Top 10 List:
Andrew W. Kiragu, MD, FAAP, Medical Director, Pediatric Intensive Care, Hennepin County Medical Center; Thomas Hellmich, MD, FAAP, University of MN Amplatz Children's Hospital, Division of Pediatric Emergency Medicine
Injuries associated with cribs, playpens, and bassinets Button battery-ingestions Emerging battery-ingestion hazard: clinical implications Preventing battery ingestions: an analysis of 8648 cases Pedestrians motor vehicle injuries Pedestrian struck by motor vehicles further worsen race and insurance-based disparities Injury prevention in child death review Grandparents driving grandchildren Sport-related concussion Emergency Department visits for concussion in young child athletes American Academy of Pediatrics – Clinical Report Pediatric falls from windows Spying or steering? Views of parents of young novice drivers on the use of ethics of driver monitoring technology Unintentional pediatric ingestion poisoning and the role of imitative behavior Adolescent development and risk of injury The choking game and YouTube: a dangerous combination
Injuries associated with cribs, playpens, and bassinets among young children in the US, 1990-2008.
Pediatrics. 2011 Mar;127(3):479-86. Epub 2011 Feb 17. Yeh ES, Rochette LM, McKenzie LB, Smith GA. Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
OBJECTIVE: To describe the epidemiology of injuries related to cribs, playpens, and bassinets among young children in the United States. METHODS: A retrospective analysis was done using data from the National Electronic Injury Surveillance System for children younger than 2 years of age treated in emergency departments in the United States from 1990 through 2008 for an injury associated with cribs, playpens, and bassinets. RESULTS: An estimated 181,654 (95% confidence interval: 148,548-214,761) children younger than 2 years of age were treated in emergency departments in the United States for injuries related to cribs, playpens, and bassinets during the 19-year study period. There was an average of 9561 cases per year or an average of 12.1 injuries per 10 000 children younger than 2 years old per year. Most of the injuries involved cribs (83.2%), followed by playpens (12.6%) and bassinets (4.2%). The most common mechanism of injury was a fall from a crib, playpen, or bassinet, representing 66.2% of injuries. Soft-tissue injuries comprised the most common diagnosis (34.1%), and the most frequently injured body region was the head or neck (40.3%). Patients with fractures were admitted 14.0% of the time, making them 5.45 (95% confidence interval: 3.80-7.80) times more likely to be hospitalized than patients with other types of injury. Children younger than 6 months were 2.97 (95% confidence interval: 2.07-4.24) times more likely to be hospitalized than older children. CONCLUSIONS: This study is the first to use a nationally representative sample to examine injuries associated with cribs, playpens, and bassinets. Given the consistently high number of observed injuries, greater efforts are needed to ensure safety in the design and manufacture of these products, ensure their proper usage in the home, and increase awareness of their potential dangers to young children.
Emerging battery-ingestion hazard: clinical implications.
Pediatrics. 2010 Jun; 125(6): 1168-77. Epub 2010 May 24. Litovitz T, Whitaker N, Clark L, White NC, Marsolek M.; National Capital Poison Center, 3201 New Mexico Ave, Suite 310, Washington, DC 20016, USA. toby@poison.org
OBJECTIVES: Recent cases suggest that severe and fatal button battery ingestions are increasing and current treatment may be inadequate. The objective of this study was to identify battery ingestion outcome predictors and trends, define the urgency of intervention, and refine treatment guidelines. METHODS: Data were analyzed from 3 sources: (1) National Poison Data System (56535 cases, 1985-2009); (2) National Battery Ingestion Hotline (8648 cases, July 1990-September 2008); and (3) medical literature and National Battery Ingestion Hotline cases (13 deaths and 73 major outcomes) involving esophageal or airway button battery lodgment. RESULTS: All 3 data sets signal worsening outcomes, with a 6.7-fold increase in the percentage of button battery ingestions with major or fatal outcomes from 1985 to 2009 (National Poison Data System). Ingestions of 20- to 25-mm-diameter cells increased from 1% to 18% of ingested button batteries (1990-2008), paralleling the rise in lithium-cell ingestions (1.3% to 24%). Outcomes were significantly worse for large-diameter lithium cells (> or = 20 mm) and children who were younger than 4 years. The 20-mm lithium cell was implicated in most severe outcomes. Severe burns with sequelae occurred in just 2 to 2.5 hours. Most fatal (92%) or major outcome (56%) ingestions were not witnessed. At least 27% of major outcome and 54% of fatal cases were misdiagnosed, usually because of nonspecific presentations. Injuries extended after removal, with unanticipated and delayed esophageal perforations, tracheoesophageal fistulas, fistulization into major vessels, and massive hemorrhage. CONCLUSIONS: Revised treatment guidelines promote expedited removal from the esophagus, increase vigilance for delayed complications, and identify patients who require urgent radiographs. Preventing battery ingestions: an analysis of 8648 cases.
