Canadian Hospitals Injury Reporting and Prevention Program (CHIRRP)
- What was the injured person doing when the injury happened?
- What went wrong?
- Where did the injury occur?
- Dr. Suzanne Beno — Physician Director
- Deborah Taylor — Manager
- Evangeline Zhang — Coordinator
- Teresa Carroll — Data Abstractor
The U of T Trauma Program is a collaboration between St Michael’s Hospital (SMH), The Hospital for Sick Children (HSC), and Sunnybrook Health Sciences Centre (SHSC) to integrate trauma-related activities in the areas of education, quality, and research. The Program is supported by their respective centres and the University of Toronto’s (U of T) Division of General Surgery. The integration of these three centres provides an opportunity to bring the highest quality of care to severely injured patients in South Central Ontario, a catchment area of over 8 million persons, while also enhancing the educational opportunities for learners.
Parachute is a national, charitable organization, formed in July 2012, which unites the former organizations of Safe Communities Canada, Safe Kids Canada, SMARTRISK and ThinkFirst Canada in to one strong leader in injury prevention. Ultimately, a new organization with the new brand Parachute was created that combines the expertise and experience of all four legacy organizations and is designed to achieve greater impact in awareness, advocacy and action in the cause of injury prevention.
SickKids has a longstanding relationship with Parachute, and the two organizations frequently collaborate on injury prevention and harm reduction programs.
The Canadian Paediatric Society is the national association of paediatricians, committed to working together to advance the health of children and youth by nurturing excellence in health care, advocacy, education, research and support of its membership.
SickKids and the CPS share many common goals, and work extremely close together to advance paediatric health. Many SickKids staff are actively involved in the CPS, from helping draft and disseminate position statements to engaging in injury prevention research.
These articles are just some pertinent learning material. This section is updated on a regular basis.
Magnet ingestion by a 3-year-old boy
Rosenfield D, Strickland M, Fecteau A. Magnet ingestion by a 3-year-old boy.CMAJ : Canadian Medical Association Journal. 2013;185(11):972-974. doi:10.1503/cmaj.121847.
A previously healthy 3-year-old boy was brought to hospital by his mother, who was concerned that he had ingested several small, spherical magnets earlier that day. The only symptom noted by his mother was increased drooling. Physical examination was unremarkable and revealed a child in no distress. Abdominal radiographs showed 2 small, round radiopacities in the right lower quadrant and one in the epigastrium (Figure 1A) consistent with the description of the magnets. No free air or other signs of perforation were visible. After consultation with the nearby children’s hospital, the child was transferred for a gastroenterology opinion and possible endoscopy.
After the Recall: Reexamining Multiple Magnet Ingestion at a Large Pediatric Hospital.
Rosenfield D, Strickland M, Hepburn CM. After the Recall: Reexamining Multiple Magnet Ingestion at a Large Pediatric Hospital. J Pediatr. 2017 Mar 7. pii: S0022-3476(17)30187-7. doi: 10.1016/j.jpeds.2017.02.002. [Epub ahead of print] PubMed PMID: 28291530.
OBJECTIVES: To evaluate the effectiveness of a mandatory product recall on the frequency of multiple mini-magnet ingestion at a large tertiary pediatric hospital, and to examine the morbidity and mortality associated with these ingestions.
STUDY DESIGN: In this retrospective chart review, we searched our institution’s electronic patient record for patients aged <18 years who had been diagnosed with ingested magnetic foreign bodies between 2002 and 2015, a period that included the mandatory product recall. We compared the frequency and character of ingestions before and after the recall.
RESULTS: Comparing the postrecall years (January 1, 2014, to December 31, 2015) with the 2 years immediately preceding the recall year (January 1, 2011, to December 31, 2012) yields an incidence rate ratio of 0.34 (95% CI, 0.18-0.64) for all magnet ingestions and 0.20 (95% CI, 0.08-0.53) for ingestion of multiple magnets. Based on the Fisher exact test, the incidence of both magnet ingestion (P < .001) and multiple magnet ingestion (P < .001) decreased, and the morbidity associated with magnet ingestion decreased. There were no deaths in either study period.
CONCLUSION: There was a significant decrease in multiple mini-magnet ingestion following a mandatory product recall. This study supports the effectiveness of the recall, which should bolster efforts to keep it in place in jurisdictions where it is being appealed. More broadly, the result provides general evidence of a recall helping decrease further harm from a product that carries a potential hazard.
Single-Use Detergent Sacs: A Retrospective Multicenter Canadian Review of Emergency Department Cases.
