Studying the impact of COVID-19 mitigation policies on childhood obesity, health behaviors, and disparities in an observational cohort: Protocol for the COVID-19 Family Study.

BACKGROUND: COVID-19 pandemic control policies, including school closures, suspended extra-curricular activities, and social distancing, were introduced to prevent viral transmission, and disrupted children's daily routines, health behaviors, and wellness. This observational cohort study among 697 families with children or adolescents, based on the Family Stress Model, aims to: 1) evaluate pre- to during-pandemic changes in child health behaviors (diet, physical activity, sleep) and weight gain, 2) identify mechanisms explaining the changes, and 3) determine projected healthcare costs on weight gain and obesity. Each aim includes an examination by racial and ethnic, socioeconomic, and geographic disparities. METHODS: The study employs a mixed methods design, recruiting children and their caregivers from two obesity prevention trials halted in 2020. Enrolled participants complete annual surveys to assess child health behaviors, family resources, routines, and demographics, and home environment in 2020-2022. Height and weight are measured annually in 2021-2022. Annual semi-structured interviews are conducted within a subsample to understand mechanisms of observed changes. Multilevel mixed models and mediation analyses are used to examine changes in child health behaviors and weight gain and mechanisms underlying the changes. Qualitative data are analyzed within and across time points and integrated with quantitative findings to further explain mechanisms. Markov models are used to determine healthcare costs for unhealthy child behaviors and weight gain. CONCLUSION: Findings from this study will aid in understanding pandemic-related changes in child health behaviors and weight status and will provide insights for the implementation of future programs and policies to improve child and family wellness.

Physical Activity, Confidence, and Social Norms Associated With Teachers' Classroom Physical Activity Break Implementation.

Despite the benefits of classroom physical activity breaks on student health and academic outcomes, more research is needed to understand what factors may be associated with classroom physical activity break implementation, to bolster buy-in from school stakeholders and increase implementation. This quantitative study examined frequency of classroom physical activity break implementation in relation to (1) objectively measured teachers' physical activity and sedentary behaviors, (2) confidence for leading classroom physical activity breaks, (3) social norms (perceptions of other teachers' classroom physical activity break implementation), and (4) teacher- and school-level demographics. In total, 153 classroom teachers in 20 elementary and middle schools completed a survey including classroom physical activity break frequency, confidence, and social norms, one item each, dichotomized (1 = "most/all the time" OR "agree/strongly agree"). Accelerometry assessed total activity and daytime sedentary behavior. Analyses included multilevel binary logistic regression. Teachers were 90% female, 68% White, and 55% in elementary schools. Odds of implementing classroom physical activity breaks were lower among middle school teachers, 14 times greater among those with greater confidence, and over 17 times greater when teachers perceived others frequently implementing classroom physical activity breaks. Teacher activity was not associated with classroom physical activity break implementation. Future interventions to increase classroom physical activity break implementation should focus on increasing teachers' confidence to lead classroom physical activity breaks and creating more buy-in from classroom teachers to enhance each school's culture of health. By enhancing teacher confidence and social norms for implementing classroom physical activity breaks, we may increase school-based physical activity opportunities.

Geospatial Reach of the Maryland COVID-19 School Meals Response: Spring 2020.

OBJECTIVE: Examine characteristics of pandemic meal site (n = 602) location and meals served per site in Maryland, Spring 2020, following federal/state waivers for local meal site placement decision-making. METHODS: Using geographic information systems, we connected meal sites to census tract-level data and generated service areas from sites and distances from population-weighted census tract centroids to the closest pandemic meal site. Regression analysis determined associations of census tract pandemic meal site count and meals served per site with socioeconomic and demographic variables. RESULTS: Census tracts with more meal sites were urban (P < 0.001), food deserts (P < 0.001), and had higher percentages of children in poverty (P < 0.001). Sites serving fewer meals were in food deserts (P < 0.001) and areas with more children in poverty (P < 0.001). CONCLUSIONS AND IMPLICATIONS: Waivers allowing local meal site placement decision-making supported meal sites in high-need areas. Geospatial approaches could optimize site locations to ensure maximum reach to populations in need. Additional supports may be needed to ensure children in poverty areas receive meals distributed at these sites.

