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Cohen JS, Howard MB, McDonald EM, Ryan LM. A Call to Action: Addressing Socioeconomic Disparities in Childhood Unintentional Injury Risk. Pediatrics 2024; 153:e2023063445. [PMID: 38439733 DOI: 10.1542/peds.2023-063445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 03/06/2024] Open
Affiliation(s)
- Joanna S Cohen
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Beth Howard
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eileen M McDonald
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Leticia Manning Ryan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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McCain JE, Bridgmon AE, King WD, Monroe K. Children's injury database: development of an injury surveillance system in a pediatric emergency department. Inj Epidemiol 2023; 10:40. [PMID: 37525256 PMCID: PMC10391750 DOI: 10.1186/s40621-023-00443-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/22/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Injuries are the leading cause of death in children and are also a leading cause of all emergency department (ED) visits for children. Obtaining epidemiologic data to define the wide range of childhood injuries for individual communities is challenging. The Children's Injury Database (CID) is an injury surveillance system developed to collect data from injury-related visits to our tertiary care pediatric emergency department. RESULTS During 2021, a total of 15,168 injury visits were analyzed representing 22% of total ED visits (68,834). A total of 2053 injury visits (13.5%) resulted in hospital admission. The 10 leading injury types included: falls, poisonings, motor vehicle collision (MVC), assault, dog bite, burns, sports, pedestrian, bicycle, and all-terrain vehicle (ATV). Admission rates varied by age group with children ages 13 years and older having the highest rate of admission (18.4%). The median length of stay (LOS) for all injured children requiring admission was 2 days while the median LOS for preschoolers was 1 day, the median LOS for school-age children was 2 days, and the median LOS for teenagers was 3 days. While MVCs were the most common cause of vehicle-related injuries, ATV-related injuries had the highest rate of admission (51%). CONCLUSIONS In this study, teenagers had significantly higher admission rates, lengths of stay, and hospital charges. Black and Hispanic children were under-represented in the number of visits for injuries compared to all ED visits. Further research should focus on disparities in injury-related visits based on race as well as gender. CID has demonstrated that injury surveillance systems can assist with reporting new injury patterns while also acting as a stimulus for new research ideas, planning interventions targeting the most at-risk populations, and evaluating the effectiveness of injury prevention interventions.
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Affiliation(s)
- Jennifer E. McCain
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL USA
| | - Ashley E. Bridgmon
- Health Education and Safety Center, Children’s of Alabama, Birmingham, AL USA
| | - William D. King
- Health Education and Safety Center, Children’s of Alabama, Birmingham, AL USA
| | - Kathy Monroe
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL USA
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Macy ML, Carter P, Kendi S, Pollock B, Miguel LS, Goldstick J, Resnicow K. “Tiny Cargo, Big Deal! Abróchame Bien, Cuídame Bien” an emergency department-based intervention to promote child passenger safety: Protocol for an adaptive randomized trial among caregivers of 6-month through 10-year-old children. Contemp Clin Trials 2022; 120:106863. [DOI: 10.1016/j.cct.2022.106863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/17/2022] [Accepted: 07/27/2022] [Indexed: 11/03/2022]
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Webb AC, Jorge EA, Omairi I, Nichols MH, Monroe KW. Self-Reported Usage of Safety Equipment Provided Through a Community Partnership Approach to Injury Prevention in the Pediatric Emergency Department. Pediatr Emerg Care 2022; 38:e1391-e1395. [PMID: 35699568 DOI: 10.1097/pec.0000000000002760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Previous studies have shown that educational programs in conjunction with provision of free or low-cost safety equipment increases the likelihood of parents changing behaviors at home. This project surveyed caregivers in the pediatric emergency department (ED) about safety behaviors before and after provision of education and safety equipment related to medication storage, firearm storage, and drowning. METHODS A convenience sample of families presenting to the ED for any complaint with a child of any age were approached for participation in this feasibility study. Exclusion criteria included patients presenting for a high acuity problem (Emergency Severity Index 1 or 2) and non-English-speaking caregivers. Enrollment, surveys, and educational intervention were performed by the graduate student investigator from the School of Public Health. Participants were surveyed regarding presence of firearms and medications within the home and their storage practices. Additional questions included relationship to the patient, number and age of children younger than 18 years in the home, and zip code of residence. Educational handouts were reviewed, and participants were provided with a medication lock box, trigger lock, toilet lock, and/or pool watcher tag as indicated by answers given to the survey questions. Process measures were collected for number of products given out, number of children potentially affected by the intervention, and time spent by the investigator. Follow-up calls assessed use of the products provided. RESULTS The student investigator spent a total of 180 hours and enrolled 357 caregivers accounting for 843 children. Fifty-seven percent of the participants answered the follow-up phone