The occurrence of external causes in childhood in emergency care: epidemiological aspects, Brazil, 2014

Malta, Deborah Carvalho; Mascarenhas, Márcio Dênis Medeiros; Silva, Marta Maria Alves da; Carvalho, Mércia Gomes Oliveira de; Barufaldi, Laura Augusta; Avanci, Joviana Quintes; Bernal, Regina Tomie Ivata

doi:10.1590/1413-812320152112.17532016

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Article • Ciênc. saúde colet. 21 (12) • Dec 2016 • https://doi.org/10.1590/1413-812320152112.17532016 copy

The occurrence of external causes in childhood in emergency care: epidemiological aspects, Brazil, 2014

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To describe emergency care for external causes in childhood, age group 0-9 years, in Brazilian capitals, collected from the Violence and Accident Surveillance System (VIVA) Survey in 2014.

Methods:

To review data from the VIVA survey conducted in public emergency services in 24 Brazilian capitals. Variables analyzed were gender, age group (0-1 years, 2-5 years and 6-9 years), race/skin color, type of events and injuries, aggressors and other.

Results:

Eight thousand five hundred eighty-eight children received care, of which 8,164 (95%) were victims of accidents and 424 (5%) of violence. Boys suffered more accidents, most events occurred at home (65%) and discharge was the most frequent outcome. Falls were the most frequent accidents, followed by other accidents, road injury and burns. Neglect prevailed among the types of violence, followed by physical violence. The perpetrator was a child's relative in 72% of the cases, and women were the most frequent aggressors for children under 1 year, and men for children aged 6 to 9 years.

Conclusion:

Childhood accidents occurred mainly at home, and falls were the most frequent events. Family members and acquaintances perpetrated violence against children. Data point to the implementation of public prevention and child protection policies.

Key words
Childhood; Injuries; External causes; Emergency care; Violence

Characteristics			Type of event^a a The number of attendances for some variables diverged due to missing data (unknown / blank).
Characteristics			Accidents (n = 8,164) %	Violence (n = 424) %	Total (n = 8,588) %	P value^b b Chi-square test.
Sociodemographic
	Gender					0.941
		Male	60.3	60.6	60.4
		Female	39.7	39.4	39.7
	Age group (years)					0.000
		0 to 1	20.3	37.5	21.4
		2 to 5	42.4	37.2	42.0
		6 to 9	37.4	25.3	36.6
	Race/skin color					0.000
		White	34.2	47.4	35.0
		Black/brown	63.6	50.5	62.8
		Yellow / indigenous	2.2	2.1	2.2
	Has some kind of disability^c c Includes physical, mental, visual, hearing impairments and other disabilities / syndromes.					^ The chi-square test and p value have not been calculated due to the existence of cell with value less than five.
		Yes	1.4	1.0	1.3
		No	98.6	99.0	98.7
	Population in vulnerable situation^d d Includes gypsy, Quilombola, villager, people living in the streets and other.					^ The chi-square test and p value have not been calculated due to the existence of cell with value less than five.
		Yes	0.9	0.5	0.9
		No	99.1	99.5	99.1
	Has health plan					0.163
		Yes	7.5	5.2	7.3
		No	92.5	94.8	92.7
Of the event
	Location of the event					0.001
		Home^e e Includes residence and collective housing.	64.4	72.4	65.0
		Public road	15.9	9.4	15.5
		School	11.9	14.3	12.0
		Leisure area	4.6	1.8	4.4
		Other^f f Includes bar or similar, trade / services, industry / construction and other.	3.2	2.2	3.2
	Location of the event					0.004
		Home	64.4	72.4	65.0
		Away fromhome	35.6	27.6	35.1
	Nature of injury					0.000
		No injury	12.5	16.9	12.8
		Contusion / sprain / dislocation	32.2	22.6	31.5
		Cut/laceration	29.8	29.1	29.7
		Fracture / amputation / trauma^g g Includes head trauma, dental trauma and polytrauma.	18.1	16.5	18.0
		Other^h h Includes poisoning, burns and other.	7.4	14.9	7.9
	Body part affected					0.000
		Head / neck	45.2	52.3	45.6
		Chest / abdomen / pelvis	3.9	9.0	4.2
		Upper limbs	24.5	21.3	24.2
		Lower limbs	20.7	8.6	19.9
		Multiple organs / parts	5.8	8.9	6.0
Of care
	Transport to hospital					0.609
		Walking / bus / minibus	24.6	27.4	24.8
		Private car	59.5	59.0	59.5
		SAMU / ambulance / rescue	12.7	11.2	12.6
		Otherⁱ i Includes police car and other.	3.2	2.3	3.1
	Period of care					0.555
		Daytime	58.3	56.1	58.2
		Nighttime	41.7	43.9	41.8
	Day of care					0.884
		Saturday and Sunday	26.6	26.2	26.6
		Monday through Friday	73.4	73.8	73.4
	Previous care in another facility					0.217
		Yes	35.9	31.7	35.6
		No	64.1	68.3	64.4
	Development					^ The chi-square test and p value have not been calculated due to the existence of cell with value less than five.
		Discharge	81.7	81.7	81.7
		Hospitalization^j j Includes hospitalization and referral to other service.	12.3	14.0	12.4
		Outpatient referral	5.1	3.1	4.9
		Other^k k Includes evasion / escape, death and other.	1.0	1.3	1.0

