Management of severely injured children in road accidents in France: impact of the acute care organization on the outcome.

OBJECTIVE: To examine the impact of acute care management on outcome in children severely injured in road accidents. DESIGN AND SETTING: Prospective follow-up study conducted in 12 French pediatric intensive care units over a 24-month period. PATIENTS: Excluding those in refractory shock or in brain death at admission, a total of 125 children aged <17 years admitted to the pediatric intensive care unit with severe trauma (Injury Severity Score > or =16) were included. RESULTS: Intracranial pressure (ICP) monitoring and admission into a trauma resuscitation room (TRR) were used as proxy markers for the center management aggressiveness. Centers which admitted to TRR and monitored ICP when indicated in >75% of cases were called aggressive centers. Children with an ICP monitoring indication admitted to a TRR and monitored, as well as those without an indication treated in a TRR, were judged appropriately managed. A poor outcome at pediatric intensive care unit discharge was defined as a difference between the baseline and discharge pediatric overall performance category above 3, or a hospital death. Children with traumatic brain injury appropriately managed in a less-aggressive center were more likely to have a poor outcome than those appropriately managed in an aggressive center (odds ratio 7.56, 95% confidence interval 1.5-38.4), after adjustment for severity, age, and type of road user. CONCLUSIONS: The management in a more aggressive center for children admitted to TRR and monitored for ICP, when indicated, is associated with a better outcome. This could be explained by a more extensive experience in trauma management.

Working conditions in call-centers, the impact on employee health: a transversal study. Part II.

PURPOSE: The present study sought to assess the impact of telephone call center employees' working conditions on health by identifying at-risk employment situations. METHODS: A transversal study was performed in companies followed by 47 occupational physicians taking part (working conditions have been previously described). A self-administered medical questionnaire was used to collect data on absence due to sick leave, hearing and visual problems, musculoskeletal disorders, psychotropic drug use, etc. An analog-scale self-assessment of health status and a general health questionnaire (GHQ-12) were used. Personal or familial events that might underlie health problems and affect GHQ-12 results were quantified and taken into account in a logistic regression. RESULTS: A total of 2,130 call-handlers were included. Workers who had availed sick leave during the previous 12 months were 60%. The most frequent musculoskeletal complaints over the previous 12-month period concerned the cervical region (59%). During the same period, 77.3% of subjects experienced visual fatigue, 50% reported auditory fatigue signs and 47% vocal disturbance or fatigue. According to the Likert scale, 39.4% of workers had showed psychological distress. Almost 24% of the workers had used psychoactive medication during the previous 12 months. A significant association was found between psychological distress and the frequency of musculoskeletal disorders. Psychological distress and musculoskeletal disorders were significantly greater in workers with Job Strain and Iso Strain. After taking non-occupational factors into account, some occupational factors were found to increase the risk of psychological distress (Likert >12): imposed full-time schedule, being unable to simultaneously meet both quality and quantity requirements, situations of tension with clients, negative comments from superiors, and lack of recognition from superiors. CONCLUSIONS: This survey of over 2,000 call center employees highlighted the high frequency of psychological distress in this population and the health impact of working conditions.

Call-handlers' working conditions and their subjective experience of work: a transversal study.

OBJECTIVES: The present study sought to describe call-center working conditions and call-handlers' subjective experience of their work. METHODS: A transversal study was performed in companies followed by the 47 occupational physicians taking part. A dedicated questionnaire included one part on working conditions (work-station organization, task types, work schedules, and controls) and another on the perception of working conditions. Psychosocial risk factors were explored by three dimensions of the Karasek questionnaire, decision latitude, psychological demands and social support. A descriptive stage characterized the population and quantified the frequency of the various types of work organization, working conditions and perception. Certain working conditions data were crossed with perception data. RESULTS: The total sample comprised 2,130 call-handlers from around 100 different companies. The population was 71.9% female, with a mean age of 32.4 years. The general educational level was high, with 1,443 (68.2%) of call-handlers having at least 2 years' higher education; 1,937 of the workers (91.2%) had permanent work contracts. Some working situations were found to be associated with low decision latitude and high psychological demands: i.e., where the schedule (full-time or part-time) was imposed, where the call-handlers had not chosen to work in a call-center, or where they received prior warning of controls. Moreover, the rate of low decision latitude and high psychological demands increased with seniority in the job. The rate of low decision latitude increased with the size of the company and was higher when call duration was imposed and when the call-handlers handled only incoming calls. The rate of high psychological demands was higher when call-handlers handled both incoming and outgoing calls. CONCLUSIONS: This study confirmed the high rate of psychosocial constraints for call-handlers and identified work situations at risk.

Severe outcome of children following trauma resulting from road accidents.

OBJECTIVE: The aim of the study was to determine the risk factors of a severe outcome for children severely injured [killed or with an Injury Severity Score (ISS)>or=16] in a road accident. MATERIALS AND METHODS: Casualties that occurred between 1996 and 2001 which involved children under 14 years of age were assessed in a population-based study based on data included in a French road trauma Registry. A severe traumatic brain injury (TBI) was defined as a head injury with an Abbreviated Injury Scale (AIS) severity score>or=3. A multivariate logistic regression was performed to quantify the risk of a "severe outcome" defined as death or an expected serious impairment 1 year later. RESULTS: The annual incidence of an ISS of 16+ was 7.7 per 100,000 children. Among the 126 severely injured children included in this study, 40 died (including 16 immediate deaths), and a severe outcome was expected for 54 of the 86 survivors. Children with an "isolated severe TBI" and those with "multiple injuries including TBI" were more likely to have a severe outcome than those who had an "isolated severe injury without TBI" (OR: 7.91; 95%CI: 1.43-43.77 and OR: 8.37; 95%CI: 1.52-46.13, respectively). Age was inversely linked to a severe outcome. The unprotected motor vehicle occupants (MVO) had an odds ratio of 7.56 (95%CI: 1.07-53.56) compared to the protected MVO. Only 30% of children who survived a severe TBI were admitted to rehabilitation. CONCLUSION: The mechanism of the injury, an injury pattern involving the head and a young age were associated with a severe outcome following a road accident. A majority of children severely injured were not referred to inpatient rehabilitation.

Incidence and risk factors of severe traumatic brain injury resulting from road accidents: a population-based study.

A population-based study was carried out in 1996-2001 to provide the incidence and to identify the risk factors of severe traumatic brain injury (TBI) resulting from a road accident. The severe TBI was defined as an injury to the brain or the skull, excluding scalp injuries, with an abbreviated injury scale (AIS) severity score greater than 2. The severe TBI of 1238 patients were described. The annual incidence and mortality of severe TBI were, respectively, 13.7 per 100,000 and 5.3 per 100,000. The fatality rate increased from 20% in childhood to 71% over 75-year-old. Compared to restrained car occupants, the odds ratio for having a severe TBI was 18.1 (95% confidence interval, CI=12.8-25.5) for un-helmeted motorcyclists, 9.2 (95% CI=7.5-11.3) for pedestrians, 6.4 (95% CI=4.7-8.8) for un-helmeted cyclists, 3.9 (95% CI=3.1-4.8) for unrestrained car occupants and 2.8 (95% CI=2.2-3.5) for helmeted motorcyclists. Even after adjustment for several severity factors, male gender and age above 55 were both risk factors. Prevention programs aiming at improving the head protection should be promoted. The circumstances of the accident should be taken into account to predict a severe TBI.