Embracing the complexity of modifiable risk reduction: A registry of modifiable risks for 0-12 month infants.

Despite relatively high medical expenditures, the United States performs poorly on population health indicators relative to many other countries. A key step in addressing this situation involves determining impactful and cost-effective interventions for at-risk populations. This requires an understanding of medical, social, behavioral health and safety domains of risk. Of immediate interest are those risks that are modifiable at the individual and family levels and could be reduced through intervention and broader care coordination efforts. Unfortunately, a comprehensive list of such risks does not exist in the published literature. Using multiple interrelated methods, including clinical, social, and care coordination experience, expert elaboration and validation, and reviews of existing assessments and literature, we present what we believe to be the most comprehensive listing of individually modifiable risk factors (IMRFs), relevant to care coordination, available for individuals aged 0-12 months. The list addresses IMRFs within four broad domains of risk (medical, social, behavioral health, and safety). Comprehensive risk registries such as the one presented here can enhance our collective efforts to identify and mitigate risks for specific populations. Such registries can also support research to build understandings of the impact of risks, individually and in interconnected signature combinations. The risk registry presented here and the enhanced understandings flowing from it may yield useful insights for clinicians, social service providers and researchers seeking a whole person approach to care, as well as for payers and policymakers seeking to enable health policy and payment reforms to improve population health.

An Intervention to Increase Knowledge and Utilization of the Low Risk Ankle Rule Among Pediatric Emergency Department Providers.

OBJECTIVES: The Low Risk Ankle Rule (LRAR) can assist pediatric emergency department providers in reducing radiographs without missing significant fractures. Most providers are unaware of this tool. This study sought to educate providers about the LRAR then determine their self-reported use immediately and 2 months after education. METHODS: A web-based survey was e-mailed to providers at one large pediatric emergency department. The survey assessed knowledge and use of the rule. Clinical scenarios, in which radiographs were not indicated, helped determine radiograph ordering practices. After a brief LRAR tutorial, respondents were requeried about radiograph ordering practices along with likelihood of future LRAR use. At 2 months, radiograph ordering was again assessed using the same scenarios; interim LRAR use was also determined. RESULTS: Response rates on the initial and follow-up surveys were 61.4% and 96.2%, respectively. A minority (20%) had heard of the LRAR. Providers initially reported ordering radiographs on 84% of ankle injuries and 82.5% ordered radiographs in the scenario. Immediately after education, only 32% ordered a radiograph in the scenario; 85% reported that they would use the tool consistently. At 2 months, there was no significant change in radiograph ordering practices (79.5% vs 84%). In the interim, 30% reported using the rule at least once. CONCLUSIONS: Most pediatric emergency department providers were unfamiliar with the LRAR. After a brief tutorial, most providers reported that planning to use the tool and self-reported radiograph ordering was significantly reduced; however, at 2 months, clinical practice was unaffected. Further work to implement the tool into practice is necessary.

Laryngeal Injury in a Male Lacrosse Player: A Case for Prevention.

Lacrosse has become increasingly popular among US children and teens. Because a lacrosse ball can serve as a projectile, neck injuries, although uncommon, can cause a severe and long-lasting injury. We report the case of a 16-year-old adolescent who experienced direct neck trauma while playing lacrosse. The clinical presentation, treatment strategies, and intubation considerations are reviewed. Finally, a call to action to prevent future, similar injuries is discussed.

High School Football Players' Knowledge and Attitudes About Concussions.

