Paediatric patients with abusive head trauma treated in US Emergency Departments, 2006-2009.

OBJECTIVE: To study characteristics and outcomes of paediatric patients with abusive head trauma (AHT) treated in emergency departments. METHODS: Nationwide Emergency Department Sample (NEDS) data were analysed. The CDC recommended AHT definition was used to classify children ≤ 4 years with head trauma into AHT and non-AHT groups. Outcomes were compared between patients with AHT and patients with non-AHT. Logistic models were fitted to identify risk factors. RESULTS: An estimated 10 773 paediatric patients with AHT were treated in EDs in 2006-2009. The average annual rate was 12.83 per 100 000 for children ≤ 4 years. Children < 1 year of age accounted for most AHT cases (60.6%) and males had a significantly higher AHT rate than females. Medicaid was the primary payer for 66.1% of AHT injuries and 40.3% of non-AHT injuries. The case mortality rate was 53.9 (95% CI = 41.0-66.7) per 1000 patients with AHT compared with 1.6 (95% CI = 1.4-1.9) per 1000 patients with non-AHT. CONCLUSIONS: Child caregivers should be educated about the serious consequences of AHT and proper techniques for caring for infants. Unbiased and accurate documentation of AHT by physicians and medical coders is crucial for monitoring AHT injuries.

Organization interventions as a mediator of change in grades in the Challenging Horizons Program.

This study evaluated whether an organization intervention was a mediator of change for grade point average (GPA) in a randomized clinical trial of a school-based treatment program for adolescents with attention deficit hyperactivity disorder (ADHD). A demographically diverse sample of 148 participants (105 males) with a diagnosis of ADHD were recruited from nine middle schools. Comprehensive diagnostic evaluations were completed and participants were randomized into one of three conditions (two active treatment conditions, one control condition) for a randomized clinical trial that lasted an entire school year. The results of the trial are reported elsewhere (Evans et al., 2016; Schultz et al., 2017); in this study we evaluated four of the criteria for determining mediation as reported by Kazdin (2007) to determine whether response to the organization intervention in this school-based treatment program mediated the relationship between dosage and GPA beyond previous GPA. The results provided evidence that response to the organization intervention mediated the relationship between intervention dosage and change in GPA.

Deliberate Self-Harm Among Chinese Children with Different Types and Severity of Disabilities.

Background: The aims of this study were to determine the prevalence of deliberate self-harm (DSH) and to compare the risk of self-harm in Chinese children with different types and severity of disabilities. Methods: Participants were 1300 children aged 6-17 years in Beijing, China; 650 children with disabilities and 650 healthy peers matched on age, gender and residence district. Questionnaires were completed anonymously by parents or children if the age or disability made it necessary. The associations between the disability type, severity and DSH were examined using the Chi-square testing and logistic regression models. Results: Children with a single disability or multiple disabilities had statistically higher rates of DSH than children without disabilities (15.6% and 39.7% compared to 10.9%). The prevalence of DSH was associated with the severity of disability, being 36.2% among children with level 1 (the most severe) disability, 19.8% among children with level 2 disability, and 9.2% among children with level 3 + 4 disability. The multivariable odds ratio (OR) of DSH among children with any disability was statistically higher than that among children without a disability (OR = 2.40; 95% CI = 1.71, 3.36; p < 0.05). Children with multiple disabilities (OR = 6.89; 95% CI: 4.24-11.20) and level 1 severity of disability (OR = 6.11; 95% CI: 3.91-9.56) had the highest risk of DSH. Conclusions: This study clearly demonstrated associations between the severity and type of disability and DSH. This finding highlights the importance of DSH in children with disabilities, and underlines the importance of the prevention of DSH among a vulnerable pediatric population in China.

High school teacher ratings of academic, social, and behavioral difficulties: Factor structure and normative data for the School Functioning Scale.

Because academic, behavioral, and social difficulties are highly prevalent among U.S. high school students, teacher report is a critical component of comprehensive screening and assessment of adolescents. Currently available teacher questionnaires have limited utility in high school settings because of time demands and lesser opportunity to observe a wide variety of student behaviors relative to elementary school teachers. The School Functioning Scale (SFS) is a 9-item measure designed to efficiently obtain teacher perceptions of specific indicators of student performance across academic, behavior, and social functioning. Online SFS ratings were collected for 799 9th through 12th grade high school students (50% female) from 400 teachers (63.7% female). Teachers also reported each student's subject grades and percentage of assignments completed within the past month. Exploratory and confirmatory factor analyses indicated a general factor and three-factor structure for the SFS: academic, behavior, and social factors. The general factor demonstrated adequate levels of internal consistency and evidence of convergent validity. Findings regarding the group factors less robust. The factor structure was consistent across age, gender, and ethnicity groups. Normative data along with suggested cut-points for screening and assessment purposes are provided. Findings support the potential use of SFS teacher ratings for multimethod assessment and, possibly, screening and treatment evaluation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Consistency and Variation in School-Level Youth Sports Traumatic Brain Injury Policy Content.