call. Only 9% initially reported that they stored medications in a locked or latched place. Medication lock boxes were given to 316 participants. On follow-up, 88% of those who received a lock box reported using it to store medications and 86% reported satisfaction with the lock box and how it worked. Of the 161 participants who admitted to gun ownership, 45% reported storing their guns locked and unloaded. Of those who reported unsafe manners of gun storage, 96% also reported unsafe manners of medication storage. Although only 161 participants endorsed gun ownership, 236 participants took a gun lock when offered. At follow-up, 66% of participants had used the gun lock and 67% of participants who took the gun lock reported satisfaction with the device. For water safety, 195 toilet latches and 275 drowning prevention lanyards were provided. On follow-up, 48% of those who had received a toilet latch were using it and 62% reported satisfaction with the device. Data were not collected on use of or satisfaction with the drowning prevention lanyards. CONCLUSIONS Families often report unsafe home storage of medications and firearms, which together account for a large amount of morbidity and mortality in pediatrics. Drowning risk for young children is ubiquitous in the home setting, and low rates of use of home safety devices indicates need for further education and outreach on making the home environment safe. Despite relying on self-reported behaviors and the risk of reporting bias skewing the data, the behaviors reported in the preintervention survey were still very unsafe, suggesting that children may have a much higher risk of injury in the actual home environments. The ED is traditionally thought of as a place to receive care when injuries happen, but any encounter with families should be seen as an opportunity for injury prevention messaging. Partnering with a local school of public health and other community resources can result in the establishment of a low-cost, consistent, and effective injury prevention program in the pediatric ED that reaches a large number of individuals without the added burden of additional tasks that take time away from already busy ED providers and staff.
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Affiliation(s)
- Alicia C Webb
- From the Division of Emergency Medicine, Department of Pediatrics, University of Alabama-Birmingham
| | - Eric A Jorge
- From the Division of Emergency Medicine, Department of Pediatrics, University of Alabama-Birmingham
| | - Iman Omairi
- University of Alabama-Birmingham School of Public Health, Birmingham, AL
| | - Michele H Nichols
- From the Division of Emergency Medicine, Department of Pediatrics, University of Alabama-Birmingham
| | - Kathy W Monroe
- From the Division of Emergency Medicine, Department of Pediatrics, University of Alabama-Birmingham
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Amiruzzaman M, Curtis A, Zhao Y, Jamonnak S, Ye X. Classifying crime places by neighborhood visual appearance and police geonarratives: a machine learning approach. JOURNAL OF COMPUTATIONAL SOCIAL SCIENCE 2021; 4:813-837. [PMID: 33718652 PMCID: PMC7938887 DOI: 10.1007/s42001-021-00107-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/23/2021] [Indexed: 05/21/2023]
Abstract
The complex interrelationship between the built environment and social problems is often described but frequently lacks the data and analytical framework to explore the potential of such a relationship in different applications. We address this gap using a machine learning (ML) approach to study whether street-level built environment visuals can be used to classify locations with high-crime and lower-crime activities. For training the ML model, spatialized expert narratives are used to label different locations. Semantic categories (e.g., road, sky, greenery, etc.) are extracted from Google Street View (GSV) images of those locations through a deep learning image segmentation algorithm. From these, local visual representatives are generated and used to train the classification model. The model is applied to two cities in the U.S. to predict the locations as being linked to high crime. Results show our model can predict high- and lower-crime areas with high accuracies (above 98% and 95% in first and second test cities, accordingly).
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Affiliation(s)
| | | | - Ye Zhao
- Kent State University, Kent, USA
| | | | - Xinyue Ye
- Texas A & M University, College Station, USA
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Gaw CE, Berthet E, Curry AE, Zonfrillo MR, Arbogast KB, Corwin DJ. Pediatric Health Care Provider Perspectives on Injury Prevention Counseling in Acute and Primary Care Settings. Clin Pediatr (Phila) 2020; 59:1150-1160. [PMID: 32668957 PMCID: PMC10066848 DOI: 10.1177/0009922820941237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The objective of this study was to characterize how pediatric primary care and emergency medicine health care providers and trainees engage in injury prevention counseling and assess perceptions toward injury prevention resources. We surveyed physicians, advanced practice providers, and trainees in the Emergency Department, Primary Care Network, and Pediatric Residency Program at Children's Hospital of Philadelphia from September to November 2019. Of the 578 eligible participants, 208 (36.0%) completed the survey. When asked to rank the suitability of alternative personnel for providing counseling, 63.0% of the participants selected an injury prevention specialist as best suited. Seventy-six percent of the providers considered a tablet or mobile device used before a patient encounter to be a helpful resource. Variability existed in provider comfort, knowledge, and frequency of counseling by injury topic. Free-text responses cited time as a barrier to counseling. Opportunities exist to improve the provision of injury education through the utilization of novel resources and personnel.
