RESUMO
STUDY OBJECTIVE: Injury is the leading cause of death and disability for children, making access to pediatric trauma centers crucial to pediatric trauma care. Our objective was to describe the pediatric population with timely access to a pediatric trauma center by demographics and geography in the United States. METHODS: Level 1, 2, and 3 pediatric trauma center locations were provided by the American Trauma Society. Geographic information systems road network and rotor wing analysis determined US Census Block Groups with the ground and/or air access to a pediatric trauma center within a 60-minute transport time. We then described, at the national and state levels, the 2020 pediatric population (< 15 years old) with and without pediatric trauma center access by ground and air, stratified by race, ethnicity, and urbanicity. RESULTS: There were 157 pediatric trauma centers (82 Level 1, 64 Level 2, 11 Level 3). Of the 2020 US pediatric population, 33,352,872 (54.5%) had timely access to Level 1-3 pediatric trauma centers by ground and 45,431,026 (74.1%) by air. The percentage of children with access by race and ethnicity were (by ground, by air): American Indian/Alaskan Native (31.0%, 43.5%), White (48.7%, 71.3%), Native Hawaiian/Pacific Islander (59.3%, 61.0%), Hispanic (60.2%, 76.9%), Black (64.2%, 78.0%), and Asian (76.5%, 89.5%). Only 48.2% of children living in rural block groups had access, compared with 83.6% in urban block groups. CONCLUSION: Significant disparities in current access to pediatric trauma centers exist by race and ethnicity, and geography, leaving some children at risk for poor trauma outcomes.
Assuntos
Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Centros de Traumatologia , Adolescente , Criança , Humanos , Etnicidade , Sistemas de Informação Geográfica , Estados Unidos , Disparidades em Assistência à Saúde/etnologia , Grupos RaciaisRESUMO
BACKGROUND: To examine differences in comorbidities and surgical management based on socioeconomics in hospitalized children with Crohn's disease (CD). METHODS: Using the Kids' Inpatient Database for 2006-2012, we identified patients (<21 years) with a CD diagnosis. Cases were analyzed and stratified by median parental income by zip code. Multivariable logistic regression was performed. RESULTS: Of the 28,337 pediatric CD hospitalizations identified, patients were more likely male (51.1%), non-Hispanic white (71.3%), and had a mean age of 15.9 years. The proportion of minority patients increased as income quartile declined. Higher income quartile patients were more likely to be coded with anxiety and less likely with anemia. The highest income quartile was more likely to have a bowel obstruction, and peritoneal/intestinal abscess and was also 28% more likely to undergo a major surgical procedure. CONCLUSIONS: Significant variability exists in the reported comorbidities and surgical interventions associated with CD by income quartile. Lower income quartile patients are more likely to be of minority ethnicity and anemic, but less likely to undergo a major surgical procedure. Further investigation is warranted to determine whether these differences represent disease variability, differences in healthcare resource allocation, or implicit bias in management. IMPACT: There is a disparity in the care of children and young adults with Crohn's disease based on parental income. Links between parental income and the treatment of Crohn's disease in children and young adults has not been assessed in national datasets in the United States. Children in the highest income quartile were more likely to undergo a major surgical procedure. The variations in healthcare for hospitalized children and young adults with CD found in this study may represent variability in patient disease, implicit bias, or a disparity in healthcare delivery across the United States.
Assuntos
Comorbidade , Doença de Crohn/economia , Doença de Crohn/cirurgia , Classe Social , Adolescente , Criança , Pré-Escolar , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Bases de Dados Factuais , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Obstrução Intestinal/complicações , Masculino , Análise Multivariada , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Few studies have analyzed pediatric spontaneous pneumothorax (SPTX) nationally. We sought to better define this patient population and explore the evolution of surgical management. METHODS: Patients (10-20 y old) with an International Classification of Diseases, Ninth Revision diagnosis of SPTX were identified within the Kids' Inpatient Database for the years 2006, 2009, and 2012. Diagnoses and procedures were analyzed by International Classification of Diseases, Ninth Revision codes. National estimates were obtained using case weighting. RESULTS: There were 11,792 pediatric SPTX hospitalizations, and patients were predominantly male (84.0%), non-Hispanic white (69.0%), with a mean age of 17.2 y (95% confidence interval, 17.2-17.3). Overall, 52.5% underwent tube thoracostomy as the primary intervention, and more than one-third had a major surgical procedure (34.9%). From 2006 to 2012, there was an increase in bleb excisions from 81.1% to 86.9% and an increase in mechanical pleurodesis from 64.2% to 69.0%. There was a significant change from a predominantly open thoracotomy approach in 2006 (76.1%) to a video-assisted thoracoscopic approach in 2012 (89.3%). CONCLUSIONS: Pediatric admission for SPTX results in tube thoracostomy in more than half of the cases and surgery in approximately one-third of the cases. Surgical intervention has changed to a more minimally invasive approach during the last decade, and counseling to patients and their families should reflect these updated management strategies. LEVEL OF EVIDENCE: III.
