study of childhood injuries at the Prince of Wales Hospital, Hong Kong
The Hong Kong Childhood Injury Prevention Research
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
- 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
- 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
- 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.
- 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.