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Affiliation(s)
- Christopher E Gaw
- Division of Emergency Medicine, Children's Hospital of Philadelphia, PA, USA
| | - Ellora Berthet
- Division of Emergency Medicine, Children's Hospital of Philadelphia, PA, USA
| | - Allison E Curry
- Division of Emergency Medicine, Children's Hospital of Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Kristy B Arbogast
- Division of Emergency Medicine, Children's Hospital of Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Corwin
- Division of Emergency Medicine, Children's Hospital of Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Attridge MM, Holmstrom SE, Sheehan KM. Injury Prevention Opportunities in the Pediatric Emergency Department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020. [DOI: 10.1016/j.cpem.2020.100761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Parental Knowledge of Appropriate Placement of Child Restraint Systems Before and After Educational Intervention in a Pediatric Emergency Department. Pediatr Emerg Care 2020; 36:43-49. [PMID: 31895201 DOI: 10.1097/pec.0000000000002020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to determine caregiver's knowledge of appropriate car restraint systems (CRSs) use and compare this with the actual use among children presenting to the pediatric emergency department (PED), and to determine the efficacy of PED-based intervention on improving knowledge. METHODS We conducted a prospective, intervention study of children (<8 years old) during a 12-month period in the PED. Based on their height and weight, children were assigned to group 1 (rear facing), group 2 (forward facing), or group 3 (booster). Caregivers were surveyed in their baseline CRS knowledge. Certified child passenger safety technicians evaluated each CRS and gave caregivers one-on-one education. Participants were called back to answer a posttest to determine if the information given was retained. RESULTS Of the 170 children enrolled, 64 (37.6%) were assigned to group 1, 68 (40%) to group 2, and 38 (22.3%) to group 3. Of these, 63% were not aware of the state law regarding CRS use. Among those without a CRS, 18% belonged to group 1, 36% to group 2, and 46% to group 3. Even among those who reportedly had CRS, 13% of children did not have one-on-on inspection. After inspection, 84% of group 1, 71% of group 2, and 70% of group 3 were in the appropriate one. Nearly 45% were not compliant with American Academy of Pediatrics guidelines of children riding in rear-facing CRS until 2 years of age. CONCLUSIONS A significant proportion of children visiting the PED are not in appropriate CRS, and caretaker knowledge about correct CRS types and installation is poor. Future educational efforts should focus on rear-facing and booster seat age-group children.
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Macy ML, Kandasamy D, Resnicow K, Cunningham RM. Pilot Trial of an Emergency Department-based Intervention to Promote Child Passenger Safety Best Practices. Acad Emerg Med 2019; 26:770-783. [PMID: 30637887 PMCID: PMC6626697 DOI: 10.1111/acem.13687] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/19/2018] [Accepted: 12/26/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite demonstrated effectiveness of child restraint systems (CRSs), use remains suboptimal. In this randomized pilot trial, we sought to determine the feasibility, acceptability, and potential efficacy of "Tiny Cargo, Big Deal" an ED-based intervention to promote guideline-concordant size-appropriate CRS use. METHODS Parents of children < 11 years old were recruited in two EDs and randomized in a 2 × 2 factorial design to four conditions: 1) generic information sheet, 2) tailored brochure mailed after the ED visit, 3) a single motivational interviewing-based counseling session in the ED, and 4) full intervention (counseling session plus tailored brochure). We assessed feasibility (recruitment, completion, follow-up rates) and acceptability (parent attitudes, uptake of information) in the ED, at 1 month and at 6 months. We obtained preliminary estimates of effect sizes of the intervention components on appropriate CRS use at 6-month follow-up. RESULTS Of the 514 parents assessed for eligibility, 456 met inclusion criteria and 347 consented to participate. Enrolled parents were mostly mothers (88.1%); 48.7% were 18 to 29 years old; 52.5% were non-Hispanic, white; and 65.2% reported size-appropriate CRS use. Completion rates were 97.7% for baseline survey, 81.6% for counseling, 51.9% for 1-month follow-up, and 59.3% for 6-month follow-up. In the ED, 70.5% rated thinking about child passenger safety in the ED as very helpful. At 1 month, 70.0% expressed positive attitudes toward the study. Of 132 parents who reported receiving study mailings, 78.9% reviewed the information. Parents randomized to the full intervention demonstrated an increase (+6.12 percentage points) and other groups a decrease (-1.69 to -9.3 percentage points) in the proportion of children reported to use a size-appropriate CRS at 6-month follow-up. CONCLUSIONS Suboptimal CRS use can be identified and intervened upon during a child's ED visit. A combined approach with ED-based counseling and mailed tailored brochures shows promise to improve size-appropriate CRS use.