Physical Education Teachers' Perceived Effectiveness in Association with Student Attendance, Teacher Adaptability, External Educational Supports, and Teaching Format During the COVID-19 Pandemic.

Spring 2020 pandemic-control policies included an abrupt shift to remote teaching, which may have affected physical education (PE) teachers' perceived effectiveness. This study examined K-12 PE teachers' perceived effectiveness in association with student attendance, teacher adaptability, PE supports, teaching format (in-person, remote synchronous, remote asynchronous, etc.), and teacher- and school-level demographics at three time points (pre-pandemic 2019-early 2020, Spring 2020, 2020-2021 school year). An electronic survey was developed by an expert panel and distributed to U.S. public school PE teachers (convenience sampling via school health-related organizations). For analyses, teacher perceived effectiveness was dichotomized (very/extremely effective= "1"; not at all/slightly/moderately effective= "0"). Logistic regression models assessed associations between perceived effectiveness and independent variables (student attendance, teacher adaptability, PE supports, teaching format, and demographic variables) at each time point. Respondents (n=134; M age=46) were mostly female (62%), general PE teachers (82%, versus adapted), had a graduate degree (66%), had >11 years of teaching experience (63%), and from 26 states. Perception of being very/extremely effective was highest pre-pandemic 2019-early 2020 (93%), lowest in Spring 2020 (12%), and recovered somewhat in 2020-2021 (45%). During the 2020-2021 school year, teachers had greater odds of perceiving they were more effective if they reported having higher student attendance (OR 1.06 [CI:1.02-1.09], p>.001) and higher adaptability (OR 1.22 [CI: 1.09-1.37], p>.001), adjusting for gender, education level, years of experience, grade level taught, and Title I status. Professional development opportunities are needed for remote teaching of PE to enhance teachers' adaptability and perceived effectiveness during potential future school closures.

Pre-pandemic to early-pandemic changes in risk of household food insecurity among Maryland families with children.

OBJECTIVE: The objective was to examine risk and protective factors associated with pre- to early-pandemic changes in risk of household food insecurity (FI). DESIGN: We re-enrolled families from two statewide studies (2017-2020) in an observational cohort (May-August 2020). Caregivers reported on risk of household FI, demographics, pandemic-related hardships, and participation in safety net programs (e.g. CARES stimulus payment, school meals). SETTING: Maryland, United States. PARTICIPANTS: Economically, geographically, and racially/ethnically diverse families with preschool to adolescent-age children. Eligibility included reported receipt or expected receipt of the CARES stimulus payment or a pandemic-related economic hardship (n=496). RESULTS: Prevalence of risk of FI was unchanged (pre-pandemic: 22%, early-pandemic: 25%, p=0.27). Risk of early-pandemic FI was elevated for non-Hispanic Black (aRR=2.1 [95% CI 1.1, 4.0]) and Other families (aRR=2.6 [1.3, 5.4]) and families earning ≤300% federal poverty level. Among pre-pandemic food secure families, decreased income, job loss, and reduced hours were associated with increased early-pandemic FI risk (aRR=2.1 [1.2, 3.6] to 2.5 [1.5, 4.1]); CARES stimulus payment (aRR=0.5 [0.3, 0.9]) and continued school meal participation (aRR=0.2 [0.1, 0.9]) were associated with decreased risk. Among families at risk of FI pre-pandemic, safety net program participation was not associated with early-pandemic FI risk. CONCLUSIONS: The CARES stimulus payment and continued school meal participation protected pre-pandemic food secure families from early-pandemic FI risk but did not protect families who were at risk of FI pre-pandemic. Mitigating pre-pandemic FI risk and providing stimulus payments and school meals may support children's health and reduce disparities in response to pandemics.

Home and Neighborhood Physical Activity Location Availability among African American Adolescent Girls Living in Low-Income, Urban Communities: Associations with Objectively Measured Physical Activity.

