International Journal of Injury Control and Safety Promotion, 2015 Vol. 22, No. 1, 68–74, http://dx.doi.org/10.1080/17457300.2013.863784
RESEARCH ARTICLE Injuries from falling objects in the United Arab Emirates Michal Grivnaa, Hani O. Eidb and Fikri M. Abu-Zidanb,c* a
Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE; bDepartment of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE; cDepartment of Surgery, Al-Ain Hospital, Al-Ain, UAE (Received 16 July 2013; accepted 30 October 2013) Our aim was to study the demography, anatomical regions injured, severity, and outcome of hospitalised trauma patients who were injured by falling objects in order to give recommendations regarding their prevention in the UAE. All trauma patients who were injured by falling objects and were admitted to Al Ain Hospital for more than 24 hours, or died after arrival to the hospital were studied for over 3 years. One hundred forty nine patients having a mean age (SD) > 34 (12.1) years were studied. The annual incidence of hospitalisation was 10.7/100,000 persons per year. Majority (97.3%) were males and 73.2% from the Indian subcontinent. The most common location for injury was work (88.6%), followed by home (9.4%). Patients injured at home were younger (p < 0.0001), and were more females (p < 0.0001). Extremities and head/neck were the most common injured regions; 1.3% of patients died. Males from the Indian subcontinent are at a higher risk of being injured by falling objects especially at work. Safety education and programs, environmental changes, use of protective devices including helmets or special shoes, and proper enforcement of the safety guidelines could reduce hospitalisations, disability, and death from these injuries. Keywords: falling object; injury; prevention; occupational safety; United Arab Emirates
1. Introduction The United Arab Emirates (UAE) is a rapidly developing country in the Middle East. In 2010, the population was estimated to be 5.4 million, with a large number of expatriates (Ministry of Health, 2010). Although health has dramatically improved, injury remains a major contributor to morbidity, mortality, and economic loss. Injury is the second leading cause of death in the UAE with an incidence rate of 27.3/100,000 persons per year. On an average, 1120 persons died every year between 2000 and 2008 (Grivna et al., 2012). The proportion of deaths caused by occupational injury in Abu Dhabi Emirate in 2007 was 18% of all injury deaths, resulting in approximately 3180 lost workdays, and 318,000 workers requiring first aid and medical treatment (Health Authority Abu Dhabi, 2008). The UAE is a federal entity consisting from seven different Emirates. It has federal and local systems responsible for safety regulations (Grivna et al., 2012). From 1980, a Federal Labour Law No. 8 stipulates that every employer shall provide adequate preventive equipment to protect workers against the dangers of occupational injuries (Government of Dubai, 2001). There are only broad guidelines while specific references to on-site safety are absent (Redfern, 2010). However, the UAE Ministry of Labour, in collaboration with the International Labour Organisation, is currently developing regulations for construction safety (Redfern, 2010). *Corresponding author. Email: [email protected] Ó 2013 Taylor & Francis
There is lack of data on injuries from falling objects in our region. In a recent study on traumatic brain injuries admitted to an Abu Dhabi Hospital, falling objects counted for 34% of the injuries (Salem, Jaumally, Bayanzay, Khoury, & Torkaman, 2013). Falling objects can cause injuries having prolonged hospitalisation and/or a permanent disability resulting in substantial cost to the healthcare system. Wu et al. who analysed 499 cases injured by falling objects at construction sites found that 66% could have been potentially prevented (Wu, Yang, Li, & Chew, 2013). The personal, environmental, and product/equipment risk factors for injuries could vary in different countries (Barss, Smith, Baker, & Mohan, 1998). This information is important for safety education, policy, and environmental interventions (Gillen & Gittleman, 2010; Grivna et al., 2012; Kansagra & Farley 2011). We aimed to study the demography, anatomical regions injured, severity and outcome of hospitalised trauma patients who were injured by falling objects in order to give recommendations regarding their prevention in the UAE.
2. Patients and methods Using cross-sectional study design, we studied all patients who were injured by falling objects and were admitted to Al Ain Hospital for more than 24 hours or died after arrival to the hospital. Al Ain Hospital has a capacity of
International Journal of Injury Control and Safety Promotion 412 beds. It is one of the two major hospitals in Al Ain city with specialised acute and emergency care (Al Ain Hospital, 2013). During the study period, the hospital treated about 80% of the hospitalised trauma patients of Al Ain city, which is the largest city in the eastern district of Abu Dhabi Emirate with a population of about 460,000 (Ministry of Health, 2007). Data were retrieved from Al Ain Hospital trauma registry. Data of the trauma registry were prospectively collected by a research fellow over three years (March 2003– March 2006). Variables studied included age, gender, nationality, location of injury, time and date of the injury, method of arrival, anatomical body part(s) injured, severity, intensive care unit (ICU) admission, duration of hospital stay, and outcome (survival or death). Severity of injury of the affected body region was assessed by the Abbreviated Injury Scale (AIS), which divides the body into six anatomical regions and assigns each a severity including minor ¼ 1, moderate ¼ 2, serious ¼ 3, severe ¼ 4, critical ¼ 5, unsurvivable ¼ 6, and by the Injury Severity Score (ISS) (Baker, O´Neill, Haddon, & Long, 1974; Maurer & Morris, 2004). The ISS was calculated manually for each patient, using the AIS Handbook, as the sum of squares of the three highest AIS scores from different body regions (Bergeron et al., 2006). Ethical approval for this study was obtained from Al Ain Health District Ethics Committee (ethical approval no: RECA/02/44). All patients who are admitted to Al Ain Hospital or their care givers sign a consent form giving permission to use their anonymous data for research and audit.