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Affiliation(s)
- Michelle L. Macy
- Department of Emergency Medicine, Michigan Medicine, Ann Arbor, Michigan; The Child Health Evaluation and Research (CHEAR) Center, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan; The University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Current affiliation: Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL;
| | - Deepika Kandasamy
- The Child Health Evaluation and Research (CHEAR) Center, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan; Current affiliation: Department of Emergency Medicine, University of Colorado-Denver, Aurora, Colorado;
| | - Ken Resnicow
- School of Public Health, University of Michigan, Ann Arbor, Michigan;
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, Michigan Medicine, Ann Arbor, Michigan; The University of Michigan Injury Prevention Center, Ann Arbor, Michigan; School of Public Health, University of Michigan, Ann Arbor, Michigan;
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Ishikawa T, Mâsse LC, Brussoni M. Changes in parents' perceived injury risk after a medically-attended injury to their child. Prev Med Rep 2019; 13:146-152. [PMID: 30591856 PMCID: PMC6305837 DOI: 10.1016/j.pmedr.2018.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/31/2018] [Accepted: 12/16/2018] [Indexed: 11/29/2022] Open
Abstract
Unintentional injuries are a major cause of hospitalization and death for children worldwide. Since children who sustain a medically-attended injury are at higher risk of recurrence, it is crucial to generate knowledge that informs interventions to prevent re-incidence. This study examines when, in the year following a medically-attended injury, parents perceive the greatest risk of injury recurrence. Since perception of injury risk is associated with parental preventive behavior, this can inform decisions on the timing of parent-targeted interventions to prevent re-injury. Study participants were 186 English-fluent parents of children 0 to 16 years, presenting at the British Columbia Children's Hospital for an unintentional pediatric injury. Parents were excluded if their child had a disability or chronic health condition. Perceived risk of the same and of any injury recurring were elicited from parents, when they sought treatment at the hospital, as well as one, four, and twelve months later. The study ran between February 2011 and December 2013. Mixed-effects models were used to analyze changes in parents' responses. Analysis indicates that perceived risk of the same injury recurring did not change. However, perceived risk of any injury recurring increased from baseline to first follow-up, then decreased during the rest of the year. Overall, perceived risk of any injury was higher for parents whose child had a history of injuries. Visits to the Emergency Department for a pediatric injury may not be optimal timing to deploy injury prevention interventions for parents. Follow-up visits (when parents' perceived risk is highest) may be better.
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Affiliation(s)
- Takuro Ishikawa
- Department of Pediatrics, University of British Columbia: Rm 2D19, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
- British Columbia Children's Hospital Research Institute, F503, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
- BC Injury Research and Prevention Unit, F508, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Louise C. Mâsse
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
- British Columbia Children's Hospital Research Institute, F503, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Mariana Brussoni
- Department of Pediatrics, University of British Columbia: Rm 2D19, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
- British Columbia Children's Hospital Research Institute, F503, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
- BC Injury Research and Prevention Unit, F508, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
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Lee C, Hanly M, Larter N, Zwi K, Woolfenden S, Jorm L. Demographic and clinical characteristics of hospitalised unintentional poisoning in Aboriginal and non-Aboriginal preschool children in New South Wales, Australia: a population data linkage study. BMJ Open 2019; 9:e022633. [PMID: 30705236 PMCID: PMC6359875 DOI: 10.1136/bmjopen-2018-022633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To investigate differences in demographic and clinical characteristics of Aboriginal and non-Aboriginal children aged 0-4 years hospitalised for unintentional poisoning in New South Wales (NSW), Australia. DESIGN AND SETTING Retrospective whole-of-population cohort analysis of linked hospital and mortality data for 2000-2014. PARTICIPANTS All children (Aboriginal and non-Aboriginal) under the age of 5 years who were born in a hospital in NSW from 2000 to 2009. OUTCOMES The primary outcome was hospitalisation for unintentional poisoning. Logistic regression was used to estimate odds of poisoning hospitalisation for Aboriginal and non-Aboriginal children. Poisoning agents and clinical outcomes were compared by Aboriginality. RESULTS The cohort included 767 119 children, including 28 528 (3.7%) Aboriginal children. Aboriginal children had approximately three times higher rates of hospitalised poisoning (1.34%) compared with non-Aboriginal children (0.41%). Poisoning incidence peaked at 2-3 years of age. Male sex, socioeconomic disadvantage and geographical remoteness were associated with higher odds of poisoning hospitalisation for Aboriginal and non-Aboriginal children, but associations with disadvantage and remoteness were statistically significant only for non-Aboriginal children. Most (83%) poisonings were caused by pharmaceutical agents. Few Aboriginal and non-Aboriginal children had repeat admissions for poisoning; most had a length of stay of 1 day or less. Only 8% of poisoning admissions involved contact with a social worker. CONCLUSION Commonly used medications in the general population contribute to poisonings among both Aboriginal and non-Aboriginal preschool-aged children. This study highlights a need to develop culturally safe poisoning prevention strategies and policies.