Assuntos
Pleurodese/tendências , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida/tendências , Toracostomia/tendências , Adolescente , Fatores Etários , Tubos Torácicos , Criança , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pleurodese/estatística & dados numéricos , Pneumotórax/epidemiologia , Fatores Sexuais , Cirurgia Torácica Vídeoassistida/estatística & dados numéricos , Toracostomia/instrumentação , Toracostomia/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: Practice patterns for the management of patent ductus arteriosus (PDA) in premature infants are changing with advances in medical management. We sought to determine the increased mortality for premature infants who had a PDA ligation with a co-existing diagnosis of intraventricular hemorrhage (IVH). METHODS: Premature neonates (<1 y old with known gestational week ≤36 wk) with a diagnosis of IVH were identified within the Kids' Inpatient Database (KID) for the years 2006, 2009, and 2012. Diagnoses and procedures were analyzed by ICD-9 codes and stratified by a diagnosis of PDA and procedure of ligation. Case weighting was used to make national estimations. Multivariable logistic regression was performed to adjust for confounders. RESULTS: We identified 7567 hospitalizations for premature neonates undergoing PDA ligation. The population was predominately male (51.6%), non-Hispanic white (41.1%), were from the lowest income quartile (33.1%), had a gestational week of 25-26 wk (34.0%), and a birthweight between 500 and 749 g (37.3%). There was an increased mortality (10.7% versus 6.3%, P < 0.01) and an increased length of stay (88.2 d versus 74.4 d, P < 0.01) in those with any diagnosis of IVH compared with those without. Adjusted multivariable logistic regression demonstrated that high-grade IVH (III or IV) was associated with a significantly increased risk of mortality in those undergoing PDA ligation (aOR 2.59, P < 0.01). Specifically, grade III and IV were associated with an increased odds of in-hospital mortality (aOR 1.99 and 3.16, respectively, P < 0.01). CONCLUSIONS: Attitudes regarding the need for surgical intervention for PDA have shifted in recent years. This study highlights that premature neonates with grade III or IV IVH are at significantly increased risk of mortality if undergoing PDA ligation during the same hospitalization. LEVEL OF EVIDENCE: III.
Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Hemorragia Cerebral Intraventricular/mortalidade , Permeabilidade do Canal Arterial/mortalidade , Mortalidade Infantil , Procedimentos Cirúrgicos Cardíacos/métodos , Comorbidade , Estudos Transversais , Permeabilidade do Canal Arterial/cirurgia , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Ligadura/efeitos adversos , Masculino , Período Perioperatório , Estudos Retrospectivos , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Both adult and pediatric patients with inflammatory bowel disease (IBD) are at increased risk of developing venous thromboembolism (VTE) when compared with those without IBD. The risk factors for VTE in pediatric IBD patients, including those undergoing major surgery, have not been previously determined. MATERIALS AND METHODS: Patients (aged <21 y) were identified with an International Classification of Diseases, Ninth Revision (ICD-9), diagnosis of IBD (555.X or 556.X) or Crohn's Disease (CD; 555.X) in the Kids' Inpatient Database for the years 2006-2012. Procedure and ICD-9 diagnosis codes were scrutinized. VTE was defined by ICD-9 codes. National estimates were obtained using case weighting. Multivariable logistic regression was performed. RESULTS: A total of 44,554 and 28,132 patients were identified with IBD and CD, respectively. During their hospital admission, 456 (1.01%) IBD and 205 (0.72%) CD patients developed VTE. The oldest patients, those having increased length of stay, a major surgical procedure, or a hypercoagulable diagnosis had the highest rate of VTE with both IBD and CD. After performing adjusted logistic regression, undergoing a major surgical procedure was associated with 1.98 and 2.24 times greater odds of developing VTE for IBD and CD patients, respectively. A hypercoagulable diagnosis was associated with increasing the odds of VTE by 7.39 and 6.91 times in IBD and CD, respectively. CONCLUSIONS: Pediatric patients with IBD are at increased risk of VTE. Our study demonstrates undergoing a major surgical procedure or having a hypercoagulable diagnosis additionally increases the risk for VTE. Given these findings, VTE prophylaxis for this population should be further investigated. LEVEL OF EVIDENCE: III.
