Pediatric Epidemiology

The epidemiology of Pediatric cardiopulmonary arrest is different from that of adults.
Sudden , primary  cardiac arrest is young children is uncommon.
Ventricular fibrillation has been reported in only 10% to 15% of children younger then 10 years who experience pulseless arrest out side the hospital.
Ventricular tachycardia or fibrillation is more likely to be observed in older children (10 years or olders) , submersion vitctims , children with complex cognital heart disease , and children who arrest in hospital.
  More commonly , injury or disease causes respiratory or ciculatory failure , which progresses to cardiopulmonary failure with hypoxemia , and acidosis , culmination in asystolic or pulseless cardiac arrest.
  Intact survival from prehospital normothermic asystolic or pulseless cardiac arrest in infants and children is uncommon. Survival averages 10% in most reports , and many of those who are resuscitated suffer permanent neurological damage.
  The survival rate is slightly higher in ventricular fibrillation is present in the initial electrocardiogram.
In contrast , respiratory arrest alone , is associated with a survival rate exceeding 50% when prompt resuscitation is provided , and most patients survive neurologically intact.
Aggressive prehospital BLS (Basic Life Support) and ALS (Advanced Life Support) have also improved the outcome of drowning victims in pulseless cardiac Arrest.
  To improve the outcome of resuscitation in all children , vigorous prehospital resuscitation should be encouraged , with particular emphasis on providing effective ventilation and oxygenation and preventing cardiac arrest.
  Pediatric cardiopulmonary arrest occurs most commonly at either end of the age spectrum - in children younger then 1 year and in adolescence. During infancy the most common causes of arrest are intentional and unintentional injury , apparent life-threatening events (including the condition formerly reffered to as "near-miss" sudden infant death syndrome) , respiratory diseases , airway obstruction (including foreign-body aspiration) , submersion , sepsis , and neurological diseases. Beyond infancy , injuries are the leading causes of pediatric prehospital cardiopulmonary arrest.

Epidemiology and Prevention of Common Childhood Injuries

Injury prevention programs will be most effective if they focus on injuries that are frequent and severe and for which proven prevention strategies are availble.
The six most common types of severe childhood injuries nation-wide are motor vehicle passenger injuries , pedestrian injuries , bicycle injuries , submersion , burnes and firearm injuries.
Prevention of these would substantially reduce childhood deaths and disability.

Motor Vehicle Injuries

Motor vehicle - related trauma accounts for nearly half of all pediatric injuries and deaths.
Contributing factors include failure to use proper passenger restraints , inexperienced adolescent drivers , and alcohol abuse.  Each of these factors should be addressed by injury prevention programs.
proper use of child seat restraints and lap-shoulder harnesses can prevent an estimated 65% to 75% of serious injuries and fatalities to passengers under 4 years of age and 45% to 55% of all pediatric motor
vehicle passenger injuries and deaths.  Use of proper seat restraints should be required and enforced by law in every state and taught to perents of infants as well as to children during their early primary school education.
A 19 city National Highway Traffic Safety Administration (NHTSA) study documented that 20% of all children
safety seats examined were seriously misused , and 1989-1990 estimatesfrom voluntary screening programs have indicated that as many as 80% to 92% of child restraint devices in use are improperly installed .  Correct use of child restraint devices and safety belts must be taught and verified .
Passive restraint devices , including adjustable shoulder harnsses and automatic lap and shoulder belts and air bags , should be further developed and implemented.
Adolescent drivers are responsible for disproportionate number of motor vehicle-related injuries.
Adolescent driver education classes do not reduce the incidence of collisions involving adolecent drivers.
They have resulted in an icreased number of licened adolescent drivers without an improvement in safety.
  Adolescent drivers are inexperienced , and this inexperience , especially if coupled with alcohol , increases the risk of collision.
Approximately 50% of adolescent motor vehicle fatalities involved alcohol. In fact , a large proportion of all pediatric motor vehicle occupant deaths occur in vehicles operated by inebriated drivers.
Legislative and educational efforts must focus on elimination of drunk driving.

Pedestrian Injuries

Pedestrian injuries are a leading cause of death among children aged 5-9 years.  Injuries tipically occur when a child darts out into the street and is struck by an automobile. Although promising educational programs attempt to improve the street-related behavior of children , roadway interventions such as adequate lighting , construction of sidewalks , and roadway barriers must also be pursued.

Bicycle Injuries

Every year approximately 200,000 children and adolescents are injured and more then 600 die from bicycle-related trauma.  Head injuries cause most bicycle-related morbidity and mortality , and bicycle-related trauma is a leading cause of severe pediatric closed-head injuries.  Use of bicycle helmets can prevent an estimated 85% of head injuries and 88% of brain injuries , but many parents are unaware of the need for helmets , and children may be reluctant to wear them.
A successful bicycle helmet education program includes an ongoing communitywide multidisciplinary approach that provides focused information about the need for and effectiveness of helmets.
To be successful , such programs must ansure the acceptability , accessability , and affordability of helmets.

Paramedic Neomi Zvi - Jan 2000