Rosenfield D, Eltorki M, VandenBerg S, Allain D, Freedman SB, Beno S. Single-Use Detergent Sacs: A Retrospective Multicenter Canadian Review of Emergency Department Cases. Pediatr Emerg Care. 2016 Jul 12. [Epub ahead of print] PubMed PMID: 27387970.
BACKGROUND: Single-use detergent sacs (SUDS) are widely used in North America and Europe with emerging literature on their toxicity. This is the first Canadian multicenter study aimed to quantify and compare SUDS exposures to traditional detergent exposures.
METHODS: A retrospective review of the Canadian Hospitals Injury Reporting and Prevention Program databases was conducted at the Hospital for Sick Children in Toronto, Alberta Children’s Hospital in Calgary and the Stollery Children’s Hospital in Edmonton. All exposures presenting to these 3 centers between 2009 and 2014 were identified, a case form was completed, and data were analyzed.
RESULTS: Forty cases of SUDS exposure were identified alongside 35 cases of traditional detergent exposure during the study period resulting in an incidence of 3.16 SUDS exposures per million children per year presenting to tertiary pediatric emergency departments (EDs). In contrast, traditional detergent exposures had an incidence of 2.78 exposures per million children per year presenting to tertiary pediatric EDs over the study period. Although there was no change in incidence of exposure to traditional detergent over the study period, there was an increase in the incidence of SUDS exposures from 2010 to 2013, with a decrease seen in 2014. There was no significant difference seen in age, sex, location of exposure, transportation to hospital, morbidity, or mortality associated with SUDS exposures compared with traditional detergent exposure. Although not statistically more likely to cause long-term complications, SUDS-exposed children required more follow-up visits to health care providers than traditional detergents.
CONCLUSIONS: This multicenter study is the first to establish the incidence of SUDS and traditional detergent exposure in 3 Canadian cities. Overall, the frequency of exposure to detergents-both traditional and SUDS-is very low. Given the increase in SUDS exposure seen from 2011 to 2013, alongside larger sales of SUDS, continued efforts are required to monitor exposures, and reduce potential exposures to SUDS and traditional detergents in the future.
Magnetic foreign body injuries: a large pediatric hospital experience
Strickland M, Rosenfield D, Fecteau A. Magnetic foreign body injuries: a large pediatric hospital experience. J Pediatr. 2014 Aug;165(2):332-5. doi: 10.1016/j.jpeds.2014.04.002. Epub 2014 May 16. PubMed PMID: 24836391.
OBJECTIVE: To examine trends in magnet-related injuries and hypothesize that changes are a result of new neodymium-iron-boron magnets that are smaller, stronger, and commonly sold in sets.
STUDY DESIGN: In this retrospective chart review, we searched our institution’s electronic patient record for patients less than 18 years old who were diagnosed with magnetic foreign body ingestion between 2002 and 2012. Cases were analyzed for patient, magnetic foreign body, and management characteristics. Incidence rates and case characteristics were compared between the first 8 years of the study period and the last 3.
RESULTS: We identified 94 patients who met our search criteria. Of confirmed ingestions, the median age was 4.5 years and 65% were male. The incidence of visits increased between the 2002-2009 period and the 2010-2012 period by a factor of 2.94 (95% CI, 1.84-4.70), whereas the incidence of injuries involving multiple magnets increased by a factor of 8.40 (95% CI, 3.44-20.56). The volume of the magnets decreased from 878.6 mm3 to 259.8 mm3. Six cases required surgical removal of the magnets because of intra-abdominal sepsis or concern for imminent bowel perforation.
CONCLUSIONS: Since 2002, there has been a significant increase in the incidence of magnetic foreign body injuries. These injuries have increasingly involved multiple, smaller magnets and required operative intervention.
Health Canada is Taking Action to have Small, Powerful Magnet Sets Removed from the Marketplace
Health Canada is Taking Action to have Small, Powerful Magnet Sets Removed from the Marketplace. Health Canada Advisory. May 22, 2013. ID# RA-31619
Health Canada is warning Canadians that a number of novelty magnet sets marketed to adults that were sold in Canada are a danger to human health or safety. These sets contain small, powerful magnets that can be easily swallowed or inhaled by children of all ages resulting in serious adverse effects on their health. Health Canada is now taking action to identify and have these dangerous products removed from the marketplace.