Assuntos
Doenças Inflamatórias Intestinais/complicações , Tromboembolia Venosa/epidemiologia , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de Risco , Estados Unidos/epidemiologia , Tromboembolia Venosa/etiologiaRESUMO
PURPOSE: In 2015, approximately 13,436 snowboarding or skiing injuries occurred in children younger than 15. We describe injury patterns of pediatric snow sport participants based on age, activity at the time of injury, and use of protective equipment. METHODS: A retrospective analysis was performed of 10-17â¯year old patients with snow-sport related injuries at a Level-1 trauma center from 2005 to 2015. Participants were divided into groups, 10-13 (middle-school, MS) and 14-17â¯years (high-school, HS) and compared using chi-square, Student's t-tests, and multivariable logistic regression. RESULTS: We identified 235 patients. The HS group had a higher proportion of females than MS (17.5% vs. 7.4%, pâ¯=â¯0.03) but groups were otherwise similar. Helmet use was significantly lower in the HS group (51.6% vs. 76.5%, pâ¯<â¯0.01). MS students were more likely to suffer any head injury (aOR 4.66, 95% CI: 1.70-12.8), closed head injury (aOR 3.69 95% CI: 1.37-9.99), or loss of consciousness (aOR 5.56 95% CI 1.76-17.6) after 4â¯pm. HS students engaging in jumps or tricks had 2.79 times the risk of any head injury (aOR 2.79 95% CI: 1.18-6.57) compared to peers that did not. HS students had increased risk of solid organ injury when helmeted (aOR 4.86 95% CI: 1.30-18.2). CONCLUSIONS: Injured high-school snow sports participants were less likely to wear helmets and more likely to have solid organ injuries when helmeted than middle-schoolers. Additionally, high-schoolers with head injuries were more like to sustain these injures while engaging in jumps or tricks. Injury prevention in this vulnerable population deserves further study. LEVEL OF EVIDENCE: Level III (Retrospective Comparative Study).
Assuntos
Traumatismos em Atletas/epidemiologia , Traumatismos Craniocerebrais/epidemiologia , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Esqui/lesões , Adolescente , Traumatismos em Atletas/prevenção & controle , Criança , Traumatismos Craniocerebrais/prevenção & controle , Feminino , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Massachusetts/epidemiologia , Análise Multivariada , Sistema de Registros , Estudos RetrospectivosAssuntos
Armas de Fogo/legislação & jurisprudência , Violência com Arma de Fogo/legislação & jurisprudência , Abandono do Hábito de Fumar/legislação & jurisprudência , Vaping/legislação & jurisprudência , Sistemas Eletrônicos de Liberação de Nicotina , Violência com Arma de Fogo/prevenção & controle , Humanos , Estados Unidos , Vaping/epidemiologia , Vaping/prevenção & controleRESUMO
OBJECTIVE: It is important to identify gaps in access and reduce health outcome disparities, understanding access to intensive care unit (ICU) beds, especially by race and ethnicity, is crucial. Our objective was to evaluate the race and ethnicity-specific 60-minute drive time accessibility of ICU beds in the United States (US). DESIGN: We conducted a cross-sectional study using road network analysis to determine the number of ICU beds within a 60-minute drive time, and calculated adult intensive care bed ratios per 100,000 adults. We evaluated the US population at the Census block group level and stratified our analysis by race and ethnicity and by urbanicity. We classified block groups into four access levels: no access (0 adult intensive care beds/100,000 adults), below average access (>0-19.5), average access (19.6-32.0), and above average access (>32.0). We calculated the proportion of adults in each racial and ethnic group within the four access levels. SETTING: All 50 US states and the District of Columbia. PARTICIPANTS: Adults ≥15 years old. MAIN OUTCOME MEASURES: Adult intensive care beds/100,000 adults and percentage of adults national and state) within four access levels by race and ethnicity. RESULTS: High variability existed in access to ICU beds by state, and substantial disparities by race and ethnicity. 