The history of paediatric trauma care in Cape Town

No Abstract. South African Medical Journal Vol. 96(9) (Part 2) 2006: 874-87

Treatment and outcome of unusual animal bite injuries in young children

Background. Animal bites are a major cause of preventable traumatic injuries.Objectives. To provide more epidemiological information on animal bites, and assist in increasing awareness of the problem.Methods. A retrospective chart review was performed including children aged >13 years presenting with bite injuries (excluding dog and human bites) to the trauma unit at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa, over a 25-year period.Results. Two hundred and thirteen children were eligible to be entered into the study. The median age was 2.9 years (range 1.2 - 6.5), with boys slightly predominating (54.9%). Most (74.6%) of the bite injuries were inflicted by mammals, the majority (64.8) of mammalian bites being rat bites. The proportions of boys and girls in the age group 0 - 4 years bitten by rats significantly differed from the proportions in the age group >4 years (p=0.039). In the age group 0 - 4 years more girls suffered rat bites, while more boys were bitten in the age group >4 years. Of 91 rat bites, 81 (89.0%) occurred inside the house. The hands (43.9%) and the head/face/neck region (39.0%) were most affected. The underdeveloped suburbs of Philippi, Gugulethu and Khayelitsha in Cape Town represented a disproportionate number (41.6%) of rat bites.Conclusions. There is a relationship between poverty, unemployment, poor housing, informal settlements and rodent infestation. These high-risk populations need to be the target for government rat eradication programmes

Laparoscopic repair of pericardio-diaphragmatic rupture: A case report

Diaphragmatic rupture following blunt trauma is a common pathology which has good outomes when discovered early and treated. The common practice has been to manage these patients with either a laparotomy or thoracotomy, with some reports showing the safety of laparoscopy. We present a case of a patient who presented with a pericadio-diaphragmatic rupture who was managed successfully using laparoscopy

Animal attacks – a red herring of child abuse?

No Abstract. South African Medical Journal Vol. 96 (3) 2006: 184-18

Latest results show urgent need to address child restraint use.

Road traffic crashes are the leading cause of morbidity and mortality in children in South Africa (SA), and are preventable through implementing a systems approach to address the causes. Proper education, child passenger legislation and enforcement of the law are priority actions. It is well known that properly employed seatbelts and child restraints reduce the risk of serious injury and death to children. However, despite campaigns such as ‘Arrive Alive’ to increase the use of child restraints, a 2008 observational study conducted by Red Cross War Memorial Children’s Hospital (RCWMH) in Cape Town, SA, found that a majority of adults and children entering the hospital gates did not use such restraints. It is possible that this was because there was no appropriate child restraint law

Evaluation of pain incidence and pain management in a South African paediatric trauma unit

Objectives. To evaluate pain incidence and pain management in a South African paediatric trauma unit, and to compare the usefulness of 5 different assessment tools. Design. A prospective observational study, using the Numerical Rating Scale for pain (NRS pain), Numerical Rating Scale for anxiety (NRS anxiety), the Alder Hey Triage Pain Score (AHTPS), the COMFORT behaviour scale and the Touch Visual Pain Scale (TVPS). All patients were assessed at admission; those who were hospitalised were again assessed every 3 hours until discharge. Results. A total of 165 patients, with a mean age of 5.3 years (range 0 - 13), were included. NRS scores were indicative of moderate to severe pain in 13.3% of the patients, and no pain in 24% at admission. Two-thirds of the patients received no analgesics; for them, NRS pain, AHTPS and TVP scores were lower than the scores for the other children. Conclusion. Pain and anxiety incidences in this paediatric trauma unit are relatively low. Implementation of a standard pain assessment tool in the emergency department triage system can improve pain management. The AHTPS is the most promising for use in non-Western settings

Can fireworks-related injuries to children during festivities be prevented?

Objective. To determine the epidemiological features and outcome of fireworks-related injuries among children 0 - 13 years old.Design. A retrospective study from the trauma registry of a children’s hospital from 2001 - 2009.Results. Fifty-five children were treated for injuries from fireworks. The mean age was 8.8 years, 78% were boys, and the largest age group was 5 - 9 years old. Firecrackers accounted for 95% of the injuries; the most commonly injured body sites were hands (44%), eyes (42%) and face (31%); 47% of the patients had more than one injury. The most common injury type was burns (67%); 25 children were admitted, mostly to the burns and ophthalmology units. The mean length of hospital stay was 3.5 days. Surgical intervention was required in 38% of the patients. Most of the fireworks accidents occurred in or around the patients’ homes. There were more fireworks-related injuries around Guy Fawkes Day (85%) than New Year’s Eve (9%).Conclusion. Consumer fireworks cause serious but preventable injuries to children, either as users or bystanders. Children and their families should be encouraged to enjoy pyrotechnical displays conducted by professionals at designated areas. All fireworks for individual private use should either be supervised by an adult or banned. Current legislation should be more strictly enforced, especially the sale to under-age children

An introduction to surgical challenges and priorities in rural areas

An introduction to surgical challenges and priorities in rural area