Work-related injury among Connecticut minors.

Work-related injuries have recently been shown to be a significant cause of morbidity among adolescents. This study represents a population-based work-related injury profile for Connecticut minors. Review of 796 worker compensation reports for adolescents from 14 through 17 years of age submitted over 12 months revealed an overall age-specific injury rate of 15 per 1000 employed 16- and 17-year-olds; frequency of injury increased with age. Social and recreational workers had an injury rate of more than 20%, predominantly sprains and contusions. Among all other occupations and industries, cuts were the major type of injury (34%); more than one third of cutting injuries were associated with use of case cutters, another third with knives. There were no work-related deaths among minors in this study. Minors in the workplace are at high risk of injury compared with adults. This study suggests that identification of specific patterns of work-related injury could lead to targeted intervention strategies.

Population, income, and ecological correlates of child pedestrian injury.

Pedestrian injury is a significant health problem among urban children. This study is an analysis of the role of population, income, and ecological factors in the occurrence of child pedestrian collisions. One hundred and ninety-eight motor vehicle collisions occurring in Hartford, Connecticut involving pedestrians younger than 15 years old were reported to police during 1986 through 1987. Collision locations were abstracted from police reports and assigned a census tract. Census tracts were classified as "high frequency" (8+ collisions), "moderate frequency" (3 to 7 collisions), or "low frequency" (0 to 2 collisions). High-frequency census tracts had greater proportions of children and of nonwhite residents than moderate- or low-frequency tracts. They also were characterized by high proportions of households headed by females living below the poverty line. High-frequency tracts had a greater number of children per acre than moderate or low tracts. Children per acre had the strongest association with collision frequency (R = .72) and remained the most consistent when other variables were controlled. The number of children per acre is a potentially useful predictor of census tracts at risk for child pedestrian collisions. This may be useful in developing focused prevention strategies within an urban environment.

A population-based study of severe firearm injury among children and youth.

BACKGROUND: Firearm injuries are a major cause of pediatric mortality and morbidity in the United States. To date, population-based studies describe the epidemiology of firearm-related deaths; however, the patterns of severe, nonfatal pediatric firearm-related injuries are not as well defined. OBJECTIVES: To determine the epidemiology of severe firearm-related deaths and injuries among a statewide population of children and youth ages birth to 19 years. METHODS: Demographic, geographic, and cost data were analyzed from Connecticut death certificates for 1988 through 1992 and hospital discharge data for 1986 through 1990 for firearm-related unintentional, self-inflicted, and assaultive injury among children and youth ages birth to 19 years. RESULTS: There were 219 firearm deaths: 68% homicides, 25% suicides, 6% unintentional, and 1% of undetermined intent, resulting in an annual age-specific death rate of 6.6 per 100,000 persons. There were 533 hospitalizations for gunshot wounds (16 per 100,000); 41% were assaults, 1% suicide attempts, 39% unintentional gunshot wounds, 1% legal interventions, and 18% of undetermined intent. More than 80% of deaths from gunshot wounds and hospitalizations occurred among 15- to 19-year-old males, most occurring in Connecticut's five largest cities. Most firearm homicides occurred among urban residents; most firearm suicides occurred among nonurban residents; and unintentional shootings were evenly distributed between urban and nonurban residents. The total cost of firearm-related hospitalizations averaged $864,000 per year. CONCLUSIONS: Firearms are a major cause of mortality and morbidity of Connecticut children and youth, exceeded only by motor vehicles as a cause of death among those 1 to 19 years of age. Handguns were responsible for a disproportionate amount of trauma compared with other firearm types. The epidemiology of pediatric gunshot injuries requires a range of strategies for prevention. Physicians caring for families with children must include firearm injury prevention counseling as a routine part of anticipatory guidance.

Evaluation of the effectiveness of a pavement stencil in promoting safe behavior among elementary school children boarding school buses.

