Worldwide, childhood injuries remain a significant public health concern. Children under the age of 18 are still susceptible to a variety of injuries despite improvements in healthcare and safety protocols. Despite dramatic advances in other areas of clinical medicine, we have the feeling that injury prevention is poorly targeted, inadequately funded and seldom evaluated [1-2]. Epidemiologic studies of injury indicated that there were enormous differences in the prevalence, economic burden, consequences and prevention of injuries between high income and middle-low-income countries [3]. Approximately 90% of child injuries are unintentional, encompassing incidents such as burns, substance ingestion, road traffic accidents, drowning, falls, and other unintentional injuries, including smothering, asphyxiation, and animal bites. Most unintentional injury occurs at home and are associated with various factors like home environment, unsafe storage of hazardous substance such as kerosene and medicine. Childhood unintentional injuries are also associated with various factors such as age, sex, area where they belong and child development [4-5]. The environment also plays an important role in child injury in which the child interacts. Therefore, care giver’s perceptions of child injury plays an important role in identifying risks and prevent injuries [6]. Yet, the ramifications of childhood unintentional injuries extend far beyond the immediate physical harm inflicted. Most pediatric injuries are

of modest severity yet many can affect behavioral and emotional development. Even minor injuries are stressful and treatment of these injuries imposes a significant financial burden on the society [7]. Pediatricians, primary care physicians, nurses and public health professionals have important roles to play in the prevention of pediatric injuries. This is recognized by the existence of programs such as Safe kids Worldwide and the American Academy of Pediatrics' "The Injury Prevention Program" which provides health care professionals and parents with age- and developmentally- appropriate resources for injury prevention [8-9].

Aim: Our study focuses on the clinic-epidemiological profile and immediate outcome of various childhood injuries; and awareness of care givers towards them in our center.

OBJECTIVES

1. To study clinico-epidemological profile of child injury in children [<18yr]
2. To study immediate outcome of children hospitalized due to such trauma at
3. tertiary level hospital.

This cross sectional Observational Single Centre Study was conducted in the PICU and ward of Department of Paediatrics, Paediatric Surgery M.Y hospital, Indore (M.P). The duration of study was one years from February 2023 to February 2024.

A total of 104 patients fulfilling the inclusion criteria were enrolled in this research

Inclusion criteria:

• Patients ≤18 years of age with both gender
• Patient with history of intentional and unintentional accidents admitted in our hospital
• Patients or their guardian who provided written informed consent for the study

Exclusion criteria

• Patients >18 years of age
• Sexual assault patients
• Patients who do not give consent to participate in the study

Demographic details, clinical parameters including relevant history and examination and investigations were recorded in a predesigned proforma. Patient management was done as per the unit treatment protocols. The outcome of the patient was recorded at the time of discharge and all the data was noted on excel sheet for statistical analysis

The study was approved by Institutional Ethics committee, MGM Indore

Statistical analysis: Statistical analysis was carried out using SPSS version.25. Continuous data were presented as medians with ranges due to potential outliers. Categorical data were expressed as frequencies and percentages. The chi-square test or Fisher’s exact test, as appropriate, was applied to compare categorical variables. A p-value of <0.05 was deemed statistically significant.

A total of 104 children with injuries were enrolled and evaluated in this study. The majority of participants (62.5%) were aged 0-5 years; males were predominant (64.4%). A larger proportion of participants resided in rural areas (60.58%). The socioeconomic status of the participants was primarily (70.19%) belonging to lower middle class. Details of socio-demographic characteristics were shown in table 1.

Table 1: Socio-demographic characteristics of study participants

Substance ingestion emerged as the leading cause of admission (25%), followed by burns and bites (25%). Majority of them (20.19%) had presented with scald burns. Road traffic injuries accounted for 8.6% of admissions, bites (11.5%), while blunt trauma and drowning each represented 11.5% and 8.6%, respectively. Fall from height were less frequent (3.8%). Other less common presentations included foreign body ingestion (4.8%) & suffocation due to hanging (0.96%) [Graph: 1].

Graph 1: Nature of injury or clinical presentation of study participants

Among the substance ingestion 2.88% of cases involved bleaching powder ingestion and 4.81% had acid ingestion cases. Other substances ingested included unknown tablets (1.92%), petrol (0.96%), other unknown substances (4.81%), herbicidal agents (1.92%), rat poison (1.92%), organophosphates (3.85%), and kerosine (1.92%).

Table 2: Type of substance ingestion among study patients

Majority of accidents (61.54%) occurred at home. Approximately eleven percent (10.58%) of accidents occurred on the street. Other locations like school, playground, road, water Source, and field, accounted for smaller percentages of accidents, ranging from 1.92% to 9.62%. Approximately four percent (3.85%) of accidents occurred in other locations.

