The Hong Kong Childhood Injury Prevention Research Group
Prince of Wales Hospital study

• Injury was the leading cause of death among children age one to fourteen in Hong Kong between 1996 and 1997. In particular, among all traumatic injuries, unintentional injuries accounted for approximately 76% of the total in 1996 (Department of Health, 1998). Confronted with such injuries among children, the Department of Health in Hong Kong summoned the following in its Public Health Report No. 3. "Suitable studies should be conducted to investigate specifically the incidence of childhood injuries, circumstances and contributing factors, severity and long term outcome, as well as economic costs."
  
  
• In light of the need of research in this area, the Hong Kong Childhood Injury Prevention Research Group (CIPRG) pursued a surveillance programme for a one-year period in the Prince of Wales Hospital, Shatin (PWH). By surveying admissions into the Accident & Emergency (A&E) service, the present study aims at sketching out the general patterns of unintentional domestic injury among children and adolescents aged 0 to 15.
  
  
• During the course of October 24, 1996 to October 23, 1997, 7813 attendance records from the PWH A&E department fulfilling our selection criteria were compiled and analysed.
  
  
• Currently, this study is continued in another hospital in Hong Kong.
  
  
• Boys are more likely to encounter an unintentional injury than girls (Male : Female ratio = approx. 2:1). The gap between number of males and females experiencing injuries increases with age, from an 11.2% discrepancy at infancy to a 51.8% difference in adolescence.
  
  
• With 43.6% of A&E admissions falling into this category, domestic injury (including injuries take place at home, school, or onthe street) was the most common type of injury by A&E classification. Unclassified and sports injuries were the second and third common types, with 25.1% and 13.8% respectively.
  
  
• From infants to 15-year-old, fall is the most common external cause of injury at 44.3%, followed by injury caused by being strike by others (18.2%) and motor-related injury (12%). Other external causes of injury comprise the remaining 25.5%.
  
  
• Falls in HK could possibly lead to more severe injuries. Comparing data from the present study and a similar study in the United States (Gallagher et al., 1984), 21.3% out of all falls at 44.3%, compared to 14% in the United States, led to fractures in areas other than the skull.
  
  
• 15% of A&E admission led to hospitalization, while 18.6% of admissions led to various referrals and follow-ups
  
• Children at a certain age are prone to experience respective developmentally specific external causes of injury. Younger children aged 0-1 year-old, verified by a statistical procedure called correspondence analysis, are more prone to experience injury through poisoning, fall, machinery-related accident, and scald.
  
  
• Adolescents, aged 12 to 15, are more likely to suffer an injury in motor accidents, animal bites, and cuts.
  
  
• The most common nature of injury in the present study is "contusion" at 34.6%, followed by "open wound of skull, neck, or trunk (15.7%) and "superficial" (12.5%). "Fracture of the upper limb", a relatively more severe nature of injury, is fourth at 11.7%. Other natures of injury comprise the remaining 25.5%.
  
  
• Overall, severity of injury among children in the present study is moderate to mild. Upon arrival at the A&E service, 11.9% of the cases observed in this study were classified as "Urgent" while 85% fell into the "Semi-urgent" category. Twenty-two cases (0.3%) were classified as "Critical" and 2.9% were considered "Non-urgent".* Among the maximum AIS scores (MAIS) yielded from 7204 cases, an MAIS score of 1 comprises 83.4 %. Cases with MAIS score of 2 accounted for 15.6% and only 1% of the 7204 cases scored 3 or higher on the MAIS.
  
  
• Though 65.5% of children in this study were discharged home, 15.1% were admitted into the Prince of Wales hospital and 13.5% were referred to operation theatre.

Concluding observations

• Recognizing fall as the major external cause of injury in Hong Kong, more attention should be put into modifying household environment that feature most of the risk factors for fall, such as bunk bed and slippery floor.
  
  
• In formulating prevention education, developmental specificity of external causes should be taken into consideration. For instance, maternal safety class should emphasize on active restraints on children and precautions against scald and fall. Meanwhile, prevention programmes working with adolescent could encourage the use of safety rules on subject such as road safety.
  
  
• Compared with international surveillance data, the present study revealed a lower rate of poisoning and flame burns in general. Yet falls command a higher proportion of injury cases than in countries compared. Such difference is possibly a reflection of the effective poisoning and flame burn prevention effort in Hong Kong. Meanwhile, such result implies that there is still room for improvement in the area of fall prevention locally.