Pediatric exposure to laundry detergent pods.

(Las cápsulas de detergente son un producto doméstico peligroso)

Valdez AL, Casavant MJ, Spiller HA, Chounthirath T, Xiang H, Smith GA.

Pediatrics. 2014 Dec;134(6):1127-35. doi: 10.1542/peds.2014-0057. Epub 2014 Nov 10.

OBJECTIVE:

Laundry detergent pods are a new product in the US marketplace. This study investigates the epidemiologic characteristics and outcomes of laundry detergent pod exposures among young children in the United States.

METHODS:

Using data from the National Poison Data System, exposures to laundry detergent pods among children younger than 6 years of age during 2012-2013 were investigated.

RESULTS:

There were 17 230 children younger than 6 years exposed to laundry detergent pods in 2012-2013. From March 2012 to April 2013, the monthly number of exposures increased by 645.3%, followed by a 25.1% decrease from April to December 2013. Children younger than 3 years accounted for 73.5% of cases. The major route of exposure was ingestion, accounting for 79.7% of cases. Among exposed children, 4.4% were hospitalized and 7.5% experienced a moderate or major medical outcome. A spectrum of clinical effects from minor to serious was seen with ingestion and ocular exposures. There were 102 patients (0.6%) exposed to a detergent pod via ingestion, aspiration, or a combination of routes, including ingestion, who required tracheal intubation. There was 1 confirmed death.

CONCLUSIONS:

Laundry detergent pods pose a serious poisoning risk to young children. This nationwide study underscores the need for increased efforts to prevent exposure of young children to these products, which may include improvements in product packaging and labeling, development of a voluntary product safety standard, and public education. Product constituent reformulation is another potential strategy to mitigate the severity of clinical effects of laundry detergent pod exposure.

 Risk and Protective Factors for Falls From Furniture in Young Children: Multicenter Case-Control Study.

Kendrick D y cols. JAMA pediatr. 2014 Dec 1. doi: 10.1001/jamapediatrics.2014.2374. [Epub ahead of print]

Importance:

Falls from furniture are common in young children but there is little evidence on protective factors for these falls.

Objective:

To estimate associations for risk and protective factors for falls from furniture in children aged 0 to 4 years.

Design, Setting, and Participants:

Multicenter case-control study at hospitals, minor injury units, and general practices in and around 4 UK study centers. Recruitment commenced June 14, 2010, and ended April 27, 2012. Participants included 672 children with falls from furniture and 2648 control participants matched on age, sex, calendar time, and study center. Thirty-five percent of cases and 33% of control individuals agreed to participate. The mean age was 1.74 years for cases and 1.91 years for control participants. Fifty-four percent of cases and 56% of control participants were male. Exposures included safety practices, safety equipment use, and home hazards.

Main Outcomes and Measures:

Falls from furniture occurring at the child's home resulting in attendance at an emergency department, minor injury unit, or hospital admission.

Results:

Compared with parents of control participants, parents of cases were significantly more likely not to use safety gates in the home (adjusted odds ratio [AOR], 1.65; 95% CI, 1.29-2.12) and not to have taught their children rules about climbing on kitchen objects (AOR, 1.58; 95% CI, 1.16-2.15). Cases aged 0 to 12 months were significantly more likely to have been left on raised surfaces (AOR, 5.62; 95% CI, 3.62-8.72), had their diapers changed on raised surfaces (AOR, 1.89; 95% CI, 1.24-2.88), and been put in car/bouncing seats on raised surfaces (AOR, 2.05; 95% CI, 1.29-3.27). Cases 3 years and older were significantly more likely to have played or climbed on furniture (AOR, 9.25; 95% CI, 1.22-70.07). Cases were significantly less likely to have played or climbed on garden furniture (AOR, 0.74; 95% CI, 0.56-0.97).

Conclusions and Relevance:

If estimated associations are causal, some falls from furniture may be prevented by incorporating advice into child health contacts, personal child health records, and home safety assessments about use of safety gates; not leaving children, changing diapers, or putting children in car/bouncing seats on raised surfaces; allowing children to play or climb on furniture; and teaching children safety rules about climbing on objects.

Lesiones atendidas en atención primaria en la Comunidad de Madrid: análisis de los registros en la historia clínica electrónica

Zoni AC, Dominguez-Berjón MF, Esteban-Vasallo MD, Regidor E.
Gac Sanit. 2014;28(1):55-60

Objetivo: Describir la incidencia de lesiones atendidas en atención primaria y analizar su distribución
según el tipo de lesión por sexo y edad en la Comunidad de Madrid en el año 2011.
Métodos: Estudio descriptivo transversal a partir de la historia clínica electrónica de atención primaria, del sistema sanitario público de la Comunidad de Madrid, en 2011. Se calcularon la incidencia de las lesiones, las tasas específicas de lesiones (fracturas, esguinces, heridas, quemaduras, lesiones por cuerpo extraño, intoxicaciones y contusiones) y las razones de tasas con un intervalo de confianza del 95%, todas estratificadas por sexo y edad.
Resultados: En 2011 se registraron 707.800 episodios de lesiones (3,5% del total de los episodios atendidos en atención primaria). La mayoría afectaron a mujeres (54,0%) y a mayores de 34 años (58,0%). Las más frecuentes fueron las heridas en los hombres (35,3%) y las contusiones en las mujeres (30,6%).
Globalmente, las mujeres presentaron tasas más altas de lesiones en edades avanzadas y los hombres se lesionaron más por debajo de los 15 años de edad. Por tipo de lesión, las tasas más altas de fracturas, quemaduras y contusiones se observaron en la población de mayor edad, las de lesiones por cuerpo extraño y heridas en la infancia, las luxaciones en jóvenes y las intoxicaciones en las edades extremas.
Conclusiones: La vulnerabilidad especial de varones menores de 5 años y de las ancianas sugiere que las intervenciones tienen que dirigirse a las necesidades específicas de estos grupos



Comentario: El análisis de las lesiones atendidas en Atención Primaria es muy importante para conocer la magnitud real del problema y las medidas preventivas necesarias. La calidad de los registros en nuestras consultas son del máximo interés.