OBJECTIVE: The majority of school bus-related fatalities among children attending elementary school in the United States occur as children board or alight from buses. Injuries occur during boarding when children enter the street and are struck by buses or other vehicles. This study evaluated the effectiveness of a stencil in the shape of a school bus applied to the pavement at a bus stop in improving safe behaviors at bus stops. Specifically, we assessed the frequency of children running toward the bus as it approached or entered the street. METHODS: Elementary school bus stops with similar roadways, traffic profiles, and numbers of children boarding participated in the study. Stops were randomly assigned to an intervention group, in which children were instructed to remain within a safe area during boarding that was demarcated by a pavement stencil, or an education-only group, in which the safe area was demarcated by some existing environmental feature. Both groups received education about safe boarding procedures. Observers rated behavior at each stop daily for 5 consecutive weeks. Data were analyzed as bivariate odds of any unsafe behavior in the education-only group. RESULTS: One hundred forty-five observations from seven bus stops with stencils and 174 daily observations from six education-only stops were completed. Observations of children in the education-only group were twice as likely to show unsafe behavior while waiting (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.3-3.6) and during boarding (OR, 2.1; 95% CI, 1.2-3.9). ORs were significantly higher in the education-only group for boys, girls, and children in grades 4 through 6. When no adult was present, there was a greater likelihood of unsafe behavior among all children in the education-only group while waiting (OR, 16.1; 95% CI, 3.9-72.4) and during boarding (OR, 15.0; 95% CI, 3.2-81.4). The presence of an adult at the stop did not have an independent effect on behavior. Children at education-only stops located on roadways with high traffic volume were more likely to engage in unsafe behavior while waiting (OR, 8.0; 95% CI, 3.8-17.3) and during boarding (OR, 4.9; 95% CI, 2.2-11.0). No differences were observed during boarding between stencil and education-only groups when 10 or more children were at the stops. CONCLUSION: The pavement stencil, when accompanied by education about safe boarding, may represent a cost-effective approach to reducing unsafe behavior at bus stops by children of elementary school age.

Inability of community-based laboratories to identify pathological casts in urine samples.

OBJECTIVE: To determine the accuracy of microscopic examination of urine from patients with known renal disease, performed by community-based laboratories. DESIGN: Twenty-six urine specimens from 7 children with Alport syndrome, lupus nephritis, and IgA nephropathy were simultaneously submitted to 4 investigative sites: 2 community-based medical laboratories (laboratories A and B), and the offices of 2 nephrologists (nephrologists C and D). Participants A, B, and C were unaware of the nature of this investigation and blinded to the diagnosis associated with each specimen. RESULTS: Twenty-six specimens from 7 children were analyzed. Pathological casts were identified in the 26 submitted specimens in the following order: 1 (4%) by laboratory A, 2 (8%) by laboratory B, 20 (77%) by nephrologist C, and 26 (100%) by nephrologist D. Four-way and 3-way (A, B, C) comparisons using the chi 2 test are significant at the P < .001 level. CONCLUSIONS: The 2 community-based medical laboratories participating in this study did not accurately identify pathological casts in urine specimens routinely submitted to them. In addition to raising quality assurance issues, these misleading reports may result in inaccurate diagnosis and unnecessary laboratory and diagnostic investigations.

Injury prevention training in pediatric residency programs.

OBJECTIVES: To quantify the content and setting of injury prevention training provided to pediatric residents and to identify aspects of residency programs associated with this training. DESIGN: Mail survey. SETTING: US pediatric residency programs. PARTICIPANTS: Residency program directors. MAIN OUTCOME MEASURES: Number of programs stating that they train residents in various injury prevention topics, and the setting of this training. RESULTS: More than 80% of programs addressed 92% of topics surveyed dealing with disease prevention, but only 59% of topics dealing with injury prevention. Injury prevention topics covered less frequently included smoke detector use and swimming pool, sports, and firearm safety. Programs used continuity clinics most often to teach injury prevention. No specific program characteristic was associated with the content or setting of injury prevention training. Residency programs located in states in which house fires, drowning, or firearm injuries are the leading causes of death were not more likely to offer prevention training on these topics. CONCLUSIONS: Injury prevention is less frequently taught than disease prevention in pediatric residency training. Injury prevention is most often taught in continuity clinics, the setting most consistent with ongoing primary patient care. A gap exists between the leading causes of injury death and injury prevention topics taught to pediatric residents. Residency programs must better recognize and adapt to the epidemiology of trauma in their communities, better enabling new pediatricians to meet their patient's needs.

Accuracy of fatal motorcycle-injury reporting on death certificates.