Characteristics			Accidents - Age group (years)^a a The number of attendances for some variables diverged due to missing data (unknown / blank).
Characteristics			0 to 1 (n = 1,742) %	2 to 5 (n = 3,494) %	6 to 9 (n = 2,928) %	Total (n = 8,164) %	P value^b b Chi-square test.
Sociodemographic
	Gender						0.006
		Male	58.2	58.8	63.3	60.3
		Female	41.8	41.2	36.7	39.7
	Race/skin color						0.000
		White	40.6	33.8	31.1	34.2
		Black/brown	57.6	63.8	66.8	63.6
		Yellow / indigenous	1.9	2.5	2.1	2.2
	Has some kind of disability^c c Includes physical, mental, visual, hearing impairments and other disabilities / syndromes.						0.000
		Yes	0.6	1.0	2.2	1.4
		No	99.4	99.0	97.8	98.6
	Population in vulnerable situation^d d Includes gypsy, Quilombola, villager, people living in the streets and other.						0.938
		Yes	0.9	0.8	0.9	0.9
		No	99.1	99.2	99.1	99.1
	Has health plan						0.097
		Yes	9.1	6.8	7.4	7.5
		No	90.9	93.2	92.6	92.5
Of the event
	Location of the event						0.000
		Home^e e Includes residence and collective housing.	85.4	69.5	47.3	64.4
		Public road	7.9	14.7	21.6	15.9
		School	2.4	9.6	19.5	11.9
		Leisure area	1.3	3.3	7.9	4.6
		Other^f f Includes bar or similar, trade / services, industry / construction and other.	2.9	2.9	3.7	3.2
	Nature of injury						0.000
		No injury	16.7	14.1	8.6	12.5
		Contusion / sprain / dislocation	33.9	28.6	35.4	32.2
		Cut/laceration	21.9	33.4	29.9	29.8
		Fracture / amputation / trauma^g g Includes head trauma, dental trauma and polytrauma.	17.9	16.2	20.5	18.1
		Other^h h Includes poisoning, burns and other.	9.7	7.7	5.7	7.4
	Body part affected						0.000
		Head / neck	62.7	50.7	30.4	45.2
		Chest / abdomen / pelvis	3.7	3.8	4.1	3.9
		Upper limbs	16.3	21.7	31.5	24.5
		Lower limbs	9.4	18.7	28.5	20.7
		Multiple organs / parts	7.8	5.2	5.5	5.8
Of care
	Transport to hospital						0.229
		Walking / bus / minibus	22.3	25.5	25.0	24.6
		Private car	60.6	59.1	59.4	59.5
		SAMU / ambulance / rescue	14.5	12.4	12.1	12.7
		Otherⁱ i Includes police car and other.	2.6	3.1	3.6	3.2
	Period of care						0.133
		Daytime	55.7	58.3	59.7	58.3
		Nighttime	44.3	41.7	40.3	41.7
	Day of care						0.167
		Saturday and Sunday	26.1	28.0	25.3	26.6
		Monday through Friday	73.9	72.0	74.7	73.4
	Previous care in another facility						0.106
		Yes	37.8	36.5	34.2	35.9
		No	62.2	63.6	65.8	64.1
	Development						0.076
		Discharge	79.3	83.1	81.4	81.7
		Hospitalization^j j Includes hospitalization and referral to other service.	14.7	11.5	11.8	12.3
		Outpatient referral	4.9	4.5	5.8	5.1
		Other^k k Includes evasion / escape, death and other.	1.1	1.0	0.9	1.0
Sociodemographic
	Gender						0.106
		Male	57.2	56.3	71.9	60.6
		Female	42.8	43.7	28.1	39.4
	Race/skin color						^ The chi-square test and p value have not been calculated due to the existence of cell with value less than five.
		White	57.4	44.9	37.2	47.4
		Black/brown	41.1	53.1	60.0	50.5
		Yellow / indigenous	1.5	2.1	2.9	2.1
	Has some kind of disability^c c Includes physical, mental, visual, hearing impairments and other disabilities / syndromes.						^ The chi-square test and p value have not been calculated due to the existence of cell with value less than five.
		Yes	0.0	1.5	1.9	1.0
		No	100.0	98.5	98.1	99.0
	Population in vulnerable situation^d d Includes gypsy, Quilombola, villager, people living in the streets and other.						^ The chi-square test and p value have not been calculated due to the existence of cell with value less than five.
		Yes	0.9	0.5	0.0	0.5
		No	99.1	99.5	100.0	99.5
	Has health plan						0.836
		Yes	4.6	4.9	6.5	5.2
		No	95.4	95.1	93.5	94.8
Of the event
	Location of the event						^ The chi-square test and p value have not been calculated due to the existence of cell with value less than five.
		Home^e e Includes residence and collective housing.	92.7	75.1	38.2	72.4
		Public road	3.8	9.5	17.4	9.4
		School	1.6	11.2	37.8	14.3
		Leisure area	1.4	0.2	4.5	1.8
		Other^f f Includes bar or similar, trade / services, industry / construction and other.	0.4	4.0	2.1	2.2
	Nature of injury						0.020
		No injury	20.5	18.4	9.5	16.9
		Contusion / sprain / dislocation	23.4	13.6	34.2	22.6
		Cut/laceration	20.7	35.8	31.8	29.1
		Fracture / amputation / trauma^g g Includes head trauma, dental trauma and polytrauma.	21.8	14.1	12.1	16.5
		Other^h h Includes poisoning, burns and other.	13.6	18.1	12.4	14.9
	Body part affected						0.006
		Head / neck	59.8	47.9	47.9	52.3
		Chest / abdomen / pelvis	3.8	15.3	8.0	9.0
		Upper limbs	25.8	13.3	25.3	21.3
		Lower limbs	3.1	10.1	13.9	8.6
		Multiple organs / parts	7.6	13.4	4.8	8.9
Of care
	Transport to hospital						^ The chi-square test and p value have not been calculated due to the existence of cell with value less than five.
		Walking / bus / minibus	27.5	21.9	35.4	27.4
		Private car	64.0	63.8	44.8	59.0
		SAMU / ambulance / rescue	6.6	13.0	15.4	11.2
		Otherⁱ i Includes police car and other.	2.0	1.3	4.4	2.3
	Period of care						0.462
		Daytime	52.0	60.6	55.6	56.1
		Nighttime	48.0	39.4	44.4	43.9
	Day of care						0.302
		Saturday and Sunday	22.9	31.2	23.6	26.2
		Monday through Friday	77.1	68.8	76.4	73.8
	Previous care in another facility						0.591
		Yes	29.9	35.7	28.5	31.7
		No	70.1	64.4	71.6	68.3
	Development						0.058
		Discharge	79.1	82.3	84.5	81.7
		Hospitalization^j j Includes hospitalization and referral to other service.	19.0	11.7	9.9	14.0
		Outpatient referral	1.9	2.6	5.6	3.1
		Other^k k Includes evasion / escape, death and other.	0.0	3.4	0.0	1.3