1.8% (n = 5,038,797) of Americans had no access to an ICU bed, and 26.8% (n = 73,095,752) had below average access, within a 60-minute drive time. Racial and ethnic analysis showed high rates of disparities (no access/below average access): American Indians/Alaskan Native 12.6%/28.5%, Asian 0.7%/23.1%, Black or African American 0.6%/16.5%, Hispanic or Latino 1.4%/23.0%, Native Hawaiian and other Pacific Islander 5.2%/35.0%, and White 2.1%/29.0%. A higher percentage of rural block groups had no (5.2%) or below average access (41.2%), compared to urban block groups (0.2% no access, 26.8% below average access). CONCLUSION: ICU bed availability varied substantially by geography, race and ethnicity, and by urbanicity, creating significant disparities in critical care access. The variability in ICU bed access may indicate inequalities in healthcare access overall by limiting resources for the management of critically ill patients.
Assuntos
Sistemas de Informação Geográfica , Acessibilidade aos Serviços de Saúde , Adulto , Humanos , Estados Unidos , Adolescente , Estudos Transversais , Etnicidade , Havaí , Disparidades em Assistência à SaúdeRESUMO
BACKGROUND: Pediatric trauma centers are required to screen patients for alcohol or other drug use (AOD), Briefly Intervene, and Refer these patients to Treatment (SBIRT) to meet Level 1 and 2 trauma center requirements set by the American College of Surgeons. We evaluated if a mandatory electronic medical record tool increased SBIRT screening compliance for all trauma and non-trauma adolescent inpatients. METHODS: A SBIRT electronic medical record tool was implemented for pediatric inpatient AOD screening. A positive screen prompted brief intervention and referral for treatment in coordination with social work and psychiatric consultants. We compared pre and post- implementation screening rates among inpatients age 12-18 years and performed sub-group analyses. RESULTS: There were 873 patients before and 1,091 after implementation. Questionnaire screening increased from 0% to 34.4% (p < 0.001), without an increase in positivity rate, and lab screening decreased by 4.2% (p = 0.003). Females were more likely to receive a social work consultation than males (14.5 vs 7.5%, p < 0.001), despite a greater number of positive questionnaires among males (9.5 vs 17.9%, p = 0.013). White patients were more likely to receive a social work consultation (12.9%) compared to Asian (2%), Black (6.3%), and Other (6.9%) (p = 0.007), despite comparable rates of positive screenings. When comparing English to non-English speakers, English speakers were more likely to have a social work consult (12.0% vs 2.4%, p < 0.001) and psychiatry/psychology consult (13.6 vs 5.6%, p = 0.011). CONCLUSION: Multidisciplinary training along with an electronic medical record tool increased SBIRT protocol compliance. Demographic disparities in intervention rates may exist.
Assuntos
Intervenção em Crise , Pacientes Internados , Adolescente , Criança , Feminino , Humanos , Masculino , Programas de Rastreamento , Cooperação do Paciente , Encaminhamento e Consulta , Atenção Terciária à SaúdeRESUMO
BACKGROUND: Unintentional injury is the leading cause of death among pediatric patients. There were 13,436 injuries related to snow sports in those younger than 15 in 2015, with 4.8% requiring admission. These sports are high-risk given the potential for injury even when using protective equipment. We hypothesized that snow sport injury patterns would differ based on patient age. METHODS: A cross-sectional analysis of the 2009 and 2012 Kids' Inpatient Database was performed. Cases of injuries were identified and analyzed using ICD-9 codes. National estimates were obtained using case weighting. Multivariable logistic regression was used to assess for confounders. RESULTS: Within 745 admissions, there was a statistically significant decrease in skull/facial fractures with increasing age and a statistically significant increase in abdominal injuries with increasing age. Children in early and middle childhood were at increased odds of being hospitalized with skull/facial fractures, while older children were more likely hospitalized with abdominal injuries. CONCLUSIONS: Within the pediatric snow sport population, younger children are more likely to experience head injuries, while older children are more likely to experience abdominal injuries. Further research is needed to determine the origin of this difference, and continued legislation on helmets is also necessary in reducing intracranial injuries. LEVEL OF EVIDENCE: III.
