Risk of pediatric back-over injuries in residential driveways by vehicle type.

OBJECTIVE: Research suggests that children experience driveway back-over injuries at a significant rate and the severity of the resulting injuries differ by type of vehicle. Yet, no US study attempted to quantify "back-over risk" for classes of vehicles because of the difficulties with determining exposure. Using vehicle registration information, we set out to estimate the relative risk of driveway back-over injuries to children by type of vehicle. METHODS: Driveway back-over events were identified from state police reports and medical records from the state level 1 pediatric trauma center and compared with vehicle registration information to estimate injury incidence for 4 classes of vehicles (passenger cars, trucks, sport utility vehicles, and minivans) over 6 years in the state of Utah. RESULTS: Reported driveway back-over injuries represent an incidence of 7.09 per 100,000 children (<10 years old) per year. Overall, passenger cars account for 1.62 injuries per 100,000 registered vehicles. Compared with passenger cars, children were 53% more likely to be injured by a truck (P = 0.01) and 2.4 times more likely to be injured by a minivan (P < 0.001). Among children transported to a trauma center, admission (P = 0.01) and need for surgery (P = 0.03) were greater among children backed over by trucks, sport utility vehicles, and minivans compared with passenger cars. CONCLUSIONS: Findings suggest that when assessing driveway back-over injuries, larger high-profile vehicles are associated with a higher incidence and severity of injuries when compared with injuries resulting from passenger cars.

Injury mortality following the loss of air medical support for rural interhospital transport.

OBJECTIVES: This study evaluated variation in mortality among interfacility transfers three years before and after discontinuation of a rotor-wing transport service. METHODS: A retrospective cohort assessment was conducted among severely injured patients transferred from four rural hospitals to a single tertiary center in regions with continued versus discontinued rotor-wing service. Thirty-day mortality following discharge from the receiving tertiary facility served as the primary outcome measure. RESULTS: Discontinuation of rotor-wing transport decreased interfacility transfers and increased transfer time. Transferred patients were four times more likely to die after (compared with before) rotor-wing service was discontinued (p = 0.05). No difference was noted in the region with continued rotor-wing service [odds ratio (OR) = 0.53, p = 0.47]. CONCLUSIONS: Injury mortality increased with loss of air transport for interfacility transfer in a rural area.

Current results with intraaortic balloon pumping in infants and children.

BACKGROUND: Intraaortic balloon pumping (IABP) is useful for support in patients with moderate left ventricular dysfunction. IABP is usually timed with the R wave of the electrocardiogram. We have utilized M-mode echocardiography timed IABP in children with left-side heart failure since 1994. Electrocardiogram timing seems inappropriate for children, who have much higher heart rates. We describe our experience with children who underwent IABP therapy before and after 1994, when echocardiographic timing was instituted. METHODS: We reviewed records of 29 children who underwent IABP for all indications at Primary Children's Medical Center since 1988. RESULTS: Overall survival was 62.1% (18 of 29) in this series. Survival was similar for infants (odds ratio = 2.0, 95% confidence interval = 0.29 to 14.31, p = 0.43) and older children. Survival was similar in the echocardiography era when compared with the electrocardiogram era (odds ratio = 2.4, 95% confidence interval = 0.56 to 10.4, p = 0.44). CONCLUSIONS: IABP is a useful means of support in children with left ventricular dysfunction. M-mode echocardiography is effective in triggering IABP. The sample size in this study is too small to detect a mortality rate difference.