Pediatrics. 2010 Jun;125(6):1178-83. Epub 2010 May 24. Litovitz T, Whitaker N, Clark L.National Capital Poison Center, 3201 New Mexico Ave, Suite 310, Washington, DC 20016, USA. toby@poison.org
OBJECTIVES: Outcomes of pediatric button battery ingestions have worsened substantially, predominantly related to the emergence of the 20-mm-diameter lithium cell as a common power source for household products. Button batteries lodged in the esophagus can cause severe tissue damage in just 2 hours, with delayed complications such as esophageal perforation, tracheoesophageal fistulas, exsanguination after fistulization into a major blood vessel, esophageal strictures, and vocal cord paralysis. Thirteen deaths have been reported. The objective of this study was to explore button battery ingestion scenarios to formulate prevention strategies. METHODS: A total of 8648 battery ingestions that were reported to the National Battery Ingestion Hotline were analyzed. RESULTS: Batteries that were ingested by children who were younger than 6 years were most often obtained directly from a product (61.8%), were loose (29.8%), or were obtained from battery packaging (8.2%). Of young children who ingested the most hazardous battery, the 20-mm lithium cell, 37.3% were intended for remote controls. Adults most often ingested batteries that were sitting out, loose, or discarded (80.8%); obtained directly from a product (4.2%); obtained from battery packaging (3.0%); or swallowed within a hearing aid (12.1%). Batteries that were intended for hearing aids were implicated in 36.3% of ingestions. Batteries were mistaken for pills in 15.5% of ingestions, mostly by older adults. CONCLUSIONS: Parents and childcare providers should be taught to prevent battery ingestions. Because 61.8% of batteries that were ingested by children were obtained from products, manufacturers should redesign household products to secure the battery compartment, possibly requiring a tool to open it. Pedestrians struck by motor vehicles further worsen race- and insurance-based disparities in trauma outcomes: the case for inner-city pedestrian injury prevention programs.
Surgery. 2010 Aug;148(2):202-8.Maybury RS, Bolorunduro OB, Villegas C, Haut ER, Stevens K, Cornwell EE 3rd, Efron DT, Haider AH. Department of Surgery, Georgetown University Hospital, Washington, DC, USA.
BACKGROUND: Pedestrian trauma is the most lethal blunt trauma mechanism, and the rate of mortality in African Americans and Hispanics is twice that compared with whites. Whether insurance status and differential survival contribute to this disparity is unknown. METHODS: This study is a review of vehicle-struck pedestrians in the National Trauma Data Bank, v7.0. Patients <16 years and > or =65 years, as well as patients with Injury Severity Score (ISS) <9, were excluded. Patients were categorized as white, African American, or Hispanic, and as privately insured, government insured, or uninsured. With white and privately insured patients as reference, logistic regression was used to evaluate mortality by race and insurance status after adjusting for patient and injury characteristics. RESULTS: In all, 26,404 patients met inclusion criteria. On logistic regression, African Americans had 22% greater odds of mortality (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.06-1.41) and Hispanics had 33% greater odds of mortality (OR, 1.33; 95% CI, 1.14-1.54) compared with whites. Uninsured patients had 77% greater odds of mortality (OR, 1.77; 95% CI, 1.52-2.06) compared with privately insured patients. CONCLUSION: African American and Hispanic race, as well as uninsured status, increase the risk of mortality after pedestrian crashes. Given the greater incidence of pedestrian crashes in minorities, this compounded burden of injury mandates pedestrian trauma prevention efforts in inner cities to decrease health disparities.
Injury prevention in child death review: child pedestrian fatalities.
