| Abstract |
Background: The protection of children and adolescents is one of the key priorities of any society. To achieve this, it is necessary to explore the incidence of physical injuries that accidents, self-injury or abuse, but also mortality levels of children in order to have a proper planning for prevention and treatment. Objective: The purpose of this research is to collect and analyse data on the violent and sudden deaths of children under 18 years of age as well as physical injuries in the region of Crete from 1987 to 2019. The main aim is the classification and statistical analysis of the information collected in order to identify the causes of injuries and death, with the ultimate goal of investigating risk factors and causes that lead to increased mortality. In addition, the present study aims to identify the physical injuries of children, and caused by negligence, accident, abuse, suicide, with the ultimate goal of informing the authorities developing preventing strategies. It should be noted that this study is the first attempt for a systematic recording of infant, child and adolescent mortality in the region of Crete. These data will constitute important epidemiological indicators as they are directly related to the health index of the local community, with high correlation with social/economic factors at local and national level. Methods: For data collection, it was requested permission to access the files from Department of Forensic Sciences of the Faculty of Medicine of the University of Crete and the State Service of Forensic Medicine of Western Crete, including almost the entire pediatric population of Crete that this study involved. The information of the study was obtained from the forensic reports, the police orders as well as from the medical documents or medical records attached to them. The data were classified based on the demographics of each incident, recorded by region and time of the event, type and cause of death / physical injuries, categorization of the reported perpetrator (in physical injuries) and recording of injuries per system of the body. The data were statistically processed and the absolute (N) for the description of qualitative variables and the relative (%) frequencies and the x2 test were calculated, while for the correlation of non-parametric variables.
Results: A total of 515 children died of natural, violent or sudden death and 972 children suffered physical injuries, for whom there was a forensic report, were included in the study. As far as deaths are concerned, natural deaths accounted for 44% and were mainly found in boys (53.5%) aged 0-1 years old (74%) (p<0.001) and the main causes of death were congenital (37%) and pathological (34%), mostly o cardiac and respiratory etiology (p<0.001). Accidents (46%) were the first manner of death especially for boys (77.6%) 12-18 years old (60.3%) while the first cause of death was traffic accidents (59%) (p=0.001). Fatal injuries involved injuries organs (76.4%), mainly cranial injuries (p<0.001). Homicides were recorded in boys (66.7%) aged 0-1 years old (33%) and 12-18 years old (29%) (p<0.001). Suicides were almost exclusively detected in boys (73.3%) aged 12-18 years old (93.3%) and suicide was mostly committed with the use of a weapon (53.3%) (p<0.001). During the period of the study, plain physical injuries (34%) had the most frequent recording mainly in boys (53%) aged >12-18 years old (52.7%) (p<0.001). These physical injuries were mainly violent injuries (46%) and traffic accidents (30%) (plt;0.001). Road accidents also caused severe physical injuries (12%) in males (73%) aged >12-18 years old (59.8%) (p<0.001). Violence (24%) and car accidents (22%) caused also dangerous physical injuries (10%) and the majority of the victims were boys (82%) aged >12-18 years old (50%) (p<0.001). In this study, the cases of children that were examined but not confirmed physical injuries reached 46% (p<0.001). The predominant sex was girls (60%) aged >12-18 years old (45.9%) while there were physical injuries related to rape (60%). The confirmed cases of physical injuries (3%) came from rape, girls (84.4%) aged> 12-18 years old (75%) (p<0.001). Girls (71.8%) aged> 12-18 years (62%) had a majority in the physical injuries related to reports of rape/indecency (whether confirmed or not), with the reported perpetrator being an adult (18.4%). Finally, in cases of violence (26%) the predominant gender was boys (63.7%) belonging to the age group >12-18 years old (59%) while cases of physical abuse (10%) were more common in boys (53.1%) aged 5-9 years (30%) and >1-5 years old (29%) (p<0.001). In both categories, the reported perpetrator was the father (19% and 15.3% respectively). Conclusion: The region of Heraklion, as the largest city of Crete and the capital of the prefecture, has gathered the majority of deaths and physical injuries. Most of the deaths in this study involved adolescent children. The tendency of children for independence, and impulsive behavior, as well as the emotional instability of this age, is reflected in the present study with the majority of deaths of children in this age group due to collision accidents and homicides. Age seemed to play an important role in the cause of death in children, as in infants the main cause of death is natural death, including congenital and pathological causes. The results of this unique research for Crete of children's physical injuries, proved that there is a great deal of agreement with the literature. Sexual abuse (rape) was detected in young girls while physical injuries (beatings, systematic abuse) was detected, more often in boys, mainly aged 1 to 9 years old. The number of physical injuries recorded in this study, underestimates the problem of violence and causing physical injuries in children, because of the clear lack of information in recording the incidents.
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Διερεύνηση των σωματικών βλαβών και θανάτων παιδιών και εφήβων στην Περιφέρεια Κρήτης : Επιδημιολογική και Ιατροδικαστική προσέγγιση
