Faulty glass in tables can cause life-threatening injuries, according to a Rutgers study, which provides evidence that stricter federal regulations are needed to protect consumers.
The study, published in the American Journal of Surgery, reviewed 3,241 cases in the National Electronic Injury Surveillance System database and 24 cases from a level 1 trauma center.
They found most of the injuries occurred in children under age 7 and in young adults in their early 20s.
Injuries that mostly affected the arms, shoulders and forehead, ranged from minor abrasions and damage to major organs and vessels, to death.
Glass table injuries are common, with more than 2.5 million per year reported, many of which are treated in trauma centers and emergency departments.
According to the U.S. Consumer Product Safety Commission, tempered glass is mandatory for doors but voluntary for horizontal surfaces such as tabletops, which often are made with untempered glass and are more likely to break into sharp edges that can cause severe lacerations.
In the national database, 1,792 of the faulty table injuries were lacerations and 24 were blunt injuries resulting from a fall after a table broke. Most frequently injured areas were the wrist, hand and finger.
About 15 percent of the injuries were classified as severe, including those to the upper and lower trunk and the wrist.
At the trauma center, half of the patients suffered injuries to their deep organs, upper torso, abdomen or joint cavities and required surgery; eight percent died within a month of injury.
About 70 percent of those injured were male, with most injuries occurring in people under age 7 and in their early twenties.
Injuries occurred when people fell into faulty glass tables, often breaking through, or from glass after the table was broken. People who had non-glass injuries, such as striking against or falling from a glass table, occurred most often in children under age 10, with injuries most often to the face, head and mouth.
“It is imperative to push for stricter regulation as consumers of glass tables should not be incurring life-threatening trauma injuries due to neglect of manufacturers in not using tempered glass,” said study author Stephanie Bonne, an assistant professor of surgery at Rutgers New Jersey Medical School.
Globally, 5.82 million deaths occurred among children under the age of five years in 2015. (Global Burden of Disease Child and Adolescent Health Collaboration et al. 2017). The injury specific mortality rate in the under five age group was 73 per 100,000 population and 3654 years of life were lost per 100,000 population (WHO 2015).
Among children aged 1–5 years, injuries are the leading cause of death in the developed world (Sminkey 2008). Additionally, there is an unequal distribution between the developed and the developing world, with the mortality rate from unintentional injuries in developing countries being nearly twice that of the developed world (Chandran et al. 2010).
According to the World Health Organization (WHO), up to 50% of the children presenting to a hospital with unintentional injuries are left with some form of disability (Peden et al. 2008). More than 95% of all the injury deaths in children occur in the Low and Middle Income countries; children in Southeast Asia have the second highest rates (49/100,000) of unintentional injuries in the world (Peden et al. 2008).
According to World Health Statistics 2015, overall under 5 mortality rate (U5MR) in India in 2013 is 52.7 per 1000 live births and injury specific mortality rate is around 2.1 per 1000 live births contributing to 4% of the total U5MR (WHO 2015).
In a national survey based on verbal autopsy, the mortality rate related to injuries among children under 5 years was 302 per 100,000 live births (Jagnoor et al. 2011). Studies from rural Andhra Pradesh and Tamil Nadu have documented injury rates of 307 and 342 per 1000 child-years respectively (Nirgude et al. 2012; Sivamani et al. 2009).
Unintentional injuries thus lead to substantial morbidity and mortality in children younger than five years of age in India. Children under the age of one have different patterns of injuries with most injury-related deaths attributed to suffocation as a result of an unsafe sleeping environment (Borse et al. 2008; Imamura et al. 2012).
At the age of 1–5 years, children start to move more independently and this increases their risk of injury. A multinational study conducted in developing nations found that children aged 1–5 years sustain injuries with the most long-term consequences with high mortality rates (Hyder et al. 2009; Morrongiello and Matheis 2007).
In India, unplanned urbanization and rise in informal settlements are leading to an increase in urban slums thus leading to high population density and overcrowding (Bandyopadhyay and Agrawal 2013; Tripathi 2015). Lack of spaces in Indian towns and cities due to rapid urbanization has increased the environmental hazards and as a consequence, injuries of all types including unintentional injuries among younger age groups have increased (Naeini et al. 2011; Nambiar et al. 2017).
In India, since most under five deaths still continue to be due to infectious causes, more emphasis is placed on vaccine-preventable diseases and there is a lack of policy focus and planning directed at unintentional injuries, a preventable source of significant morbidity and mortality (Fadel et al. 2017).
With the paucity of literature regarding childhood unintentional injuries in India, this study aims to estimate the burden and examine factors associated with unintentional injuries among children aged 1–5 years residing in urban slums of Vellore city in Tamil Nadu, southern India. We have also attempted to assess the hazards posed by the living environment of these children and study their association with unintentional injury patterns.
Definitions of injuries, outcome, and explanatory variables
The primary outcome of the study was to assess the presence of UI in the children during the past three months from the date of data collection. Unintentional Injuries are defined as injuries occurring in short period of time with an unsought outcome and as a result of one of the forms of physical energy in the environment or normal body functions being blocked by external means (Christoffel et al. 1992).
