Research Article
J Dent App. 2015; 2(8): 282-286.
Facial Trauma among Children and Adolescents Victims of Traffic Accidents
Lima MMSM¹, Bernardino íDM¹, Ferreira AVP¹, Barbosa KGN², Nóbrega LM¹ and Avila S¹*
¹Departament of Dentistry, State University of Paraíba, Brazil
²Departament of Dentistry, Federal University of Minas Gerais, Brazil
*Corresponding author: Sérgiod’Avila, Department of Dentistry, State University of Paraíba, Campina Grande, Brazil
Received: April 08, 2015; Accepted: September 10, 2015; Published: September 12, 2015
Abstract
Introduction: In the literature there are several studies on facial trauma, but the epidemiology of these lesions is not well characterized regarding children and adolescents. Therefore, this study aimed to identify the prevalence of facial trauma among Brazilian children and adolescents victims of traffic accidents.
Materials and Methods: A cross-sectional study was performed from 196 reports of children and adolescents undergoing forensic examination for a period of four years in a Forensic Unit located in a metropolitan area of Northeast Brazil. The statistical analysis included the calculation of absolute frequencies and percentages of the variables and a chi-square test (p<0.05) in order to identify possible associations.
Results: A total of 21.1% of the victims had facial trauma. The average age of victims was 13.23 (SD = 4.77). Most of the victims were male (68.4%), belonging to the age group 12-18 years (69.9%) from rural areas (56.5%). The most common type of traffic accident was motorcycle accident (52.6%), mainly occurring during the day (55.8%) and during weekdays (72.5%). Trauma cases prevailed in lower limbs (36.1%), followed by multiple trauma cases (33.0%). Moreover, the majority of facial trauma was in soft tissue areas (63.4%) and in more than one third of the face (50.0%). The presence of facial trauma was associated with the type of accident (p = 0.030) and the time of day (p = 0.012).
Conclusions: Most victims were adolescents; most cases occurred during weekdays and motorcycle accidents constituted the main etiologic agent.
Keywords: Traffic Accident; Child; Adolescent
Introduction
Despite the initiatives in different regions of the world aimed at preventing injuries and deaths from traffic accidents, many people fall victim every day, making traffic accidents a major public health issue that needs to be addressed through a multidisciplinary approach [1-3].
The epidemiology of facial fractures in pediatric and adolescent patients differs among countries, and these differences are strongly influenced by social, environmental, educational and cultural factors [4-7]. In addition, the occurrence of traffic-related trauma may vary greatly from birth to late adolescence due to the gradual increase in body resistance or even by several types of impact to which the individual is vulnerable in different age groups [8].
Facial trauma may occur in isolation or in combination with other serious injuries such as intracranial lesions, lesions of the spine and lower limbs and although its occurrence among children and adolescents is generally lower if compared to the adult age group, it may have different clinical and epidemiological characteristics [5, 6, 9].
The face involves hard and soft tissues extending superiorly from the frontal bone and inferiorly to the jaw. It is one of the most exposed regions of the body to trauma capable of causing lesions in skeleton components, teeth and the soft tissues of the face [10].
Although in the literature there are several studies on facial trauma, the epidemiology of these lesions is not well characterized regarding children and adolescents [11]. Data on the distribution of traumas resulting from traffic accidents and their consequences are vital, as they help in planning and improving health care systems and social support systems, as well as in the implementation of public health laws and initiatives in order to prevent and/or reduce the number of deaths and disabilities resulting from traffic accidents [7,8,12,13].
Moreover, in view of the possibility of verifying changes in tendencies and complexities of maxillofacial trauma among children and adolescents, this study aimed to identify the prevalence of facial trauma in Brazilian children and adolescent’s victims of traffic accidents.
Materials and Methods
The study consisted of a cross-sectional and census type study, conducted from secondary data from children and adolescents who sought a Forensic Medical Service to perform “corpus delicti” examination in order to record the extent of injuries caused by the events. The analyzed reports related to living people, from the age group 0-18 years, both sexes, living in urban or rural areas of a metropolitan region located in northeastern Brazil, which has a population close to 687, 545 inhabitants.
All reports of individuals who have had some kind of body or facial trauma recorded in the four-year period (January 2008 to December 2011) due to non-fatal land transport accidents were included. Institution’s employees who, at the time of the examination, were legal experts filled these reports.
To organize the information, a form has been structured and divided in two parts according to the information provided in reports of victims. It consisted of a first identificatory part and a second part covering information related to the accident event. Prior to the survey, a pilot study was conducted and calibration procedures, aiming to verify possible faults or errors, were made.