Based on the ecological model of active living, the neighborhood environment may relate to individual physical activity (PA) behaviors. The purposes of this study were to (1) generate a replicable neighborhood-level physical activity location availability score (PALAS) from data variables associated with physical activity among adolescents and adults, and apply this score to Baltimore City, Maryland, and (2) determine if relationships exist between PA and PA location availability. Geographic information systems (GISs) were used to create the PALAS. Using linear regression models, we examined relations between objectively measured PA among low-income, urban, predominantly African American adolescent girls (n = 555, 2009-2012 data collection), and the PALAS rating of their neighborhood environment (neighborhood PALAS) and their home neighborhood area (PALAS variables/subcomponents within 0.25 miles of the home). A PALAS map of the study area was created, illustrating neighborhoods varying in availability and variety of PA locations. After adjusting for confounders, a higher neighborhood PALAS (ß = 0.10, p = 0.041) and the presence of a recreation center in the home neighborhood area (ß = 0.46, p = 0.011) were associated with more minutes per day spent in moderate to vigorous PA. Policy makers and stakeholders should consider increasing access to PA locations as a strategy to promote PA among adolescent girls.

A Systematic Review of Multi-Component Comprehensive School Physical Activity Program (CSPAP) Interventions.

OBJECTIVE: To identify, review, and describe multicomponent physical activity (PA) interventions in terms of: (a) number and combination of Comprehensive School Physical Activity Program (CSPAP) components, (b) study characteristics, and (c) primary outcomes. DATA SOURCE: Five electronic databases (i.e., PubMed, PsychInfo, Physical Education Index, Sport Discus, and ERIC). STUDY INCLUSION AND EXCLUSION CRITERIA: Included articles were peer-reviewed, written in English language, published since 1987, and included multicomponent school-based interventions. DATA EXTRACTION: Data items extracted were: school level, setting, CSPAP component description, health outcomes, academic outcomes, main conclusion, and reference. DATA SYNTHESIS: Included articles were synthesized by: (1) CSPAP components utilized, and (2) research outcome measured (i.e., health or academic). RESULTS: Across 32 studies, 11 included physical education plus 1 additional CSPAP component (PE + 1); 10 included PE + 2 additional CSPAP components; 8 included PE + 3 additional CSPAP components; and 1 included all 5 CSPAP components. Two other studies included 2 or 3 CSPAP components without PE. Most interventions targeted health outcomes (94%) rather than academic outcomes (6%). CONCLUSIONS: Multicomponent approaches aligned with CSPAPs are effective in promoting PA and other positive outcomes for youth in schools. Future research should seek to understand effects of CSPAP components on a variety of outcomes and settings.

Associations between elementary and middle school teachers' physical activity promoting practices and teacher- and school-level factors.

BACKGROUND: Few studies have evaluated teacher- and school-level characteristics associated with implementation of recommended physical activity (PA) promoting practices. The purpose of this study is to examine associations between teachers' PA practices and: [1] teacher-level factors, including their own PA, and [2] school-level factors. METHODS: This cross-sectional study examined time spent daily in light PA (LPA) and moderate-vigorous PA (MVPA) in association with 7 teacher PA practices among 288 classroom/special area teachers and teaching assistants in 20 urban, suburban and rural schools (recruited through a school wellness trial) in 4 districts. LPA and MVPA was assessed using 24-h ankle accelerometry (up to seven consecutive days). A sum score for teacher PA practices was assessed via survey (7 items; sum score range: 7-35; Cronbach's alpha = 0.73; higher scores indicate more PA promoting practices). Teacher-level factors included gender, race, self-reported height/weight, years teaching, and education. School-level factors included school type, free-and-reduced-price meal eligibility, student racial/ethnic composition, and urbanicity. Analyses included multilevel regression models, accounting for clustering within schools and adjusting for demographic covariates and school district. RESULTS: Teachers were 91% female, 63% elementary, 60% white, mean age 43.2 years (SD = 11.3), and 41% obese). Teachers wore accelerometers an average of 5.8 days, spent 399.6 min in LPA (SD = 85.0) per day, 24.1 min in MVPA (SD = 14.4) per day, and the mean teacher PA practices sum score was 22.4 (SD = 5.0). Every 15-min increase in MVPA was related to an increase in teacher PA practices sum score (coeff =1.07; SE = 0.28; p < 0.001). Female gender (versus males; coeff = - 1.95; SE = 0.92, p = 0.034), an obese weight status (versus non-obese; coeff = - 1.38; SE = 0.54, p = 0.010), and teaching in a middle school (versus elementary; coeff = - 3.86; SE = 0.54, p < 0.001) were associated with lower teacher PA practices scores. LPA was not associated with teacher PA promoting practices. CONCLUSIONS: Teachers with higher MVPA, but not higher LPA, and those without obesity were more likely to implement PA promoting practices that could positively impact their students' PA. Similar to prior studies, these practices were more commonly implemented in elementary schools and by male teachers. Future studies in schools should explore whether improvement of teacher health behaviors subsequently impacts student health behaviors. TRIAL REGISTRATION: Clinical Trials, NCT03432715 ; Registered on 02/2/2018.

