Ladder-related injuries treated in emergency departments in the United States, 1990-2005.

BACKGROUND: Ladder use is involved in many occupational and non-occupational activities. Falls from ladders can result in serious injury and affect people of all ages. The purpose of this study was to comprehensively examine nonfatal ladder-related injuries on a national level. METHODS: Using the National Electronic Injury Surveillance System (NEISS) database, cases of nonfatal ladder-related injuries treated in U.S. emergency departments (EDs) from 1990 through 2005 were selected using NEISS ladder product codes. Analysis was conducted from June 2006 to August 2006. RESULTS: An estimated 2,177,888 (95% confidence interval [CI]=1,885,311-2,470,466) individuals ranging in age from 1 month to 101 years were treated in U.S. EDs for ladder-related injuries during the 16-year study period, yielding an average of 136,118 cases annually, an average of 49.5 per 100,000 people. Males predominated in ladder-related injuries (76.5%, 95% CI=75.8-77.2). Fractures were the most common type of injury (31.5%, 95% CI=30.5-32.6). The body parts most frequently injured were the legs and feet (30.4%, 95% CI=29.5-31.2). Nearly 10% of injuries resulted in hospitalization (8.5%, 95% CI=7.4-9.6) or transfer to another hospital (1.4%, 95% CI=1.1-1.8), approximately twice that of consumer product-related injuries overall. The number of ladder-related injuries increased by more than 50% from 1990 to 2005. Ladder-related injuries per 100,000 people rose almost 27% during the 16-year study period. Of the cases for which locale of injury was recorded, 97.3% occurred in non-occupational settings, such as homes and farms. CONCLUSIONS: Given the 50% increase in ladder-related injuries during the study period, the relatively high likelihood of hospital admission, and the predominance of injuries in non-occupational settings, increased efforts are needed to prevent ladder-related injuries.

Development of injury prevention materials for people with low literacy skills.

OBJECTIVE: Children living in low income urban environments are at high risk for preventable injuries, which result in thousands of Pediatric Emergency Department (PED) visits every year. The development and evaluation of written injury prevention materials used in a PED-based intervention trial are presented. The purpose is to describe the development of injury prevention materials for people with low literacy skills, and explain literacy and comprehension abilities among a sample of parents from the PED. METHODS: Materials were developed using rules of plain language and with consideration of the needs of a low literacy population. Materials were assessed using the Flesch-Kincaid and Suitability Assessment of Materials. Literacy and comprehension abilities in a PED sample were tested using the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Cloze. RESULTS: REALM results for n=59 parents sampled from the PED indicated that 27% (n=16) read below 9th grade reading level. Cloze results demonstrate that materials were appropriate for 71% (n=21) when written for 8th grade reading level and 80% (n=23) when rewritten for 6th grade reading level. CONCLUSION: Others designing similar interventions can use these methods to develop interventions for low literacy populations. PRACTICE IMPLICATIONS: When developing injury prevention materials for use with PED populations, health professionals should consider reading ability, reading level, content, and design of materials.

Tipping the scales: obese children and child safety seats.

OBJECTIVE: To shed light on the extent to which childhood obesity affects the types of appropriate child safety seats for young children, by providing an estimate of the number of US children whose weight renders them unable to use safely the majority of child safety seat types currently available. METHODS: The types of appropriate child safety seats were assessed by using National Highway Traffic Safety Administration 2005 Child Safety Seat Ease of Use Ratings. Estimates of the numbers of children weighing above the maximal weight for those child safety seats were calculated by using the tabulations of growth curves based on National Health and Nutrition Examination Survey 1999 to 2000 data that were assembled by the National Center for Health Statistics and the US Census for the year 2000. RESULTS: A total of 283,305 children 1 to 6 years of age would have a difficult (if not impossible) time finding a safe child safety seat because of their age and weight. The vast majority of these children are 3 years of age and weigh >40 lb (182,661 children). For these children, there are currently only 4 child safety seat types available, each of which costs between $240 and $270. CONCLUSIONS: This study determined that there is limited availability of child safety seat types for the ever-increasing number of obese young children. There are substantial numbers of children who weigh more than the upper weight limit for most currently available child safety seats. While we await reductions in the childhood obesity epidemic, options for maximizing the protection of obese children in automobiles must be identified.

Evaluation activities to strengthen an injury prevention resource center for urban families.

The Johns Hopkins Children's Safety Center (CSC) is a unique health care provider and patient education resource that elevates the attention injury prevention receives in a medical setting and reduces barriers to injury prevention experienced by low-income, urban families, the Center's priority population. This article describes the CSC's development, implementation, and selected elements of its evaluation. Because evaluation has played an important role in the CSC from its inception through its implementation and sustainability, three evaluation activities are described: process evaluation to monitor activity, impact evaluation to understand its effects on parents' safety behaviors, and qualitative interviews with CSC visitors and non-visitors to enhance services. Implications of each evaluation activity are described and recommendations are made for strengthening the CSC.

The burden of injury in preschool children in an urban medicaid managed care organization.

BACKGROUND: Efforts to control injuries within managed care organization (MCO) populations require information about the incidence and costs associated with the injuries cared for in MCOs. OBJECTIVE: This study uses administrative data to measure the rates and the costs of burn, choking, poisoning, blunt, and penetrating injuries in an urban Medicaid MCO. DESIGN/METHODS: A database was assembled from all medical claims submitted to a Medicaid MCO covering children aged < or =6 years in urban Baltimore between the dates of July 1, 1997, and August 7, 1999. The database included claims submitted on behalf of 1732 children observed for 2180 person-years. International Classification of Disease-9 codes were reviewed to identify claims for burn, poisoning, choking, and blunt/penetrating injuries. Trained coders reviewed outpatient records to assign E-codes. RESULTS: A total of 796 injuries occurred. The overall injury rate was 36.5% per year. The total cost of the medical care for these injuries was $863 552, or $396 per covered person-year, representing 42%-55% of the capitated rate received in Baltimore. Falls, being struck by something, and cutting/piercing injuries accounted for 68% of injuries. Emergency departments were the most common service sites for injured children for all injuries except in the case of burns. CONCLUSION: The children enrolled in this urban Medicaid population had nearly twice the rate of injury when compared to the national average. The medical costs of injuries account for about half of the capitated reimbursement for this age group.