Inj Prev. 2011 Feb;17 Suppl 1:i4-9. Desapriya E, Sones M, Ramanzin T, Weinstein S, Scime G, Pike I. Department of Pediatrics, University of British Columbia, Canada. edesap@cw.bc.ca
OBJECTIVE: This article describes the epidemiology of child pedestrian fatalities in British Columbia using data generated by the province's Child Death Review Unit, to demonstrate the unique capacity of child death review to provide an ecological understanding of child mortality and catalyze evidence based, multi-level prevention strategies. METHODS: All child pedestrian fatalities in British Columbia from 1 January 1 2003 to 31 December 2008 were reviewed. Data on demographics, circumstance of injury, and risk factors related to the child, driver, vehicle, and physical environment were extracted. Frequency of sociodemographic variables and modifiable risk factors were calculated, followed by statistical comparisons against the general population for Aboriginal ancestry, gender, ethnicity, income assistance and driver violations using z and t tests. RESULTS: Analysis of child pedestrian fatalities (n=33) found a significant overrepresentation of Aboriginal children (p=0.06), males (p<0.01), and children within low-income families (p<0.01). The majority of incidents occurred in residential areas (51.5%), with a speed limit of 50 kph or higher (85.7%). Risky pedestrian behavior was a factor in 56.7% of cases, and 33% of children under 10 years of age were not under active supervision. Drivers had significantly more driving violations than the comparison population (p<0.01). CONCLUSION: Child pedestrian fatalities are highly preventable through the modification of behavioral, social, and environmental risk factors. This paper illustrates the ability of child death review to generate an ecological understanding of injury epidemiology not otherwise available and advance policy and programme interventions designed to reduce preventable child mortality.
Grandparents driving grandchildren: an evaluation of child passenger safety and injuries.
Pediatrics. 2011 Aug;128(2):289-95. Epub 2011 Jul 18., Henretig FM, Durbin DR, Kallan MJ, Winston FK.
OBJECTIVES: To compare restraint-use practices and injuries among children in crashes with grandparent versus parent drivers.
METHODS: This was a cross-sectional study of motor vehicle crashes that occurred from January 15, 2003, to November 30, 2007, involving children aged 15 years or younger, with cases identified via insurance claims and data collected via follow-up telephone surveys. We calculated the relative risk of significant child-passenger injury for grandparent-driven versus parent-driven vehicles. Logistic regression modeling estimated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for several child occupant, driver, vehicle, and crash characteristics.
RESULTS: Children driven by grandparents comprised 9.5% of the sample but resulted in only 6.6% of the total injuries. Injuries were reported for 1302 children, for an overall injury rate of 1.02 (95% CI: 0.90-1.17) per 100 child occupants. These represented 161 weighted injuries (0.70% injury rate) with grandparent drivers and 2293 injuries (1.05% injury rate) with parent drivers. Although nearly all children were reported to have been restrained, children in crashes with grandparent drivers used optimal restraint slightly less often. Despite this, children in grandparent-driven crashes were at one-half the risk of injuries as those in parent-driven crashes (OR: 0.50 [95% CI: 0.33- 0.75]) after adjustment.
CONCLUSIONS: Grandchildren seem to be safer in crashes when driven by grandparents than by their parents, but safety could be enhanced if grandparents followed current child-restraint guidelines. Additional elucidation of safe grandparent driving practices when carrying their grandchildren may inform future child-occupant driving education guidelines for all drivers.
Emergency department visits for concussion in young child athletes.
Pediatrics. 2010 Sep;126(3):e550-6. Epub 2010 Aug 30. Bakhos LL, Lockhart GR, Myers R, Linakis JG. Pediatric Emergency Medicine, Waren Alpert Medical School, Brown University, Injury Prevention Center, Rhode Island Hospital, 593 Eddy St, Claverick Building 2nd Floor, Providence, RI 02903, USA. lbakhos@gmail.com
OBJECTIVES: The objective of this study was to characterize emergency department (ED) visits for pediatric sport-related concussion (SRC) in pre-high school- versus high school-aged athletes. METHODS: A stratified probability sample of US hospitals that provide emergency services in the National Electronic Injury Surveillance System (1997-2007) and All Injury Program (2001-2005) was used. Concussion-related ED visits were analyzed for 8- to 13- and 14- to 19-year-old patients. Population data were obtained from the US Census Bureau; sport participation data were obtained from National Sporting Goods Association. RESULTS: From 2001 to 2005, US children who were aged 8 to 19 years had an estimated 502 000 ED visits for concussion. The 8- to 13-year-old group accounted for approximately 35% of these visits. Approximately half of all ED visits for concussion were SRC. The 8- to 13-year-old group sustained 40% of these, which represents 58% of all concussions in this group. Approximately 25% of all SRC visits in the 8- to 13-year-old group occurred during organized team sport (OTS). During the study period, approximately 4 in 1000 children aged 8 to 13 years and 6 in 1000 children aged 14 to 19 years had an ED visit for SRC, and 1 in 1000 children aged 8 to 13 years and 3 in 1000 children aged 14 to 19 years had an ED visit for concussion sustained during OTS. From 1997 to 2007, although participation had declined, ED visits for concussions in OTS in 8- to 13-year-old children had doubled and had increased by >200% in the 14- to 19-year-old group. CONCLUSIONS: The number of SRCs in young athletes is noteworthy. Additional research is required
American Academy of Pediatrics. Clinical report--sport-related concussion in children and adolescents.
