High prevalence of non-accidental trauma among deceased children presenting at Level I trauma centers in the Netherlands

Abstract Purpose Between 0.1—3% of injured children who present at a hospital emergency department ultimately die as a result of their injuries. These events are typically reported as unnatural causes of death and may result from either accidental or non-accidental trauma (NAT). Examples of the latter include trauma that is inflicted directly or resulting from neglect. Although consultation with a forensic physician is mandatory for all deceased children, the prevalence of fatal inflicted trauma or neglect among children is currently unclear. Methods This is a retrospective study that included children (0–18 years) who presented and died at one of the 11 Level I trauma centers in the Netherlands between January 1, 2014, and January 1, 2019. Outcomes were classified based on the conclusions of the Child Abuse and Neglect team or those of forensic pathologists and/or the court in cases referred for legally mandated autopsies. Cases in which conclusions were unavailable and there was no clear accidental cause of death were reviewed by an expert panel. Results The study included 175 cases of childhood death. Seventeen (9.7%) of these children died due to inflicted trauma (9.7%), 18 (10.3%) due to neglect, and 140 (80%) due to accidents. Preschool children (< 5 years old) were significantly more likely to present with injuries due to inflicted trauma and neglect compared to older children (44% versus 6%, p < 0.001, odds ratio [OR] 5.80, 95% confidence interval [CI] 2.66–12.65). Drowning accounted for 14 of the 18 (78%) pediatric deaths due to neglect, representing 8% of the total cases. Postmortem radiological studies and autopsies were performed on 37 (21%) of all cases of childhood death. Conclusion One of every five pediatric deaths in our nationwide Level I trauma center study was attributed to NAT; 44% of these deaths were the result of trauma experienced by preschool-aged children. A remarkable number of fatal drownings were due to neglect. Postmortem radiological studies and autopsies were performed in only one-fifth of all deceased children. The limited use of postmortem investigations may have resulted in missed cases of NAT, which will result in an overall underestimation of fatal NAT experienced by children.

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High prevalence of undetected highly resistant microorganisms among residents of long-term care facilities in Amsterdam, the Netherlands

10.26226/morressier.56d5ba2cd462b80296c9692a ◽

2016 ◽

Author(s):

Aletta Tholen

Keyword(s):

The Netherlands ◽

Long Term Care ◽

Term Care ◽

High Prevalence ◽

Care Facilities

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Observing the Interethnic Friendships in Elementary and Secondary Religion-Based School

10.31237/osf.io/mzvqu ◽

2019 ◽

Author(s):

Adib Rifqi Setiawan

Keyword(s):

Student Perceptions ◽

Externalizing Behavior ◽

Internalizing Behavior ◽

Acting Out ◽

Classroom Context ◽

Older Children ◽

School Students ◽

School Year ◽

Interethnic Friendships ◽

Level I

Friendships provide opportunities to build empathy and practice social skills. Being friends with ethnically diverse peers can create opportunities for academic and social learning different from the opportunities afforded by same-ethnic friendships. Through my observation, I had been finding that elementary and secondary school students are less likely to have friends of a different ethnic — even from the beginning to the end of a single school year, as they progress in school. My observation show that most childhood friendships are formed in classrooms, but children tend to form friendships with others of their own ethnicity, with interethnic friendships decreasing across ages and grades. The observation looked at student and classroom factors that affect the likelihood of children forming friendships across ethnic. On an individual or student level, I looked at age, ethnic, and psychosocial factors, including sociability, internalizing behavior (such as worrying or feeling sad) and externalizing behavior (such as acting out or getting in trouble). I also examined factors related to classroom context, including teacher support, whether teachers treat students with varying levels of academic achievement differently, and competition among students. Results suggest that same-ethnic friendships increase over the school year, with greater increases among white and older children. Externalizing behavior predicted a greater increase in same-ethnic friendships, particularly among ‘domestic’ (Javanese: ‘cah kene dewe’) students. Teachers and classroom context influenced student friendships in two different ways. It suggests that teachers may make a difference in how students select and maintain friends. Classroom support -- measured by student perceptions of teachers' warmth, respect, and trust -- predicted less of an increase in same-ethnic friendships from fall to spring. In last, my observation points to the need not just for diverse schools, but also for teachers to foster classrooms where students and teachers support one another, and social and academic hierarchies are not dominant, which could increase the likelihood of students developing and maintaining interethnic friendships.