Assuntos
Traumatismos em Atletas , Traumatismos Craniocerebrais , Esqui , Esportes na Neve , Adolescente , Traumatismos em Atletas/epidemiologia , Criança , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/etiologia , Estudos Transversais , Dispositivos de Proteção da Cabeça , Humanos , Estudos RetrospectivosRESUMO
INTRODUCTION: Falls remain the leading cause of unintentional pediatric trauma in the United States. Identifying risk factors for pediatric building falls would influence public health policy. We hypothesized that building falls disproportionately affect low income communities. METHODS: We performed a cross-sectional analysis of the Kids' Inpatient Database for years 2006, 2009, and 2012. We identified cases (age <12 years) of falls from a building using external cause of injury codes. Patient characteristics and injuries were analyzed using ICD-9 codes. National estimates were obtained using case weighting. Multivariable logistic regression was performed to adjust for confounders. RESULTS: There were 2,294 hospitalizations nationally for pediatric falls from a building. The victims were predominately male, in early childhood, non-Hispanic White, in the lowest income quartile, resided in urban settings, and occurred during summer. The mean age was 3.76 years. Logistic regression revealed males were 33% more likely than females, and as compared to non-Hispanic White youth, Black (33%) and Asian or Pacific Islanders (65%) were more likely to experience a fall from a building. Toddlers and those in early childhood were at significantly increased odds than those younger than one year old. Children in the highest income quartile were 29% more likely to experience a building fall. CONCLUSIONS: Building falls are a common cause of injury in the U.S. for children under 12 years old. Injury prevention strategies focused on the parents of children aged 1-5 years has the potential to make a significant public health impact.
Assuntos
Acidentes por Quedas , Hospitalização , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Renda , Lactente , Masculino , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Dog bites are a common cause of pediatric trauma requiring hospital admission. We aim to describe pediatric bite victims, associated injuries and interventions. METHODS: Children (≤18â¯years old) were identified with an ICD-9 diagnosis of dog bite in the Kids' Inpatient Database for the years 2006, 2009 and 2012. National estimates were obtained using case weighting. Multivariable logistic regression was performed. RESULTS: We identified 6323 admissions for a dog bite with mean age of 6.63â¯years. Patients were predominately male (56.9%), non-Hispanic white (61.9%), resided in the South (35.1%), and in an urban environment (59.9%). Almost one third underwent a surgical procedure. Open wounds of the head, neck and trunk were the most common injury and decreased in prevalence with increasing age. Open wounds of the extremities were the second most common and the prevalence increased with increasing age. Children aged 1-4 and 5-10â¯years were both more than three times more likely to be admitted than those more than age 11. CONCLUSIONS: Dog bite injuries are common for pediatric patients. Children less than age 11 are at greatest risk, particularly in the summer. Dog safety training should be focused on elementary and middle school children close to the start of summer vacation. LEVEL OF EVIDENCE: III.
Assuntos
Mordeduras e Picadas , Cães , Animais , Mordeduras e Picadas/epidemiologia , Mordeduras e Picadas/terapia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Estudos RetrospectivosRESUMO
PURPOSE: We examined the impact of comorbidities on length of stay and total hospital charges for children and young adults with Crohn's Disease (CD) undergoing surgery. METHODS: Patients (<21â¯years) were identified with a diagnosis of CD and an intraabdominal surgery in the Kids' Inpatient Database for the years 2006, 2009 and 2012. Length of stay (LOS) and total hospital charges (THC; USD$) were stratified by anemia, anxiety, depression and nutritional deficiency. National estimates were obtained using case weighting and multivariable linear regression was performed. RESULTS: We identified 3224 CD admissions with an intraabdominal surgery. The population was predominantly male, non-Hispanic white, and high school aged. There was an increase in LOS and THC for nutritional deficiency in all study years, and for depression and anemia in specific years. Multivariable linear regression revealed a 3.3-5.5â¯day increase in LOS associated with a comorbid diagnosis of nutritional deficiency. However, no increase in THC was seen for any comorbidity under evaluation. CONCLUSIONS: Behavioral health and, particularly, nutritional status have a significant impact on the care of children and young adults with CD. Nutritional deficiency, anemia, and depression resulted in increased LOS for those undergoing surgery. Improved presurgical management of comorbidities may reduce LOS for these patients. LEVEL OF EVIDENCE: III.