This study identifies differences in motorcycle injury fatality statistics gathered from different sources. Police Accidents Reports (PARs), identifying fatal motorcycle injuries occurring in Connecticut during 1987 were matched with state death certificates. Matched death certificates were analyzed in three major areas: content, coding, and motorcycle fatality reporting. Death certificates underreported motorcycle fatalities by 38% compared to PARs. Forty percent of death certificates were missing some or all of the required information: 7 did not include the word motorcycle, 18 did not contain acceptable ICD-9 terminology for a motorcyclist, and 17 did not describe how the injury occurred. Forty-one percent of death certificates contained external cause of injury code (E-code) errors. Incomplete information on death certificates was responsible for 52% of inaccurate reporting and E-code errors for 48%. The accuracy of fatal motorcycle injury cause of death reporting on death certificates could be improved by better physician training and rapid implementation of both the computerized death certificate coding systems and upcoming ICD-10 classification system.

The ability of mothers to read a thermometer.

The ability of 100 mothers in a suburban private pediatric practice and 100 mothers in an urban hospital-based practice to read a mercury glass thermometer accurately was assessed. Ninety-three percent of suburban practice parents could read three pre-set thermometers correctly, but only 10% of urban practice parents could perform the same task. Education level only partially explained the inability of most urban parents to read successfully. Because certain clinical situations require accurate fever assessment at home, simplified methods of fever assessment should be considered in populations with low competence in reading a thermometer by traditional methods.

Childhood injuries in Hartford, Connecticut.

Vital statistics and hospital discharge data were analyzed to provide a detailed epidemiologic profile of injury among Hartford residents 0 to 19 years of age. During 1980-86, 76 death certificates identified injury as the cause of death, resulting in an annual age-specific death rate of 2.3 per 10,000 persons. Injuries caused more deaths among one to 19 year olds (58%) than all other diseases combined. During 1982-86 injury was listed as the principal diagnosis leading to hospitalization for 2,220 Hartford residents 0 to 19 years. The hospitalization rate was 95 per 10,000 persons. Injuries accounted for 16% of all hospital discharges. For ages 0 to 19, homicide was the leading injury-related cause of death accounting for 43% of fatalities. Falls were the leading cause of injury-related hospitalizations accounting for 22% if all discharges. Clay-Arsenal (23%) and the Northeast (17%) neighborhoods accounted for the largest proportion of injury deaths. Actual inpatient hospital charges for 1986 were reviewed. The total cost for 420 injury discharges utilizing 2,208 hospital days exceeded $1.4 million dollars. Fifty-one percent of the injury discharges listed Medicaid as the primary expected payment source for acute care injury-related discharges. The statistical patterns identified in this report will help public health professionals establish goals for injury control efforts such as a reduction in morbidity, mortality, severity, and/or medical costs.

Bicycle injury in Connecticut.

We reviewed vital statistics (1987-92) and hospital discharge data (1987-91) for Connecticut residents to describe the epidemiology of bicycle-related injuries in the state. Each year there are approximately eight deaths (rate = 0.25/100,000) and 289 hospitalizations (rate = 8.8/100,000) due to bicycle related injury. Nonfatal bicycle injuries resulted in 1,500 hospital days at a cost of $1.7 million dollars. Death and hospitalization rates are highest among male children and adolescents five to 19 years of age. Most of the mortality and serious morbidity from bicycle-related trauma is due to head injuries. Both fatal and nonfatal bicycle head injury rates are highest in towns with a population less than 50,000 residents. Bicycle-related head injury is an important cause of mortality and morbidity of Connecticut children and youth and is largely preventable through the use of bicycle helmets. The data presented here allow for the development, implementation, and evaluation of community-based bicycle safety and helmet programs.

Childhood injury in Connecticut.

We reviewed vital statistics (1988-95) and hospital discharge data (1990-94) for Connecticut children and youth to describe the epidemiology of childhood injuries. There are approximately 175 deaths (rate = 21/100,000) and 4,230 hospitalizations (rate = 468/100,000) annually due to injury. Nonfatal injuries resulted in over 94,000 hospital days at a cost of nearly $155 million dollars. Death and hospitalization rates are highest among male children and adolescents 15 to 19 years of age. Geographic analysis of injury revealed significantly higher injury death and hospitalization rates in towns greater than 100,000 population. In addition, a majority of the homicides occurred in large urban areas, and most of the motor vehicle occupant deaths and suicides occurred in suburban and rural areas. Injury is an important cause of mortality and morbidity in youth and is largely preventable. The data presented here allow for the development, implementation, and evaluation of community based injury prevention programs.