2.1.
69
Statistics
We have analysed data using statistical package for Social Sciences (IBM-SPSS version 20, Chicago, IL) by regrouping, frequencies, and cross-tabulations. The Mann–Whitney U-test or Fisher’s exact test was used as appropriate to compare continuous or categorical data. Non-parametric statistical methods were used to compare two independent groups because the numbers were small in one of these groups. The non-parametric methods are advised in this situation because they compare the ranks, and a normal distribution is not required (Munro, 2001). Probabilities of less than 0.05 were considered significant. Incidence rates were estimated using 2005 census data, assuming the Al Ain population age structure to be similar to that of the entire Abu Dhabi Emirate (Ministry of Health, 2007). Nationality was categorised into two groups: Indian subcontinent and others, because studies have shown that risks for these two groups differ. More workers in construction sites are from the Indian subcontinent (Barss, Addley, Grivna, Stanculescu, & Abu-Zidan, 2009).
3. Results Out of the 2573 patients in the trauma registry, 149 patients had injuries from falling objects (6%). The mean (SD) age of patients was 34.2 (12.1) years, 79.6% of the patients were in the age group of 20–49 (Figure 1). Majority of patients were males (97.3%, n ¼ 145). Most of the patients were from the Indian subcontinent (73.2%, n ¼ 109),
Figure 1. A histogram showing the age distribution of hospitalised patients injured by falling objects, Al Ain Hospital, 2003–2006 (n ¼ 149).
70
M. Grivna et al.
Table 1. Comparison between patients injured at home and those injured at work. Variable
Home
Work
p value
10.5 (4–65)
35.0 (19–73)
RESEARCH ARTICLE Injuries from falling objects in the United Arab Emirates Michal Grivnaa, Hani O. Eidb and Fikri M. Abu-Zidanb,c* a
Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE; bDepartment of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE; cDepartment of Surgery, Al-Ain Hospital, Al-Ain, UAE (Received 16 July 2013; accepted 30 October 2013) Our aim was to study the demography, anatomical regions injured, severity, and outcome of hospitalised trauma patients who were injured by falling objects in order to give recommendations regarding their prevention in the UAE. All trauma patients who were injured by falling objects and were admitted to Al Ain Hospital for more than 24 hours, or died after arrival to the hospital were studied for over 3 years. One hundred forty nine patients having a mean age (SD) > 34 (12.1) years were studied. The annual incidence of hospitalisation was 10.7/100,000 persons per year. Majority (97.3%) were males and 73.2% from the Indian subcontinent. The most common location for injury was work (88.6%), followed by home (9.4%). Patients injured at home were younger (p < 0.0001), and were more females (p < 0.0001). Extremities and head/neck were the most common injured regions; 1.3% of patients died. Males from the Indian subcontinent are at a higher risk of being injured by falling objects especially at work. Safety education and programs, environmental changes, use of protective devices including helmets or special shoes, and proper enforcement of the safety guidelines could reduce hospitalisations, disability, and death from these injuries. Keywords: falling object; injury; prevention; occupational safety; United Arab Emirates
1. Introduction The United Arab Emirates (UAE) is a rapidly developing country in the Middle East. In 2010, the population was estimated to be 5.4 million, with a large number of expatriates (Ministry of Health, 2010). Although health has dramatically improved, injury remains a major contributor to morbidity, mortality, and economic loss. Injury is the second leading cause of death in the UAE with an incidence rate of 27.3/100,000 persons per year. On an average, 1120 persons died every year between 2000 and 2008 (Grivna et al., 2012). The proportion of deaths caused by occupational injury in Abu Dhabi Emirate in 2007 was 18% of all injury deaths, resulting in approximately 3180 lost workdays, and 318,000 workers requiring first aid and medical treatment (Health Authority Abu Dhabi, 2008). The UAE is a federal entity consisting from seven different Emirates. It has federal and local systems responsible for safety regulations (Grivna et al., 2012). From 1980, a Federal Labour Law No. 8 stipulates that every employer shall provide adequate preventive equipment to protect workers against the dangers of occupational injuries (Government of Dubai, 2001). There are only broad guidelines while specific references to on-site safety are absent (Redfern, 2010). However, the UAE Ministry of Labour, in collaboration with the International Labour Organisation, is currently developing regulations for construction safety (Redfern, 2010). *Corresponding author. Email: [email protected] Ó 2013 Taylor & Francis
There is lack of data on injuries from falling objects in our region. In a recent study on traumatic brain injuries admitted to an Abu Dhabi Hospital, falling objects counted for 34% of the injuries (Salem, Jaumally, Bayanzay, Khoury, & Torkaman, 2013). Falling objects can cause injuries having prolonged hospitalisation and/or a permanent disability resulting in substantial cost to the healthcare system. Wu et al. who analysed 499 cases injured by falling objects at construction sites found that 66% could have been potentially prevented (Wu, Yang, Li, & Chew, 2013). The personal, environmental, and product/equipment risk factors for injuries could vary in different countries (Barss, Smith, Baker, & Mohan, 1998). This information is important for safety education, policy, and environmental interventions (Gillen & Gittleman, 2010; Grivna et al., 2012; Kansagra & Farley 2011). We aimed to study the demography, anatomical regions injured, severity and outcome of hospitalised trauma patients who were injured by falling objects in order to give recommendations regarding their prevention in the UAE.
