Rev. bras. ortop. vol.49 número4

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w w w . r b o . o r g . b r

Original

Article

Transport

accidents

among

children

and

adolescents

at

the

emergency

service

of

a

teaching

hospital

in

the

southern

zone

of

the

city

of

São

Paulo

夽

,

夽夽

Carlos

Gorios

∗

_,

_Renata

_Maia

_de

_Souza,

_Viviane

_Gerolla,

_Bruno

_Maso,

Cintia

Leci

Rodrigues,

Jane

de

Eston

Armond

UniversidadedeSantoAmaro,SãoPaulo,SP,Brazil

a

r

t

i

c

l

e

i

n

f

o

Articlehistory:

Received1May2013

Accepted10October2013

Availableonline14May2014

Keywords:

Accidentprevention

Trafficaccidents

Accidents

a

b

s

t

r

a

c

t

Objective:todescribethevictimprofileandcircumstancesoftransportaccidentsinvolving

childrenandadolescentswhowereattendedatateachinghospitalinthesouthernzoneof

thecityofSãoPaulo.

Methods:thiswasanindividualobservationalcaseseriesstudyamongpatientsuptothe

ageof19yearswhowereattendedatahospitalinthesouthernzoneofthecityofSão

Paulo,stateofSãoPaulo,Brazil,duetotrafficaccidents.Thefilesnotifyingsuspectedor

confirmedcasesofviolenceandaccidents(SIVVAfiles)coveringJanuarytoDecember2012

wereanalyzed.

Results:amongthe149casesnotified,64.4%relatedtomalesand35.6%tofemales.The

transportaccidentswerepredominantlyamongmales,irrespectiveofage.Themaininjury

diagnosesweresuperficialheadtrauma(24.8%)followedbymultiplenon-specifiedtrauma

(36.4%),inbothsexes.

Conclusion: transportaccidentsamongchildrenandadolescentsoccurredmoreoftenamong

males.Themaintransportaccidentsamongthechildrenandadolescentsattendedas

emer-gencycaseswerecausedbymotorvehiclesandmotorcycles.Amongtheaccidentvictims,

thelargestproportionwasattendedbecauseofbeingrunover.

Ltda.Allrightsreserved.

Acidentes

de

transporte

de

crianc¸as

e

adolescentes

em

servic¸o

de

emergência

de

hospital

de

ensino,

Zona

Sul

da

cidade

de

São

Paulo

Palavras-chave:

Prevenc¸ãodeacidentes

Acidentesdetrânsito

Acidentes

r

e

s

u

m

o

Objetivo:descreveroperfildasvítimaseascircunstânciasdosacidentesdetransporte

ocor-ridoscomcrianc¸aseadolescentesatendidosemhospital-escolanaZonaSuldacidadede

SãoPaulo.

夽

Pleasecitethisarticleas:GoriosC,deSouzaRM,GerollaV,MasoB,RodriguesCL,ArmondJE.Acidentesdetransportedecrianc¸ase

adolescentesemservic¸odeemergênciadehospitaldeensino,ZonaSuldacidadedeSãoPaulo.2014;49:391–395.

夽夽

WorkperformedatGrajaúGeneralHospital,SãoPaulo,SP,Brazil.

∗ _{Corresponding}_author_.

E-mail:gorios@terra.com.br(C.Gorios).

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Métodos: trata-sedeumestudoindividuadoobservacionaldetipolevantamentodecasos,

compacientesaté19anos,queforamatendidosporacidentesdetrânsitoemhospitalna

ZonaSuldacidadedeSãoPaulo,estadodeSãoPaulo,Brasil.ForamanalisadasasFichasde

Notificac¸ãodeCasosSuspeitosouConfirmadosdeViolênciaeAcidentes(SIVVA),dejaneiro

adezembrode2012.

Resultados: entreos149casosnotificados,64,4%correspondemaosexomasculinoe35,6%

aofeminino.Osacidentesdetransportesãopredominantesnosexomasculino,

indepen-dentementedaidade.Osprincipaisdiagnósticosdelesãoforamotraumasuperficialda

cabec¸a(24,8%),seguidoportraumamúltiplonãoespecificado(36,4%)emambosossexos.