PURPOSE: The purpose of the study was to examine the consistency and variation in content of high school written traumatic brain injury (TBI) policies in relation to the three key tenets of youth sports TBI laws. METHODS: A content analysis was conducted on written TBI policies retrieved from 71 high schools currently participating in High School Reporting Information Online. Each policy was independently analyzed by two trained coders. The number and percent of the policies reflecting the three key tenets of state youth sports TBI laws were described and compared on policy enforcement (i.e., strictness of language), policy description (i.e., details and definitions of the requirements), and policy implementation steps (i.e., specific steps for implementing the requirements). Direct quotes were identified to support quantitative findings. RESULTS: All 71 high school TBI policies contained at least two of the three main TBI law tenets, where 98.6% (n = 70) included the return to play tenet, 83.1% (n = 59) included the removal from play tenet, and 59.2% (n = 42) specified the distribution of TBI information sheets to student-athletes and their parents. Nearly half of the policies (49.3%, n = 35) required parents' signature while only 39.4% (n = 28) required students' signature on the TBI information sheet. The language exhibited wide variance across the 71 TBI policies regarding policy enforcement, policy description, and policy implementation specifications. CONCLUSIONS: All 71 TBI policies covered at least two of the three youth sports TBI law tenets, but with considerable variation. Future research should assess variations by schools within the same state and their impact on TBI rates in school athletics.

Clinical Practice Experiences in Diagnosis and Treatment of Traumatic Brain Injury in Children: A Survey among Clinicians at 9 Large Hospitals in China.

Proper diagnosis and treatment of traumatic brain injury (TBI) in children is becoming an increasingly problematic issue in China. This study investigated Chinese clinicians to provide information about their knowledge and experiences in diagnosis and treatment of pediatric TBI. We conducted a questionnaire survey among clinicians in the emergency departments and neurosurgery departments at 9 major hospitals in China. The questionnaire included demographic information, and knowledge and experiences regarding the diagnosis and treatment of pediatric TBI. A total of 235 clinicians completed questionnaires. 43.8% of the surveyed clinicians reported children with only scalp hematoma without any other signs and symptoms of concussion as TBI cases. Most clinicians (85.1%) reported no existing uniform diagnostic criteria for children with TBI in China. The majority of clinicians (91.9%) reported that CT scans were performed in all patients with suspected head injury as a routine procedure in their hospitals. Only 20.9% of clinicians believed that radiation from CT scanning may increase cancer risk in children. About 33.6% of the clinicians reported that they ordered CT scans to investigate suspected head injury due to the poor doctor-patient relationship in China, and to protect themselves against any medical lawsuits in the future. About 80% of the clinicians reported that there are no existing pediatric TBI treatment guidelines in China. Instead a senior doctor's advice is the most reported guidelines regarding treating pediatric TBI (66.0%). All of the surveyed clinicians reported that the lack of diagnosis and/or treatment standard is the biggest problem in effectively diagnosing and treating pediatric TBI in China. Developing guidelines for the diagnosis and treatment of children with TBI is a high priority in China. The extremely high usage of CT for pediatric TBI in China suggests that it is important to establish evidence-based clinical decision rules to help Chinese clinicians make diagnostic and therapeutic decisions during their practice in order to identify children unlikely to have a clinically-important TBI who can be safely discharged without a CT scan.

Lacrosse injuries among high school boys and girls in the United States: academic years 2008-2009 through 2011-2012.