An ecological momentary assessment study of physical activity behaviors among mothers of toddlers from low-income households.

BACKGROUND: Mothers of young children from low-income communities may be vulnerable to barriers associated with low physical activity. The purpose of this study was to examine associations between home environment factors and maternal physical activity among mothers of toddlers. METHODS: Mothers of toddlers (n = 200) recruited from low-income communities simultaneously wore an ankle-placed accelerometer and were given a personal digital assistant for ecological momentary assessment. Mothers received randomly prompted questions about their current environment, activity, and social setting several times a day over eight consecutive days. Data were analyzed using linear mixed-effects regression models with random intercepts; within-group and between-group relations between physical activity and environment factors were disaggregated. RESULTS: Within-group relations included higher physical activity counts for specific mothers with television off versus on (95% CI = 130.45, 199.17), children absent versus present (95% CI = 82.00, 3.43), engaging with a child versus not (95% CI = 52.66, 127.63), and outside versus inside location (95% CI = 277.74, 392.67). Between-group relations included higher physical activity on average when other adults were absent versus present (95% CI = - 282.63, - 46.95). Recruitment site (urban vs. semi-urban) significantly moderated the within-group relation between being outside versus inside and activity count (ß = - 243.12, 95% CI = - 358.74, - 127.47), and showed stronger relations among urban mothers (ß = 440.33, 95% CI = 358.41, 522.25), than semi-urban (ß = 190.37, 95% CI = 109.64, 271.11). Maternal body weight significantly moderated the within-group relation between being located outside versus inside the home and activity count (ß for interaction = - 188.67, 95% CI = - 308.95, - 68.39), with a stronger relation among mothers with normal weight (ß = 451.62, 95% CI = 345.51, 557.73), than mothers with overweight/obesity (ß = 271.95, 95% CI = 204.26, 339.64). CONCLUSIONS: This study highlights home environmental factors, including screen time, the presence of others (adults and children), and location (i.e., outside versus inside) that may relate to maternal physical activity behaviors. Understanding factors associated with physical activity could reduce physical activity disparities. Trial registry ClinicalTrials. NCT02615158, April 2006.

On the Move or Barely Moving? Age-Related Changes in Physical Activity, Sedentary, and Sleep Behaviors by Weekday/Weekend Following Pandemic Control Policies.

This study examined pre-pandemic (2017-early March 2020) to early-pandemic (Spring 2020) changes in moderate-to-vigorous PA (MVPA), light PA (LPA), and sedentary behavior/sleep (SS), by weekday/weekend, and age (preschool, elementary, middle school). We re-enrolled children from two pre-pandemic obesity prevention trials and examined differences in accelerometer-measured PA from pre-pandemic to early-pandemic across age groups using linear mixed models. Children (n = 75) were 51% multiple race/ethnicities, 29% preschool, 28% elementary, 43% middle school, 65% suburban, 21% rural, and 13% urban. Pre-pandemic to early-pandemic changes in weekday MVPA (p = 0.006), LPA (p = 0.018), and SS (p = 0.003) differed by age. On weekdays, middle schoolers' MVPA decreased 15.36 min/day (p = 0.002) and SS increased 94.36 min/day (p < 0.001) with non-significant changes among preschoolers and elementary schoolers. Compared to elementary schoolers, middle schoolers' changes in weekday MVPA (b = -16.34, p = 0.036) and SS (b = 63.28, p = 0.039) significantly differed. Declines in weekday MVPA and increases in SS among middle schoolers suggest that, compared with younger children, middle schoolers are dependent on school and recreational facilities for PA, and in their absence engage in more sedentary activities and sleep.