Suffocation Deaths Associated with Use of Infant Sleep Positioners — United States, 1997–2011

Morbidity and Mortality Weekly Report (MMWR)
November 23, 2012 / 61(46);933-937

Unintentional suffocation is the leading cause of injury death among children aged less than 1 year in the United States, accounting for nearly 1,000 infant deaths annually. Since 1984, an estimated fourfold increase has been observed in accidental suffocation and strangulation in bed, with many of these deaths linked to unsafe sleep environments (1,2). Infant sleep positioners (ISPs) are devices intended to keep an infant in a specific position while sleeping, yet ISPs have been reported to have been present in the sleep environment in some cases of unintentional infant suffocation (Figure).
To characterize infant deaths associated with ISPs, FDA, the U.S. Consumer Product Safety Commission (CPSC), and CDC examined information reported to CPSC about 13 infant deaths in the past 13 years associated with the use of ISPs.

Home safety education and provision of safety equipment for injury prevention

Cochrane Database Syst Rev. 2012 Sep 12;9:CD005014. doi: 10.1002/14651858.CD005014.pub3.

Es una actualización de:

• Cochrane Database Syst Rev. 2007;(1):CD005014.

Kendrick D, Young B, Mason-Jones AJ, Ilyas N, Achana FA, Cooper NJ, Hubbard SJ, Sutton AJ, Smith S, Wynn P, Mulvaney C, Watson MC, Coupland C.

Source

Division of Primary Care, University of Nottingham, Nottingham, UK. denise.kendrick@nottingham.ac.uk.

Abstract

BACKGROUND:

In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic evidence that child home safety interventions reduce injury rates or improve a range of safety practices, and little evidence on their effect by social group.

OBJECTIVES:

We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment (hereafter referred to as home safety interventions), in reducing child injury rates or increasing home safety practices and whether the effect varied by social group.

SEARCH METHODS:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2009, Issue 2) in The Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Social Sciences Citation Index (SSCI), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S), CINAHL (EBSCO) and DARE (2009, Issue 2) in The Cochrane Library. We also searched websites and conference proceedings and searched the bibliographies of relevant studies and previously published reviews. We contacted authors of included studies as well as relevant organisations. The most recent search for trials was May 2009.

SELECTION CRITERIA:

Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after (CBA) studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, and which reported injury, safety practices or possession of safety equipment.

DATA COLLECTION AND ANALYSIS:

Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneously combined in meta-regressions by social and demographic variables. Pooled incidence rate ratios (IRR) were calculated for injuries which occurred during the studies, and pooled odds ratios were calculated for the uptake of safety equipment or safety practices, with 95% confidence intervals.

MAIN RESULTS:

Ninety-eight studies, involving 2,605,044 people, are included in this review. Fifty-four studies involving 812,705 people were comparable enough to be included in at least one meta-analysis. Thirty-five (65%) studies were RCTs. Nineteen (35%) of the studies included in the meta-analysis provided IPD.There was a lack of evidence that home safety interventions reduced rates of thermal injuries or poisoning. There was some evidence that interventions may reduce injury rates after adjusting CBA studies for baseline injury rates (IRR 0.89, 95% CI 0.78 to 1.01). Greater reductions in injury rates were found for interventions delivered in the home (IRR 0.75, 95% CI 0.62 to 0.91), and for those interventions not providing safety equipment (IRR 0.78, 95% CI 0.66 to 0.92).Home safety interventions were effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.41, 95% CI 1.07 to 1.86), functional smoke alarms (OR 1.81, 95% CI 1.30 to 2.52), a fire escape plan (OR 2.01, 95% CI 1.45 to 2.77), storing medicines (OR 1.53, 95% CI 1.27 to 1.84) and cleaning products (OR 1.55, 95% CI 1.22 to 1.96) out of reach, having syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) or poison control centre numbers accessible (OR 3.30, 95% CI 1.70 to 6.39), having fitted stair gates (OR 1.61, 95% CI 1.19 to 2.17), and having socket covers on unused sockets (OR 2.69, 95% CI 1.46 to 4.96).Interventions providing free, low cost or discounted safety equipment appeared to be more effective in improving some safety practices than those interventions not doing so. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury.

AUTHORS' CONCLUSIONS:

Home safety interventions most commonly provided as one-to-one, face-to-face education, especially with the provision of safety equipment, are effective in increasing a range of safety practices. There is some evidence that such interventions may reduce injury rates, particularly where interventions are provided at home. Conflicting findings regarding interventions providing safety equipment on safety practices and injury outcomes are likely to be explained by two large studies; one clinic-based study provided equipment but did not reduce injury rates and one school-based study did not provide equipment but did demonstrate a significant reduction in injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment, was less effective in those participants at greater risk of injury. Further studies are still required to confirm these findings with respect to injury rates.