Abstract
In the 6-year period from 1983 to 1988, 12 infants (<24 months of age) and 103 children (2 to 14 years of age) were killed in road crashes in South Australia. This represents an annual incidence of 6.4 deaths per 100,000 children at risk. At least 4 other children were killed in off-road vehicle-related accidents. Of these deaths, approximately half were car passengers, one third pedestrians, and one sixth pedal cyclists. Most of these infants and children died at the accident site or soon after, but 26 of them survived long enough to be admitted to hospitals with neurosurgical units and an audit of these patients suggests that there were at least 3 preventable deaths. However, autopsies of 78 patients show that the great majority of these deaths resulted from devastating brain and/or trunk visceral injuries. Better emergency care and the use of neurosurgical retrieval teams may save some lives. But more lives might be saved by the use of appropriate restraints for infants and children in cars, by reducing the exposure of child pedestrians and cyclists to road traffic, and by mandatory use of helmets by child cyclists. Off-road vehicular accidents are not as a rule included in road crash statistics; the practice of giving small motorcycles to young children has created a new category of vehicular accidents sometimes causing severe head injury.
Résumé
Pendant la période de six ans allant de 1983 à 1988, 12 enfants âgés de moins de 24 mois et 103 enfants âgés de 2 à 14 ans ont été tués dans un accident de la route en Australie du Sud. Ceci représente une incidence annuelle de 6.4 morts par 100,000 enfants à risque. Au moins quatre autres enfants ont été dans un accident dû à un véhicule motorisé mais hors de la route. Parmi ces morts, la moitié, environ, était des passagers de la voiture, un tiers, des piétons, et un sixième, des cyclistes. La plupart sont morts sur le lieu de l'accident, mais 26 ont survécu suffisamment pour être transportés dans un Hôpital comportant une service de neurochirurgie avant de décéder. Une évaluation de ces accidents mortels a montré qu'au moins trois décès eux étaient évitables. L'autopsie de 78 de ces enfants a démontré que la plupart des décès étaient dus soit à des lésions cérébrales, soit à des lésions viscérales ou du tronc. De meilleurs soins en urgence, et un meilleur déploiment des équipes neurochirurgicales pourraient éviter quelques morts, mais aussi, un certain nombre de morts pourraient être évitées en utilisant correctement less ceintures de sécurité adaptées aux enfants dans les voitures, en réduisant l'exposition aux accidents de ces enfants, ainsi qu'en rendant obligatoire le port de casque pour les enfants se déplacant à vélo. Les accidents qui n'ont pas lieu sur les routes ne sont pas habituelement inclus dans ces statistiques. La croissance de l'utilisation de petits véhicules motorisés par de très jeunes enfants a créé une nouvelle catégorie d'accidents pouvant parfois être responsables de traumatismes crâniens graves.
Resumen
En el período de seis anños 1983–1988, murieron 12 infantes (edades menores de 24 meses) y 103 niños (edades 2–14 años) en accidentes viales en el Sur de Australia, lo cual representa una incidencia anual de 6.4 muertes por 100,000 miños en riesgo. Por lo menos cuatro niños más murieron en accidentes fuera de carreteras pero relacionados con automotores. De tales muertes, approximadamente la mitad correspondió a pasajeros en carros, una tercera parte a peatones y una sexta parte a ciclistas. La mayoría murió en el lugar del accidente o poco tiempo después, pero 26 sobrevivieron un tiempo sufiente para ser hospitalizados en instituciones con unidades neurológicas; una auditoría de tales casos sugiere que por lo menos hubo tres muertes prevenibles. Sin embargo, la autopsia de 78 casos demostró que la mayoría de estas muertes se debió a lesiones devastadores del cerebro y/o las vísceras corporales. Mejores servicios de urgencia y la utilización de equipos de resucitación neuroquirúrgica pueden salvar algunas vidas, pero más vidas pueden ser salvadas mediante el uso de sistemas adecuados de seguridad para infantes y para niños instalados en los carros, reduciendo la exposición de peatones y ciclistas infantiles al tráfico víal y mediante el uso obligatorio de cascos por los ciclistas infantiles. Los accidentes que ocurren por fuera de las carreteras generalmente no son incluídos en las estadísticas de siniestros víales; la costumbre de obsequiar pequeñas motocicletas a niños pequeños ha creado una nueva categoría de accidentes vehículares que en ocasiones causan grave trauma craneano.