Age and the risk of All-Terrain Vehicle-related injuries in children and adolescents: a cross sectional study
McLean et al. Age and the risk of All-Terrain Vehicle-related injuries in children and adolescents: a cross sectional study. BMC Pediatrics. 2017. 17:81 DOI 10.1186/s12887-017-0807-y
BACKGROUND: The study was designed to determine if youth <16 years are at a greater risk of serious injuries related to all-terrain vehicle (ATV) use compared to older adolescents and adults.
METHODS: We performed cross sectional study of children and adults presenting to pediatric and adult emergency departments between 1990 and 2009 in Canada. The primary exposure variable was age <16 years and the primary outcome measure was moderate to serious injury determined from physician report of type and severity of injury.
RESULTS: Among 5005 individuals with complete data, 58% were <16 years and 35% were admitted to hospital. The odds of a moderate to serious injury versus minor injury among ATV users <16 years of age was not different compared with those ≥16 years of age (OR: 0.94; 95% CI: 0.84, 1.06). After adjusting for era, helmet use, sex and driver status, youth <16 years were more likely to present with a head injury (aOR: 1.45; 95% CI: 1.19–1.77) or fractures (aOR: 1.60; 95% CI: 1.43–1.81), compared with those ≥16 years. Male participants (aOR: 1.21; 95% CI: 1.06–1.38) and drivers (aOR: 1.30, 95% CI: 1.12–1.51) were more likely to experience moderate or serious injuries than females and passengers. Helmet use was associated with significant protection from head injuries (aOR: 0.59; 95% CI: 0.44–0.78).
CONCLUSIONS: Youth under 16 years are at an increased risk of head injuries and fractures. For youth and adults presenting to emergency departments with an ATV-related injury, moderate to serious injuries associated with ATV use are more common among drivers and males. Helmet use protected against head injuries, suggesting minimum age limits for ATV use and helmet use are warranted.
Canadian Paediatric Society Injury Prevention Statements:
Bicycle helmet use in Canada: The need for legislation to reduce the risk of head injury
Brent E Hagel, Natalie L Yanchar; Canadian Paediatric Society, Injury Prevention Committee. Bicycle helmet use in Canada: The need for legislation to reduce the risk of head injury. Paediatr Child Health 2013;18(9):475-80
Bicycling is a popular activity and a healthy, environmentally friendly form of transportation. However, it is also a leading cause of sport and recreational injury in children and adolescents. Head injuries are among the most severe injuries sustained while bicycling, justifying the implementation of bicycle helmet legislation by many provinces. There is evidence that bicycle helmet legislation increases helmet use and reduces head injury risk. Evidence for unintended consequences of helmet legislation, such as reduced bicycling and greater risk-taking, is weak and conflicting. Both research evidence to date and recognition of the substantial impact of traumatic brain injuries support the recommendation for all-ages bicycle helmet legislation.
Preventing choking and suffocation in children
C Cyr; Canadian Paediatric Society, Injury Prevention Committee. Preventing choking and suffocation in children. Paediatr Child Health 2012;17(2):91-2
Choking, suffocation, and strangulation cause serious unintentional injuries in children and are leading causes of unintentional death in infants and toddlers. Nearly all choking, suffocation and strangulation deaths and injuries are preventable. The present statement reviews definitions, epidemiology and effective prevention strategies for these injuries. Recommendations that combine approaches for improving safety, including research, surveillance, legislation and standards, product design and education, are made. Paediatric health care providers should be encouraging parents and other caregivers to learn CPR and choking first aid, as well as offering anticipatory, age-appropriate guidance to prevent these injuries, at regular health visits.
Transportation of infants and children in motor vehicles
C van Schaik; Canadian Paediatric Society, Injury Prevention Committee. Transportation of infants and children in motor vehicles. Paediatr Child Health 2008;13(4):313-8
Motor vehicle collisions remain the leading cause of death in Canadian children. In 2006, 16% of Canadian motor vehicle traffic collision fatalities and 19% of injuries occurred among children and adolescents (zero to 19 years of age). Despite all 10 provinces and three territories having laws requiring the use of child safety seats, many injuries and deaths are directly attributed to nonuse or misuse of child restraints.
Recommendations for snowmobile safety
R Stanwick; Canadian Paediatric Society, Injury Prevention Committee. Recommendations for snowmobile safety. Paediatr Child Health 2004;9(9):639-42
Snowmobiles continue to pose a significant risk to children younger than 15 years of age and young adults aged 15 to 24 years. Head injuries remain the leading cause of mortality and serious morbidity, arising largely when snowmobilers collide, fall or overturn during operation. Children have also been injured while being towed by snowmobiles in a variety of conveyances.