OBJECTIVES: To assess high school (HS) football players' knowledge of concussions and to determine whether increased knowledge is correlated with better attitudes toward reporting concussion symptoms and abstaining from play. DESIGN: Two survey tools were used to assess athletes' knowledge and attitudes about concussions. Surveys collected information about demographics, knowledge about concussions, and attitudes about playing sports after a concussion. All athletes present completed one of the 2 surveys. A knowledge and attitude score for each survey was calculated. Frequencies and mean values were used to characterize the population; regression analysis, analysis of variance, and t tests were used to look for associations. SETTING: A football camp for HS athletes in the Cincinnati area. PARTICIPANTS: Male HS football players from competitive football programs in the Cincinnati area. INTERVENTION: None. MAIN OUTCOME MEASURE: Scores on knowledge and attitude sections; responses to individual questions. RESULTS: One hundred twenty (100%) athletes were enrolled although not every athlete responded to every question. Thirty (25%) reported history of a concussion; 82 (70%) reported receiving prior concussion education. More than 75% correctly recognized all concussion symptoms that were asked, except "feeling in a fog" [n = 63 (53%)]. One hundred nine (92%) recognized a risk of serious injury if they return to play too quickly. Sixty-four (54%) athletes would report symptoms of a concussion to their coach; 62 (53%) would continue to play with a headache from an injury. There was no association between knowledge score and attitude score (P = 0.08). CONCLUSIONS: Despite having knowledge about the symptoms and danger of concussions, many HS football athletes in our sample did not have a positive attitude toward reporting symptoms or abstaining from play after a concussion. CLINICAL RELEVANCE: Physicians should be aware that young athletes may not report concussion symptoms.

Pediatric emergency department discharge prescriptions requiring pharmacy clarification.

OBJECTIVES: The aims of the study were to analyze and classify reasons why retail pharmacies need to contact the pediatric emergency department (PED) for clarification on outpatient prescriptions generated using an electronic prescribing system and to categorize the severity of errors captured. METHODS: A retrospective chart review was conducted at a PED that cares for approximately 92,000 patients annually. All pharmacy callbacks documented in the electronic medical record between August 1, 2008 and July 31, 2009 were included. A datasheet was used to capture patient demographics (age, sex, race, insurance), prescriptions written, and reason for callback. Each call was then assigned a severity level, and time to respond to all calls was estimated. Frequencies were used to analyze the data. RESULTS: A total of 731 errors for 695 callbacks were analyzed from 49,583 prescriptions written at discharge. The most common errors included administrative/insurance issues 342/731 (47%) and prescription writing errors 298/731 (41%). The errors were classified as insignificant (340/729 [47%]), problematic (288/729 [40%]), significant (77/729 [11%]), serious (12/729 [1.64%]), and severe (12/729 [1.64%]). Almost 96% of errant prescriptions were not able to be filled as originally written and required a change by the prescriber. These calls required approximately 127 hours to complete. CONCLUSIONS: Prescription errors requiring a pharmacy callback are typically insignificant. However, 13.8% of callbacks about an error were considered significant, serious, or severe. Automated dose checking and verifying insurance coverage of prescribed medications should be considered essential components of prescription writing in a PED.

A comprehensive approach to pediatric injury prevention in the emergency department.

Injury is the leading cause of pediatric mortality and long-term disability. Although the primary care setting has traditionally been considered as the main venue to address injury anticipatory guidance, an emergency department (ED) visit may serve as a "teachable moment" because most injured children are cared for in this setting and the experience may elicit a greater chance of behavior change. However, EDs can also provide additional information and services beyond counseling to prevent injuries. These adjunct efforts and activities focus on primary injury prevention (screening for and promoting safe behaviors and collecting data to survey high-risk community locations), secondary prevention (use of safety products to mitigate injury), and tertiary prevention (maximizing injury care and minimizing injury sequelae). This review will describe several ways an ED can help to mitigate the epidemic of pediatric injuries through surveillance, screening, education, product disbursement, community engagement, and quality improvement efforts.

Assessment of the Smoke Free Families Tobacco Screening, Counseling, and Referral Program in Pediatric Primary Care Practices.