Characteristics			Type of event^(a) (a) Adjusted OR for age and skin color.
Characteristics			Violence (n = 424) %	OR	Accidents (n = 8,164) %	crude OR	adjusted OR	CI(95%)	Total (n = 8,588) %	p value^(b) (b) Adjusted OR for gender and skin color.
Sociodemographic
	Gender									0.941
		Male	60.6	1	60.3	0.99	0.93^(a) (a) Adjusted OR for age and skin color.	0.73 – 1.20	60.4
		Female	39.4	1	39.7	1.01	1.07^(a) (a) Adjusted OR for age and skin color.	0.84 – 1.37	39.7
	Age group (years)									0.000
		0 to 1	37.5	1	20.3	0.42	0.44^(b) (b) Adjusted OR for gender and skin color.	0.35 – 0.57	21.4
		2 to 5	37.2	1	42.4	1.24	1.23^(b) (b) Adjusted OR for gender and skin color.	0.95 – 1.60	42
		6 to 9	25.3	1	37.4	1.77	1.71^(b) (b) Adjusted OR for gender and skin color.	1.34 – 2.20	36.6
	Race/skin color									0.000
		White	47.4	1	34.2	0.61	0.65^(c) (c) Adjusted OR for age and gender.	0.52 – 0.82	35
		Black/brown	50.5	1	63.6	1.31	1.27^(c) (c) Adjusted OR for age and gender.	1.13 – 1.44	62.8
		Yellow / indigenous	2.1	1	2.2	1.06	1.05^(c) (c) Adjusted OR for age and gender.	1.02 – 1.08	2.2
	Has some kind of disabilityc									**
		Yes	1	1	1.4	1.31	1,15	0.43 – 3.10	1.3
		No	99	1	98.6	0.77	0.87	0.32 – 2.35	98.7
	Population in vulnerable situation									**
		Yes	0.5	1	0.9	1.66	1.84	0.62 – 5.46	0.9
		No	99.5	1	99.1	0.60	0.54	0.18 – 1.61	99.1
	Has health plan									0.163
		Yes	5.2	1	7.5	1.48	1.60	0.91 – 2.80	7.3
		No	94.8	1	92.5	0.68	0.63	0.36 – 1.10	92.7
Of the event
	Location of the event									0.001
		Home	72.4	1	64.4	0.71	0.90	0.69 – 1.17	65
		Public road	9.4	1	15.9	1.85	1.54	1.04 – 2.27	15.5
		School	14.3	1	11.9	0.81	0.62	0.44 – 0.87	12
		Leisure area	1.8	1	4.6	2.70	2.19	0.91 – 5.28	4.4
		Other	2.2	1	3.2	1.52	1.46	0.70 – 3.04	3.2
	Location of the event									0.004
		Home	72.4	1	64.4	0.71	0.90	0.69 – 1.17	65
		Away fromhome	27.6	1	35.6	1.40	1.11	0.85 −1.44	35.1
	Nature of injury									0.000
		No injury	16.9	1	12.5	0.70	0.79	0.57 – 1.08	12.8
		Contusion / sprain / dislocation	22.6	1	32.2	1.63	1.60	1.17 – 2.21	31.5
		Cut/laceration	29.1	1	29.8	1.04	0.98	0.75 – 1.26	29.7
		Fracture / amputation / traumag	16.5	1	18.1	1.11	1.09	0.74 – 1.61	18
		Other	14.9	1	7.4	0.45	0.49	0.34 – 0.71	7.9
	Body part affected									0.000
		Head / neck	52.3	1	45.2	0.87	1.01	0.77 – 1.33	45.6
		Chest / abdomen / pelvis	9	1	3.9	0.69	0.65	0.36 – 1.18	4.2
		Upper limbs	21.3	1	24.5	0.14	0.14	0.07 – 0.27	24.2
		Lower limbs	8.6	1	20.7	2.03	1.72	1.27 – 2.35	19.9
		Multiple organs / parts	8.9	1	5.8	0.68	0.70	0.43 – 1.15	6
Of care
	Transport to hospital									0.609
		Walking / bus / minibus	27.4	1	24.6	0.86	0.83	0.62 – 1.11	24.8
		Private car	59	1	59.5	1.02	1.08	0.83 – 1.39	59.5
		SAMU / ambulance / rescue	11.2	1	12.7	1.15	1.13	0.78 – 1.63	12.6
		Other	2.3	1	3.2	0.86	0.83	0.62 – 1.11	3.1
	Period of care									0.555
		Daytime	56.1	1	58.3	1.09	1.05	0.78 – 1.42	58.2
		Nighttime	43.9	1	41.7	0.92	0.95	0.71 – 1.28	41.8
		Day of care								0.884
		Saturday and Sunday	26.2	1	26.6	1.02	1.02	0.74 – 1.41	26.6
		Monday through Friday	73.8	1	73.4	0.98	0.98	0.71 – 1.35	73.4
	Previous care in another facility									0.217
		Yes	31.7	1	35.9	1.02	1.02	0.74 – 1.41	35.6
		No	68.3	1	64.1	0.98	0.98	0.71 – 1.35	64.4
	Development									**
		Discharge	81.7	1	81.7	1.00	1.00	0.71 – 1.40	81.7
		Hospitalization	14	1	12.3	0.86	0.87	0.61 – 1.24	12.4
		Outpatient referral	3.1	1	5.1	1.67	1.60	0.82 – 3.13	4.9
		Other	1.3	1	1	0.77	0.86	0.24 – 3.04	1.0