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Affiliation(s)
- Caroline Lee
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Hanly
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Natasha Larter
- Department of Community Child Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Karen Zwi
- Department of Community Child Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Susan Woolfenden
- Department of Community Child Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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Violano P, Aysseh N, Lucas M, Gawel M, Morrell P, Norway C, Alfano A, Bechtel K. Feasibility of providing child restraint devices after a motor vehicle crash in a pediatric emergency department. TRAFFIC INJURY PREVENTION 2019; 19:844-848. [PMID: 30657709 DOI: 10.1080/15389588.2018.1496243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 05/17/2018] [Accepted: 06/28/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Motor vehicle crashes (MVCs) cause disproportionate childhood morbidity and mortality. Ensuring that children are placed in appropriate child restraint devices (CRDs) would significantly reduce injuries and deaths as well as medical costs. The goal of the study is to evaluate the feasibility of providing child restraint devices after an MVC in a pediatric emergency department (PED). METHODS A guideline was developed to assess the need for CRDs for patients discharged from a PED after an MVC. Providers were educated on the use of the guideline. Caregivers were provided a brief educational intervention on legislation, proper installation, and best practices prior to distribution of a CRD. Quality assurance was conducted weekly to monitor for any missed opportunities. RESULTS From August 31, 2015, to August 31, 2016, 291 patients <7 years were evaluated in the PED of a level 1 trauma center following an MVC. Two hundred forty-seven children were correctly identified according to the guidelines (84.9%). Of these, 187 (75.7%) were identified as not requiring a replacement seat and 60 (24.3%) required a CRD replacement based on crash mechanisms and restraint use status and received a CRD replacement. Of the remaining 44 children, 38 (86.4%) whose crash mechanisms were severe enough or who were inappropriately restrained were not provided a CRD and thus missed; 6 (13.6%) received a replacement seat even though criteria were not met. Thus, PED providers correctly identified 61.2% (60/98) of children who required CRD replacement after an MVC. CONCLUSION Caring for children who present for evaluation after an MVC offers an opportunity for ED personnel to provide education to caregivers about the appropriate use of CRDs and state legislation. Establishing guidelines for the provision of a CRD for children who present to an ED following an MVC may help to improve the safety of children being transported in motor vehicles. Having a systematic process and adequate supply of CRDs readily available contributes to the success of children being discharged with the appropriate age- and weight-based CRD after being treated in an ED following an MVC.
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Affiliation(s)
- Pina Violano
- a Injury Prevention, Community Outreach & Research, Yale New Haven Hospital , New Haven , Connecticut
- b Injury Free Coalition for Kids of New Haven, Yale New Haven Children's Hospital , New Haven , Connecticut
| | - Nick Aysseh
- a Injury Prevention, Community Outreach & Research, Yale New Haven Hospital , New Haven , Connecticut
- b Injury Free Coalition for Kids of New Haven, Yale New Haven Children's Hospital , New Haven , Connecticut
| | - Monica Lucas
- a Injury Prevention, Community Outreach & Research, Yale New Haven Hospital , New Haven , Connecticut
- b Injury Free Coalition for Kids of New Haven, Yale New Haven Children's Hospital , New Haven , Connecticut
| | - Marcie Gawel
- a Injury Prevention, Community Outreach & Research, Yale New Haven Hospital , New Haven , Connecticut
- b Injury Free Coalition for Kids of New Haven, Yale New Haven Children's Hospital , New Haven , Connecticut
| | - Patricia Morrell
- c Trauma Department , Yale New Haven Hospital , New Haven , Connecticut
| | - Calvin Norway
- a Injury Prevention, Community Outreach & Research, Yale New Haven Hospital , New Haven , Connecticut
- c Trauma Department , Yale New Haven Hospital , New Haven , Connecticut
| | - April Alfano
- d Emergency Operations Center, Yale New Haven Health System , New Haven , Connecticut
| | - Kirsten Bechtel
- a Injury Prevention, Community Outreach & Research, Yale New Haven Hospital , New Haven , Connecticut
- b Injury Free Coalition for Kids of New Haven, Yale New Haven Children's Hospital , New Haven , Connecticut
- e Department of Pediatrics , Yale School of Medicine , New Haven , Connecticut
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Beno S, Ackery A, Colaco K, Boutis K. Parental Knowledge of Trampoline Safety in Children. Acad Pediatr 2018; 18:166-171. [PMID: 28414102 DOI: 10.1016/j.acap.2017.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/20/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Recreational trampoline use is increasing in popularity, with a resulting increase in significant trampoline-related injuries in children. Parents are the best advocates for the safety of their children during recreational trampoline use. Our primary objective was to determine the proportion of parents who were aware of 5 key recommendations for safer recreational trampoline use in children. METHODS This was a cross-sectional survey of parents whose children presented to a tertiary care pediatric emergency department with an extremity injury. Survey questions were derived and validated using expert opinion, available literature, and pre- and pilot testing of questions on the target audience. RESULTS Of the 1415 enrolled parents, 654 (46.2%) had regular access to a trampoline and 125 (8.8%) of their children had a history of trampoline injury. A total of 116 (8.2%; 95% confidence interval, 6.8-9.6) parents were aware of all 5 key safety recommendations for home trampoline use. Specifically, the proportion of parents who reported knowledge of the requirement for active supervision, regularly inspected safety equipment, avoiding stunts, multiple jumpers, and use by children 6 years of age and older was 89.0%, 77.2%, 44.3%, 41.6%, and 18.3%, respectively. CONCLUSIONS Trampoline safety knowledge of the 5 key recommendations among parents was low, specifically with respect to recommended age, number of jumpers, and stunts. Because it is unlikely that use of recreational trampolines will decrease, a harm reduction approach that includes a public knowledge translation strategy of recommendations for safer home use of trampolines is necessary.