Graph 2: Graphical presentation of Places of accident (%)

Majority of cases (74.04%) sought medical attention within 24 hours of injury. A smaller proportion (25.96%) presented to the hospital more than 24 hours after sustaining the injury

Graph 3: Duration from injury to presentation at hospital

Sixty seven percent of cases (67.31%) presented with mild severity based on the Glasgow Coma Scale. Approximately fifteen percent cases (14.42%) had moderate severity. Eighteen percent (18.27%) of cases were admitted with severe severity levels.

Graph 4: Severity of symptoms at time of admission (Glasgow Coma Scale)

Twenty three percent (23.07 %) of cases received resuscitation at admission and during hospital stay. Among these cases, 7 were due to drowning out of which 5 survived, 6 cases were associated with substance ingestion, 5 cases were associated with burns, 3 case were of road traffic accidents. Blunt trauma, bites and hanging were associated with one case each.

Table 3: Resuscitation required at admission and during hospital stay

The major common complications were Respiratory failure (47.06%), Infections. (17.65%) and Shock (11.76%). Other complications observed were Liver Failure, Seizure, Pulmonary Hemorrhage, MODS (Multiple Organ Dysfunction Syndrome), in 5.88% of cases each.

Table 4: Complications in study participants at presentation

Majority of cases (76.92%) were discharged from the hospital. A smaller proportion (9.62%) chose to leave against medical advice. Approximately fourteen percent (13.46%) of cases resulted in death. The death rate was higher in rural areas (10.58%) compared to urban areas (2.88%)

Table 5: Final outcome in cases of child accidents

Pediatric age group injuries are one of the significant causes of child death age < 18 years which are preventable. The injuries under 18 years of age are various types, broadly classified into intentional and unintentional injury. Unintentional injuries are more common like burns, substance ingestion, motor vehicle accident, drowning, fall, animal bite and asphyxiation. Intentional injuries are comparatively less common like homicide and self-inflicted injuries.

In our study, majority of participants were 0-5 years of age, followed by 6-10 years age group. It means that pre-school children are more prone to injuries. Similar results were seen by H. Oubejja, et al [10] and Mallangouda, et al [11].

Our study found that the male participants are predominant than female, which was in concordance with the study conducted by Mathur, A, et al [12] and DH Stone, et al [13]. This could be due to the fact that boys are more fearless & stronger; and less supervised and protected from parents.

In this study, it was observed that most patients belong to lower middle socioeconomic class (IV) which is in agreement with the Faelker, et al [14], which conclude that child from poorest families are more prone to injuries.

Present study found that everyday life accidents are more common than road traffic accident which was in accordance with study conducted by Fadoua Boughaleb, et al [15].

We have observed that higher proportion of substance ingestion cases are there, out of which home use acid ingestion and unknown substance ingestion accounted for the maximum variety. Our findings were comparable with the Charan LS, et al [16]. These injuries are mainly due to lack of supervision of care givers.

In this study, we had higher proportions of cases in the burn and substance ingestion category. We compared them in terms of types, age of presentation, severity at time of presentation, time of presentation after incident and the need for resuscitation. We observed that most common type of burn injury was scald type, and similar results found in a study done by Flavin, M.P, et al [17].

A study done by Galal S B, et al [18] reported that the most common injuries were fall from height, drowning, suffocation, poisoning, burns and road traffic accidents, which was in disconcordance with our study.

In the final outcome of the present study, majority of the patients were discharged, and 13.46% cases succumbed to death. In terms of statistically significance more deaths were observed in rural area as compared to urban area. Similar finding was observed by Ramesha KN, et al [19] and AA Skiredj, et al [20]. a

The systemic review done by Mohan Kumar, et al [21], summarizes that road traffic accident was the most common cause among all injuries leads to death, which was different from our study.

Addressing child injury requires a coordinated effort involving parents, caregivers, healthcare providers, policymakers, and communities. By understanding the epidemiological profiles and immediate outcomes, we can develop targeted prevention strategies, provide effective medical care, and ensure comprehensive support for injured children. There is a strong association between stage of life and type of injury sustained by a child. The age of child, how it interacts with the surroundings, and the type of activities the child undertakes is relevant to this association. Through education, environmental safety improvements, policy enforcement, and ongoing research, we can significantly reduce the incidence and impact of child injuries, enhancing the health and well-being of children globally. The quality of access to medical center is an important factor that can influence an injury in the long-term consequence. Through these efforts, we can create safer environments for children and ensure they receive the best possible care and support following an injury. This holistic approach will ultimately lead to a reduction in the incidence and severity of child injuries, promoting the child health.

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