Conclusão: osacidentesdetransporteentrecrianc¸aseadolescentesforammaioresnosexo

masculino.Osprincipaisacidentesdetransporteentreascrianc¸aseosadolescentes

aten-didosnaurgênciaforamocasionadosporautomóveisemotocicletas.Entreasvítimasde

acidentesamaiorpartefoiatendidaporatropelamento.

EditoraLtda.Todososdireitosreservados.

Introduction

InBrazil,accidentsformtheso-calledexternalcausesof

mor-bidityandmortalityandarethemainprobleminthisregard

amongchildrenover the age ofone year and among

ado-lescents.Accidentsarebecominganincreasinglyimportant

publichealthproblemandthereforegreaterdepthofstudyon

theircharacteristics,magnitudeandimpactonpeople’slives

isrequired.1,2

It has to be recognized that hospital morbidity and

mortality data present limitations in characterizing the

epidemiologicalprofileofaccidentsandactsofviolence.

Acci-dentsthatdonotendindeathorhospitalizationarenotpicked

up.3

Frombirthuntiltheendofadolescence,theinjury

mech-anismsrelating totrafficaccidentsmay varygreatly, either

through the gradual increase in the body’s resistance, or

becauseofthemany typesofimpactthat childrenmay be

subjectedtoatdifferentages.Beingrunoverisnotarisk

dur-ingthefirstyearoflife,justasfallingoffamotorcycleisnot

typicalatschoolage.4

Theterm “accidents”islittleusedinternationallyinthe

literature,becauseofthemistakeninterpretationthatthese

aresomethingthatisrandomorunpredictable,andtherefore

unavoidableorimpossibletoprevent.Termslike“crash”and

“injury”havebeen usedintheEnglishlanguagesincethey

seemnottotransmitthisconnotation.InBrazil,theconcept

oftransportaccidentsisusedasanunintentionalbut

avoid-ableevent.Thisconceptisimportantbecauseittranslatesthe

non-randomnessoftheeventandthepossibilityof

identify-ingfactorsthatprovideconditionsforanddeterminantsof

interventionandprevention.5

According to the definition of the Brazilian Ministry of

Health(2001),unintentionalandavoidableeventscause

phys-icalinjuriesand/oremotionaldistress withinthe domestic

settingorinothersocialenvironmentssuchaswork,traffic,

school,sportsorleisureactivities.3

Dataonhospitalizationand deathduetoinjuriesinthe

agegroupup to19 yearshaveshown thatthe highest

fre-quencyisinrelationtotransportaccidents.Safetyissuesin

traffichavebecomea publichealthproblem and theyalso

involve other sectors, which need to have a commitment

towardprevention.6

Thecurrentviewregardingphysicalinjuriesisthatboth

intentional and unintentionalinjuriesare consideredtobe

preventable.Theirfrequencyisvariable,accordingtoage,

gen-der,socialgroupandgeographicalregion.6

Theimplementationoftheinformationsystemfor

surveil-lance of violence and accidents (SIVVA) in the municipal

healthcarenetworkofSãoPaulo,Brazil,hasmadeitpossible

togatherdataonthelocationsofoccurrenceofviolenceand

accidentsandtorevealthegroupsthataremorevulnerable

andtheconsequencesstemmingfromtheseevents,soasto

establishcriteriaforinterventionsthattakeintoaccountthis

diversity.Thesystemalsoenablesconstructionofinformation

onthenatureofaccidentsandforcharacterizingthem.3

In2010,theUnitedNationsOrganization(UNO)proclaimed

that the periodfrom 2011 to2020would be thedecade of

action for traffic safety and asked countries to reach the

target ofstabilizing and reducing deathscaused bytraffic,

through implementing a plan of actionaimed toward five

intervention pillars: strengthening ofmanagement;

invest-ment inroad infrastructure;vehiclesafety;safety behavior

amongtransportusers;andpre-hospitalandhospital

atten-dancefortraumacases.7

In2012,therewere2238notifiedtransportaccidentsamong

childrenandadolescents(upto19yearsofage)inthecityof

SãoPaulo:49.1%involvedpedestrians,47.3%involvedvehicle

occupantsand3.7%wereunknown.Inthesameyear,inthe

southern zoneofthe cityofSãoPaulo,whereourteaching

hospitalislocated,149casesoftransportaccidentsinvolving

childrenandadolescentswerenotified:55.8%among

pedestri-ansand44.2%amongmotorvehicleoccupants.Amongcases

ofbeingrunoverinthecityofSãoPaulo,55.9%werecaused

bymotorvehicles.Inourteachinghospital,amongthecases

ofbeingrunoverthatwereattended,51.2%wereduetomotor

vehicles.