A Systematic Review of Community Engagement Outcomes Research in School-Based Health Interventions.

BACKGROUND: Involving communities in school health has been purported as a practice integral to supporting a Whole School, Whole Community, Whole Child (WSCC) approach. Although community collaboration is often included in school-based health initiatives, there is little research considering methods for increasing community engagement. The purpose of this study was to identify effective school-based health interventions documenting changes in community engagement. METHODS: Academic experts and school stakeholders guided procedures for a systematic review of studies published from 1987-2017 and gray literature (ie, best practice documents; policy documents, etc.) on comprehensive school health interventions including community engagement as a targeted outcome. RESULTS: The search identified 9 studies addressing community as an outcome of school-based health interventions; types of partnership mechanisms and partners' roles were classified. CONCLUSIONS: Although involving communities is a WSCC component and commonly recommended as a strategy fundamental to school health, there is little empirical research examining effective strategies for engaging communities and engagement is often not measured as part of intervention studies. Further measurement and research in engaging communities in school health is warranted.

Motor Competence and Attainment of Global Physical Activity Guidelines among a Statewide Sample of Preschoolers.

Global physical activity guidelines for preschoolers include 60 min of moderate-to-vigorous physical activity (MVPA) daily. This study, based on the developmental model of motor skill competence, examines how motor competence relates to preschoolers' likelihood of meeting global guidelines using ankle accelerometry. We measured physical activity using 24-h ankle-placement accelerometry (Actical) for at least two consecutive days (87% with six-seven days), motor competence using the Test of Gross Motor Development-2 (TGMD-2), and BMI-for-age z-scores (BMIz) using anthropometry and age- and sex-specific CDC norms. Caregivers provided demographic characteristics of children's age, sex, and race. We used multivariable logistic regression to examine how motor competence, BMIz weight status, and demographic characteristics related to meeting global physical activity guidelines. The sample included 588 preschoolers, age 3-5 years; 55% male; 60% white; and 28% overweight/obese; 75% attained the recommended 60 min of MVPA per day. The odds of meeting MVPA guidelines were associated with higher gross motor quotient, higher object control scores, sex (male), age (older), and race (white), but not with BMIz weight status. Findings support the use of 24-h ankle accelerometry among preschoolers and are consistent with the developmental model of motor competence applied to preschoolers, whereby object control competence relates positively to attaining global physical activity guidelines.

Implementation evaluation of a professional development program for comprehensive school physical activity leaders.

The purpose of this study was to conduct an implementation monitoring evaluation of a yearlong comprehensive school physical activity program (CSPAP) professional development program across eight multi-state physical education (PE) teacher cohorts. Mixed-method data were collected during a three-year implementation period via workshop attendance sheets and evaluations, post-workshop implementation plans and artifacts, and follow-up phone interviews to enumerate and evaluate the program's process of recruitment, reach, dose delivered, dose received, fidelity, and context. Recruitment strategies reached a total of 234 PE teacher attendees across eight workshops, with 77 PE teachers (primarily female, elementary, public school teachers) completing all program requirements. Facilitators among full program completers were participation incentives and network opportunities, while common inhibitors were difficulty with online technology and perceptions of added workload. Completers submitted implementation plans with at least three action steps, ranging from 4 to 7 months to accomplish, that predominately commenced with securing administration approval as the first step (81%), focused on implementing student physical activity initiatives beyond PE (76%), and evidenced with mostly picture artifacts (78%). Implementation was facilitated by the presence of multilevel support at school and an elevated image of PE and PE teachers at school, and was inhibited by scheduling constraints, unrealistic planning, and conflicting perceptions of physical activity and PE. Overall, this evaluation reveals unique perspectives of PE teachers regarding schoolwide PA promotion and informs future efforts to target and effectively support CSPAP leaders.