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Affiliation(s)
- Suzanne Beno
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
| | - Alun Ackery
- Division of Emergency Medicine, Department of Medicine, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Keith Colaco
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Kathy Boutis
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
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McKenzie LB, Roberts KJ, Kaercher RM, Collins CL, Comstock RD, Fernandez S, Abdel-Rasoul M, Casavant MJ, Mihalov L. Paediatric emergency department-based carbon monoxide detector intervention: a randomised trial. Inj Prev 2016; 23:314-320. [PMID: 28007971 DOI: 10.1136/injuryprev-2016-042039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 10/03/2016] [Accepted: 11/04/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although non-fire-related carbon monoxide (CO) poisoning is almost entirely preventable, over 400 people die and 20 000 people are injured each year in the USA from unintentional CO poisoning. Thus, there is a critical need for evidence-based interventions for preventing CO poisoning and increasing the proper use and installation of CO detectors. METHODS A randomised, controlled trial (Project CODE, a Carbon Monoxide Detector Education intervention) with 2-week and 6-month follow-up home observations was conducted in 299 parents of children aged ≤18 years recruited in the emergency department of a level 1 paediatric trauma centre. The intervention group received an educational tool, a spiral-bound, laminated booklet that resembled a CO detector containing theory-based safety messages based on the precaution adoption process model, a plug-in CO detector and 9 V battery. The control group received a one page flyer on CO poisoning prevention. RESULTS Although the difference was not statistically significant, mean CO knowledge score increased at a greater rate for the intervention group than the control group. Intervention group parents were more likely to exhibit 'safe' CO detector use than control group parents at the 2-week follow-up (RR: 2.75; 95% CI 2.06 to 3.69) and 6-month follow-up (RR: 2.78; 95% CI 2.06 to 3.76), after adjusting for self-reported CO detector use behaviour at enrolment and annual per capita income. CONCLUSIONS An emergency department-delivered intervention containing a theory-based educational tool paired with a CO detector can be an effective method for increasing knowledge about CO poisoning, for prevention and for appropriate use of a CO detector. TRIAL REGISTRATION NUMBER NCT00959478.
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Affiliation(s)
- Lara B McKenzie
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Kristin J Roberts
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Roxanne M Kaercher
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - R Dawn Comstock
- Dept. of Epidemiology, Colorado School of Public Health and Dept. of Pediatrics, Emergency Medicine, School of Medicine, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Soledad Fernandez
- Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | | | - Marcel J Casavant
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Leslie Mihalov
- Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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Abstract
OBJECTIVE The aim of the study was to describe grill-related injuries in pediatric patients seeking emergency treatment. METHODS Data from the National Electronic Injury Surveillance System from 1990 through 2009 were investigated. Sample weights were used to calculate national estimates. United States Census Bureau data were used to calculate injury rates per 100,000 individuals. Linear regression and computation of relative risks (RRs) with 95% confidence intervals (CIs) were performed. RESULTS An estimated 308,560 children were treated in US emergency departments for grill-related injuries during the study period, with an average of 15,428 cases per year. The rate of injuries increased by 32.3% during the study period. Males (62.8%) and children aged 11 to 18 years (55.8%) sustained the largest number of injuries. Children younger than 5 years were more likely to injure the head and neck (RR, 1.26 [95% CI, 1.21-1.33]), be injured by impact with a grill (RR, 1.97 [95% CI, 1.88-2.07]), and sustain burns (RR, 1.39 [95% CI, 1.35-1.45]) when compared with other age groups. Children aged 11 to 18 years were more likely to experience a fracture or dislocation (RR, 2.07 [95% CI, 1.58-2.72]) and more likely to sustain a grill-related injury while the grill was not in use (RR, 7.95 [95% CI, 6.25-10.12]). CONCLUSIONS The rate of grill-related injuries among children is increasing, which underscores the need for increased prevention efforts. Prevention strategies should address measures such as lighting a grill and grill location in addition to burn prevention.
