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Carey A, Starkweather A, Bai A, Horgas A, Cho H, Beneciuk JM. Emergency Department Discharge Teaching Interventions: A Scoping Review. J Emerg Nurs 2024; 50:444-462. [PMID: 38323972 DOI: 10.1016/j.jen.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/17/2023] [Accepted: 12/24/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Emergency department discharge education is intended to provide patients with information to self-manage their condition or injury, identify potential complications, and follow-up or referral. However, most patients cannot recall the discharge information provided, leading to adverse clinical outcomes, return visits, and higher costs. A scoping review was undertaken to explore discharge education interventions that have been studied in the emergency department setting and outcomes that have been used to evaluate the effectiveness of the interventions. METHODS A literature review was conducted using the databases PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature, and Education Resources Information Center, with search terms focused on emergency nursing and patient discharge education interventions. RESULTS Of the publications identified, 18 studies met the inclusion criteria. There was variation among studies on the conditions/injuries and populations of focus for the intervention. The interventions were categorized by learning styles, including auditory (n=10), kinesthetic (n=1), visual (n=15), reading/writing (n=1), and multimodal (n=7). Outcomes evaluated included those that were patient-specific (education, self-management, clinical, and adherence) and metrics of the health system and public health. DISCUSSION Multimodal discharge education that addresses various learning styles and levels of health literacy improved patient education, self-management, and clinical outcomes. Additional support and reminders improved patient adherence. Identified gaps included limited kinesthetic interventions and culturally tailored education. Translational science for advancing sustainable interventions in clinical practice is needed to enhance the emergency department discharge process and patient, system, and public health outcomes.
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Chen SY, Garcia I, Ourshalimian S, Lowery C, Chaudhari PP, Spurrier RG. Childhood opportunity and appropriate use of child safety restraints in motor vehicle collisions. WORLD JOURNAL OF PEDIATRIC SURGERY 2024; 7:e000703. [PMID: 38571719 PMCID: PMC10989117 DOI: 10.1136/wjps-2023-000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/01/2024] [Indexed: 04/05/2024] Open
Abstract
Objectives Safety restraints reduce injuries from motor vehicle collisions (MVCs) but are often improperly applied or not used. The Childhood Opportunity Index (COI) reflects social determinants of health and its study in pediatric trauma is limited. We hypothesized that MVC patients from low-opportunity neighborhoods are less likely to be appropriately restrained. Methods A retrospective cross-sectional study was performed on children/adolescents ≤18 years old in MVCs between January 1, 2011 and December 31, 2021. Patients were identified from the Children's Hospital Los Angeles trauma registry. The outcome was safety restraint use (appropriately restrained, not appropriately restrained). COI levels by home zip codes were stratified as very low, low, moderate, high, and very high. Multivariable regression controlling for age identified factors associated with safety restraint use. Results Of 337 patients, 73.9% were appropriately restrained and 26.1% were not appropriately restrained. Compared with appropriately restrained patients, more not appropriately restrained patients were from low-COI (26.1% vs 20.9%), high-COI (14.8% vs 10.8%) and very high-COI (10.2% vs 3.6%) neighborhoods. Multivariable analysis demonstrated no significant associations in appropriate restraint use and COI. There was a non-significant trend that children/adolescents from moderate-COI neighborhoods were more likely than those from very low-COI neighborhoods to be appropriately restrained (OR=1.82, 95% CI 0.78, 4.28). Conclusion Injury prevention initiatives focused on safety restraints should target families of children from all neighborhood types. Level of evidence III.
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Affiliation(s)
- Stephanie Y Chen
- Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Iris Garcia
- Injury Prevention Program, Children's Hospital Los Angeles, Los Angeles, California, USA
| | | | - Chantel Lowery
- Injury Prevention Program, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Pradip P Chaudhari
- Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
- Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ryan G Spurrier
- Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA
- Surgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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Kumar V, Barik S, Raj V, Varshney S. Prevention of "bygone futures" due to road traffic injuries in children. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02378-7. [PMID: 37870567 DOI: 10.1007/s00068-023-02378-7] [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: 08/03/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
Road traffic injuries remain one of the common and leading causes of death among children and adolescents till the age of 19 years. Road safety is important for children since their physical activity, active travel, independence and development are largely affected by it. Solutions for road safety with benefits for people as well as an economy exist which should be implemented effectively and efficiently. These solutions which combine engineering, legislation and behavioural interventions should be implemented in an integrated Safe Systems Approach. The future of the children must be safeguarded from these injuries and every effort towards it being converted into "bygone figures" must be done diligently and honestly. The various risk factors and interventions possibly explained in this review article shall help in better understanding of the causes and possible guidelines at a policy level to prevent road traffic injuries in children.