2. Patients and methods Using cross-sectional study design, we studied all patients who were injured by falling objects and were admitted to Al Ain Hospital for more than 24 hours or died after arrival to the hospital. Al Ain Hospital has a capacity of
International Journal of Injury Control and Safety Promotion 412 beds. It is one of the two major hospitals in Al Ain city with specialised acute and emergency care (Al Ain Hospital, 2013). During the study period, the hospital treated about 80% of the hospitalised trauma patients of Al Ain city, which is the largest city in the eastern district of Abu Dhabi Emirate with a population of about 460,000 (Ministry of Health, 2007). Data were retrieved from Al Ain Hospital trauma registry. Data of the trauma registry were prospectively collected by a research fellow over three years (March 2003– March 2006). Variables studied included age, gender, nationality, location of injury, time and date of the injury, method of arrival, anatomical body part(s) injured, severity, intensive care unit (ICU) admission, duration of hospital stay, and outcome (survival or death). Severity of injury of the affected body region was assessed by the Abbreviated Injury Scale (AIS), which divides the body into six anatomical regions and assigns each a severity including minor ¼ 1, moderate ¼ 2, serious ¼ 3, severe ¼ 4, critical ¼ 5, unsurvivable ¼ 6, and by the Injury Severity Score (ISS) (Baker, O´Neill, Haddon, & Long, 1974; Maurer & Morris, 2004). The ISS was calculated manually for each patient, using the AIS Handbook, as the sum of squares of the three highest AIS scores from different body regions (Bergeron et al., 2006). Ethical approval for this study was obtained from Al Ain Health District Ethics Committee (ethical approval no: RECA/02/44). All patients who are admitted to Al Ain Hospital or their care givers sign a consent form giving permission to use their anonymous data for research and audit.
2.1.
69
Statistics
We have analysed data using statistical package for Social Sciences (IBM-SPSS version 20, Chicago, IL) by regrouping, frequencies, and cross-tabulations. The Mann–Whitney U-test or Fisher’s exact test was used as appropriate to compare continuous or categorical data. Non-parametric statistical methods were used to compare two independent groups because the numbers were small in one of these groups. The non-parametric methods are advised in this situation because they compare the ranks, and a normal distribution is not required (Munro, 2001). Probabilities of less than 0.05 were considered significant. Incidence rates were estimated using 2005 census data, assuming the Al Ain population age structure to be similar to that of the entire Abu Dhabi Emirate (Ministry of Health, 2007). Nationality was categorised into two groups: Indian subcontinent and others, because studies have shown that risks for these two groups differ. More workers in construction sites are from the Indian subcontinent (Barss, Addley, Grivna, Stanculescu, & Abu-Zidan, 2009).
3. Results Out of the 2573 patients in the trauma registry, 149 patients had injuries from falling objects (6%). The mean (SD) age of patients was 34.2 (12.1) years, 79.6% of the patients were in the age group of 20–49 (Figure 1). Majority of patients were males (97.3%, n ¼ 145). Most of the patients were from the Indian subcontinent (73.2%, n ¼ 109),
Figure 1. A histogram showing the age distribution of hospitalised patients injured by falling objects, Al Ain Hospital, 2003–2006 (n ¼ 149).
70
M. Grivna et al.
Table 1. Comparison between patients injured at home and those injured at work. Variable
Home
Work
p value
10.5 (4–65)
35.0 (19–73)