Assuntos
Doença de Crohn , Deficiências Nutricionais , Adolescente , Adulto , Criança , Comorbidade , Doença de Crohn/complicações , Doença de Crohn/epidemiologia , Doença de Crohn/cirurgia , Deficiências Nutricionais/complicações , Deficiências Nutricionais/epidemiologia , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Adulto JovemRESUMO
BACKGROUND: Design changes of nonpowder guns, including BB and air guns, have significantly increased their potential to injure. We sought to characterize the demographics of children injured with nonpowder weapons and the specific injuries suffered. METHODS: A cross-sectional analysis of the study years 2006, 2009, and 2012 was performed by combining the Kids' Inpatient Database into a single dataset. We identified cases (ageâ¯<â¯21â¯years) of air gun injuries using external cause of injury codes. Patient characteristics and injuries were analyzed using ICD-9 codes, and national estimates were obtained using case weighting. RESULTS: There were 1028 pediatric admissions for nonpowder weapon related injuries. The victims were predominately male (87.0%), non-Hispanic white (52.3%), resided in the South (47.3%), and in the lowest income quartile (39.2%). Half required a major surgical procedure. The predominant injuries were open wounds to the head, neck, or trunk (40.3%), and contusion (22.5%). Notable other injuries were intracranial injury (9.1%) and blindness or vision defects (3.3%). CONCLUSIONS: The nonpowder weapons available to this generation can paralyze, blind, and cause lasting injury to children. Injuries frequently require surgical intervention, and these weapons should no longer be considered toys. Further research and legislation should be aimed at limiting children's access to these weapons. LEVEL OF EVIDENCE: III.
Assuntos
Armas de Fogo , Jogos e Brinquedos/lesões , Ferimentos por Arma de Fogo/epidemiologia , Adolescente , Criança , Contusões/epidemiologia , Traumatismos Craniocerebrais/epidemiologia , Estudos Transversais , Bases de Dados Factuais , Etnicidade/estatística & dados numéricos , Traumatismos Oculares/epidemiologia , Feminino , Hospitalização , Humanos , Masculino , Lesões do Pescoço/epidemiologia , Fatores Sexuais , Tronco/lesões , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricos , Ferimentos por Arma de Fogo/cirurgiaRESUMO
The development of pediatric surgery as a specialty has its roots in disaster medicine. In recent years, the medical community and population at large have begun to acknowledge injury prevention as a public health priority. Domestic terrorist attacks and natural catastrophes over the last decade have highlighted the need for disaster preparedness. Recognition of the unique problems that the pediatric-age population can encounter in a natural or manmade disaster situation has exposed a new facet of injury prevention. Recounting the history of pediatric trauma care and identifying current efforts for injury prevention are essential toward achieving an injury-free America.
Assuntos
Prevenção de Acidentes/história , Serviços Médicos de Emergência/história , Política de Saúde/história , Pediatria/história , Traumatologia/história , Ferimentos e Lesões/história , Adulto , Criança , História do Século XX , Humanos , Estados Unidos/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controleRESUMO
BACKGROUND: Cervical spine clearance in the very young child is challenging. Radiographic imaging to diagnose cervical spine injuries (CSI) even in the absence of clinical findings is common, raising concerns about radiation exposure and imaging-related complications. We examined whether simple clinical criteria can be used to safely rule out CSI in patients younger than 3 years. METHODS: The trauma registries from 22 level I or II trauma centers were reviewed for the 10-year period (January 1995 to January 2005). Blunt trauma patients younger than 3 years were identified. The measured outcome was CSI. Independent predictors of CSI were identified by univariate and multivariate analysis. A weighted score was calculated by assigning 1, 2, or 3 points to each independent predictor according to its magnitude of effect. The score was established on two thirds of the population and validated using the remaining one third. RESULTS: Of 12,537 patients younger than 3 years, CSI was identified in 83 patients (0.66%), eight had spinal cord injury. Four independent predictors of CSI were identified: Glasgow Coma Score <14, GCSEYE = 1, motor vehicle crash, and age 2 years or older. A score of <2 had a negative predictive value of 99.93% in ruling out CSI. A total of 8,707 patients (69.5% of all patients) had a score of <2 and were eligible for cervical spine clearance without imaging. There were no missed CSI in this study. CONCLUSIONS: CSI in patients younger than 3 years is uncommon. Four simple clinical predictors can be used in conjunction to the physical examination to substantially reduce the use of radiographic imaging in this patient population.
