Traumatic hand amputations among children in Greece: epidemiology and prevention potential
- Paraskevi Panagopoulou1,
- Constantine N Antonopoulos1,
- Ilias Iakovakis1,
- Nick Dessypris1,
- Andreas Gkiokas2,
- Dimitrios Pasparakis3,
- Theodoros Michelakos1,
- Prodromos Kanavidis1,
- Panayotis N Soucacos4,
- Eleni Th Petridou1
- 1Department of Hygiene, Epidemiology and Medical Statistics, Athens University, Medical School, Athens, Greece
- 2First Department of Pediatric Orthopaedics, “P. &. A. Kyriakou” General Children's Hospital, Athens, Greece
- 3Second Department of Pediatric Orthopaedics, “P. &. A. Kyriakou” General Children's Hospital, Athens, Greece
- 4Center for Orthopaedic Research & Education “Attikon” University Hospital, Athens University Medical School, Greece
- Correspondence to Professor Eleni Th Petridou, Department of Hygiene, Epidemiology, and Medical Statistics, Athens University Medical School, 75 M. Asias str., 11527 Athens, Greece;
Contributors PP: data analysis and interpretation, drafting of the manuscript and final approval of the submitted version. CNA: data analysis and interpretation, drafting of the manuscript and approval of the submitted version. II: data acquisition, drafting of the manuscript and final approval of the submitted version. ND: acquisition and statistical analysis of the data, drafting of the manuscript and approval of the submitted version. AG: study design and data acquisition, critical revision of the manuscript for important intellectual content and approval of the submitted version. DP: study design and data acquisition, critical revision of the manuscript for important intellectual content and approval of the submitted version. TM: data acquisition, critical revision of the manuscript and approval of the submitted version. PK: data acquisition and analysis, critical revision of the manuscript and approval of the submitted version. PNS: conception and design of the study, data interpretation, critical revision of the manuscript for important content and approval of the submitted version. EThP: conception and design of the study, data analysis and interpretation, critical revision of the manuscript for important intellectual content and approval of the submitted version.
- Accepted 28 November 2011
- Published Online First 17 December 2011
Background Traumatic hand and finger amputations frequently lead to permanent disability.
Objective To investigate their epidemiological characteristics and estimate the prevention potential among children 0–14 years old, through a cross-sectional survey.
Methods Nationwide extrapolations were produced based on data recorded between 1996 and 2004 in the Greek Emergency Department Injury Surveillance System and existing sample weights. Incident and injury related characteristics were analysed to identify preventable causes.
Results Among 197 417 paediatric injuries, 28 225(14%) involved the hand and fingers resulting in 236 amputations (∼1% of hand injuries). The annual probability to seek emergency department care for a hand injury was 3%. The estimated incidence rate (IR) of hand amputations was 19.7/100 000 person-years. Over 50% concerned children 0–4 years old (male:female=2:1), peaking at 12–24 months. Male preschoolers suffered the highest IR (38.7/100 000). Migrant children were overrepresented among amputees. Of all amputations, 64% occurred in the house/garden and 14% in day-care/school/sports activities, usually between 08:00 and 16:00 (61%). Doors were the product most commonly involved (55% overall; 72% in day-care/school/gym) followed by furniture/appliances (15%) and machinery/tools (7%). Crushing was the commonest mechanism. Inadequate supervision and preventive measures were also frequently reported. 5% of the amputees were referred to specialised units for replantation/reconstructive surgery.
Conclusions The majority of paediatric hand and finger amputations could be prevented in Greece, particularly among preschoolers, by a single product modification, namely door closure systems, coupled with improved supervision. Paediatricians should incorporate this advice into their routine child-safety counselling. This country-specific profile supports the need for maintaining similar databases as an indispensable tool for assisting decision-making and preventing disabling and costly injuries.
- burden of disease
- injury surveillance systems
- multiple injury
- public health
- trauma systems
- descriptive epidemiology
- medical error
- hand injury
- product modification
Funding This project was supported in part by the Ministry of Health and Welfare of Greece (grant no. 2003ΣM09100000). EDISS was also partly funded by the European Union (DG SANCO–grant agreement number 2003313 (SI2.379687)). Role of the funder: MOHAW provided financial support and facilitated establishment of the EDISS in the collaboration hospitals and financial as well as technical support DG-SANCO provided support within the framework of the project ‘Coordination and Administration of the European Injury Prevention Working Party on Accidents and Injuries Program’.
Competing interests None.
Patient consent All patients before the interview gave informed consent for use of the information they provided.
Ethics approval Ethics approval was provided by Bioethics Committee of the University of Athens Medical School.
Provenance and peer review Not commissioned; externally peer reviewed.