Firearm-related fatality surveillance in Hartford County, Connecticut.

OBJECTIVES: To evaluate the feasibility of implementing a firearm fatality surveillance system in Hartford County, Connecticut. METHODS: Medical examiner, police, and crime lab data were collected for firearm deaths occurring in Hartford County during 1997. Data included characteristics of victims, suspects, and firearms. We used standard criteria for evaluating an epidemiological surveillance system. RESULTS: The surveillance system detected 52 firearm-related fatalities; 31 were suicides and 21 were homicides. Handguns accounted for 50% of the suicides and 72% of the homicides. Sensitivity was 96%, specificity was 100%, representativeness adequate, simplicity enhanced by a common case identifier, flexibility constrained by the use of existing data, timeliness varied by data source, and system acceptable to all data sources. Estimated statewide cost is $200 per case, or $52,000 per year. CONCLUSION: Firearm injury surveillance in Hartford County is feasible and expansion to statewide coverage possible. The surveillance yielded considerable data at reasonable costs.

Ability of mothers to subjectively assess the presence of fever in their children.

We assessed the ability of mothers to subjectively determine the presence or absence of fever in their children when compared with simultaneous temperature determination obtained by thermometer. Mothers who said their children were febrile were correct 52.3% of the time; those who said their children were afebrile were correct 93.9% of the time. The sensitivity was 73.9% of the specificity was 85.6%. Ninety percent of children aged 2 years or younger with temperatures of 38.9 degrees C or higher were correctly identified as febrile. Administration of antipyretics to both febrile and afebrile children was greater among those whose temperature was determined at home by thermometer than among those whose temperature was determined by subjective criteria. We conclude that maternal subjective fever assessment criteria are useful as a screening method to rule out the presence of fever at all ages and that mothers can identify high fevers in most young children without the use of a thermometer.

Reading a thermometer by use of temperature zones.

Previous studies have suggested that poor, urban parents are often unable to identify the presence of fever by use of a mercury glass thermometer. We investigated whether 145 mothers whose children received care in an urban hospital ambulatory care center could accurately read a thermometer. If they could not, their ability to identify zones of temperature, either by use of colors or numbers, was assessed. Although 57.9% of parents owned a mercury glass thermometer, only 9.7% could accurately read three thermometers presented to them. When those parents who were unable to accurately read were asked to identify the zones of temperature within which the mercury fell, 87.0% could successfully identify number zones; 78.6% could correctly identify color zones. Teaching the zone-reading techniques required only 15 to 30 seconds. We conclude that for parents unable to read a thermometer by conventional means, the use of color zones or number zones is a technique that is easily taught and reliably carried out.

Gonorrhea in a five year-old boy with hematuria.

A case of hematuria due to gonorrheal infection occurring in a 5 year-old child is described. Since venereal disease in a prepubertal child may reflect sexual abuse, all cases of prepubertal gonorrhea should be carefully investigated.

The inability of a temperature-sensitive pacifier to identify fevers in ill infants.

We assessed the utility and accuracy of a temperature-sensitive pacifier in screening for fever in ill children under 2 years of age. Of 189 candidates for study, 83 (42%) did not use pacifiers, and of the 106 who did, 25 (24%) could not sustain a suck for five minutes of direct observation. Among those 81 children who could sustain five minutes of sucking, only two of 20 children with rectal temperatures above 100 degrees F (37.8 degrees C) were correctly identified as febrile. Furthermore, seven of eight children with temperatures of 102 degrees F (38.9 degrees C) or greater were incorrectly identified as being afebrile. There were no false-positive fever assessments in afebrile infants. The temperature-sensitive pacifier tested in this study does not accurately identify fevers in most infants who are shown to have fevers by rectal temperature determination. The use of this pacifier for screening fever in ill infants cannot be recommended.

The infant walker. A previously unrecognized health hazard.

The use of infant walkers within a large prepaid pediatric group practice was investigated. Of 195 patients (age range, 5 to 15 months) surveyed during a three-months) surveyed during a three-month period, 150 patients (77%) used infant walkers. Of those, 47 patients (31%) had suffered mishaps. These included closed head trauma, fractures, lacerations, tooth evulsion, and soft palate perforation. There is no proved benefit associated with the use of such walkers. The risk of injury associated with the use of infant walkers should be of concern for those physicians who care for preambulatory children.