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Affiliation(s)
- Vishal Kumar
- Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| | - Sitanshu Barik
- Orthopedics, All India Institute of Medical Sciences, Deoghar, India.
| | - Vikash Raj
- Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| | - Saurabh Varshney
- Orthopedics, All India Institute of Medical Sciences, Deoghar, India
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Sun YR, Liu T, Ran N, Chen JY, Niu YS, Wang X, Luo Y, Lu MQ, Yang XL. Assessment of the effectiveness of parent-targeted interventions for the use of child restraint systems: a systematic review and meta-analysis. Transl Pediatr 2022; 11:1939-1948. [PMID: 36643670 PMCID: PMC9834943 DOI: 10.21037/tp-22-560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND It is essential to implement parent-targeted interventions to increase the use of child restraint systems (CRS) and thus reduce the injuries and deaths of children due to motor vehicle collisions. To optimize future intervention designs, this meta-analysis sought to quantify the effects of parent-targeted interventions and explore potential intervention moderators. METHODS Studies met inclusion criteria if they included a parents-targeted intervention that focused on increasing CRS use for children, published from the inception of the databases to January 2022, were systematically retrieved from the PubMed, Embase, Cochrane library, Web of Science, Sinomed, Wanfang, and CNKI databases. Next, 2 researchers independently screened the retrieved articles, evaluated their quality according to the Cochrane Tool, and extracted the data. Finally, Stata12.0 was used for the meta-analysis. Heterogeneity was examined with I2, stratified analyses, and meta-regression. RESULTS Of the 1,690 articles retrieved, 9 studies, comprising 22,329 parents of children aged 0-12 years, were ultimately included in the analysis. The results of the meta-analysis showed that the CRS use rate of the intervention group was 1.62 times higher than that of the control group [95% confidence interval (CI): 1.25-2.11, Z=3.616, P<0.001], indicating the positive effect of parent-targeted interventions on promoting the use of CRS. The subgroup analysis found that interventions guided by behavioral theories increased the use of CRS (odds ratio: 1.44, 95% CI: 1.27-1.63, n=5). The difference in the use of CRS between the groups in the studies that were not guided by theories was not statistically significant, indicating that interventions guided by behavioral theories may be the source of the heterogeneity. Risk of bias was low in most studies. CONCLUSIONS It is necessary to conduct interventions with parents to increase the use of CRS. The effects on CRS use appear to differ depending on whether the interventions are guided by behavioral theories. In-depth research needs to be conducted to explore the characteristics of the interventions, especially those guided by different behavioral theories, to reduce child vehicle injuries.
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Affiliation(s)
- Ya-Ru Sun
- Department of Nursing, School of Nursing, Qingdao University, Qingdao, China
| | - Ting Liu
- Department of Nursing, School of Nursing, Qingdao University, Qingdao, China
| | - Ni Ran
- Department of Child Prevention and Health Care, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jun-Yu Chen
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Yu-Shuo Niu
- Department of Hepatobiliary Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Qingdao, China
| | - Xin Wang
- Department of Nursing, School of Nursing, Qingdao University, Qingdao, China
| | - Ying Luo
- Department of Nursing, School of Nursing, Qingdao University, Qingdao, China
| | - Ming-Qin Lu
- Department of Nursing, School of Nursing, Qingdao University, Qingdao, China
| | - Xiu-Ling Yang
- Department of Nursing, School of Nursing, Qingdao University, Qingdao, China
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Adequacy of Emergency Department Documentation of Child Restraint Use After a Motor Vehicle Crash. Pediatr Emerg Care 2022; 38:686-691. [PMID: 36449738 DOI: 10.1097/pec.0000000000002589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There are limited data on how often providers collect and document adequate restraint information in children seen in the emergency department (ED) after motor vehicle crashes (MVCs). The objectives of this study are to determine (1) how often adequate child restraint information to determine age-appropriate use is documented after MVC; (2) the frequency of incorrect use of the child restraint when adequate details are documented; and (3) for those discharged from the ED with identified incorrect use, the frequency of provision of information on child passenger safety (CPS). METHODS Retrospective chart review of visits of children younger than 13 years with an International Classification of Diseases, Tenth Revision code for MVC to an urban, academic, level 1 pediatric trauma center, from October 2015 to September 2018. Adequate documentation of child restraint use was defined as identification of location of the child in the car (front vs rear row), type of restraint used, and forward or rear facing for children 24 months or younger. RESULTS A total of 165 visits qualified for inclusion. There was adequate documentation in 46% of visits. Of those, incorrect child restraint use was identified in 49%. Of discharged patients with incorrect use, 10% had documentation of provision of CPS information. CONCLUSIONS Adequate details to determine proper age-appropriate restraint use are documented in only half of ED visits for MVC. Very few are given CPS instructions on discharge, even when incorrect use has been identified. Identification of incorrect restraint use in the ED is an opportunity for a teachable moment that is being underused.