OBJECTIVE: The Smoke Free Families (SFF) program trained pediatric providers to use an SFF tool during well-child visits (WCVs) of infants ≤12 months to "Ask" caregivers about tobacco use, "Advise" smokers to quit, and "Refer" smokers to cessation services (AAR). The primary objectives were to assess the prevalence and changes in caregiver tobacco use after being screened and counseled by providers using the SFF tool. A secondary objective was to examine providers' AAR behavior facilitated by using the SFF tool. METHODS: Pediatric practices participated in 1 of 3 6-9-month SFF program waves. Over the 3 waves, all initial SFF tools completed on caregivers during their infant's WCV were evaluated for the caregiver and household tobacco use and providers' AAR rates. An infant's first and next WCV was matched to determine changes in caregiver tobacco product use. RESULTS: In total, the SFF tool was completed at 19,976 WCVs; 2081 (18.8%) infants were exposed to tobacco smoke. A total of 834 (74.1%) caregivers who smoked received counseling: 786 (69.9%) were advised to quit, 700 (62.2%) were given cessation resources, and 198 (17.6%) were referred to the Quitline. In total, 230 (27.6%) of caregivers who smoked had a second visit; 58 (25.2%) self-reported that they quit using tobacco. Among cigarette users (n = 183), 89 (48.6%) reported that they used fewer cigarettes or quit at their infants' second WCV. CONCLUSIONS: Systematic use of the SFF AAR tool during infants' WCVs could improve the health of caregivers and children, resulting in decreases in tobacco-related morbidity.

Pediatric outdoor recreational injuries: another hidden concern during the COVID-19 pandemic.

BACKGROUND: Recreational equipment sales rose significantly during the COVID-19 pandemic. This study investigated changes in the incidence of pediatric emergency department (PED) visits related to outdoor recreational activities during the COVID-19 pandemic. METHODS: A retrospective cohort study was conducted at a large children's hospital with a level 1 trauma center. Data were obtained from PED electronic medical records of children 5-14 years with a visit from March 23-September 1 in years 2015-2020. Patients with an ICD-10 code for injury associated with recreation and use of common outdoor recreational equipment were included. Initial pandemic year, 2020, was compared with pre-pandemic years (2015-2019). Data collected included patient demographics, injury characteristics, deprivation index, and disposition. Descriptive statistics were used to characterize the population and Chi-squared analysis was used determine relationships between groups. RESULTS: There were 29,044 total injury visits during the study months with 4715 visits (16.2%) due to recreational mechanisms. A higher proportion of visits due to recreational injury visits occurred during the COVID pandemic (8.2%) compared to before (4.9%). Comparing patients included within the two times, were no differences in sex, ethnicity, or ED disposition. During the COVID pandemic, there was a higher percentage of White patients (80% vs 76%) and patients with commercial insurance (64% vs 55%). There was a significantly lower deprivation index for patients injured during the COVID pandemic. There were more injuries due to bicycles, ATV/motorbike, and non-motorized wheeled vehicles during the COVID pandemic. CONCLUSIONS: During the COVID-19 pandemic, there was an increase in bicycle, ATV/motorbike, and non-motorized wheeled vehicle injuries. White patients with commercial insurance were more likely to be injured compared to years prior. A targeted approach to injury prevention initiatives should be considered.

Impact of standardization on racial and socioeconomic disparities in non-accidental trauma evaluations in infants in a pediatric emergency department.

BACKGROUND: Studies have illustrated racial and socioeconomic disparities in evaluation of non-accidental trauma (NAT). We aimed to investigate how implementation of a standardized NAT guideline in a pediatric emergency department (PED) impacted racial and socioeconomic disparities in NAT evaluation. RESULTS: 1199 patients (541 pre- and 658 post-guideline) were included for analysis. Pre-guideline, patients with governmental insurance were more likely than those with commercial insurance to have a social work (SW) consult completed (57.4% vs. 34.7%, p < 0.001) and a Child Protective Services (CPS) report filed (33.4% vs. 13.8%, p < 0.001). Post-guideline, these disparities were still present. There were no differences in race, ethnicity, insurance type, or social deprivation index (SDI) in rates of complete NAT evaluations pre- or post-guideline implementation. Overall adherence to all guideline elements increased from 19.0% before guideline implementation to 53.2% after (p < 0.001). CONCLUSION: Implementation of a standardized NAT guideline led to significant increase in complete NAT evaluations. Guideline implementation was not associated with elimination of pre-existing disparities in SW consults or CPS reporting between insurance groups.

