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Paediatric orthopaedics and global initiative for children’s surgery

Volume 4 | Issue 1 | January-June 2018 | Page: 01-02 | Vrisha Madhuri Authors: Vrisha Madhuri [1] [1] Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India. Address for correspondence: Dr. Vrisha Madhuri, Professor and Head, Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India E-mail: madhuriwalter@cmcvellore.ac.in […]

Grievous injuries in children due to tractor-related accidents

Volume 4 | Issue 1 | January-June 2018 | Page: 34-37 | Kala Ebenezer, Rimi Manners, Sampath Karl [1], Vrisha Madhuri [2] DOI- 10.13107/ijpo.2018.v04i01.008 Authors: Kala Ebenezer, Rimi Manners, Sampath Karl [1], Vrisha Madhuri [2] Paediatric Intensive Care Unit, [2] Paediatric Orthopaedic Unit, [1] Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India […]

Paediatric orthopaedics and global initiative for children’s surgery

Grievous injuries in children due to tractor-related accidents

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Paediatric orthopaedics and global initiative for children’s surgery

Volume 4 | Issue 1 | January-June 2018 | Page: 01-02 | Vrisha Madhuri

Authors: Vrisha Madhuri [1]

[1] Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India.

Address for correspondence:
Dr. Vrisha Madhuri,
Professor and Head, Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College,
Vellore, Tamil Nadu, India
E-mail: madhuriwalter@cmcvellore.ac.in

Global burden of surgical disease and attendant morbidity and mortality has received much attention in the recent past from the World Health Organization and the Lancet Commission on Global Surgery.[1],[2],[3] This has led to several initiatives in the last 2 years by the global surgical community to address the relevant issues. Among them is a coalition of children’s surgery organizations, led by American Paediatric Surgery Association and British Association of Paediatric Surgeons, who are working to bring together the providers and the implementers of surgical services for children in low- and medium-income countries. The coalition consists of health, advocacy and policy experts from the western world. Two meetings of this Global Initiative for Children’s Surgery (GICS) have taken place with the aim of analysing the current state of the surgical care; develop priorities to improve its delivery and identify and bring together needed resources.[4] The dream of GICS is that every child in the world with a surgical need will have access to the resources necessary to optimise his or her individual care.[4]

India has the largest child population in the world. Similar to other developing countries, we have a very wide range of causes including acute, chronic and neglected problems, with many of them being amenable to surgical treatment. The few centres providing high-quality specialised paediatric surgical care are concentrated in the metropolises, and inadequately trained non-paediatric specialists are available to address these problems in the community. Despite the success of a few focussed programs, such as ‘Smile Train’ for cleft lip and palate and the collaborative program between CURE International, India and several state governments for clubfoot conservative treatment and bracing, much of the surgical needs of the children in the community remain unaddressed because of the lack of adequate infrastructure to support children’s surgery, service delivery systems and trained manpower. The supporting services such as paediatric anaesthesia, intensive care, nursing and orthotics also lack infrastructure and trained personnel. Adequate planning at national and regional levels requires paediatric-specific determination of burden of illnesses in different areas such as congenital, neuromuscular disorders, trauma and oncology.

Rashtriya Bal Swasthya Karyakram, a new initiative by the Government of India, envisages the screening of all children and adolescents for key medical and surgical conditions and their referral and treatment by the existing healthcare providers in public and private sectors. However, in the existing system, the lack of paediatric surgical specialists forms a crisis, wherein identified children are unable to access or obtain quality care, and those suffering from complex conditions do not receive comprehensive care. The lack of a triaging system burdens the tertiary care referral centres with routine surgical conditions, which are best handled at secondary levels, causing overcrowding.

The paediatric orthopaedic community is a major stakeholder in the development of surgical services in the country. Our help, along with other paediatric surgical specialists, is required in needs assessment in the area of infrastructure, service delivery and manpower. A specialist organization such as paediatric orthopaedic society can do these in addition to setting up appropriate standards of care for different conditions, triaging systems by level of hospital, standardizing training programs and identifying areas of research. They can also be great advocates for children’s surgery and attract funding and resources. The baseline demographic studies can be used to determine optimal resources such as the number of children’s hospitals required for the population served. The other important areas are the standardization of equipment to be made available for children’s need and integration of infrastructure needs into national children’s surgical plan. They can also promote preventive strategies such as improved prenatal diagnosis and health promotion and rehabilitation.

While GICS is setting up the needs assessment and standards for infrastructure, healthcare delivery and processes and personnel at all levels of care, we can join hands with them and other paediatric surgical colleagues to provide the appropriate inputs and help build up systems and best practices to provide safe affordable surgical care for children.

References

1. Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA,
et al. Global Surgery 2030: Evidence and solutions for achieving health,
welfare, and economic development. Lancet 2015;386:569-624.
2. Available from: http://www.who.int/bulletin/volumes/86/8/07-050435/
en/. [Last accessed on 2017 Jan 23].
3. Available from: http://bulletin.facs.org/2015/04/the-lancet-commissionon-
global-surgery-makes-progress-in-first-year-of-work-an-update/.
[Last accessed on 2017 Jan 23].
4. Global Initiative for Children’s Surgery (GICS) Organizing Committee,
GICS I Summary.Available from: http://www.baps.org.uk/announcements/
global-initiative-childrens-surgery-gics-inaugural-meeting-report/.
June 2016. [Last accessed on 2017 Jan 31].