Pediatrics. 2010 Sep;126(3):597-615. Epub 2010 Aug 30. Halstead ME, Walter KD; Council on Sports Medicine and Fitness. Collaborators (10) McCambridge TM, Benjamin HJ, Brenner JS, Cappetta CT, Demorest RA, Gregory AJ, Halstead ME, Koutures CG, LaBella CR, Weiss-Kelly AK.
Abstract
Sport-related concussion is a "hot topic" in the media and in medicine. It is a common injury that is likely underreported by pediatric and adolescent athletes. Football has the highest incidence of concussion, but girls have higher concussion rates than boys do in similar sports. A clear understanding of the definition, signs, and symptoms of concussion is necessary to recognize it and rule out more severe intracranial injury. Concussion can cause symptoms that interfere with school, social and family relationships, and participation in sports. Recognition and education are paramount, because although proper equipment, sport technique, and adherence to rules of the sport may decrease the incidence or severity of concussions, nothing has been shown to prevent them. Appropriate management is essential for reducing the risk of long-term symptoms and complications. Cognitive and physical rest is the mainstay of management after diagnosis, and neuropsychological testing is a helpful tool in the management of concussion. Return to sport should be accomplished by using a progressive exercise program while evaluating for any return of signs or symptoms. This report serves as a basis for understanding the diagnosis and management of concussion in children and adolescent athletes.
Pediatric Injuries Attributable to Falls From Windows in the United States in 1990-2008.
Pediatrics. 2011 Aug 22. Harris VA, Rochette LM, Smith GA. Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; and.
OBJECTIVES: To examine the epidemiological features of pediatric injuries related to falls from windows.
METHODS: By using the National Electronic Injury Surveillance System, emergency department (ED) data for pediatric injury cases associated with window falls in 1990-2008 were reviewed.
RESULTS: An estimated 98 415 children (95% confidence interval [CI]: 82 416-114 419) were treated in US hospital EDs for window fall-related injuries during the 19-year study period (average: 5180 patients per year [95% CI: 4828-5531]). The mean age of children was 5.1 years, and boys accounted for 58.1% of cases. One-fourth (25.4%) of the patients required admission to the hospital. The annual injury rate decreased significantly during the study period because of a decrease in the annual injury rate among 0- to 4-year-old children. Children 0 to 4 years of age were more likely to sustain head injuries (injury proportion ratio [IPR]: 3.22 [95% CI: 2.65-3.91]) and to be hospitalized or to die (IPR: 1.65 [95% CI: 1.38-1.97]) compared with children 5 to 17 years of age. Children who landed on hard surfaces were more likely to sustain head injuries (IPR: 2.05 [95% CI: 1.53-2.74]) and to be hospitalized or to die (IPR: 2.23 [95% CI: 1.57-3.17]) compared with children who landed on cushioning surfaces.
CONCLUSIONS: To our knowledge, this is the first study to investigate window fall-related injuries treated in US hospital EDs by using a nationally representative sample. These injuries are an important pediatric public health problem, and increased prevention efforts are needed, including development and evaluation of innovative prevention programs.
Spying or steering? Views of parents of young novice drivers on the use and ethics of driver-monitoring technologies.
