Lawn mower-related injuries to children.

Lawn mower-related injuries to children are relatively common and can result in severe injury or death. Many amputations during childhood are caused by power mowers. Pediatricians have an important role as advocates and educators to promote the prevention of these injuries.

American Academy of Pediatrics. Committee on Injury and Poison Prevention. Safe transportation of newborns at hospital discharge.

All hospitals should set policies that require the discharge of every newborn in a car safety seat that is appropriate for the infant's maturity and medical condition. Discharge policies for newborns should include a parent education component, regular review of educational materials, and periodic in-service education for responsible staff. Appropriate child restraint systems should become a benefit of coverage by Medicaid, managed care organizations, and other third-party insurers.

American Academy of Pediatrics. Committee on Injury and Poison Prevention. Transporting children with special health care needs.

Children with special health care needs should have access to proper resources for safe transportation. This statement reviews important considerations for transporting children with special health care needs and provides current guidelines for the protection of children with specific health care needs, including those with a tracheostomy, a spica cast, challenging behaviors, or muscle tone abnormalities as well as those transported in wheelchairs.

The hospital record of the injured child and the need for external cause-of-injury codes. American Academy of Pediatrics. Committee on Injury and Poison Prevention, 1998-1999.

Proper record-keeping of emergency department visits and hospitalizations of injured children is vital for appropriate patient management. Determination and documentation of the circumstances surrounding the injury event are essential. This information not only is the basis for preventive counseling, but also provides clues about how similar injuries in other youth can be avoided. The hospital records have an important secondary purpose; namely, if sufficient information about the cause and mechanism of injury is documented, it can be subsequently coded, electronically compiled, and retrieved later to provide an epidemiologic profile of the injury, the first step in prevention at the population level. To be of greatest use, hospital records should indicate the "who, what, when, where, why, and how" of the injury occurrence and whether protective equipment (eg, a seat belt) was used. The pediatrician has two important roles in this area: to document fully the injury event and to advocate the use of standardized external cause-of-injury codes, which allow such data to be compiled and analyzed.

Patient and provider factors associated with selected measures of quality of care.

Studies assessing quality of general pediatric care are handicapped by (1) lack of explicit criteria, (2) the broad spectrum of medical needs presented, and (3) the need to distinguish between influence of patient and provider factors. In this study, part of a comprehensive study of utilization of pediatric services at five sites (three neighborhood health centers, an emergency room, and a hospital-based primary care program), we selected three measures sampling different aspects of quality of care, including (1) immunization status, (2) screening procedures, and (3) ongoing care for ten tracer conditons. Adequacy of follow-up of the tracer conditions was assessed along two dimensions: (1) whether a return appointment was scheduled, and (2) whether the patient kept the appointment ("compliance"). Results indicate that attainment of fully immunized status varies inversely with age, while for the tracer conditions, arrangement of follow-up (provider factor) was associated with site, and compliance (patient factor) was associated with both site and pattern of use. Accomplishment of follow-up was better for patients diagnosed in a primary care facility than in the emergency room and for patients with close ties to a primary care facility than for those with limited or no involvement with primary care. These findings support the value of continuity of care in a setting designed to deliver comprehensive care.