Withregardtoaccidents,accordingtothecharacterization

ofthevictim,46.1%weredrivers;whileaccordingtothetypeof

vehicle,43.6%weremotorcyclistsand48.2%wereonbicycles.

Itwasnotpossibletoassesstheuseofhelmetsandseat

(3)

vehiclesbecauseofpoorfillingoutofthenotificationforms.

Thishasresultedinalimitationofthisstudy.

Itisknownthatthemajorityofemergenciesattendedin

hospitals,especiallythoseresultingfrom accidentalcauses,

couldhavebeenavoidedifcertainpreventivemeasureshad

been used. Within this context, studying the causes and

circumstancesofthese adverseevents amongthe children

andadolescentpopulationbecomesessentialfordeveloping

strategiesforhealthpromotionandforpreventionofthese

events.

Theaimofthisstudywastodescribetheprofileofvictims

and the circumstances oftransportaccidents withvictims

agedupto19yearswhowereattendedatateachinghospital

inthesouthernzoneofthecityofSãoPaulo.

Method

Thiswasanindividualizeddescriptiveobservationalstudyin

whichcasesinvolvingtransportaccidentvictimsagedupto

19yearsweresurveyed.Theseindividualswereattendedata

hospitalinthesouthernzoneofthecityofSãoPaulo,stateof

SãoPaulo,Brazil.

Thenotificationformsforsuspectedorconfirmed cases

of violence or accidents (SIVVA) relating from January to

December2012wereanalyzedattheMedicalAttendanceand

StatisticsService(SAME)ofthishospital.Theanalysisfocused

onnotificationsofpatientswhohadbeentransportaccident

victims,codedasV01–V99intheInternationalClassification

ofDiseases(ICD-10).

In this study,149 records were analyzed. Theinclusion

criteriausedweretheagegroupandnotificationofthe

acci-dentsattended.Subjectswhodidnotmeetthesecriteriawere

excludedfromthestudy.

Thevariablesselectedforthestudywere:age,sex,origin

anddiagnosespresentedbythepatients.

ThisstudyconformedtoResolution196/96oftheNational

ResearchEthicsCommittee(CONEP)andtheNationalHealth

Council(CNS)oftheMinistryofHealth.Moreover,withregard

to research ethics issues, the study was submitted to the

researchethicscommitteeofGrajaúGeneralHospitalandwas

approvedinaccordancewithdecisionreportno.122/2010of

November17,2010,withexemptionfromtheneedforafree

andinformedconsentstatementbecausethestudyconsisted

ofsurveyinginformationintheSIVVA.

Results

Amongthe149casesnotified,64.4%weremalepatientsand

35.6% were female patients. Transport accidents

predomi-natedamongmales,independentofage(Fig.1).

Withregardtoethnicity,32.2%ofthevictimswerewhites,

63.8%wereofmixedskincolorand4%wereblack.

Accordingtoinformationonthetypeofvehicleinvolved,

42.8%werecars,40.1%motorcycles,13.6%bicycles,2.7%buses

and1.4%were unknownvehicles.Thus,carsand

motorcy-cleswereinvolvedmostoften.Caraccidentspredominatedin

theagegroupfrom15to19years(32.3%),asdidmotorcycle

accidents(59.3%)(Fig.2).

160

140

120

100

80

60

40

20

0

10 a 14 years 5 to 9 years 0 to 4

years

15 a 19 years

Total

Male

Total Female

Fig.1–Notifiedtransportaccidentcasesamongchildren andadolescents(upto19yearsofage),accordingtosex, whowereattendedatateachinghospitalinthesouthern zoneofthecityofSãoPaulo,in2012.

Thetimesatwhich theaccidentsoccurred were mostly

intheafternoons(13:00to18:00h;38.7%)andintheevening

(19:00to24:00h;26.1%).

Themaintransportaccidentsamongthechildrenand

ado-lescentsattended asemergency caseswere causedbycars

andmotorcycles.Amongthevictimsofaccidentsduetocars,

55.8% were pedestriansand 44.2%were occupants.Among

theaccidentsduetomotorcycles,52.5%relatedtopedestrians

whowererunover.

