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High-risk periods for childhood injury among siblings
B D Johnston1, D C Grossman, F A Connell
1Division of General Pediatrics, Department of Pediatrics, Harborview Injury Prevention and Research Center, Seattle, WA 91804-2499, USA. bdj@u.washington.edu
Insights
Children whose sibling was recently injured face a higher risk of unintentional injury, especially older children. This increased risk is temporary, lasting about 90 days, suggesting shared environmental factors may play a role.
Area of Science:
- Pediatric injury prevention
- Public health research
- Epidemiology of childhood injuries
Background:
- Unintentional injuries are a leading cause of morbidity in children.
- Previous research has not fully explored the potential clustering of injuries within sibling groups.
- Understanding factors that increase injury risk in children is crucial for developing effective prevention strategies.
Purpose of the Study:
- To investigate if a sibling's injury transiently increases a child's risk of requiring emergency department (ED) or inpatient care.
- To identify the time frame over which this increased risk might persist.
- To examine how age influences the risk of injury following a sibling's injury.
Main Methods:
- Retrospective cohort study design.
- Utilized Medicaid data from King County, Washington, for children aged 0-15 years.
- Analyzed injury incidence rates and hazard ratios, adjusting for covariates, comparing children with and without a recently injured sibling.
Main Results:
- Children with a sibling injured in the preceding 90 days had a 1.75 times higher risk of ED-treated unintentional injury.
- The risk of injury peaked 4-10 days after a sibling's injury and gradually decreased over 90 days.
- Older children experienced a greater relative risk of injury compared to younger children.
Conclusions:
- Childhood injuries requiring medical attention appear to cluster within sibling groups over short periods.
- Shared environmental or social exposures may contribute to this injury clustering.
- Findings suggest potential for targeted, time-limited prevention interventions for families experiencing a recent injury.
Objective:
To determine whether the risk of unintentional injury requiring emergency department (ED) or inpatient care in children is transiently increased over a 90-day period after injury to a sibling.
Design:
Retrospective cohort.
Setting:
King County, Washington. Participants. A total of 41 242 children 0 to 15 years of age continuously enrolled in Medicaid and living in King County during the period October 1, 1992 through September 30, 1993 (27 450 child-years).
Outcome Measures:
The outcome was an unintentional injury treated in the ED or inpatient setting. Incidence rates and hazard ratios were calculated for children whose sibling had been injured in the previous 90 days, compared with children without such exposure. Multivariate analysis was used to adjust for age, gender, race, sibling group size, and noninjury ED use.
Results:
. There were 4921 injuries treated only in the ED and 82 hospital admissions. The incidence of ED treated injury was 305 per 1000 child-years among children whose sibling had been injured in the previous 90 days and 174 per 1000 child-years among children without this exposure (relative risk: 1.75; 95% confidence interval: 1.56-1.95). The incidence of injury-related hospitalization was 1.7 per 1000 child-years among children whose sibling had been injured in the previous 90 days, compared with 3.0 per 1000 child-years among children without this exposure (relative risk:.57; 95% confidence interval:.07-2.12). Injury risk peaked in the period 4 to 10 days after a sibling's injury and returned toward, but did not attain, baseline risk over the subsequent 21/2 months. The magnitude of this effect depended on the child's age; the relative risk of injury was higher among older children.
Conclusions:
Injuries treated in the ED or inpatient setting appear to cluster within sibling groups over brief periods of time. Shared social or environmental exposures may contribute to this clustering and may be amenable to targeted, time-limited prevention interventions.