The epidemiology of pediatric traumatic brain injury in Minnesota.

OBJECTIVES: To determine the epidemiology of pediatric traumatic brain injury (TBI) in a midwestern state and to examine differences between metropolitan and nonmetropolitan residents. DESIGN: Population-based case series. PARTICIPANTS: Patients aged 0-19 years sustaining TBI in 1993 that resulted in hospitalization or death. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Incidence, mortality and case-fatality rates, length of hospital stay, discharge status, and Glasgow Outcome Scale score. RESULTS: Nine hundred seventy-seven patients met inclusion criteria. Incidence, mortality, and case-fatality rates were 73.5 per 100 000, 9.3 per 100 000, and 12.8 per 100, respectively. Higher median household incomes and percentages of adult high-school graduates in a patient's census block group correlated with lower incidence. Median length of stay was 2 days. Of those included in the study, 720 patients (74%) were discharged home with self-care. Three hundred fifty-seven patients met criteria for severe TBI; 346 (97%) were assigned Glasgow Outcome Scale scores, of which 161 (47%) had disabilities or died. Severe TBI was associated with nonmetropolitan residence, higher median household income, and certain injury mechanisms. Incidence was similar for metropolitan and nonmetropolitan residents. Median head-region Abbreviated Injury Score, Injury Severity Score, and mortality and case-fatality rates were higher for nonmetropolitan residents. CONCLUSIONS: This study reports the lowest incidence of pediatric TBI that results in death or hospitalization to date. One half of severely injured patients suffered poor outcomes. A greater proportion of nonmetropolitan than metropolitan residents suffered severe TBI and had higher mortality and case-fatality rates.

Delayed incubation of blood culture bottles: effect on recovery rate of Streptococcus pneumoniae and Haemophilus influenzae type B.

This study investigated the effects of incubation delay on the rate of recovery of common pediatric pathogens from blood culture bottles. Known concentrations of Streptococcus pneumoniae and Haemophilus influenzae type b (three isolates each) were inoculated into BACTEC NR-6A bottles with 1.0 mL of donor blood. Bottles were subjected to a time delay (zero to six hours) before incubation. The BACTEC NR-660 was used for incubation and measurement of positive conversion. Data were analyzed using chi 2 analysis, Fisher's exact test, logistic regression, and multiple logistic regression, with P < 0.05 considered significant. Immediate incubation yielded positive blood cultures in 88 of 100 and 65 of 70 bottles containing S. pneumoniae and H. influenzae type b, respectively, in the concentration range 1.0 to 9.99 colony-forming units per milliliter (CFU/ml). For each organism, this was the minimal range required to produce a positive culture (P < 0.0001). Bottles inoculated with 1 ml of blood containing organisms in the range of 1.0 to 9.99 CFU/ml were then subjected to incubation delay. The recovery rate of S. pneumoniae significantly (P = 0.0003) decreased from a two-hour delay (57 of 60; 95%) to a three-hour delay (42 of 60; 70%). No significant change in recovery rate was seen in bottles inoculated with H. influenzae type b subjected to similar delays. Delayed incubation (two to six hours) of bottles inoculated with 1.0 ml of blood containing organisms in a concentration range of 1.0 to 9.99 CFU/ml of blood significantly decreases the recovery rate of S. pneumoniae but has no effect on H. influenzae type b.

Pediatric analgesia and sedation.

Sedation and analgesia are essential components of the ED management of pediatric patients. Used appropriately, there are a number of medications and techniques that can be used safely in the emergency care of infants and children. Emergency physicians should be competent in the use of multiple sedatives and analgesics. Adequate equipment and monitoring, staff training, discharge instructions and continuous quality management should be an integral part of the ED use of these agents.