Identifying Health-Related Social and Unintentional Injury Risks Among Patients Presenting to a Pediatric Urgent Care.

OBJECTIVE: Many families seek medical care at pediatric urgent care centers. The objective of this study was to determine social and unintentional injury risks reported by these families. METHODS: This cross-sectional study surveyed a convenience sample of guardians of patients 1 to 5 years of age presenting to our pediatric urgent care, 9/10/21 to 2/25/22. Outcomes were the number of reported social and unintentional injury risks. Predictors and covariates included child and parent demographic characteristics and a neighborhood socioeconomic deprivation index. Chi-square, Student's t test, Pearson's correlation tests, and multinominal regression were used. RESULTS: A total of 273 guardians (and children) were included; 245 of guardians (89.7%) were female; 137 (50.2%) of included children identified as Black. Approximately 60% reported ≥1 social risk; 31.5% reported ≥3. Approximately 90% reported ≥1 unintentional injury risk; 57.9% reported ≥3. There were significant associations between social risk presence and Black race, public/no insurance, and neighborhood deprivation (all P < .05). There were no significant associations between unintentional injury risks and assessed predictors. Black guardians were more likely than those of other races to report a greater number of social risks (adjusted odds ratio [AOR] 2.90, 95% confidence interval [CI] 1.50, 5.58 for ≥3 vs 0 risk). Children with public/no insurance compared to private insurance were more likely to experience a greater number of social risks (AOR 3.34, 95% CI 1.42, 7.84 for ≥3 vs 0 risks). CONCLUSIONS: Many presenting to pediatric urgent cares experience social and unintentional injury risks. Risk identification may guide equitable responses.

Types of Tobacco Products Used by Caregivers of Newborns in the Primary Care Setting.

This study determined the types of tobacco products used by caregivers who presented to infant well-child visits (WCVs), tobacco product use by other household members, and caregivers' readiness to quit. The Ohio Chapter of the American Academy of Pediatrics conducted a 10-month quality improvement collaborative to improve providers' tobacco screening and cessation counseling practices. A sub-analysis of the initial screenings was performed to determine types of tobacco products used and caregivers' readiness to quit. Fourteen practices (60 providers) participated, and 3972 initial screens were analyzed; 320 (8.1%) caregivers and 490 (12.4%) household members used tobacco products. Most smoking caregivers and household members exclusively used cigarettes (79% and 72%, respectively). There was no difference in caregiver intention to quit by tobacco type, yet 53% of smoking caregivers were ready to quit. Providers should provide screening and cessation counseling to caregivers of infants at WCVs since many are ready to quit.

Attitudes and perceived barriers to firearm safety anticipatory guidance by pediatricians: a statewide perspective.

BACKGROUND: Firearms are the second leading cause of injury-related death in American children. Safe storage of firearms is associated with a significantly decreased odds of firearm-related death, however more than half of US firearm owners store at least one firearm unlocked or accessible to a minor. While guidance by primary care providers has been shown to improve storage practices, firearm safety counseling occurs infrequently in the primary care setting. The primary objective of this study was to describe pediatricians' perceived barriers to providing firearm safety education to families in the pediatric primary care setting. Secondary objectives included identifying pediatric provider attitudes and current practices around firearm counseling. METHODS: This was a cross-sectional survey of pediatric primary care providers in Ohio. Participants were recruited from the Ohio AAP email list over a 3-month period. Only pediatric primary care providers in Ohio were included; subspecialists, residents and non-practicing physicians were excluded. Participants completed an anonymous online survey detailing practice patterns around and barriers to providing firearm safety counseling. Three follow-up emails were sent to pediatricians that failed to initially respond. Response frequencies were calculated using Microsoft Excel. RESULTS: Two hundred eighty-nine pediatricians completed the survey and 149 met inclusion criteria for analysis. One hundred seven (72%) respondents agreed that it is the responsibility of the pediatric primary care provider to discuss safe storage. Counseling, however, occurred infrequently with 119 (80%) of respondents performing firearm safety education at fewer than half of well child visits. The most commonly cited barriers to providing counseling were lack of time during office visits, lack of education and few resources to provide to families. A majority, 82 of pediatric providers (55%), agreed they would counsel more if given additional training, with 110 (74%) conveying they would distribute firearm safety devices to families if these were available in their practice. CONCLUSION: Ohio pediatricians agree that it is the responsibility of the primary care provider to discuss firearm safety. However, counseling occurs infrequently in the primary care setting due to a lack of time, provider education and available resources. Improving access to resources for primary care pediatricians will be critical in helping educate families in order to protect their children through improved storage practices.