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Emergency physicians as human billboards for injury prevention: a randomized controlled trial. CAN J EMERG MED 2016; 19:277-284. [PMID: 27628210 DOI: 10.1017/cem.2016.366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the impact of a novel injury prevention intervention designed to prompt patients to initiate an injury prevention discussion with the ED physician, thus enabling injury prevention counselling and increasing bicycle helmet use among patients. METHODS A repeated measures 2 x 3 randomized controlled trial design was used. Fourteen emergency physicians were observed for two shifts each between June and August 2013. Each pair of shifts was randomized to either an injury prevention shift, during which the emergency physician would wear a customized scrub top, or a control shift. The outcomes of interest were physician time spent discussing injury prevention, current helmet use, and self-reported change in helmet use rates at one year. Logistic regression analyses were used to examine the impact of the intervention. RESULTS The average time spent on injury prevention for all patients was 3.3 seconds. For those patients who actually received counselling, the average time spent was 17.0 seconds. The scrub top intervention did not significantly change helmet use rates at one year. The intervention also had no significant impact on patient decisions to change or reinforcement of helmet use. CONCLUSIONS Our study showed that the intervention did not increase physician injury prevention counselling or self-reported bicycle helmet use rates among patients. Given the study limitations, replication and extension of the intervention is warranted.
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Abstract
Amber teething necklaces supposedly provide analgesia for teething infants. Their use is becoming more widespread, despite lack of peer-reviewed evidence and warnings from Health Canada that they pose a strangulation and aspiration risk. To date, there have been no published reports of strangulation secondary to amber teething necklaces. In this report we present a case of non-fatal infant strangulation from the first time use of an amber teething necklace. We will also discuss the role of physicians as advocates in reporting similar cases and educating families. Finally, we will comment on the responsibility of all professionals and professional organizations that work with infants and toddlers to advocate for children by raising concerns and counselling parents.
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Cutler GJ, Flood A, Dreyfus J, Ortega HW, Kharbanda AB. Emergency Department Visits for Self-Inflicted Injuries in Adolescents. Pediatrics 2015; 136:28-34. [PMID: 26077475 DOI: 10.1542/peds.2014-3573] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe emergency department (ED) visits for self-inflicted injury (SII) among adolescents, examine trends in SII mechanisms, and identify factors associated with increased risk. METHODS Analyses included patients aged 10 to 18 years from the National Trauma Data Bank, years 2009 to 2012. We used Cochran-Armitage trend tests to examine change over time and generalized linear models to identify risk factors for SII. RESULTS We examined 286,678 adolescent trauma patients, 3664 (1.3%) of whom sustained an SII. ED visits for SII increased from 2009 to 2012 (1.1% to 1.6%, P for trend ≤ .001), whereas self-inflicted firearm visits decreased (27.3% to 21.9%, P for trend = .02). The most common mechanism in males was firearm (34.4%), and in females, cut/pierce (48.0%). Odds of SII were higher in females (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.13-1.77), older adolescents (OR 2.73, 95% CI 2.38-3.14), adolescents with comorbid conditions (OR 1.64; 95% CI 1.49-1.80), and Asian adolescents (OR 1.67, 95% CI 1.35-2.08) and lower in African American adolescents (OR 0.78, 95% CI 0.70-0.87). Adolescents in the public or self-pay insurance category had higher odds of SII (OR 1.44, 95% CI 1.27-1.64) than those in the private insurance category (OR 1.15, 95% CI 1.01-1.31). Adolescents with an SII had higher odds of death than those with other injuries (OR 12.9, 95% CI 6.78-24.6). CONCLUSIONS We found a significant increase in the number of SIIs by adolescents that resulted in ED visits from 2009 to 2012. Although SIIs increased, we found a significant decrease in the percentage of adolescents who self-injured with a firearm. SIIs reflect a small percentage of ED visits, but these patients have dramatically higher odds of death.
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Affiliation(s)
| | - Andrew Flood
- Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Jill Dreyfus
- Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
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Kelley-Quon LI, Crowley MA, Applebaum H, Cummings K, Kang RJ, Tseng CH, Mangione CM, Shew SB. Academic-community partnerships improve outcomes in pediatric trauma care. J Pediatr Surg 2015; 50:1032-6. [PMID: 25812442 DOI: 10.1016/j.jpedsurg.2015.03.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/10/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND To address the specialized needs of injured children, pediatric trauma centers (PTCs) were established at many large, academic hospitals. This study explores clinical outcomes observed for injured children treated at an academic-sponsored community facility. METHODS In partnership with an academic medical center in a major metropolitan area, a not-for-profit community hospital became a designated Level II PTC in October 2010. Data for injured children <15 years old treated prior to PTC designation from January 2000 to September 2010 were prospectively collected using the Trauma and Emergency Medicine Information System and compared to data collected after PTC designation from January 2011 to December 2013. RESULTS Overall, 681 injured children were treated at the community hospital from January 2011 to December 2013. Children treated after PTC designation were less likely to undergo computed tomography (CT) (50.9% vs. 81.3%, p<0.01), even when controlling for age, gender, injury type, injury severity, and year (OR 0.18, 95%CI 0.08-0.37). Specifically, fewer head (45.7% vs. 68.7%, p<0.01) and abdominal CTs (13.2% vs. 26.5%, p<0.01) were performed. Hospital length of stay was significantly shorter (2.8 ± 3.7 days vs. 3.7 ± 5.9 days, p<0.01). Mortality was low overall, but also decreased after PTC designation (0.4% vs. 2.0%, p=0.02). CONCLUSIONS These results indicate that academic-community partnerships in pediatric trauma care are a feasible alternative and may lead to improved outcomes for injured children.