BACKGROUND: Lacrosse is a fast growing youth sport in the United States. Although there have been published studies examining injuries associated with lacrosse, significantly less research has been conducted in high school lacrosse players than in older lacrosse players. The objective of this study was to compare high school lacrosse injury rates and patterns by type of athletic activity (ie, competition vs practice) and sex. HYPOTHESIS: Lacrosse injury rates and patterns differ by type of athletic activity and sex. STUDY DESIGN: Descriptive epidemiology study. METHODS: Using the High School RIO (Reporting Information Online) database, lacrosse exposure and injury data were collected during 4 academic years, 2008-2012, from a large sample of high schools in the United States. Schools' certified athletic trainers submitted exposure and injury information weekly. RESULTS: During the study period, 1406 injuries occurred during 716,812 athlete exposures, for an injury rate of 1.96 per 1000 athlete exposures (AEs). Injury rates were higher in competition than in practice (3.61 vs 1.23 per 1000 AEs, respectively; rate ratio [RR], 2.94; 95% CI, 2.65-3.27). Boys had a higher injury rate than girls (2.26 vs 1.54 per 1000 AEs, respectively; RR, 1.47; 95% CI, 1.32-1.64). The most common injury diagnoses among both boys and girls were sprains/strains (boys: 35.6%; girls: 43.9%) and concussions (boys: 21.9%; girls: 22.7%). The most commonly injured body sites in competition were the head/face (32.0%), lower leg/ankle/foot (17.8%), and knee (12.2%), while in practice, the most commonly injured body sites were the lower leg/ankle/foot (34.9%), head/face (16.4%), and knee (12.7%). Among boys, the most common mechanisms of injury were contact with another person (40.9%) and no contact (21.1%). Among girls, the most common mechanisms of injury were no contact (26.2%), contact with a playing apparatus (24.0%), and overuse/chronic (17.7%). Most injured athletes (71.8%) returned to activity in ≤21 days, but 6.9% of all injuries required surgery. CONCLUSION: Lacrosse injury rates and patterns among high school athletes in the United States differ by type of athletic activity and sex. Future studies should continue to compare differences in injury rates and patterns in high school lacrosse, with particular emphasis placed on high-risk plays in competition and the prevention and management of concussions in both boys and girls.

Clinically-important brain injury and CT findings in pediatric mild traumatic brain injuries: a prospective study in a Chinese reference hospital.

This study investigated injury patterns and the use of computed tomography (CT) among Chinese children with mild traumatic brain injury (MTBI). We enrolled children with MTBI who were treated within 24 hours of head trauma in the emergency department of Wuhan Medical Care Center for Women and Children in Wuhan, China. Characteristics of MTBIs were analyzed by age and gender. Results of cranial CT scan and clinically-important brain injury (ciTBI) for children were obtained. The definition of ciTBI was: death from TBI, intubation for more than 24 h for TBI, neurosurgery, or hospital admission of 2 nights or more. Of 455 eligible patients with MTBI, ciTBI occurred in two, and no one underwent neurosurgical intervention. CT scans were performed for 441 TBI patients (96.9%), and abnormal findings were reported for 147 patients (33.3%, 95% CI 29.0-37.8). Falls were the leading cause of MTBI (61.5%), followed by blows (18.9%) and traffic collisions (14.1%) for children in the 0-2 group and 10-14 group. For children aged between 3 and 9, the top three causes of TBI were falls, traffic collisions and blows. Leisure activity was the most reported activity when injuries occurred for all age groups. Sleeping/resting and walking ranked in the second and third place for children between 0 and 2 years of age, and walking and riding for the other two groups. The places where the majority injuries occurred were the home for the 0-2 and 3-9 years of age groups, and school for the 10-14 years of age group. There was no statistical difference between boys and girls with regard to the activity that caused the MTBI. This study highlights the important roles that parents and school administrators in the development of preventive measures to reduce the risk of traumatic brain injury in children. Also, identifying children who had a head trauma at very low risk of clinically important TBI for whom CT might be unnecessary is a priority area of research in China.

Characteristics and trends of hospitalized pediatric abuse head trauma in Wuhan, China: 2002­2011.

This study investigated characteristics and trends of hospitalized abuse-related traumatic brain injuries (TBI) treated at a large pediatric medical center in Wuhan, China during the past 10 years. De-identified hospital discharge data for patients 0­4 years old hospitalized at the Wuhan Medical Care Center for Women and Children were analyzed, and ICD-10 codes were used to identify cases of TBI. Medical notes provided by doctors in the medical record were used to identify TBI cases in which suspected child abuse was the cause. From 2002 to 2011, 3,061 pediatric TBI patients were hospitalized and 4.6% (140) of these cases were suspected child abuse-related. The majority of suspected child abuse cases involved children younger than 1 year of age (68.6%) and usually affected males (63.6%). Children with non-Abusive Head Trauma (AHT) were more likely to have full recovery outcome (68.4%, 95% CI: 66.6%--70%) than children with suspected AHT (44.3%, 95% CI: 36.1%--52/5%). The proportion of all childhood TBI attributable to abuse did not appear to have increased in the 10-year period at this medical center. This is the first comprehensive study highlighting the important role of suspected child abuse in causing TBIs among Chinese children. Child abuse as a major cause of TBIs among infants in China should be studied further, and there should be greater awareness of this important social and medical problem in China.