Injury reduction and bounce characteristics of safety baseballs and acceptability by youth leagues.

The only reasonable way to reduce the potential for ball-related youth baseball injuries sustained by the defensive players (the majority of ball-related injuries) is to make the ball less injurious. The American Academy of Pediatrics' 1994 statement on youth baseball injuries in this regard reads, "Consideration should be given to utilizing low-impact NOCSAE-approved baseballs and softballs for children 5 to 14 years of age, if these balls demonstrate satisfactory playing characteristics and reduce injury risk. A variety of studies should be undertaken to determine the efficacy of low-impact balls in reducing serious impact injuries." The purpose of this study, in accordance with this AAP policy, is to investigate the following: A) injury reduction potential of softer baseballs, B) their bounce characteristics, and C) their acceptability by youth leagues. Six simple injury models were studied, baseball bounce characteristics were analyzed, and attitudes of safety baseballs among statewide Little League district presidents were surveyed. Injury models demonstrated less injury potential with safety baseballs compared to that with standard hard baseballs. Safety baseballs bounced higher after vertical drops and slow throws, but during fast throws (with the greatest injury potential), the bounce heights were similar for all ball types. Of 27 survey cards sent out, 13 were returned. While 9 respondents indicated that they were already using safety baseballs for the younger players, none of the 13 respondents indicated that they were planning to expand the use of safety baseballs in their leagues. In conclusion, safety baseballs are less injurious in these models. The bounce characteristics of safety baseballs are satisfactory. Youth baseball league officials are not very willing to expand the use of safety baseballs. We recommend using safety baseballs as a standard for all youth baseball leagues because these balls are safer.

Clinical pearls in pediatric toxicology: a systematic approach to the poisoned child.

Toxic ingestions in children can present various clinical dilemmas. This brief article will focus on some of the key clinical pearls that will enhance the physician's ability to approach any poisoning case in a more systematic and organized fashion.

Stool appearance in intussusception: assessing the value of the term "currant jelly".

This study surveyed the stool appearance descriptions of 107 inpatient children with intussusception. Fifty-six patients presented with grossly bloody stools (passed spontaneously), 10 of which were determined on chart review to resemble currant jelly. Of the 51 patients without grossly bloody spontaneously passed stools, 35 patients had rectal examination results charted. Eight of these children had grossly bloody stools noted on rectal examination, 4 of which were determined on chart review to resemble currant jelly. While most of the grossly bloody stools were not consistent with pure currant jelly, the most common terms used in describing the grossly bloody stools were "bloody," "mucus," "red," and "diarrhea." Since stools truly resembling currant jelly account for a minority of the grossly bloody stools in intussusception, the term "currant jelly stools" should be assessed in the teaching of intussusception. Generic terms such as blood, mucus, burgundy, red, etc, are more objective and sensitive at identifying cases of intussusception. Junior physicians who are taught the classic presentation of intussusception with currant jelly stool should also be taught that intussusception should be considered in the differential diagnosis of children passing any type of bloody stool. As a result, physicians with limited experience will be more likely to appropriately consider the diagnosis of intussusception, permitting a more timely diagnosis and a better outcome.

Personal computer teleradiology interhospital image transmission to facilitate tertiary pediatric telephone consultation and patient transfer: soft-tissue lateral neck and elbow radiographs.

Although teleradiology systems are available commercially, they are expensive ($30,000), and different makes are incompatible with each other, making them unusable for interhospital image transfers. Standard components were added to a personal computer (PC) to build a functional teleradiology unit capable of interhospital image transmission at a low cost ($600 upgrade). This PC teleradiology system was studied to assess its accuracy in the interpretation of soft-tissue lateral neck x-rays with epiglottitis or retropharyngeal abscesses and elbow x-rays with joint effusions, fractures, or both. A radiologist and a pediatric emergency physician were asked to read the PC teleradiology images. Both physicians read 13 of 13 soft-tissue lateral neck x-rays and 15 of 15 elbow x-rays correctly. This study supports the premise that PC teleradiology can be used to facilitate telephone consultation and patient transfers between tertiary pediatric emergency centers by transmitting pertinent radiographic information over a phone line. Although verbal communication can often suffice in a telephone consultation or transfer, there are many instances when visualizing a radiographic image such as an x-ray or computed tomography scan can provide important information that cannot be optimally described verbally. Rural hospitals can form interhospital image transmission links with tertiary center resources. Tertiary centers may elect to organize interhospital image transmission and referral networks with their rural hospital sources.

An update on the evaluation and management of plantar puncture wounds and Pseudomonas osteomyelitis.

The management of children who present to the ED with plantar puncture wounds is dependent upon the nature of the injury, the examination of the puncture site, and the potential risk of a retained foreign body. Not all patients will require wound enlargement and a search for a retained foreign body. Close follow-up of all children who are being treated as outpatients is of vital importance in detecting an early development of an infectious complication. Pseudomonas osteomyelitis should be suspected in all patients who present with foot pain, swelling, and a decreased ability to bear weight after sustaining a nail puncture through a sneaker. The current consensus favors open surgical débridement followed by a course of intravenous antibiotics. The exact duration of the postoperative antibiotic course is still being debated.

An approach to pediatric trauma. Unique anatomic and pathophysiologic aspects of the pediatric patient.

Effective evaluation and management of the pediatric trauma patient is based on knowledge of the unique anatomic and pathophysiologic differences in children. An understanding of these differences along with the trauma resuscitation guidelines established by the American College of Surgeons will allow the trauma team to provide systematic and comprehensive resuscitation of the child with multiple injuries. Continued research in the field of pediatric trauma resuscitation and the ongoing efforts of the National Pediatric Trauma Registry will continue to advance our understanding and management of injured children.