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Does Gender Matter: A Multi-Institutional Analysis of Viscoelastic Profiles for 1565 Trauma Patients With Severe Hemorrhage

The American Surgeon ◽

10.1177/00031348211033542 ◽

2021 ◽

pp. 000313482110335

Author(s):

Alison Smith ◽

Juan Duchesne ◽

Matthew Marturano ◽

Shaun Lawicki ◽

Kevin Sexton ◽

...

Keyword(s):

Alpha Angle ◽

Reaction Times ◽

Maximum Amplitude ◽

Trauma Patients ◽

Trauma Centers ◽

Survival Difference ◽

Severe Hemorrhage ◽

Male Patients ◽

Level I ◽

Clot Formation Time

Background Viscoelastic tests including thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are being used in patients with severe hemorrhage at trauma centers to guide resuscitation. Several recent studies demonstrated hypercoagulability in female trauma patients that was associated with a survival advantage. The objective of our study was to elucidate the effects of gender differences in TEG/ROTEM values on survival in trauma patients with severe hemorrhage. Methods A retrospective review of consecutive adult patients receiving massive transfusion protocol (MTP) at 7 Level I trauma centers was performed from 2013 to 2018. Data were stratified by gender and then further examined by TEG or ROTEM parameters. Results were analyzed using univariate and multi-variate analyses. Results A total of 1565 patients were included with 70.9% male gender (n = 1110/1565). Female trauma patients were older than male patients (43.5 ± .9 vs 41.1 ± .6 years, P = .01). On TEG, females had longer reaction times (6.1 ± .9 min vs 4.8 ± .2 min, P = .03), increased alpha angle (68.6 ± .8 vs 65.7 ± .4, P < .001), and higher maximum amplitude (59.8 ± .8 vs 56.3 ± .4, P < .001). On ROTEM, females had significantly longer clot time (99.2 ± 13.7 vs 75.1 ± 2.6 sec, P = .09) and clot formation time (153.6 ± 10.6 sec vs 106.9 ± 3.8 sec, P < .001). When comparing by gender, no difference for in-hospital mortality was found for patients in the TEG or ROTEM group ( P > .05). Multivariate analysis showed no survival difference for female patients (OR 1.11, 95% CI .83-1.50, P = .48). Conclusions Although a difference between male and females was found on TEG/ROTEM for certain clotting parameters, no difference in mortality was observed. Prospective multi-institutional studies are needed.

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Double, triple or quadruple hits? Exploring the impact of cybercrime on victims in the Netherlands

International Review of Victimology ◽

10.1177/02697580211010692 ◽

2021 ◽

pp. 026975802110106

Author(s):

Raoul Notté ◽

E.R. Leukfeldt ◽

Marijke Malsch

Keyword(s):

Public Opinion ◽

Literature Review ◽

The Netherlands ◽

Public Discourse ◽

Moral Judgments ◽

Victim Blaming ◽

High Prevalence ◽

Different Types ◽

The Impact ◽

Insight Into

This article explores the impact of online crime victimisation. A literature review and 41 interviews – 19 with victims and 22 with experts – were carried out to gain insight into this. The interviews show that most impacts of online offences correspond to the impacts of traditional offline offences. There are also differences with offline crime victimisation. Several forms of impact seem to be specific to victims of online crime: the substantial scale and visibility of victimhood, victimisation that does not stop in time, the interwovenness of online and offline, and victim blaming. Victims suffer from double, triple or even quadruple hits; it is the accumulation of different types of impact, enforced by the limitlessness in time and space, which makes online crime victimisation so extremely invasive. Furthermore, the characteristics of online crime victimisation greatly complicate the fight against and prevention of online crime. Finally, the high prevalence of cybercrime victimisation combined with the severe impact of these crimes seems contradictory with public opinion – and associated moral judgments – on victims. Further research into the dominant public discourse on victimisation and how this affects the functioning of the police and victim support would be valuable.

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The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01615-1 ◽

2021 ◽

Author(s):

Suzan Dijkink ◽

Erik W. van Zwet ◽

Pieta Krijnen ◽

Luke P. H. Leenen ◽

Frank W. Bloemers ◽

...

Keyword(s):

The Netherlands ◽

Trauma Care ◽

Trauma System ◽

Future Research ◽

Severely Injured ◽

Trauma Centers ◽

Severely Injured Patients ◽

The Right ◽

Injured Patients ◽

The Impact

Abstract Background Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time. Methods All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008–2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS. Results The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63–74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC. Conclusion Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.

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