Severe unintentional injuries sustained by Ohio children: Is there urban/rural variation?

BACKGROUND: Determining at risk populations is essential to developing interventions that prevent injuries. This study examined the rates of severe unintentional injuries among urban versus rural Ohio children. METHODS: Demographic and injury data for children 0 to 14 years old who had unintentional injuries from January 1, 2003, to December 31, 2012, were extracted retrospectively from the Ohio Trauma Acute Care Registry. Cases with no designated county were excluded. Injury rates per 100,000 children 14 years or younger were calculated annually using county of residence and US census data. Each county was assigned an urbanization level based on population density (A = most urban, D = most rural). RESULTS: There were 40,625 patients from 88 Ohio counties who met the inclusion criteria; the overall annual injury rate was 231.9. The mean age was 6.7 (SD, 4.5) years; 26,035 (64.1%) were male, and 31,468 (77.5%) were white. There were 593 deaths (1.5%). Injury rates by urbanization level were as follows: A: 120.4, B: 196.8, C: 249.1, and D: 247.4 (p = 0.04). Nearly 50% of all deaths occurred in the most urban counties. Those in the most urban areas were more likely to suffer injury from burns, drownings, and suffocations and less likely to be injured by animal bites or motorized vehicle collisions (p < 0.001). Length of stay and injury severity score were highest in the most urban children (p < 0.001). CONCLUSION: While rural counties experienced higher injury rates, urban areas suffered more severe injuries. Specific mechanisms of injury differed by demographics and urbanization in Ohio, suggesting areas for targeted injury prevention. LEVEL OF EVIDENCE: Epidemiologic study, level III.

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.

Intentional injuries in young Ohio children: is there urban/rural variation?

BACKGROUND: Intentional injuries are the third leading cause of death in children 1 year to 4 years of age. The epidemiology of these injuries based on urban/rural geography and economic variables has not been clearly established. The study purposes are (1) to determine the rate of severe intentional injuries in children younger than 5 years in urban versus rural Ohio counties and (2) to determine if poverty within counties is associated with intentional injury rate. METHODS: Demographic and injury data on children younger than 5 years who experienced intentional injuries, from January 1, 2003, to December 31, 2011, were extracted retrospectively from the Ohio Trauma Acute Care Registry. We calculated injury rates using the county of residence and US census data. We assigned each county to an urbanization level based on population density (A, most urban; D, most rural). Mean income and percentage of families with children younger than 5 years living below poverty in Ohio counties were obtained from the US census. Rates are per 100,000 children younger than 5 years per year. RESULTS: A total of 984 patients were included; the overall injury rate was 15.9. The mean age was 0.66 years (SD, 1.02 years); 583 (59.2%) were male and 655 (66.6%) were white. One hundred twenty-nine (13.1%) died. Injury rates by urbanization level were as follows: A, 16.5; B, 10.7; C, 18.7; and D, 15.2 (p = 0.285). There were significant associations between county injury rate and mean income (p = 0.05) and percentage of families with children younger than 5 years living below poverty (p = 0.04). CONCLUSION: We found no association between intentional injury rate and urbanization level in young Ohio children. However, we did find an association between county mean income and percentage of families living below poverty, with intentional injury rate suggesting that financial hardship may be an important risk factor of these injuries.

An atypical presentation of atypical Kawasaki disease.

Kawasaki disease (KD) is a well-known inflammatory disorder that, despite its classic description, can pose a diagnostic challenge. We report a case of a 3-year-old girl who presented to the emergency department with a limp and urinary incontinence who was ultimately diagnosed with KD. She was found to have a large coronary artery aneurysm on echocardiogram. We discuss the challenges in diagnosing incomplete KD.