Effects of Sharing Data With Teachers on Student Physical Activity and Sedentary Behavior in the Classroom.

BACKGROUND: Data-driven decision making is an accepted best practice in education, but teachers seldom reflect on data to drive their physical activity (PA) integration efforts. The purpose of this study was to explore the impact of a data-sharing intervention with classroom teachers on teacher-directed movement integration and students' PA and sedentary behavior. METHODS: Teacher-directed movement behaviors from 8 classroom teachers in 1 primary school were systematically observed during four 1-hour class periods before (pre) and after (post) an intervention in which teachers individually discussed student movement data with a trained interviewer. Teachers' K-2 students (N = 132) wore accelerometers for 10 school days both preintervention and postintervention. RESULTS: Multilevel mixed effects regression indicated a nonsignificant increase in teacher-directed movement from preintervention to postintervention (+7.42%, P = .48). Students' classroom time spent in moderate to vigorous PA increased (males: +2.41 min, P < .001; females: +0.84 min, P = .04) and sedentary time decreased (males: -9.90 min, P < .001; females: -7.98 min, P < .001) postintervention. Interview data inductively analyzed revealed teachers' perspectives, including their surprise at low student PA during the school day. CONCLUSIONS: Findings suggest that sharing data with classroom teachers can improve student PA and decrease sedentary behavior at school.

Impact of trained champions of comprehensive school physical activity programs on school physical activity offerings, youth physical activity and sedentary behaviors.

OBJECTIVE: A quasi-experimental cluster-controlled design was used to test the impact of comprehensive school physical activity program (CSPAP) professional development on changes in school physical activity (PA) offerings, moderate-to-vigorous physical activity (MVPA) and sedentary behaviors of 9-14 year-old children during school. METHODS: Two groups of Louisiana elementary and middle school physical education teachers (N=129) attended a CSPAP summer workshop (95 in 2012=intervention, 34 in 2013=control) and were assessed on school PA offerings (teacher-reported; pre, mid, and post). During the 2012-2013 school year, intervention teachers received CSPAP support while implementing new school PA programs. MVPA and sedentary behaviors were assessed (accelerometry; baseline and post) on a sample of 231 intervention, 120 control students from 16 different schools. RESULTS: Multivariate analysis of covariance indicated that intervention teachers reported significantly more PA offerings during school (3.35 vs. 2.37) and that involve staff (1.43 vs. 0.90). Three-level, mixed model regressions (stratified by sex) indicated that students overall spent less time in MVPA and more time being sedentary during school, but the effects were significantly blunted among intervention students, especially boys. CONCLUSIONS: This study provides preliminary evidence for CSPAP professional development programs to influence school-level PA offerings and offset student-level declines in MVPA and increases in sedentary behavior.

Minimally invasive repair of pectus excavatum in patients with Marfan syndrome and marfanoid features.

