Accident-related hospitalization in early childhood

Background: Since the end of the 1960ies, accidents have been identified as the most common cause of mortality in children and account for considerabl e childhood morbidity in industrialized western countries. In contrast to t raffic-related accidents in older children and adolescents, which were cons equently registered and documented, no epidemiological data exist about hom e injuries and accidents during the first years of life in Germany. This re port presents data on accident-related hospitalizations in a cohort of 1027 1 infants,who participated in a prospective vaccine efficacy trial in Germa ny from 1991 to 1994. Methods: From the time-point of study entry (at the age of 2-4 months) unti l the end of the study (December 15, 1994) study families were biweekly con tacted by phone using a standardized questionnaire, asking for medically-re levant events and hospitalizations. Results: Overall 1598 hospitalizations in 1282 study children were reported . Accidents were responsible for 338 hospitalizations (21.2%) in 319 childr en (57.1% boys). Two children died (one after a traffic accident and anothe r one after drowning); mortality was 0.6%. The peak accident incidence was at the age of 9-12 months with 22 events/1000 observation years. Most accid ents occurred in May (10.9%) and September/October (11.8%). Thursday was th e day on which most accidents occurred (n=61, 18.1%). 72.5% of all accident s (n=245) were caused by physical trauma of kinetic (n=227) or thermic natu re (n=18). Only 12 accidents (3.5%) were traffic-related. Head trauma was t he most frequent accident (n=193, 57.2%), followed by ingestions (n=79, 23. 4%), injuries (n=20, 5.9%), extremity-fractures (n=19, 5.6%), scalds/burns (n=18, 5.3%) and aspirations (n=9, 2.6%). Overall 12.7% of all hospitalizat ions registered during the study period were accident-related. Mean duratio n of hospitalization ranged from 1.3+/-1.2/1.9+/-1.8 d (ingestions, injurie s) to 9.8+/-8.3/11.4+/-11.8 d (burns/scalds/fractures of the extremities). Children without siblings, cared by one parent showed the lowest, children with more than two siblings in families with four or more adults showed the highest accident rate (1.6 vs. 4.4%). Conclusion: Accidents in infants and toddlers represent an important, altho ugh generally underestimated childhood morbidity factor with higher inciden ce rates but lower mortality compared to accidents in older children.