Thursday, May 18, 2017

After hours presentation of traumatic dental injuries to a major paediatric teaching hospital

Department of Pediatric Dentistry

Lutheran Medical Center
Resident’s Name: John Diune                                                      Date: 5/17/2017

Article Title: After hours presentation of traumatic dental injuries to a major paediatric teaching hospital
Author(s): M Warren, R Widmer, M Arora, S Hibbert
Journal: Australian Dental Journal
Date: 2014
Major Topic: Trauma
Type of Article: Prospective study
Main Purpose: Assess the efficacy of a structured paper history (over non-structured notes or computer aided records) for recording traumatic dental injuries, and also analyze the etiology and epidemiology of injuries in a major pediatric teaching hospital during afterhour’s emergency visits.
1)      Key Points: (2 lines Max): Structured paper history (SPH) improved the likelihood that important factors associated with the event were recorded.
2)      See below for breakdown of findings that may be interesting regarding after hours emergencies
SPH was put into use at The Children’s Hospital at Westmead for 12 months from February 2011 to January 2012. Afterhours emergency was defined as weekends, public holidays, and from 5pm to 8am on weekdays.
-          Emergencies were triaged by the ED, and the pediatric dental resident called only if the injury warranted their attention (note bias)
-          During the 12 months total of 190 patients required treatment
o   94 dental injuries only
o   88 combined dental and soft tissue injuries
o   8 soft tissue injuries only
-          Age/gender
o   Peak incidence at 0-2 years (26%) and 6-8 years (23%)
§  (Bias – younger patients parents may seek treatment more urgently, also during eruption of permanent teeth injuries parents also may deal more urgently)
o   Lowest incidence 12+ age group (13%)
o   115 males / 75 females (1.5:1)
§  (Bias as this study included only up to 15yo and also 44% of patients were age from 0-5yo, and research shows minimal gender predilection during primary dentition years)
o   Broken down for “male/female” per age group:
§  1:1 for 0-2yo and 6-8yo
§  1.6:1 for 3-5yo
§  2.2:1 for 9-11yo
§  3.2:1 for 12-15yo
-          Chronology
o   Majority of injuries Saturday (31%) and Sunday (20%)
o   Highest: October (13%), April (11%), March (10%)
o   Lowest: February (5%), June (6%)
o   30% injuries occurred during school holidays
-          Locations
o   57% outdoors / 43% indoors (bias after hours so not in school)
-          Injury type
o   368 had 1 injury / 28 had 2 injuries (to individual tooth)
o   214 primary teeth / 210 permanent teeth
o   Most common injury including all teeth
§  Subluxation, then uncomplicated crown fracture and lateral luxation
o   Separated for primary vs permanent:
§  Avulsions and luxations 63% of primary teeth
§  26% in permanent teeth              
§  (bias regarding severity of injuries seen in “afterhours emergency dental clinics” are 2 reasons:
1)      Severe injuries are often referred to ED/hospitals whereas minor injuries may be handled in office
2)      Parents may hold off on going to the ED for minor injuries , and wait to be treated the following day by the primary provider
Assessment of Article:  Level of Evidence/Comments:


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