Investigating head injury and dental trauma related to shopping carts amongst children under the age of 12 years old: A meta-analysis of observational studies

Background: Understanding the epidemiology of traumatic head injuries (THI) is essential to shape public health (PH) policies, implement prevention strategies, and justify the allocation of resources towards public safety, education, and research 1 . The World Health Organization (WHO) has recognized a gap in data and the high financial cost of THI's. Falls from shopping carts (SCs) are the most common cause of such injuries. This study aimed to investigate trauma related to SCs amongst children under 12 years of age, to help design safety strategies and effective intervention 2 . Methods: A systematic review was conducted using the search engines PubMed, Medline, Web of Science, and Cochrane Library databases between 1999 and 2020. A meta-analysis approach was adopted to evaluate the effect size, confidence level, and odds ratios of head and teeth injuries attributed to SCs. The search resulted in a total of 38,402 studies, of which 38,317 were excluded for not meeting the first level criteria. 7 out of 20 were further excluded due to primary outcome and variable relations. Results: 13 studies were subject to full meta-analysis (Table 1). The review involved an overall total sample of 180,857 children, the weight of 100%, and a confidence interval (CI) of 5.47 and 9.05 as the lower and upper limits; respectively. The result of the analysis showed the heterogeneity of the study was statistically significant at a 5% level (p = 0.000 < 0.05). There was a strong relation between falling from a shopping cart and head injuries (Figure 1) with high incidence rates (up to 72%). Conclusion: Trauma associated with SCs is a major PH concern, attributed to poor adult supervision, unrestrained child, or cart misuse. It is imperative to develop a national safety strategy plan to reduce or prevent serious injuries, involving public awareness through verbal prompts, posters, flyers, and stickers 3 . Further investigation into associated dental trauma is needed.qscienc