How to Cite this Article: Madhuri V | Paediatric orthopaedics and global initiative for children’s surger y| International Journal of Paediatric Orthopaedics | January-June 2018; 4(1): 01-02.

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Grievous injuries in children due to tractor-related accidents

Volume 4 | Issue 1 | January-June 2018 | Page: 34-37 | Kala Ebenezer, Rimi Manners, Sampath Karl [1], Vrisha Madhuri [2]

DOI- 10.13107/ijpo.2018.v04i01.008

Authors: Kala Ebenezer, Rimi Manners, Sampath Karl [1], Vrisha Madhuri [2]

Paediatric Intensive Care Unit, [2] Paediatric Orthopaedic Unit, [1] Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India

Address of Correspondence
Dr. Kala Ebenezer,
Paediatric Intensive Care Unit (PICU), Christian Medical College, Vellore – 632 004, Tamil Nadu, India.
E-mail: picu@cmcvellore.ac.in

Abstract

Introduction: Tractor-related accidents are common among the agricultural injuries. Children are prone to such incidents as farmers live in the vicinity of the farmland.
Materials and Methods: From the Paediatric Intensive Care unit (PICU) database we extracted the details of children with unintentional injuries and poisonings during the period January 2008 to June 2009. Those with tractor-related injuries were further analyzed using outpatient and inpatient charts, computerized hospital records were accessed to obtain laboratory and radiological investigations details. The clinical characteristics, injuries, and outcome of these children are presented.
Results: In the 18 months period, there were 107 children with trauma, envenomations and poisoning constituting 6.5% of all PICU admissions. Of the 31 (29%) with polytrauma, four (12.9%) children, three of them boys had sustained tractor-related injuries. The injuries included three with multiple limb fractures, two each of head, chest, musculoskeletal and perineal injury and one each of abdominal and major vascular injury. All had reached the hospital in life-threatening shock and were resuscitated. Multidisciplinary surgical intervention including craniectomy, liver resection and femoral vessels anastomosis were required along with blood transfusions, ventilatory support and inotropes. Three of them survived the injuries after a mean PICU stay of 34 days.
Conclusion: Tractor-related incidents among rural children are associated with major injuries and fatalities in children. The findings call for interventions to prevent such injuries and education of the farming community involved with tractors and other agricultural machineries.
Keywords: Critically ill, Farming machinery, Tractor

References

1. Nag PK, Nag A. Drudgery, accidents and injuries in Indian agriculture. Ind Health 2004;42:149-62.
2. Mandal SK, Maity A. Current trends of Indian tractor industry: A critical review. App Sci Rep 2013;3:132-9.
3. Reed DB, Claunch DT. Nonfatal farm injury incidence and disability to children: A systematic review. Am J Prev Med 2000;18(Suppl 4):70-9.
4. Rivara FP. Fatal and non-fatal farm injuries to children and adolescents in the United States, 1990-3. Inj Prev 1997;3:190-4.
5. Mitchell RJ, Franklin RC, Driscoll TR, Fragar LJ. Farm-related fatalities involving children in Australia, 1989-92. Aust N Z J Public Health 2001;25:307-14.
6. Smith GA, Scherzer DJ, Buckley JW, Haley KJ, Shields BJ. Paediatric farm-related injuries: A series of 96 hospitalized patients. Clin Pediatr 2004;43:335-42.
7. Cogbill TH, Busch HM Jr, Stiers GR. Farm accidents in children. Pediatrics 1985;76:562-6.
8. Goldcamp EM, Myers J, Hendricks K, Layne L, Helmkamp J. Nonfatal all-terrain vehicle-related injuries to youths living on farms in the United States, 2001. J Rural Health 2006;22:308-13.
9. Kumar A, Mohan D, Mahajan P. Studies on tractor related injuries in northern India. Accid Anal Prev 1998;30:53-60.
10. Rees WD. Agricultural tractor accidents: A description of 14 tractor accidents and a comparison of road traffic accidents. Br Med J 1965;2:63-6.
11. Tiwari PS, Gite LP, Dubey AK, Kot LS. Agricultural injuries in Central India: Nature, magnitude and economic impact. J Agric Saf Health 2002;8:95-111.

How to Cite this Article: Ebenezer K, Manners R, Karl S, Madhuri V | Grievous injuries in children due to tractor-related accidents | January-June 2018; 4(1): 34-37.

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Paediatric orthopaedics and global initiative for children’s surgery

Grievous injuries in children due to tractor-related accidents

Paediatric orthopaedics and global initiative for children’s surgery

Grievous injuries in children due to tractor-related accidents

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Paediatric orthopaedics and global initiative for children’s surgery

Authors: Vrisha Madhuri [1]

References

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Grievous injuries in children due to tractor-related accidents

Authors: Kala Ebenezer, Rimi Manners, Sampath Karl [1], Vrisha Madhuri [2]

Abstract

References

(Article Text HTML) (Download PDF)

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