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Affiliation(s)
- Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Department of Surgery, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS Bldg., MC 957098, Los Angeles, CA, USA, 90095-7098; Robert Wood Johnson Foundation Clinical Scholars, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 10940 Wilshire Blvd. Ste 710, Los Angeles, CA, USA, 90095-7394.
| | - Melanie A Crowley
- Trauma Department, Northridge Hospital Medical Center - Richie Pediatric Trauma Center, 18300 Roscoe Boulevard, Northridge, CA, USA, 91328.
| | - Harry Applebaum
- Division of Pediatric Surgery, Department of Surgery, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS Bldg., MC 957098, Los Angeles, CA, USA, 90095-7098; Trauma Department, Northridge Hospital Medical Center - Richie Pediatric Trauma Center, 18300 Roscoe Boulevard, Northridge, CA, USA, 91328.
| | - Katie Cummings
- Trauma Department, Northridge Hospital Medical Center - Richie Pediatric Trauma Center, 18300 Roscoe Boulevard, Northridge, CA, USA, 91328.
| | - Richard J Kang
- Pediatrics Department, Northridge Hospital Medical Center - Richie Pediatric Trauma Center, 18300 Roscoe Boulevard, Northridge, CA, USA, 91328.
| | - Chi-Hong Tseng
- Robert Wood Johnson Foundation Clinical Scholars, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 10940 Wilshire Blvd. Ste 710, Los Angeles, CA, USA, 90095-7394.
| | - Carol M Mangione
- Robert Wood Johnson Foundation Clinical Scholars, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 10940 Wilshire Blvd. Ste 710, Los Angeles, CA, USA, 90095-7394; David Geffen School of Medicine, University of California, Los Angeles, Jonathan and Karin Fielding School of Public Health, 10940 Wilshire Blvd Ste 700, Los Angeles, CA, USA, 90095-7394.
| | - Stephen B Shew
- Division of Pediatric Surgery, Department of Surgery, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS Bldg., MC 957098, Los Angeles, CA, USA, 90095-7098; Trauma Department, Northridge Hospital Medical Center - Richie Pediatric Trauma Center, 18300 Roscoe Boulevard, Northridge, CA, USA, 91328.
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Vlodaver Z, Ortega HW, Arms J, Vander Velden H, Smith GA. Throw rug-related injuries treated in US EDs: are children the same as adults? Am J Emerg Med 2014; 32:1494-8. [PMID: 25294409 DOI: 10.1016/j.ajem.2014.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/10/2014] [Accepted: 09/13/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Various characteristics of floors and floor coverings are well established as injury hazards. Loose carpeting, such as rugs, is often cited as a hazard leading to injury. PURPOSE To describe the epidemiology and patterns of rug, mat, and runner-related injuries in patients seeking emergency treatment. METHODS Data from the National Electronic Injury Surveillance System from 1990 through 2009 were investigated. Sample weights were used to calculate national estimates. US Census Bureau data were used to calculate injury rates per 100 000 individuals. Linear regression and computation of relative risks (RRs) with 95% confidence intervals (CIs) were performed. RESULTS An estimated 245 605 patients were treated in US emergency departments for rug-related injuries during the study period, with an average of 12 280 cases per year. Females (72.3%) and individuals older than 64 years (47.1%) sustained the largest number of injuries. Patients younger than 6 years were more likely to injure the head or neck region (RR, 3.52 [95% CI, 3.26-3.81]) compared with all other groups. Patients older than 18 years were more likely to experience a fracture or dislocation (RR, 2.52 [95% CI, 2.13-2.88]) and sustain an injury as a result of tripping or slipping on a rug (RR, 1.36 [95% CI, 1.26-1.41] compared with other age groups. Increasing age was associated with increased risk of hospitalization in this study. Patients who sustained an injury from a rubber or plastic mat/rug were significantly less likely to be admitted (RR, 0.67 [95% CI, 0.55-0.83]). Injuries occurring in kitchens or bathrooms resulted in significantly higher admission rates (RR, 1.45 [95% CI, 1.34-1.54]). CONCLUSIONS Rug-related injuries are an important source of injury for individuals of all ages.
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Affiliation(s)
- Zlata Vlodaver
- Emergency Services, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN, 55404, USA
| | - Henry W Ortega
- Emergency Services, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN, 55404, USA.
| | - Joseph Arms
- Emergency Services, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN, 55404, USA
| | - Heidi Vander Velden
- Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Gary A Smith
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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