Risk factors for dating violence among adolescent females presenting to the pediatric emergency department.

BACKGROUND: Intimate partner violence (IPV) among the adolescent population is an increasing concern. This study was designed to assess the prevalence, associated risk factors, and best ways to identify IPV among teens presenting to a pediatric emergency room. METHODS: This prospective, convenience study was conducted in a busy, pediatric emergency department. Young women, aged 15 years to 21 years, presenting with any chief complaint were enrolled. Adolescents completed a verbally assisted survey, and responses were recorded. Surveys consisted of three sections: demographic information, an eight-item date violence screening tool, and a risk factor assessment tool. Teens who screened positive for IPV were offered immediate social services assistance. Analysis was performed to compare youth risk factors between young women who were screened positive and negative for IPV. All eight of the date violence screening questions were reviewed to analyze whether a set of questions were consistently positive in all the teens who were screened. RESULTS: A total of 246 of 270 (91%) approached were enrolled. The prevalence of IPV was 36.6%. Many of the risk-taking behaviors assessed correlated with dating violence. The most significant included having tried alcohol (odds ratio [OR], 2.4; confidence interval [CI], 1.3-4.4), having ridden in a car with a partner who was doing drugs (OR, 2.4; CI, 1.1-5.0) or alcohol (OR, 2.5; CI, 1.0-6.3), fighting with peers (OR, 3.5; CI, 1.6-7.8), and history of sexually transmitted disease (OR, 2.2; CI, 1.2-4.2). Four questions were identified that detected 99% of positive screens for adolescent dating violence. CONCLUSIONS: IPV among female adolescents presenting to a pediatric emergency department is high. Certain risk-taking behaviors are correlated with adolescent dating violence. Four specific questions, if asked in this setting, can capture teens at risk.

Implementing and evaluating an injury prevention curriculum within a pediatric residency program.

BACKGROUND: Many pediatric residency programs struggle to incorporate injury prevention training into their curricula. OBJECTIVE: To analyze whether a 2-week injury prevention course helps pediatric residents to learn and retain more information than their peers who receive the standard education on injury prevention topics. METHODS: A mandatory 2-week injury prevention course is provided for all interns at Cincinnati Children's Hospital Medical Center (CCHMC). Residents at CCHMC, completed a 50-question test on basic injury prevention topics at intern orientation and at the end of their first and third years of training. A control group of two intern classes from comparable children's hospitals who did not receive the injury prevention course were given the identical test at similar time periods. Data were analyzed using SPSS, and t tests were used to calculate and compare the mean percent change in test scores. RESULTS: Seventy-six pediatric interns were enrolled (33 intervention and 43 controls). After internship, posttests were obtained on 29 (88%) intervention residents and 38 (88%) controls. On completing residency, posttests were received from 16 (48%) CCHMC residents and 22 (51%) controls. There was no difference in demographics or prior injury prevention training between the groups at study enrollment. A total of 63.6% of controls reported receiving injury prevention training by the end of their residency. There was a significant difference in the improvement of mean test scores between the intervention and control groups after internship (14.1% vs. 3.2%; p < 0.001) and again after the third year (11.9% vs. 5.5%; p = 0.02). CONCLUSIONS: An injury prevention curriculum for pediatric residents can significantly increase and sustain their fund of knowledge on these important topics.

