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Using Local Data to Drive Injury Prevention Strategies

Lee Ann Wurster MS, RN, CPNP

Trauma Coordinator

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Disclosures

No financials interest or other relationships with commercial

entities

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Objectives

• Analyze local data to guide injury prevention strategies

• Identify patient populations at risk

• Educate patients and families of the risk of injuries

• Describe prevention strategies to impact your area

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Problem

• Injury = #1 killer

• > 9,000 children age 0-19 died in 2010

• Millions more treated in ED

• Leading causes of injuries

• Significant public health problem

• Data drives prevention

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Nationwide Children’s Hospital

Between 2013-2015, 4709 patients admitted with an injury

62 Deaths

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FALLS

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0

50

100

150

200

250

300

<1 1‐4 yr 5‐9 yr 10‐14 yr > 14 yr

Occurrences

Age

Non‐fatal Admissions Related to Falls2013‐2015

2013

2014

2015

N=1776

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0

1

2

3

4

5

6

7

8

9

10

2013 2014 2015

Occurences

Year

Deaths related to Falls2013‐2015

<1

1‐4 yr

5‐9  yr

10‐14 yr

> 14 yr

3

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Falls prevention

“If It’s High Up,

It’s High Risk”

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Falls Prevention

• Summer bike safety campaign

• My Helmet is My Friend program

• Play It safe on line game and kiosk

• SAFE

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MVC

………………..……………………………………………………………………………………………………………………………………..

0

5

10

15

20

25

30

35

40

45

50

<1 1‐4 yr 5‐9 yr 10‐14 yr > 14 yr

Occurrences

Age

Non‐Fatal Admissions Related to MVC2013‐2015

2013

2014

2015

N=381

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Deaths related to MVC2013-2015

Age Total 2013 2014 2015

MVC 5 3 1 1

<1 0 0 0 0

1‐4 yr 2 1 0 1

5‐9 yr 2 1 1 0

10‐14 yr 1 1 0 0

> 14 yr 0 0 0 0

Age Total 2013 2014 2015

MVC 5 3 1 1

<1 0 0 0 0

1‐4 yr 2 1 0 1

5‐9 yr 2 1 1 0

10‐14 yr 1 1 0 0

> 14 yr 0 0 0 0

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Passenger SafetyInfants/ToddlersRear facing until at least 2

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Passenger SafetyToddlers/Preschoolers Forward-facing with 5-point harness

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Passenger SafetySchool-Aged Children Belt-positioning booster seat until 4ft 9in and

8-12 years of age

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Passenger Safety

Older ChildrenLap and shoulder seat belt

Rear seat until at least

13 years

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Passenger Safety

• No texting while driving pledge (on line)

• SAFE

• Car seat chooser app (2012)

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Sports Related Injuries

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0

10

20

30

40

50

60

70

<1 1‐4 yr 5‐9 yr 10‐14 yr > 14 yr

Occurences

Age

Non‐Fatal Admissions Related to Sports Injuries2013‐2015

2013

2014

2015

N=320

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Sports Related Injuries2013-2015

Of the 320 admitted sports related injuries, 23 had intra-

abdominal injuries

• Pancreas: 15 yr. olds2 Football

1 Soccer

• Liver: 15-16 yr. olds1 Football

1 Baseball

• Kidney: 15-16 yr. olds1 Football

1 Baseball

• Spleen: 8-17 yr. olds2 Soccer

1 Baseball

6 Football

4 Baseball

1 Other

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Intra-abdominal Injuries

• Blunt trauma

• Low-frequency, high risk

• Most common in contact sports

• Kidney

• Spleen

• Liver

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Recognizing Abdominal Injuries

• Abdominal pain/ tenderness over the injured area

• Rigid abdomen

• Left arm and shoulder pain

• Right sided abdominal pain and right shoulder pain

• Blood in urine

• Cold, sweaty skin

• Bruising to abdomen

• Nausea and vomiting

• Tachycardia

• Hypotension

• LOC

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Injury Prevention for Sports Related Injuries

• NCH offers PAV classes for coaches. Injury prevention is a section of the course.

• Sports medicine does performance and prevention programs for athletes.

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Non-accidental Trauma

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0

10

20

30

40

50

60

<1 1‐4 yr 5‐9 yr 10‐14 yr > 14 yr

Occurrences

Age

Non‐fatal Admissions Related to Assault2013‐2015

2013

2014

2015

N=260

0

20

40

60

80

100

120

140

160

180

<1 1‐4 yr 5‐9 yr 10‐14 yr > 14 yr

Occurrences

Age

Non‐fatal Admissions related to NAT2013‐2015

NAT

N=204

0

1

2

3

4

5

6

7

8

9

10

<1 1‐4 yr 5‐9 yr 10‐14 yr > 14 yr

Occurrences

Age

Deaths Related to Non‐Accidental Trauma2013‐2015

2013

2014

2015

N=12

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Child Abuse

• 2.9 million child abuse reports every year in the US

• 80% of the time the parent was the perpetrator

• Abused children are 25% more likely to experience teen pregnancy

• Children who experience child abuse and neglect are 59% more likely to be arrested as a juvenile and 30% more likely to commit a violent crime

http://www.safehorizon.org/page/child-abuse-facts-56.html

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Non-accidental Trauma Prevention

• Kids on the Block Puppetry in classrooms

• Kenpo classes

• It’s Not Cool to be Cruel- anti bullying program

• Understanding and responding to Family violence program

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Child Abuse Screening Tool

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0

5

10

15

20

25

<1 1‐4 yr 5‐9 yr 10‐14 yr > 14 yr

Occurences

Age

Non‐Fatal Admissions related to Drowning2013‐2015

2013

2014

2015

N= 71

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0

1

2

3

4

5

6

7

8

9

10

2013 2014 2015

Occurences

Age

Deaths Related to Drowning2013‐2015

<1

1‐4 yr

5‐9 yr

N=13

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Drowning Injury Prevention

• Water safety brochure

• Water safety activity book

• Content covered in babysitting classes, infant care classes and active parenting classes

• On hold messages

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Hanging

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0

1

2

3

4

5

6

<1 1‐4 yr 5‐9 yr 10‐14 yr > 14 yr

Occurences

Age

Non‐Fatal Admissions Related to Hanging2013‐2015

2013

2014

2015

N=29

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0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

2013 2014 2015

Occurences

Age

Deaths Related to Hanging2013‐2015

<1

1‐4 yr

5‐9 yr

10‐14 yr

> 14 yr

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Suicide Prevention

• Youth suicide prevention project

• Behavioral health

• Crisis unit

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Burns

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Time for a burn injury to occur

Time Temp

Adult 30 seconds 130 degrees F

Child 10 seconds 130 degrees F

< 5 seconds 140 degrees F

Infant 1 second 140 degrees F

Home hot water heaters are often set to 140 degrees

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0%

10%

20%

30%

40%

50%

60%

Scald Fire Object Chemical Electrical

2013

2014

2015

Mechanism of Injury

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0%

10%

20%

30%

40%

50%

60%

70%

2013 2014 2015

0-4

5-9

10-18

Age Distribution

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Prevention Strategies

• Helping hands

• Kids on the block – fire safety

• Re-entry programs

• On hold messages

• Community education

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What Can You Do?• Screen patients for suicidal ideation and refer

appropriately

• Talk about teaching children to swim and proper supervision around pools

• Ask about helmet use and give positive feedback when appropriate

• Educate parents about injury risks

• Assess patients for unusual bruising patterns not appropriate for developmental age and REPORT!

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Summary

We know that it is possible to create conditions where injury is less likely to

happen if we work together