The age of the victims was categorized according to the Brazilian Statute for Children and Adolescents, which recognizes a child as an individual who has up to twelve incomplete years, and a teenager as an individual who has between twelve and eighteen years [14]. Other variables related to victims were categorized as follows: sex (male/ female) and region of residence (urban/rural). The variables related to accidents were type of accident (car/motorcycle/ trampling), day of the week in which the event occurred (weekdays /weekend) and time of occurrence (day/night). Variables related to trauma presented by victims were presence of facial trauma (yes/no), affected region of the body (head/face/neck/arm/leg/chest/abdomen/more than one), type of facial trauma (lesions in soft tissues/bone fracture/dentoalveolar fracture) and area of the face affected (upper third/middle third/lower third/more than one third).
Absolute and percentage frequencies of the studied variables were calculated and then a chi-square test (p<0.05) was made in order to investigate possible associations between the presence/absence of facial trauma (dependent variable) and variables related to the characteristics of victims and accidents (independent variables). The adopted confidence interval was 95%.
This study followed national and international standards on ethics in research with human beings and it was approved by the ethics committee of independent research (No. 0652.0.133.203-11). The recommendations highlighted in the “STROBE Statement” [15] were complied.
Results
196 reports were evaluated. Of this total, 59 were children aged 0-11 years and 137 were adolescents aged 12-18 years. The average age of the victims was 13.23 (SD = 4.77) and the ratio of male and female individuals was 2.16:1.
Table 1 shows absolute and percentage distributions of data related to sociodemographic characteristics of victims. It was found that cases of males (68.4%), in the 12-18 years age group (69.9%), resident in rural areas (56.5%), prevailed.
Variable
n
%
Sex [196]
Male
134
68.4
Female
62
31.6
Age group [196]
0-11 years
59
30.1
12-18 years
137
69.9
Regionofresidence [193]
Urbanarea
84
43.5
Rural area
109
56.5
Table 1: Absolute and percentage distributions of data related to sociodemographic characteristics of victims.
Table 2 shows absolute and percentage distributions of data related to sociodemographic characteristics of accidents. It was observed that cases of motorcycle accidents (52.6%), followed by trampling (28.9%), mainly occurring during the day (55.8%) and during weekdays (72.5%), prevailed.
Variable
n
%
Typeofaccident [194]
Automobile
36
18.6
Motocycle
102
52.6
Trampling
56
28.9
Time ofoccurrence [163]
Day
91
55.8
Night
72
44.2
Day ofoccurrence [189]
Weekdays
137
72.5
Weekends
52
27.5
Table 2: Absolute and percentage distributions of data related to the characteristics of accidents.
Table 3 describes absolute and percentage distributions of data related to victims’ injuries. The prevalence of facial trauma was 21.1%. Trauma cases prevailed in the lower limbs (36.1%), followed by multiple trauma cases (33.0%). Moreover, the majority of facial trauma was in soft tissue areas (63.4%) and in more than one third of the face (50.0%).
Variable
n
%
Presenceof facial trauma[194]
Yes
41
21.1
No
153
78.9
Bodyregion [194]
Head
7
3.6
Face
20
10.3
Neck
1
0.5
Upperlimbs
27
13.9
Lowerlimbs
70
36.1
Chest
1
0.5
Abdomen
4
2.1
More thanone
64
33.0
Typeof facial trauma [41]
Soft tissue
26
63.4
Bonefracture
11
26.8
Dentoalveolar fracture
4
9.8
Thirdof face hit [40]
Upperthird
13
32.5
Middlethird
4
10.0
Lowerthird
3
7.5
More thanone
20
50.0
Table 3: Absolute and percentage distributions of data related to victims’ lesions.
Table 4 shows the distribution of facial trauma presence/absence according to the characteristics of victims and accidents. After analyzing the results of the chi-square test (p<0.05), it were observed the following results: sex (p=0.065), age (p=0.333), place of residence (p=0.438), type of accident (p=0.030), time of occurrence (p=0.012), day of occurrence (p=0.118).
Presenceof facial trauma
Variables
Yes
%
No
%
Total
p
Sex
0.065
Male
23
17.4%
109
82.6%
132
Female
18
29.0%
44
71.0%
62
Age group
0.333
0-11 years
15
25.4%
44
74.6%
59
12-18 years
26
19.3%
109
80.7%
135
Regionofresidence
0.438
Urban zone
20
24.1%
63
75.9%
83
Rural zone
21
19.4%
87
80.6%
108
Typeofaccident
0.030
Automobile
13
37.1%
22
62.9%
35
Motorcycle
20
19.8%
81
80.2%
101
Trampling
8
14.3%
48
85.7%
56
Time ofoccurrence
0.012
Day
14
15.6%
76
84.4%
90
Night
23
32.4%
48
67.6%
71
Day ofoccurrence
0.118
Weekdays
33
24.3%
103
75.7%
136
Weekends
7
13.7%
44
86.3%
51
Table 4: Distribution of presence/absence of facial trauma according to the characteristics of victims and accidents.