Personalising Safe Sleep Messaging for Infant Caregivers in the United States.

The purpose of our study was to better understand why parents/caregivers might not practice safe sleep behaviours. In autumn 2016, we conducted 'pulse' interviews with 124 parents/caregivers of children under the age of one year at a variety of local community events, festivals and meetings in cities with high infant mortality rates around the Midwestern US state of Ohio. Through an inductive approach, pulse interviews were analysed using thematic coding and an iterative process which followed for further clarification of themes (Qualitative Research in Psychology, 2006, 3, 77; BMC Medical Research Methodology, 2013, 13, 117). The six major themes of underlying reasons why parents/caregivers might not practice safe sleep behaviours that were identified in our coding process included the following: (a) culture and family tradition, (b) knowledge about safe sleep practices, (c) resource access, (d) stressed out parents, (f) lack of support and (g) fear for safety of baby. Using the descriptive findings from the pulse interviews, qualitative themes and key informant validation feedback, we developed four diverse fictional characters or personas of parents/caregivers who are most likely to practice unsafe sleep behaviours. These personas are characteristic scenarios which imitate parent and caregiver experiences with unsafe sleep behaviours. The personas are currently being used to influence development of health promotion and education programs personalised for parents/caregivers of infants less than one year to encourage safe sleep practices.

A pilot QI primary care practice program to help reduce infant mortality risks.

BACKGROUND: Tobacco smoke exposure (TSE) and inappropriate sleep position/environments contribute to preventable infant deaths. The objective of our quality improvement (QI) program was to increase primary care provider (PCP) screening and counseling for TSE and safe sleep risks at well-child visits (WCVs) and to assess caregiver behavior changes at subsequent visits. METHODS: Pediatric practices, recruited from the Ohio Chapter, American Academy of Pediatrics' database, self-selected to participate in this TSE and safe sleep PCP QI program. At every WCV over a 10-month period, caregivers with children < 1 year old were to be screened and counseled by providers. Caregiver demographics, TSE, and safe sleep practices were assessed. Individual PCP results were paired with subsequent family screening tools at follow up visits to determine changes in TSE and safe sleep practices. Differences in frequencies were determined and paired t-tests were used to compare means. RESULTS: Fourteen practices (60 providers) participated; 7289 screens were completed: 3972 (54.5%) initial screens and 1769 (24.3%) subsequent WCV screens. Caregivers on the initial screen were primarily white (61.7%), mothers (86.0%) with public insurance (41.7%). Within the first month after QI program initiation, PCPs TSE screening was during 80% of WCVs, which increased to > 90% by end of the QI program. A total of 637 /3953 (16.1%) screened positive for home TSE on the initial visit: 320/3953 (8.1%) exposed by at least the primary caregivers, and 317/3953 (8.0%) exposed by a home adult smoker (not the identified caregiver). Of caregivers receiving smoking counseling with subsequent follow-up WCV (n = 100), the mean number of cigarettes smoked daily decreased significantly from 10.6 to 4.6 (p = 0.03). Thirty-four percent of caregivers (34/100) reported they quit smoking at their second visit. A total of 1072 (27%) infants screened at risk for inappropriate sleep position or environment at their initial visit. Of these at-risk infants whose caregivers received safe sleep counseling, 49.1% practiced safer sleep behaviors at follow-up. CONCLUSIONS: PCPs participating in a QI program increased screening at WCVs for infant mortality risks. After counseling and providing resources about TSE and safe sleep, many caregivers reported practicing safer behaviors at their next WCV.

Drug ingestions in children 10-14 years old: an old problem revisited.

To determine changes in rates of drug ingestions in 10-14 year old children in our country, a retrospective chart review of 10-14 year olds hospitalized for drug ingestion between 1993-1995 and 2000-2004 was performed. Odds ratios and Chi-square were used for analyses. From 1993-1995 there were 92.8 ingestions/100,000 children/year; from 2000-2004 there were 63.3 ingestions/100,000 children/year. More males ingested in 2000-2004 than 1993-1995 (26.3% vs.14.2% O.R. 2.15 [1.19, 3.92]). More patients took psychiatric medications in 2000-2004 than 1993-1995 (38.9% vs. 27.0%, O.R. 1.72 [1.06, 2.80]). More patients ingested SSRIs in 2000-2004 than 1993-1995; fewer ingested tricyclics. Hospitalization rates for drug ingestions have decreased. There has been a change in drug ingested, and more males are ingesting drugs.