Amongthechildrenandadolescentsattendedatthe

emer-gencyservice,65.3%werereleasedfromhospital,32.2%were

keptunderobservationand1.7%weretransferredtoanother

service.

Themaininjuriesdiagnosedweresuperficialheadtrauma

(24.8%),followed byunspecifiedmultipletrauma(36.4%),in

bothsexes(Fig.3).

Theplaceswere thevictims livedwere:53.7%inGrajaú

and25.6%inCidadeDutra,i.e.withinthehospital’scoverage

area;9.9%inParelheiros,i.e.withinthehospital’sareaof

influ-ence;0.8%inCapãoRedondo;0.8%inCachoeirinha;and9.1%

inunknownplaces.

70

60

50

40

30

20

10

0

Cars Bicycles Motorcycles Buses Unknown Total Occupants Pedestrians

(4)

Total

Others

Unspecified multiple trauma

Superficial head trauma

0 20 40 60 80 100 120 140

Total

Male

Female

Fig.3–Injuriesdiagnosedintransportaccidentsamong childrenandadolescents(upto19yearsofage),according tosex,whowereattendedatateachinghospitalinthe southernzoneofthecityofSãoPaulo,in2012.

Discussion

Theteachinghospitalislocatedinthesouthernzoneofthe

city ofSãoPaulo andcovers the area ofthe city’sregional

authorityofCapeladoSocorro.

The region of Capela do Socorro is composed of three

administrative districts: Grajaú, CidadeDutra and Socorro.

Itspopulationin 2011wasestimatedtobe 598,039

inhabi-tants,i.e.5.3%ofthetotalpopulationofthecityofSãoPaulo.

Onecharacteristicofthis regionisthatit iscomposedofa

youngpopulation;32.9%arechildrenandadolescents(upto

19yearsofage).Themostpopulousadministrativedistrictis

Grajaú,whichaccountsfor60.8%ofthepopulationofCapela

doSocorro.8

Among the children and adolescents attended by the

hospital’s emergency service, 53.7% lived in Grajaú, the

mostpopulous districtoftheregion andthe onethat also

presents the greatest number of childrenand adolescents

(35.5%).

Studiesonmortalityintrafficindevelopedcountrieshave

identifiedthatduringeconomicgrowththereareincreasesin

thevehiclefleetandinmortalityrates.AccordingtoMorais

Netoetal.,7 _Brazil_is_among_the_countries_with_the_highest

numbersofdeathsintraffic.Thisistheprimarycauseofdeath

inthegroupofpatientswithinjuriesduetoexternalcauses

fortheagegroupfrom10to14years,andmalespredominate

inhospitaladmissionsanddeathsduetotrafficaccidents.

Inthepresentstudy,transportaccidentswithvictimswho

werechildrenoradolescentsaffectedmalesmorefrequently.

StudiesbyCaixetaetal.9_and_Almeida_et_al.10_presented_results

relatingtopredominanceofmalesamongtheyoungvictims

oftransportaccidents,whichcorroborateotherstudies.

Trafficaccidentsareanimportantpublichealthproblem

becauseoftheirgreatimpactonmorbidityandmortality,

par-ticularlyamongtheyoungmalepopulation.11

Themaintypesofvehicleswerecarsandmotorcycles,and

thevictimswerepedestrians.Withregardtoprojectsaimed

towardpreventionofbeingrunover,whichisthemain

prob-leminthecaseofchildrenandadolescents,somemeasures

aredirectedspecificallytothesegroupsandothermeasures

benefitallusersofpublicroads,coveringeducationalactions,

policing,urbandesignandlandscaping.12

Educationrelatingtotraffic,especiallyfortheinfantand

child population, is oneof the instruments that may

con-tributeinthemediumand longtermstowardreducing the

alarmingtrafficaccidentrates.Trafficthatreallyissafewill

onlybeachievedwhencitizensaremoreawareoftheir

indi-vidualresponsibilities and more respectfulofthe rightsof

others.Asocietyinwhichits citizensmorereadilydevelop

thesevaluesmaybeattainedif,fromanearlyage,childrenand

adolescentsareeducatedsuchthat,whentheyreach

adult-hood,theybecomepedestriansand,especially,driverswho

havegreaterawareness.12

Asshowninthisstudy,theaccidentsoccurredduringthe

afternoons or evenings. Theage group most affected was

betweensixandtenyearsofage.Fromtheobservedtimes

oftheaccidents,the victimsmayhavebeencomingoutof

schoolordoingleisureactivitiesonpublicroads.