Characteristics		Age group (years)^a a The number of attendances for some variables diverged due to missing data (unknown / blank).
Characteristics		0 to 1 (n) %	2 to 5 (n) %	6 to 9 (n) %	Total (n) %	P value^b b Chi-square test.
Type of accident		(1,742)	(3,494)	(2,928)	(8,164)	0.000
	Road injury	5.1	9.1	12.1	9.4
	Fall	63.1	50.8	48.3	52.4
	Burn	4.8	1.7	1.4	2.2
	Other accidents	27.0	38.4	38.3	36.0
Road injury: type of victim		(112)	(361)	(392)	(865)	0.000
	Pedestrian	20.2	29.2	32.5	29.8
	Driver	13.8	21.8	40.0	29.6
	Passenger	66.0	49.0	27.5	40.6
Road injury: means of victim's transport		(112)	(361)	(392)	(865)	0.000
	Walking	20.2	29.2	32.5	29.8
	Car	33.6	10.9	6.1	11.1
	Motorbike	17.9	11.8	9.2	11.2
	Bicycle	24.9	40.9	45.8	41.5
	Bus/minibus/other	3.4	7.1	6.3	6.3
Type of fall		(1,092)	(1,793)	(1,376)	(4,261)	0.000
	Same level	31.7	49.6	60.2	48.9
	Bed/furniture	42.5	22.6	9.8	23.0
	Ladder/step	10.7	13.2	9.7	11.4
	Tree/roof/scaffold/slab	0.9	1.9	6.7	3.3
	Hole/other levels	14.2	12.8	13.6	13.4
Type of burn		(73)	(62)	(41)	(176)	^ The chi-square test and p value have not been calculated due to the existence of cell with value less than five.
	Fire/flame	1.8	10.3	19.5	8.7
	Hot substance	72.8	48.4	69.0	64.0
	Hot object	21.6	29.2	5.7	20.3
	Other^c c Includes electrical shock and chemical substances.	3.8	12.2	5.9	7.0
Other accidents		(450)	(1,255)	(1,102)	(2,807)	0.000
	Cutting injury	4,5	8,5	14,5	10,3
	Accidents with animals	12.4	12.7	13.5	13.0
	Object falling on person	12.8	12.7	7.3	10.6
	Collision with object/person	15.7	18.9	32.1	23.7
	Sprain/crushing	19.7	13.2	15.2	15.0
	Other^d d Includes choking / suffocation, foreign body, drowning, poisoning / intoxication, injury by firearms, others.	34.9	34.0	17.4	27.5