The operational definitions of different types of UI used in this study are as follows: fall as injury due to fall to the ground or fall on the ground; burns as injury that causes burns of any degree to the body tissue; electric burns as burn injury due to electrical and electronic gadgets; drowning as submerging in a body of water; poisoning as consumption of non edible substances, including chemicals; road traffic accidents as injury to any part of the body due to moving automobiles; heavy mechanical injury as injury due to a heavy object.
Severe UI were defined as those UI requiring medical attention, that is, those that needed a visit to the hospital or treatment by a physician. Families with more than two persons living per room were defined as overcrowded dwellings. Modified kuppuswamy scale was used for assessing the socioeconomic status (Bairwa et al. 2013).
Housing type was considered as “pucca” if houses were made with high quality materials throughout, including the floor, roof, and exterior walls and houses made from mud, thatch, or other low-quality materials were called kutcha houses (Ministry of Statistics and Programme Implementation, GOI 2013).
- Bairwa M, Rajput M, Sachdeva S. Modified Kuppuswamy’s socioeconomic scale: social researcher should include updated income criteria, 2012. Indian J Community Med. 2013;38(3):185–6.Article Google Scholar
- Bandyopadhyay DA, Agrawal V. Slums in India: from past to present. Int Refereed J Eng Sci IRJES. 2013;2(4):55–9.Google Scholar
- Bartlett S. The problem of children’s injuries in low income countries: a review. Health Policy Plan. 2002;17:1–13.Article Google Scholar
- Borse NN, Gilchrist J, Dellinger AM, Rudd RA, Ballesteros MF, Sleet DA. Patterns of unintentional injuries among 0–19 year olds in the United States. 2008;Google Scholar
- Chandran A, Hyder A, Peek-Asa C. The global burden of unintentional injuries and an agenda for progress. Epidemiol Rev. 2010;32(1):110–20.Article Google Scholar
- Chaudhari V, Srivastava R, Moitra M, Desai V. Risk of domestic accidents among under five children. Internet J Fam Pract. 2009;7:1.Google Scholar
- Christoffel KK, Scheidt PC, Agran PF, Kraus JF, McLoughlin E, Paulson JA. Standard definitions for childhood injury research: excerpts of a conference report. Pediatrics. 1992 Jun 1;89(6):1027–34.Google Scholar
- Dal Santo JA, Goodman RM, Glik D, Jackson K. Childhood unintentional injuries: factors predicting injury risk among preschoolers. J Pediatr Psychol. 2004;29(4):273–83.Article Google Scholar
- Damashek A, Williams N, Sher K, Peterson L, Lewis T, Schweinle W, et al. Risk for minor childhood injury: an investigation of maternal and child factors. Psychol Sep Epub Mar 3. 2005;30(6 SRC-GoogleScholar):469–480.Article Google Scholar
- Dudani A, Macpherson A, Tamim H. Childhood behavior problems and unintentional injury: a longitudinal, population-based study. J Behav Pediatr May. 2010;31(4 SRC-GoogleScholar):276–285.Article Google Scholar
- Fadel SA, Rasaily R, Awasthi S, Begum R, Black RE, Gelband H, et al. Changes in cause-specific neonatal and 1–59-month child mortality in India from 2000 to 2015: a nationally representative survey. Lancet. 2017;390(10106):1972–80.Article Google Scholar
- Glik D, Kronenfeld J, Jackson K. Predictors of risk perceptions of childhood injury among parents of preschoolers. Health Educ Q Fall. 1991;18(3 SRC-GoogleScholar):285–301.Article Google Scholar
- Global Burden of Disease Child and Adolescent Health Collaboration, Kassebaum N, Kyu HH, Zoeckler L, Olsen HE, Thomas K, et al. Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study. JAMA Pediatr. 2017 Jun 1;171(6):573–92.Article Google Scholar
- Hajian-Tilaki K. Sample size estimation in epidemiologic studies. Casp J Intern Med. 2011;2(4):289–98.MATH Google Scholar
- Hong J, Lee B, Ha EH, Park H. Parental socioeconomic status and unintentional injury deaths in early childhood: consideration of injury mechanisms, age at death, and gender. Accid Anal Prev. 2010;42(1):313–9.Article Google Scholar
- Hyder AA, Sugerman DE, Puvanachandra P, Razzak J, El-Sayed H, Isaza A, et al. Global childhood unintentional injury surveillance in four cities in developing countries: a pilot study. Bull World Health Organ. 2009;87(5):345–52.Article Google Scholar
- Imamura J, Troster E, Oliveira C. What types of unintentional injuries kill our children? Do infants die of the same types of injuries? A systematic review. Clin Sao Paulo Sep. 2012;67(9 SRC-GoogleScholar):1107–1116.Article Google Scholar
- Jagnoor J, Bassani DG, Keay L, Ivers RQ, Thakur JS, Gururaj G, et al. Unintentional injury deaths among children younger than 5 years of age in India: a nationally representative study. Inj Prevention. 2011;17(3):151–5.Article Google Scholar
- John SM, Thomas RJ, Kaki S, Sharma SL, Ramanujam K, Raghava MV, et al. Establishment of the MAL-ED birth cohort study site in Vellore, Southern India. Clin Infect Dis. 2014 Nov 1;59(Suppl 4):S295–9.Article Google Scholar
- Larsson L, Butterfield P, Christopher S, Hill W. Rural community leaders’ perceptions of environmental health risks: improving community health. AAOHN J Mar. 2006;54(3 SRC-GoogleScholar):105–112.