Thegreaterproportionofmalesintransportaccidentsmay

berelatedtothegreaterfreedomgrantedtoboys,toplayonthe

streetsandclosetohighways.Boysalsostarttogotoschoolon

theirownatanearlieragethangirls,whichgivesrisetogreater

rates ofbeingrunover than amonggirls. Thus,more

con-tinuoussurveillanceoverfemaleswouldperhapscontribute

towardlowerexposureamongchildrenandadolescentsofthis

sex.13

Itwasnotpossibletoassesswhetherthechildrenand

ado-lescentswereinvolvedinaccidentsatthetimeofcomingout

ofschoolorwhether theywereplayinginthestreets.This

informationwasnotfoundintheaccidentnotificationfiles.

According toSallum and Koizumi,14 _the _frequency_with

whichlimbsandtheheadareinjuredamongaccidentvictims

iswidelydescribedintheliterature.Ourfindingsconfirmed

thepreviousdata,andalsothehighfrequencyofheadinjuries

amongpedestrians.These dataareextremely importantin

relationtopreventionandforattendingthevictims.

Inthisstudy,themainvictimswerepedestriansandthe

maininjurydiagnosiswassuperficialheadtrauma.

AstudyconductedbyAnjosetal.15_in_São_Paulo_in₂₀₀₇

foundthatin60%ofthedeathsduetotrafficaccidents,the

victim wasapedestrian.Thepercentageroseto75%when

onlythedeathsamongchildrenundertheageof15yearswere

takenintoconsideration.

Another interestingpoint demonstrated inthis study is

thatmotorcyclistswere thegroupthatmostfrequentlyhad

accidents,andthatpedestrianswereinsecondposition.This

showsandprovesthevulnerabilitythatthesegroupshaveon

publicroads.Onadailybasis,theyareexposedtohigherrisks,

asproclaimedbymass-circulationnewspapers.The

motorcy-clecouriersinterviewedalreadyhadrecordsintheirmedical

filesatHospitaldasClínicasofseveraloccurrencesofhealth

problems,therebygivingrisetohigh-costtreatmentswiththe

implicationofsignificantexpenditureforthepublic

health-careservices.15

Themajormotorcyclemanufacturingcompaniesandthe

vehicleinsurancecompaniesdonotbearthecoststhatthese

patientsproduceinhospitals.Thecompanieskeepon

mak-ingiteasiertobuymotorcycles,throughlowcostandvarious

installmentplans.Theyshouldinvestmoreinthese

motorcy-clists’safetyandineducationregardingtraffic,giventhatin

theaccidentsduetomotorcyclesseeninthisstudy,71%ofthe

(5)

Occurrences ofpedestrians being run over by cars and

motorcycles, especiallyinyoungerage groups, revealsthat

thereisaneedtostimulatedriversand motorcycliststobe

moreattentivetotrafficandtothemovementsofnearby

chil-dren,giventhatchildrenoftenareunabletogaugethetime

thatavehicletakestotravelacertaindistance.Moreover,there

isafundamentalneedtoexpandappropriateleisureareas,so

thathavingchildrenplayingandrunninginthestreetscanbe

avoided.13

Inrelationtochildrenwhoarepedestrianvictimsof

trans-portaccidents,theheadtraumaandmultipletraumasuffered

show their total exposureand lack of protection. Thus, it

can be affirmed that the only measurefor reducing these

injurieswouldreallybetoavoidoccurrencesofthistypeof

accidents.13,16,17

Conclusions

Transport accidents involving children and adolescents

occurredmoreoftenamongmales.

Themaintransportaccidentsamongchildrenand

adoles-centswhowereattendedasemergencycaseswerecausedby

carsandmotorcycles.Amongtheaccidentvictims,thelargest

proportionwasattendedduetobeingrunover.

Themaininjuriesdiagnosedweresuperficialheadtrauma,

followedbyunspecifiedmultipletrauma,inbothsexes.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

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2. GawryszewskiVP,CoelhoHM,ScarpeliniS,ZanR,JorgeMH, RodriguesEM.Landtransportinjuriesamongemergency departmentvisitsinthestateofSãoPaulo,in2005.RevSaude Publica.2009;43(2):275–82.

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2007;15(5):262–6.

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