Characteristics		Age group (years)^a a The number of attendances for some variables diverged due to missing data (unknown / blank).
Characteristics		0 to 1 (n) %	2 to 5 (n) %	6 to 9 (n) %	Total (n) %	P value^b b Chi-square test.
Type of violence		(140)	(162)	(122)	(424)	^ The chi-square test and p value have not been calculated due to the existence of cell with value less than five.
	Self-inflicted injury	0.8	4.4	2.3	2.5
	Aggression^c c Includes abuse and intervention by legal public officer.	99.2	95.6	97.7	97.5
Nature of violence/aggression		(135)	(146)	(112)	(393)	^ The chi-square test and p value have not been calculated due to the existence of cell with value less than five.
	Physical	14.6	25.4	75.2	33.4
	Sexual	0.8	4.8	4.3	3.1
	Psychological	0.0	0.5	0.0	0.2
	Neglect	84.1	69.4	20.6	63.2
	Other	0.4	0.0	0.0	0.2
Means of aggression		(132)	(147)	(113)	(392)	^ The chi-square test and p value have not been calculated due to the existence of cell with value less than five.
	Body strength / beating	10.9	21.4	50.7	24.8
	Firearm	0.8	2.4	1.9	1.7
	Sharp objects	1.1	3.7	7.5	3.7
	Pointed objects	0.8	2.3	15.2	5.0
	Other	86.4	70.3	24.9	65.0
Family member as aggressor		(135)	(146)	(111)	(392)	^ The chi-square test and p value have not been calculated due to the existence of cell with value less than five.
	Yes^d d Includes father/ mother and other family members.	92.4	75.5	35.5	72.0
	No	7.6	24.5	64.5	28.0
Gender of likely aggression perpetrator		(114)	(122)	(92)	(328)	0.0406
	Male	17.0	38.5	62.7	36.4
	Female	83.0	61.6	37.3	63.7

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[1] Collaborations

DC Malta worked on the design of the study, on the analysis and interpretation of the data and on the critical review, also approved the version to be published. MDM Mascarenhas and RTI Bernal performed the analysis and interpretation of the data and the final revision of the text. MMA Silva, MGO Carvalho, LA Barufaldi and JQ Avanci contributed with critical analysis, final revision of the text. All authors approved their final version.