Figure 1 shows the distribution of victims according to the type of accident according to age. It was observed that, while adolescents were more involved in automobile and motorcycle accidents, children suffered most trampling.
Figure 1: Distribution of victims according to the type of accident according
to age group.
Discussion
The significant increase of the number of vehicles on the roads has led to an increase in the number of traffic accidents that are often associated with the occurrence of maxillofacial injuries. Children and adolescents are among the most victimized [16, 17].
The present study demonstrated that the prevalence of facial trauma among children and adolescents was 21.1%. A study by Cavalcanti et al. [18] in the same study area, but analyzing hospitalbased data, found that 15.8% of the victims presented facial fractures.
Another study developed in Chile identified a prevalence of 6% of facial fractures in children [7]. Trauma to the facial region may result in physical, emotional, social and economic consequences, negatively impacting the quality of life of victims and overloading the health system [9, 10, 19-22].
The prevalence of trauma resulting from traffic accidents illustrates the need to strengthen and expand the legislation destined to prevent traffic accidents, and thus to reduce the resulting consequences of injuries among children and adolescents.
The most victimized sex, both pediatric and adolescent, was male. The ratio identified between men and women was 2.16:1. A study conducted by Collao-González et al. [7] showed that, among Chilean children, the proportion of boys and girls was 3.5:1, supporting the hypothesis that boys are more victimized than girls. A study conducted in Norway also obtained results that suggest a higher male victimization [23].
Adolescents aged from 12 to 18 suffered more facial trauma than children with 0-11 years. Similar results were observed in the literature [6]. Cavalcanti et al. [18] reported that the most affected age group was 1-4 years. This difference may be explained by the fact that they included in their sample cases of trauma resulting from etiologic agents other than traffic accidents, such as aggression and falls.
The prevalence of maxillofacial fractures is generally higher in large cities, among other reasons due to heavy traffic and violence. The causes, types and location of these fractures seem to change according to the geographical location [12]. However, there was no statistically significant difference when analyzing the occurrence of facial trauma and the place of residence of the victim.
Regarding the type of accident, cases of motorcycle accidents followed by trampling prevailed. By analyzing the distribution of types of accidents according to the age of the victims, it was observed that, among trampling victims, children prevailed. The occurrence of pedestrian trampled by motorcycles and cars, especially in younger age groups, reflects the need to encourage the drivers of these vehicles to beware the transit and the movement of children nearby, for they often fail to realize the time a vehicle takes to reach a certain distance [8].
Regarding the time of day, it was observed that most of the events occurred during the day and during weekdays. This finding can probably be explained by the fact that, during the week, children and adolescents have to go to school and, therefore, they become more vulnerable.
The most affected body region was lower limbs. In relation to the face, it was observed that situations in which more than one third of the face was hit prevailed. The literature shows that children, when compared with younger teenagers, have a more prominent front projection of the skull. Consequently, central cranial and facial lesions are more common in children and babies, whereas lesions in the lower third of the face are more common in adolescents, suggesting differences in the occurrence of age-related maxillofacial fractures [11].
The most common type of facial trauma was soft tissue injuries. A study conducted in Norway found that lesions in soft tissues, including lacerations, bruises, contusions and abrasions, were the most common lesions resulting from traffic accidents [23]. Soft tissue injuries, although not life threatening in most cases, may require a complex treatment and they generate a significant impact on the function and the patient’s facial aesthetics [24]. Therefore, the diagnosis, the correct handling and interdisciplinary cooperation among general surgeons, plastic surgeons, bucomaxillofacial and ophthalmologists is essential [12].
A limitation of this study is due to the fact that it is crosssectional, and therefore cannot establish causal relationships. Another limitation was due to the use of secondary data, which do not always present complete information.
It was not possible to evaluate the use of helmets and safety belts and the location of the victim (front or back seat) in motor vehicles. It is interesting that future researches address other age groups and compare the differences in victimization according to life-cycle stages.
This study provided a specific vision of the distribution of facial trauma in children and adolescents. It is expected that the results may contribute to epidemiological surveillance of health outcomes in the studied population and support decision-making.
Conclusions
It was concluded that the most victimized individuals were male adolescents, resident in rural areas and involved in motorcycle accidents. Most accidents happened during the day and during weekdays. Furthermore, the most affected area of the body were the lower limbs. The most common situations of facial traumas were in more than one third of the face, and the most common type of facial trauma injury was soft tissue injury.
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