Accid Anal Prev. 2011 Jan;43(1):412-20. Epub 2010 Oct 23. Guttman N, Lotan T. Department of Communication, Tel Aviv University, Israel. guttman@post.tau.ac.il
Abstract
In-vehicle technologies that document driving practices have the potential to enhance the driving safety of young drivers, but their installation depends largely on their parents' willingness and raises ethical dilemmas. This study investigated, using closed and open-ended questions, the views of 906 parents of young drivers in Israel regarding their willingness to install such a technology, and their conceptions of social norms and ethical issues associated with the technology and of factors that would encourage or discourage parents to adopt it. Most believed parents should feel morally obligated to install it. When cost was not a consideration, most said they would, and believed other parents would be willing to install the technology. Fewer (about half) expressed willingness to install it after being told about its estimated cost. Monetary cost was rated as a barrier to install it by about half. Environmental considerations were viewed as an incentive. Parents who supported the installation believed it would serve as a trigger for parent-young driver communication but those who did not thought it would erode trust in the parent-young driver relationship. Most said parents should have access to the monitoring data. Policy implications regarding issues of privacy and resources for parents are discussed.
Unintentional paediatric ingestion poisonings and the role of imitative behaviour.
Inj Prev. 2011 Jun 27. Rodgers GB, Franklin RL, Midgett JD. Directorate for Economic Analysis, US Consumer Product Safety Commission, Bethesda, Maryland, USA.
OBJECTIVES: To quantify the relationship between imitative behavior and poisonings in children. Setting USA.
METHODS: This study is based on the evaluation of a large national database of unintentional oral ingestion poisonings involving children aged <5 years treated in US hospital emergency departments during 2004 and 2005. It begins with the premise that, among other factors, oral drug poisonings can result from children observing and imitating adult behavior, but that non-oral drug and non-drug poisonings (to be referred to as non-drug poisonings) generally do not, because children do not see adults ingesting non-drug products. The study then compares and contrasts the child poisonings between the two poisoning categories. Differences in the poisoning rate between the oral drug and non-drug categories are estimated by the age and sex of the children. A binary logistic regression analysis is also conducted using non-drug poisonings as a control group to compare against oral drug poisonings.
RESULTS: There was a significant increase in the relative likelihood of oral drug poisonings beginning at age 20-23 months that is consistent with the expected onset of complicated imitative behaviors in children. Based upon our analysis, imitative behavior may have contributed to about 17 300 child poisonings treated annually in the emergency department, possibly accounting for about 20% of poisonings involving children aged <5 years and 30% of the poisoning injuries involving children aged 20-59 months.
CONCLUSIONS: Comprehensive efforts to prevent poisoning need to address the problem of imitative behavior in children. Caregivers should never ingest medications in the presence of children.
Adolescent development and risk of injury: using developmental science to improve interventions.
Inj Prev. 2011 Feb;17(1):50-4. Epub 2010 Sep 28. Johnson SB, Jones VC. Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. sjohnson@jhsph.edu
Abstract
In adolescence, there is a complex interaction among physical, cognitive, and psychosocial developmental processes, culminating in greater risk-taking and novelty-seeking. Concurrently, adolescents face an increasingly demanding environment, which results in heightened vulnerability to injury. In this paper, we provide an overview of developmental considerations for adolescent injury interventions based on developmental science, including findings from behavioral neuroscience and psychology. We examine the role that typical developmental processes play in the way adolescents perceive and respond to risk and how this integrated body of developmental research adds to our understanding of how to do injury prevention with adolescents. We then highlight strategies to improve the translation of developmental research into adolescent injury prevention practice, calling on examples of existing interventions including graduated driver licensing.
The choking game and YouTube: a dangerous combination.
Clin Pediatr (Phila). 2010 Mar;49(3):274-9. Epub 2009 Jul 13. Linkletter M, Gordon K, Dooley J. Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. marthalinkletter@yahoo.ca
PURPOSE: To study postings of partial asphyxiation by adolescents on YouTube and to increase awareness of this dangerous activity as well as the value of YouTube as a research tool. METHODS: Videos were searched on YouTube using many terms for recreational partial asphyxiation. Data were gathered on the participants and on the occurrence of hypoxic seizure. RESULTS: Sixty-five videos of the asphyxiation game were identified. Most (90%) participants were male. A variety of techniques were used. Hypoxic seizures were witnessed in 55% of videos, but occurred in 88% of videos that employed the "sleeper hold" technique. The videos were collectively viewed 173550 times on YouTube. CONCLUSIONS: YouTube has enabled millions of young people to watch videos of the "choking game" and other dangerous activities. Seeing videos may normalize the behavior among adolescents. Increased awareness of this activity may prevent some youths from participating and potentially harming themselves or others.
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