Assuntos
Vértebras Cervicais/lesões , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/epidemiologia , Ferimentos não Penetrantes/diagnóstico , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Índices de Gravidade do Trauma , Estados Unidos , Ferimentos não Penetrantes/complicaçõesRESUMO
BACKGROUND: To describe the demographic characteristics and burden of pediatric suicides by firearm in the United States using a large all-payer pediatric inpatient care database. METHODS: Children and young adults (<21 years old) were identified with an International Classification of Diseases, Ninth Revision diagnosis of suicide and self-inflicted injury with a firearm (SIF) in the Kids' Inpatient Database for the study years of 2006, 2009, and 2012. National estimates were obtained using case weighting. Multivariable logistic regression was performed to examine the association between SIF and risk factors while adjusting for various sociodemographic characteristics using separate models incorporating mental health diagnoses. RESULTS: There were a total of 613 hospitalizations for SIF during the years under study. Almost four hospitalizations per week occurred, and in-hospital mortality was 39.1%. The mean age of the study population was 17.3 years, and this population was predominantly male (87.5%), white (62.4%), resided in an urban area (43.8%), lived in the south (51.3%), and within the lowest income quartile (33.8%). Mental health (38.3%) and mood disorders (28.3%) were common. Males had a markedly increased likelihood of hospitalization for SIF (adjusted odds ratio [aOR], 7.56; 95% confidence interval [CI], 5.54-10.30). Children and adolescents from rural environments and those in the south were more likely to have a hospitalization for SIF than respective comparison groups. Using separate regression models, a diagnosis of any mental health disorder increased the likelihood of hospitalization for a SIF (aOR, 11.9: 95% CI, 9.51-14.9), mood disorders (aOR, 17.2; 95% CI, 13.3-22.3), and depression (aOR, 21.3; 95% CI, 16.1-28.3). CONCLUSION: Pediatric hospitalizations for SIF are a common occurrence with high associated mortality. The prevalence of mental health disorders and their impact on this population highlight the need for early identification and intervention for individuals at risk. LEVEL OF EVIDENCE: Epidemiological, level III.
Assuntos
Armas de Fogo , Suicídio/estatística & dados numéricos , Adolescente , Criança , Estudos Transversais , Bases de Dados Factuais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Fatores de Risco , População Rural/estatística & dados numéricos , Tentativa de Suicídio/estatística & dados numéricos , Estados Unidos , População Urbana/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Gun buyback programs represent one arm of a multipronged approach to raise awareness and education about gun safety. METHODS: The city of Worcester, MA has conducted an annual gun buyback at the Police Department Headquarters since 2002. We analyzed survey responses from a voluntary, 18-question, face-to-face structured interview from December 2009 to June 2015 using descriptive statistics to determine participant demographics and motivations for participation. RESULTS: A total of 943 guns were collected, and 273 individuals completed surveys. The majority of participants were white males older than 55years (42.4%). Participants represented 61 zip codes across Worcester County, with 68% having prior gun safety training and 61% with weapons remaining in the home (27% of which children could potentially access). The top reasons for turning in guns were "no longer needed" (48%) and "fear of children accessing the gun" (14%). About 1 in 3 respondents knew someone injured/killed by gun violence. Almost all (96%) respondents claimed the program raised community awareness of firearm risk. CONCLUSION: The Worcester Goods for Guns Buyback has collected more than 900 guns between 2009 and 2015. The buyback removes unwanted guns from homes and raises community awareness about firearm safety.