Use of a safety resource center in a pediatric emergency department.

OBJECTIVE: To describe the use of a safety resource center (SRC) within a pediatric emergency department (ED) about injury prevention (IP) counseling, sales, costs, and parental responses to the services. METHODS: The SRC was established in June 2005 in the waiting area of an urban pediatric ED caring for approximately 96,000 patients annually. Safety resource center staff sells products of proven efficacy (eg, car seats, smoke alarms, and bike helmets) and offers safety education materials to patients and families. Activities including sales, educational content provided, types of inquiries from families, and overall satisfaction with the service were logged into a Microsoft Access database. Follow-up phone calls are made to all families 3 weeks after they purchase a product. RESULTS: Between June 20, 2005 and July 1, 2007, the SRC served approximately 13,000 families. Seven hundred eighty-six families purchased 816 products, generating $14,859. An additional 473 products were given away, totaling 1289 product items provided to families. The most commonly purchased items were car safety seats and bicycle helmets. Roughly 7000 IP-related brochures were distributed to ED families, and 120 car seats were fitted. Of the 786 families who made a purchase, 383 (49%) were reached for follow-up. Ninety-seven percent reported to still be using the purchased product, and 28% made a different change in the home to practice safer behaviors. Ninety-five percent were grateful that the SRC was located in the ED. CONCLUSIONS: The SRC can provide IP product, encourage families to practice safer behaviors, and is well-received within a large, urban pediatric ED.

Trends of ED visits, admissions, and deaths for pediatric traumatic brain injury comparing sport and non-sport mechanisms.

BACKGROUND: Traumatic brain injuries (TBI) in children result in significant morbidity and mortality. There are many mechanisms, both sport and non-sport related, which cause these injuries. Studies have reported that Emergency Department (ED) visits for pediatric TBI caused by sports are increasing; however, no subsequent study has evaluated the trend in non-sport TBI. The objective of this study was to evaluate ED visits, admissions, and deaths for non-sport TBI compared to those caused by sports. METHODS: A retrospective study of children 5-19 years of age was performed at a pediatric, level 1 trauma center from 2002 to 2012. Subjects with a primary or secondary diagnosis of TBI were identified from the hospital's trauma registry, and mechanism of injury, disposition, injury severity score, and length of stay were recorded. Frequencies were used to characterize the population, Chi-square analysis was performed to determine differences between groups, and linear trend lines were calculated for sport-related and non-sport TBI by year. RESULTS: Thirteen thousand two hundred ninty one subjects were seen in the ED between 2002 and 2012 for a TBI; 9527 (72%) were from a non-sport mechanism, and 3764 (28%) were from a sport mechanism. Subjects with a non-sport TBI were more likely to be younger (p < 0.001), African American (p < 0.001), and have Medicare/Medicaid (p < 0.001). Subjects with a non-sport TBI were admitted to the hospital 15% of the time, and subjects with a sport-related TBI were admitted 10% of the time (p < 0.001). When evaluating all TBI by mechanism of injury, sport had the lowest injury severity score (mean 4.4) and the shortest length of stay (mean 1.6 days) of any mechanism. There were six deaths reported from non-sport TBI and none from sport-related TBI. ED visits for sport-related TBI increased 92%, and non-sport TBI increased 22% over 10 years. There was a peak in TBI, in both groups, seen in 2009. CONCLUSIONS: ED visits for both sport and non-sport TBI have increased over the past 10 years. TBI from a non-sport mechanism was more likely to result in hospitalization or death. Prevention efforts should be expanded to include all high-risk TBI mechanisms, not just sports.