Similar content being viewed by others
References
Trinca, G.W., Johnston, I.R., Campbell, B.J., Haight, F.A., Knight, P.R., Mackay, G.M., McLean, A.J., Petrucelli, E.: Reducing Traffic Injury: A Global Challenge, Melbourne, Royal Australasian College of Surgeons, 1988
Selecki, B.R., Ring, I.T., Simpson, D.A., Vanderfield, G.K., Sewell, M.F.: Injuries to the Head, Spine and Peripheral Nerves: Report on a Study, Sydney, N.S.W. Government Printer, 1981
Simpson, D., Antonio, J.D., North, J.B., Ring, I.T., Selecki, B.R., Sewell, M.F.: Fatal injuries of the head and spine: Epidemiological studies in New South Wales and South Australia. Med. J. Aust.2:660, 1981
McLean, A.J., Brewer, N.D., Sandow, B.L.: Adelaide in-depth accident study, 1975–1972. Part 2: Pedestrian accidents. Part 3: Pedal cycle accidents. Adelaide, Road Accident Research Unit, The University of Adelaide, 1979
South Australian Yearbook 1988, Adelaide, Australian Bureau of Statistics, S.A. Office. S.A. Government Printer, 1988
Gibson, T.J., McCaul, K.A., McLean, A.J., Blumbergs, P.C.: Investigation of head injury mechanisms in motor vehicle accidents: A multidisciplinary approach. In Field Accidents: Data Collection, Analysis, Methodologies and Crash Injury Reconstructions, (SAE Technical Paper Series 850093), Warrendale, Society of Automotive Engineers, 1985, pp. 65–79
Blumbergs, P.C., Jones, N.R., North, J.B.: Diffuse axonal injury in head trauma. J. Neurol. Neurosurg. Psychiatry52:838, 1989
Simpson, D.A., Blumbergs, P.C., Cooter, R.D., Kilminster, M., McLean, A.J., Scott, G.: Pontomedullary tears and other gross brainstem injuries after vehicular accidents. J. Trauma29:1519, 1989
Simpson, D.A., Yeo, P.H.: Rehabilitation after head injuries in a paediatric neurosurgical unit. In Australian Approaches to Rehabilitation in Neurotrauma and Spinal Cord Trauma, Monograph no. 19, J.F. Garrett, editor, New York, World Rehabilitation Fund, 1982, pp. 8–19
Jennett, B., Bond, M.R.: Assessment of outcome after severe brain damage. Lancet1:480, 1974
Woodward, A.J., Dorsch, M.M., Simpson, D.: Head injuries in country and city: A study of hospital separations in South Australia. Med. J. Aust.141:13, 1984
Gilligan, J.E., McLeave, D., Nicholson, B., Lafsky, P., Jacquier, D., Fuller, W., Allen, T.H., Phillips, G., Butler, L., Stableford, V.: Retrieval of the critically ill in South Australia: A coordinated approach. Med. J. Aust.2:849, 1977
Molloy, C.J., McCaul, K.A., McLean, A.J., North, B.J., Simpson, D.A.: Extradural haemorrhage in infancy and childhood: A review of 35 years' experience in South Australia. Child's Nerv. Syst.6:383, 1990
RAA Survey: The Use of Child Restraints by Children in Motor Vehicles, Adelaide, Royal Automobile Association of South Australia, 1987
Taylor, T.K.F., Cummine, J.L.: Spinal cord injury in children from the wearing of seat belts (letter). Med. J. Aust.154:784, 1991
Carlsson, G., Norm, H., Ysander, L.: Rearward facing child seats: The safest car restraints for children? In Proceedings of the 33rd Annual Meeting for the Association for the Advancement of Automotive Medicine, Des Plaines, Association for the Advancement of Automotive Medicine, 1989, pp. 249–265
Sharples, P.M., Storey, A., Aynsley-Green, A., Eyre, J.A.: Causes of fatal childhood accidents involving head injury in Northern Region, 1979–86, Br. Med. J.301:1193, 1990
Howarth, C.I., Gunn, M.J.: Pedestrian safety and the law. In Pedestrian Accidents, A.J. Chapman, F.M. Wade, and H.C. Foot, editors, Chichester, John Wiley & Sons, 1982, pp. 265–290
Sandels, S.: An overview of children in traffic. In Children: The Environment and Accidents, R.H. Jackson, editor, Tunbridge, Pitman Medical, 1977, pp. 20–27
Russam, K.: The psychology of children in traffic. In Children: The Environment and Accidents, R.H. Jackson, editor, Tunbridge, Pitman Medical, 1977, pp. 49–65
Dorsch, M.M., Woodward, A.J., Somers, R.L.: Do bicycle safety helmets reduce severity of head injury in real crashes? Accid. Anal. Prev.19:183, 1987
McDermott, F.T.: Helmets for bicyclists: Another first for Victoria (editorial). Med J. Aust.154:156, 1991
Thompson, R.A., Rivara, F.P., Thompson, D.C.: A case-control study of the effectiveness of bicycle safety helmets. N. Engl. J. Med.320:1361, 1989
Williams, M.: The protective value of bicycle helmets. Accid. Anal. Prev.23:119, 1991
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Simpson, D.A., Blumbergs, P.C., McLean, A.J. et al. Head injuries in infants and children: Measures to reduce mortality and morbidity in road accidents. World J. Surg. 16, 403–409 (1992). https://doi.org/10.1007/BF02104439
Issue Date:
DOI: https://doi.org/10.1007/BF02104439