- Laursen B, Nielsen J. Influence of sociodemographic factors on the risk of unintentional childhood home injuries. Eur J Health Aug Epub May 31. 2008;18(4 SRC-GoogleScholar):366–370.Article Google Scholar
- McGee K, Sethi D, Peden M, Habibula S. Guidelines for conducting community surveys on injuries and violence. Int J Inj Control Saf Promot. 2004;11(4):303–6.Article Google Scholar
- Ministry of Statistics and Programme Implementation, GOI. Housing Condition and household amenities. Stat. Year b. India 2013 [Internet]. The government of India; 2013 [cited 2018 Oct 13]. p. 28. Available from: http://mospi.nic.in/sites/default/files/Statistical_year_book_india_chapters/HOUSING%20-%20WRITEUP.pdf.
- Morrongiello BA, Matheis S. Understanding Children’s injury-risk behaviors: the independent contributions of cognitions and emotions. J Pediatr Psychol. 2007;32(8):926–37.Article Google Scholar
- Morrongiello BA, Ondejko L, Littlejohn A. Understanding toddlers’ in-home injuries: II. Examining parental strategies, and their efficacy, for managing child injury risk. J Pediatr Psychol. 2004a;29(6):433–46.Article Google Scholar
- Morrongiello BA, Ondejko L, Littlejohn A. Understanding toddlers’ in-home injuries: I. context, correlates, and determinants. J Pediatr Psychol. 2004b;29(6):415–31.Article Google Scholar
- Munro S, van Niekerk A, Seedat M. Childhood unintentional injuries: the perceived impact of the environment, lack of supervision and child characteristics. Child Care Health Dev May. 2006;32(3 SRC-GoogleScholar):269–279.Google Scholar
- Naeini HS, Lindqvist K, Jafari HR, Mirlohi AH, Dalal K. Playground injuries in children. Open Access J Sports Med. 2011;2:61–8.Google Scholar
- Nambiar D, Razzak J, Afsana K, Adams AM, Hasan A, Mohan D, et al. Mental illness and injuries: emerging health challenges of urbanisation in South Asia. BMJ. 2017;357:j1126.Article Google Scholar
- Nirgude AS, Naik PR, Sheikh NA. Pattern of Childhood Injuries in a Rural Area of South India. Indian J Forensic Med Toxicol. 2012;6:1.Google Scholar
- Parmeswaran GG, Kalaivani M, Gupta SK, Goswami AK, Nongkynrih B. Unintentional childhood injuries in urban Delhi: a community-based study. Indian J Community Med. 2017;42(1):8–12.Article Google Scholar
- Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, Rahman AF, et al., editors. World Report on Child Injury Prevention [Internet]. Geneva: World Health Organization; 2008 [cited 2018 Jun 2]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK310641/
- Reading R, Langford I, Haynes R, Lovett A. Accidents in preschool children: Comparing family and neighborhood risk factors. Soc Sci Med. 1999;48(3 SRC-GoogleScholar):321–30.Article Google Scholar
- Rizvi N, Luby S, Azam SI, Rabbani F. Distribution and circumstances of injuries in squatter settlements of Karachi. Pakistan Accid Anal Prev. 2006;38(3):526–31.Article Google Scholar
- Ruiz-Casares M. Unintentional childhood injuries in sub-Saharan Africa: an overview of risk and protective factors. J Care Poor Underserved. 2009;20(4 Suppl SRC-GoogleScholar):51–67.Article Google Scholar
- Russell KM, Champion VL. Health beliefs and social influence in home safety practices of mothers with preschool children. Image J Nurs Sch. 1996;28(1):59–64.Article Google Scholar
- Sathiyasekaran BW. Population-based cohort study of injuries. Injury. 1996;27(10):695–8.Article Google Scholar
- Sivamani M, Balraj V, Muliyil J. Validity of a surveillance system for childhood injuries in a rural block of tamilnadu. Indian J Community Med. 2009;34(1):43–7.Article Google Scholar
- Sminkey L. World report on child injury prevention. Inj Prev. 2008;14(1):69.Article Google Scholar
- Tripathi S. Determinants of large City slum incidence in India: a cross-sectional study. Poverty Public Policy. 2015;7(1):22–43.Article Google Scholar
More information: Usha Trivedi et al, Glass table injuries: A silent public health problem, The American Journal of Surgery (2020). DOI: 10.1016/j.amjsurg.2020.07.002