Preventing injuries from all-terrain vehicles
Natalie L Yanchar; Canadian Paediatric Society, Injury Prevention Committee. Preventing injuries from all-terrain vehicles.
All-terrain vehicles (ATVs) are widely used in Canada for recreation, transportation and occupations such as farming. As motorized vehicles, they can be especially dangerous when used by children and young adolescents who lack the knowledge, physical size, strength, and cognitive and motor skills to operate them safely. The magnitude of injury risk to young riders is reflected in explicit vehicle manual warnings and the warning labels on current models, and evidenced by the significant number of paediatric hospitalizations and deaths due to ATV-related trauma. However, helmet use is far from universal among youth operators, and unsafe riding behaviours, such as driving unsupervised and/or driving with passengers, remain common. Despite industry warnings and public education that emphasize the importance of safety behaviours and the risks of significant injury to children and youth, ATV-related injuries and fatalities continue to occur. Until measures are taken that clearly effect substantial reductions in these injuries, restricting ridership by young operators, especially those younger than 16 years of age, is critical to reducing the burden of ATV-related trauma in children and youth. This document replaces a previous Canadian Paediatric Society position statement published in 2004.
Child and youth injury prevention: A public health approach
Natalie L Yanchar, Lynne J Warda, Pamela Fuselli; Canadian Paediatric Society, Injury Prevention Committee. Child and youth injury prevention: A public health approach. Paediatr Child Health. 2012;17(9): 511
The majority of child and youth injuries are preventable. This statement provides background, direction and a statement of commitment to the issue of child and youth injury prevention in Canada. It acts as a foundation to build upon by focusing first on definitions, scope and priorities for injury prevention. It also describes the burden and patterns of unintentional injury, and the principles of effective intervention for prevention. A list of resources for obtaining data and evidence-based information is included. This statement can also be used for broad-based injury prevention advocacy.
Trampoline use in homes and playgrounds
L Purcell, J Philpott; Canadian Paediatric Society, Healthy Active Living and Sports Medicine Committee, Injury Prevention Committee. Trampoline use in homes and playgrounds. Paediatr Child Health 2007;12(6):501-5
Trampolining was introduced in 1936 by George Nissen, a circus acrobat. Since the 1950s, the recreational use of trampolines has increased dramatically, particularly in North America, Europe and Australia. In the United States, backyard trampoline sales exceed 500,000 units annually.
Swimming lessons for infants and toddlers
B Hong Nguyen, L Warda; Canadian Paediatric Society, Injury Prevention Committee. Swimming lessons for infants and toddlers. Paediatr Child Health 2003;8(2):113-4
Drowning is the second leading cause of unintentional injury death in Canadian children one to four years of age, accounting for more than one-fifth of deaths in this age group. Hospitalization rates for near-drowning peak in the toddler age group, with a five-fold increased risk compared with older children.
Preventing playground injuries
P Fuselli; NL Yanchar; Canadian Paediatric Society, Injury Prevention Committee. Preventing playground injuries. Paediatr Child Health 2012;17(6):328
With concerns increasing around childhood obesity and inactivity, playgrounds offer a chance for children to be active. But playgrounds also have risks, with injuries from falls being the most common. Research has shown that playground injuries can be reduced by lowering the heights of play equipment and using soft, deep surfaces to cushion falls. The Canadian Standards Association (CSA) has published voluntary standards for playgrounds to address these risks for several years. Parents can further reduce injury risks by following simple playground strategies. This statement outlines the burden of playground injuries. It also provides parents and health care providers with opportunities to reduce injury incidence and severity through education and advocacy, and to implement evidence-informed safety standards and safer play strategies in local playgrounds. This document replaces a previous Canadian Paediatric Society position statement published in 2002.
Skiing and snowboarding injury prevention
LJ Warda, NL Yanchar; Canadian Paediatric Society, Injury Prevention Committee. Skiing and snowboarding injury prevention. Paediatr Child Health 2012;17(1):35-6
Skiing and snowboarding are popular recreational and competitive sport activities for children and youth. Injuries associated with both activities are frequent and can be serious. There is new evidence documenting the benefit of wearing helmets while skiing and snowboarding, as well as data refuting suggestions that helmet use may increase the risk of neck injury. There is also evidence to support using wrist guards while snowboarding. There is poor uptake of effective preventive measures such as protective equipment use and related policy. Physicians should have the information required to counsel children, youth and families regarding safer snow sport participation, including helmet use, wearing wrist guards for snowboarding, training and supervision, the importance of proper equipment fitting and binding adjustment, sun safety and avoiding substance use while on the slopes.