PURPOSE: The presence of a pectus excavatum (PE) requiring surgical repair is a major skeletal feature of Marfan syndrome. Marfanoid patients have phenotypic findings but do not meet all diagnostic criteria. We sought to examine the clinical and management differences between Marfan syndrome patients and those who are marfanoid compared with all other patients undergoing minimally invasive PE repair. METHODS: A retrospective institutional review board-approved review was conducted of a prospectively gathered database of all patients who underwent minimally invasive repair of PE. Patients were grouped according to diagnosis of Marfan syndrome (MAR), Marfanoid appearance (OID), and all others (ALL). Patient demographics, preoperative imaging and testing, operative strategy, complications, and postoperative surveys were evaluated. Fisher's Exact test and chi(2) were applied for statistical analysis. RESULTS: From June 1987 to September 2008, 1192 patients underwent minimally invasive PE repair (MAR = 33, OID = 212, ALL = 947). There was a significantly higher proportion of females with either MAR or OID who underwent repair (21.5%vs 15.5%, P = .04). The MAR patients had significantly more severe PE determined by computed tomography index (MAR = 8.75, OID = 5.82, ALL = 4.94, P < .0001) and required multiple pectus bars (> or =2) to be placed during operation (MAR = 58%, OID = 36%, ALL = 29%, P = .001). There was a trend toward higher wound infection rates in MAR patients (MAR = 6%, OID = 1.4%, ALL = 1.3%, P = .07). The recurrence rate was similar among all groups (MAR = 0%, OID = 2%, ALL = 0.7%, P = .12). Successful outcome from surgeon perspective in either MAR or OID patients was similar to ALL (98%vs 98%, P = .88) and correlated well with patient satisfaction after repair (96%vs 95%, P = .43). CONCLUSIONS: Minimally invasive PE repair is safe in patients with Marfan syndrome or marfanoid features with equally good results. Patients with Marfan syndrome have clinically more severe PE requiring multiple bars for chest repair and may have slightly higher wound infection rates. Patients are satisfied with minimally invasive repair despite a phenotypically more severe chest wall defect.

Inguinal herniation of the bladder in an infant.

Inguinal herniation of the bladder is an uncommon finding with fewer than 200 cases reported in the literature. It is found most commonly in older, obese men with lower urinary tract symptoms. We report a case of inguinal herniation of the bladder in a premature infant.

Pediatric major resuscitation--respiratory compromise as a criterion for mandatory surgeon presence.

UNLABELLED: The American College of Surgeons Committee on Trauma has indicated that there are minimum criteria for a trauma surgeon to respond to a major resuscitation (MR) within 15 minutes. These criteria have been required for children without significant data to support their validity. Our hypothesis is that prehospital intubation/respiratory compromise (IRC) as a criterion to define an MR will be an accurate predictor. METHODS: The trauma registry of a level I trauma center was used for data collection of age, injury severity score (ISS), IRC, mortality, hospital days, intensive care unit (ICU) days, and emergency operations. Chi2 with Yates correction and Mann-Whitney rank-sum testing was used for statistical analysis expressed as mean +/- SEM. RESULTS: One hundred eighteen patients were encoded as MR. Forty patients had prehospital IRC and 78 patients did not. There were statistically significant differences seen in ISS, ICU length of stay, and mortality (P < .001). Forty-five percent of patients with IRC died. None of the patients without IRC died. CONCLUSION: Injured children with prehospital IRC are significantly more likely to die, have a higher ISS, and a longer ICU length of stay. Prehospital respiratory distress in injured children in our trauma system is a reasonable criterion to define an MR in children.

Management of penetrating colon and rectal injuries in the pediatric patient.

PURPOSE: Management of civilian penetrating colon injuries in the adult has evolved from the universal use of fecal diversion to the highly selective use of colostomy. We hypothesized that a similar management approach was appropriate for the pediatric population. METHODS: A retrospective review of pediatric patients (age <17 years) with a penetrating colorectal injury was performed at six Level I trauma centers for the period January 1990 through June 2001. RESULTS: For the period of review, 53 children with a penetrating colorectal injury were identified. Firearms caused 89 percent of the injuries. The colon was injured in 83 percent (n = 44) of patients and the rectum in 17 percent (n = 9) of patients. The colorectal injury was managed without colostomy in 62 percent (n = 33) and with colostomy in 38 percent (colon = 11, rectum = 9). All rectal injuries were treated with colostomy. The hospital length of stay was longer in the colostomy group (17.6 days vs. 11.4 days). The complication rate was higher in the colostomy group (55 percent vs. 27 percent), which included two patients with stoma-related complications. There was no mortality in this series. CONCLUSIONS: Primary repair was used safely in most cases of civilian penetrating colon injuries in the pediatric population. All rectal injuries were treated with colostomy in this series. Fecal diversion was used selectively. Colostomy was performed for selected cases of colon wounds associated with shock, multiple blood transfusions, multiple other injuries, extensive contamination, and high-velocity weapons. In the absence of these associated factors, primary repair appears justified.