M. Prevalence of Residential Smoke Alarms and Fire Escape Plans in the US: Results from the Second Injury Control and Risk Survey. Public Health Rep 2007;122:224–31.

The burden of injury has been assessed in six European countries: Austria, Denmark, Ireland, Netherlands, Norway and the United Kingdom. This article describes years prematurely lost, years lived with disability, and disability‐adjusted life years. In all countries, not surprisingly, young men (25–44 years) accounted for one third of the total injury burden. Permanent disability burden was primarily caused by spinal cord and brain injuries. Austria lost the most disability‐adjusted life years, whereas these were relatively low in the UK and Netherlands. The study examines the burden by age, gender, external cause, and country. Note that burns were excluded from this analysis. Polinder S, Meerding WJ, Mulder S, et al, EUROCOST Reference Group. Assessing the burden of injury in six European countries. Bull World Health Organ 2007;85:27–34.

Hip fractures are all too common among the elderly, increasing each year as the population ages, and causing significant mortality and disability. A study in Israel asked whether we can do a better job of identifying which patients are at high risk of hip fracture by diagnosing osteoporosis or previous fractures. Medical histories, x‐rays, and various lab results were obtained for 113 elderly hip fracture patients. The authors found that about one‐third of their patients may have been missed using the current assessment criteria. They suggest that other factors might also be assessed including vitamin D status, diabetes, and coronary artery disease that may increase the likelihood of falls. Segal E, Zinman C, Raz B, et al. Current criteria for hip fracture risk assessment - Are we missing something? Israel Isr Med Assoc J 2007;9:35–8.

As the population ages, we also confront problems of more older drivers. A US agency surveyed all 50 state departments of transportation to ascertain whether they have incorporated pre‐existing recommendations to design roads with features to enhance safety for older drivers and have developed plans for older driver safety. Two reports present the results. More than half of the states have implemented licensing requirements for older drivers that are more stringent than requirements for younger drivers, but the assessments used are not comprehensive, frequently focusing only on vision screening. Most states are not focusing on older driver safety, but rather trying to incorporate older drivers into their ongoing traffic safety efforts. US Government Accountability Office. http://www.gao.gov/docdblite/details.php?rptno = GAO‐07‐517SP and http://www.gao.gov/docdblite/details.php?rptno = GAO‐07‐413.

We know that smoke alarms save lives, but what kinds of smoke do they detect? What do we know about the different types of smoke that are created by combustible materials? A year long study by the Underwriters Laboratories and the Fire Protection Research Foundation examined materials used in modern US homes and what happens when they burn. The results informed recommendations for current smoke alarm standards, development of new technology to sense smoke, and encourage new smoke suppression technologies. Smoke characterization project technical report. Quincy, MA: The Fire Protection Research Foundation, 2007. http://www.nfpa.org/assets/files/PDF/Research/SmokeCharacterization.pdf.

Each year, many children are injured at school. Authors of a new study sought to determine the costs of these injuries by examining 455 resulting lawsuits, verdicts, and settlements. Although the median award for lawsuits that were tried or settled was US$50,000, the highest award was more than 15 million dollars. Most injuries were fractures (38.9%), but there were also substantial numbers of brain injuries (12.5%), lacerations, strains, and spinal injuries. In 23 cases, death was the outcome. Among the cases analyzed, 22% involved falls injuries, 16% were attributed to slips or trips, and 12% involved motor vehicle crashes. In 58%, a failure of proper supervision was noted as contributing to the student's injury. Barrios LC, Jones SE, Gallagher SS. Legal liability: the consequences of school injury. J Sch Health 2007;77:273–9.

Have you read—or published—an interesting article recently? Please send the citation, and copy if possible, to the editor of Splinters & Fragments: Anara Guard, 44 King Street, Auburndale, MA 02466, USA (fax +1 617 969‐9186; email aguard@edc.org or Anara_guard@verizon.net).


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