Sexual Assault in Adolescents.

Child sexual abuse is a severely underreported crime in the United States. The consequences of child sexual abuse extend beyond physical injury, including an increased likelihood to develop chronic physical and mental diseases/disorders, including substance abuse and suicide. Care involves trauma-informed screening, assessment, and documentation, education of, and access to sexually transmitted infection prophylaxis and emergency contraception, safety interventions, and access to community resources. Medical providers should know the response process their facility, community, and state practices for victims of sexual abuse. Acknowledging and responding to victims of sexual abuse as a multidisciplinary team will ensure comprehensive care for the patient.

Transfusing Wisely: Clinical Decision Support Improves Blood Transfusion Practices.

BACKGROUND: The cost and risks of red blood cell (RBC) transfusions, along with evidence of overuse, suggest that improving transfusion practices is a key opportunity for health systems to improve both the quality and value of patient care. Previous work, which included a BestPractice Advisory (BPA), was adapted in a quality improvement project designed to reduce both exposure to unnecessary blood products and costs. METHODS: A prospective, pre-post study was conducted at an academic medical center with a diverse patient population. All noninfant inpatients without gastrointestinal bleeding who were not within 12 hours of surgical procedures were included. The interventions were education, a BPA, and other enhancements to the computerized provider order entry system. RESULTS: The percentage of multiunit (≥ 2 units) RBC transfusions decreased from 59.9% to 41.7% during the intervention period and to 19.7% postintervention (p < 0.0001). The percentage of inpatient RBC transfusion units administered for hemoglobin (Hb) ≥ 7 g/dL declined from 72.3% to 57.8% during the intervention period and to 38.0% for the postintervention period (p < 0.0001). The overall rate of inpatient RBC transfusion (units administered per 1,000 patient-days without exclusions) decreased from 89.8 to 78.1 during the intervention period and to 72.7 during the postintervention period (p <0.0001). The estimated annual cost savings was $1,050,750. CONCLUSION: The interventions reduced multiunit transfusions (by 67.1%) and transfusions for Hb ≥ 7 g/dL (by 47.4%). The improvement in the overall transfusion rate (19.0%) was less marked, limited by better baseline performance relative to other centers.

Major Trauma and the Elder West Virginian: A Six Year Review at a Level I Trauma Center.

BACKGROUND: Trauma was the seventh leading cause of death for persons 65 and older in West Virginia (WV) in 2010. In 2007, fatality rates for both accidental falls and motor vehicle crashes were higher in West Virginia than the nation as a whole. US Census Data from 2010 showed WV to have one of the oldest median ages in the nation (surpassed by Maine and Vermont) and currently 16% of the population of WV is over 65 years of age. METHODS: This is a retrospective observational study of data extracted from the John Michael Moore Trauma Center (JMMTC) trauma registry for the time period of January 1, 2009 to December 31, 2014. RESULTS: There were 3,895 patients, aged 65 years or older, treated at the Jon Michael Moore Trauma Center in Morgantown, WV during the study time period. Accidents accounted for 98.6% of the injuries. The elderly were most commonly injured in their place of residence (59.8%). The top two mechanisms of injury were falls (75.2%) and motor vehicular crashes (13.9%). Frequently, disposition from the Emergency Department was to a higher level of care: Intensive Care Unit (32.3%) and Step-down Unit (21.2%). The most common serious injuries were intracranial hemorrhage (40.0%), lower extremity fractures (38.1%), and spine fracture (26.0%). The average hospital stay was 5.6 days and the average ICU stay was 3.2 days. Hospital discharge dispositions frequently resulted in care out of the home; skilled nursing facility (22.0%), rehabilitation facility (15.5%), morgue/funeral home (6.6%), and long-term residential care facility (5.7%). The most common pre-existing medical conditions were hypertension (71.9%), diabetes mellitus (29.3%), chronic obstructive pulmonary disease (19.5%), and dementia (18.8%). CONCLUSION: Elder West Virginians most frequently are injured in falls and motor vehicular crashes. Pre-existing medical conditions are very common. Trauma in the elderly creates a significant burden on the patient, their families, and on the health care system in West Virginia. Injury prevention interventions have the potential to diminish the impact of trauma on elder West Virginians.

Pediatric bicycle injury prevention and the effect of helmet use: the West Virginia experience.

OBJECTIVES: The primary objective was evaluation of the injury pattern of children 14 years old or less involved in bicycle accidents and comparison of the differences between those wearing a helmet and not wearing a helmet. METHODS: This was a retrospective cohort study of all pediatric patients involved in bicycle crashes from 2008 through 2010 who were treated within the West Virginia Trauma System. A case was selected for further analysis if "bicycle" and "blunt cause of injury" were present in the Mechanism of Injury field and if age was 14 years old or less. Descriptive statistics were calculated on all variables. Differences between the helmeted and un-helmeted cohorts were tested using the Wilcoxon test or Fisher's exact test as appropriate. In all cases an alpha of 0.05 was selected as the threshold for statistical significance. RESULTS: The helmeted group had a concussion rate of 19.4% while concussions were noted in 37.4% of the un-helmeted group (p = 0.0509). Additionally, there was a significant difference in the rate of skull fractures seen. Skull fractures occurred in 3.2% of the helmeted and 17.4% of the un-helmeted (p = 0.0408) riders. The rate of intra-cranial hemorrhage was 0% in helmeted riders and 17.4% in un-helmeted riders (p = 0.0079). Finally, perhaps the largest indicator of the effectiveness of helmets in the pediatric bicycle population is the mortality rate. While not statistically different, 100% (n = 2) of the deaths occurred in the un-helmeted group. CONCLUSION: This study of the West Virginia pediatric population demonstrates findings similar to prior studies looking at the effectiveness of helmets in preventing injuries during a bicycle crash. Bicycle helmets were shown to significantly reduce the rates of both skull fractures and intracranial hemorrhage. Based on this, the expanded use of helmets within the pediatric population should continue to be encouraged both from an educational and legislative standpoint.

Recovery of Mycobacterium bovis from soft fresh cheese originating in Mexico.

Recent outbreaks of human tuberculosis in the United States caused by Mycobacterium bovis have implicated cheese originating in Mexico as a source of these infections. A total of 203 samples of cheese originating in Mexico were cultured, and M. bovis was recovered from one specimen. Therefore, M. bovis can be recovered from cheese and may be a source of human infections.

Association between early returns and frequent ED visits at a rural academic medical center.

The objective of this study was to examine the influence of frequent emergency department (ED) use on early returns to the ED at a large rural academic medical center. An analysis was done of all 35,440 visits by 22,442 individuals to a large rural academic medical center ED during calendar year 2000. Of 35,440 ED visits, there were 1,992 (5.62%) return visits within 72 hours (early return). Frequent ED visits (visits made by individuals making 4 or more visits per year) was a predictor of early return visits (odds ratio [OR] 3.21, 95% confidence interval [CI] 2.93-3.52; Wald chi(2), P <.0001). Of 22,442 individuals who came to the ED during the study period, 1,601 (7.13%) returned within 72 hours. Frequency of ED use by a particular individual (4 or more visits per year) was also a predictor of early return for that individual (OR 14.55, 95% CI 12.84-16.48; Wald chi(2), P <.000001). The high rate of early returns to this rural academic ED was significantly associated with frequent visits (4 or more times per year) to the ED by particular individual.