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Kappy B, Edmunds K, Frey M, Zhang Y, Boyd S, Looman K, Pomerantz WJ, Hanke S, Kerrey B. Emergency Department Visits Before Sudden Unexpected Infant Death: A Touchpoint for Unsafe Sleep Reduction. Acad Pediatr 2022; 22:1065-1072. [PMID: 35307602 DOI: 10.1016/j.acap.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Unsafe sleep remains a leading cause of preventable sudden unexpected infant death (SUID). Infants frequently visit emergency departments (EDs), but the frequency of visits before SUID is unknown. The objective of this study was to determine how often SUID infants visited a pediatric ED or urgent care (UC) before death. METHODS We performed a retrospective study of infant deaths in the county of a large, academic pediatric institution. We linked institutional records with coroner reports and death scene investigations. We excluded deaths associated with childbirth, prematurity, injury, or underlying medical condition. We characterized all SUID infants, focusing on unsafe sleep factors detailed in the medical record and scene reports. The main outcome was ED/UC visit(s) before the visit for SUID. RESULTS Seventy-three of 122 infant deaths met inclusion criteria for SUID over 76 months (April 2014-July 2020). Median age at death was 87 days (IQR 58, 137); 68 (93%) died before 6 months-of-age. Twenty infants (27%) had an ED/UC visit before SUID; mean visits for these infants were 1.7 (SD 0.8). Median days between the last ED/UC visit and SUID was 39; five infants visited the ED/UC within 2 weeks of SUID. Most visits were for minor medical conditions. All 73 SUID infants had at least one unsafe sleep factor; 88% had ≥2 and 56% ≥3. CONCLUSIONS Many SUID infants visited a pediatric ED/UC before death, and unsafe sleep factors were found in every case. Early infancy ED/UC visits may present an opportunity for targeted prevention efforts.
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Affiliation(s)
- Brandon Kappy
- Division of Emergency Medicine (B Kappy, K Edmunds, M Frey, Y Zhang, S Boyd, WJ Pomerantz, and B Kerrey), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Katherine Edmunds
- Division of Emergency Medicine (B Kappy, K Edmunds, M Frey, Y Zhang, S Boyd, WJ Pomerantz, and B Kerrey), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (K Edmunds, WJ Pomerantz, B Kerrey and S Hanke), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mary Frey
- Division of Emergency Medicine (B Kappy, K Edmunds, M Frey, Y Zhang, S Boyd, WJ Pomerantz, and B Kerrey), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Yin Zhang
- Division of Emergency Medicine (B Kappy, K Edmunds, M Frey, Y Zhang, S Boyd, WJ Pomerantz, and B Kerrey), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephanie Boyd
- Division of Emergency Medicine (B Kappy, K Edmunds, M Frey, Y Zhang, S Boyd, WJ Pomerantz, and B Kerrey), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Karen Looman
- Hamilton County Coroner's Office (K Looman), Cincinnati, Ohio; Department of Pathology and Laboratory Medicine (K Looman), University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Wendy J Pomerantz
- Division of Emergency Medicine (B Kappy, K Edmunds, M Frey, Y Zhang, S Boyd, WJ Pomerantz, and B Kerrey), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (K Edmunds, WJ Pomerantz, B Kerrey and S Hanke), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Samuel Hanke
- Department of Pediatrics (K Edmunds, WJ Pomerantz, B Kerrey and S Hanke), University of Cincinnati College of Medicine, Cincinnati, Ohio; Heart Institute, Cincinnati Children's Hospital Medical Center (S Hanke), Cincinnati, Ohio
| | - Benjamin Kerrey
- Division of Emergency Medicine (B Kappy, K Edmunds, M Frey, Y Zhang, S Boyd, WJ Pomerantz, and B Kerrey), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (K Edmunds, WJ Pomerantz, B Kerrey and S Hanke), University of Cincinnati College of Medicine, Cincinnati, Ohio
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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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Kendi S, Winkels JL, Chamberlain JM, Macy ML. An Adapted Child Safety Seat Hassles Score Is Associated With Suboptimal Child Passenger Safety Behaviors Among Parents. Acad Pediatr 2021; 21:892-899. [PMID: 33577991 DOI: 10.1016/j.acap.2021.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We modified the Child Safety Seat (CSS) Hassles Scale to characterize CSS hassles in a diverse population and test for associations between hassles and caregiver-reported child passenger safety behaviors. METHODS Secondary analysis of a 2-site survey of caregivers seeking emergency care for their ≤10-year-old child in 2015. Caregivers answered questions regarding CSS hassles, child passenger safety behaviors, and demographics. Size-appropriate restraint use was defined by the American Academy of Pediatrics (AAP) 2011 Guidelines for Child Passenger Safety. We tested for associations between the number of hassles and adherence to AAP guidelines (including the consistent use of a size-appropriate CSS, travel in a back seat, and never traveling unrestrained). RESULTS There were 238 caregivers included in analyses. Overall, caregivers endorsed a median of 5 hassles (interquartile range 2, 8). Half (50.8%) of caregivers endorsed child passenger safety behaviors that were nonadherent to AAP guidelines. Compared with caregivers reporting no hassles, there was an increased odds of not adhering to AAP child passenger safety guidelines for each additional hassle reported (adjusted odds ratio [aOR] 1.11; 95% confidence interval [CI] 1.03, 1.19). In addition, a higher number of hassles was associated with the inconsistent use of a size-appropriate CSS (aOR 1.15; 95% CI 1.06, 1.25) and as sometimes traveling unrestrained (aOR 1.13; 95% CI 1.03, 1.23). CONCLUSIONS Caregivers who reported more CSS hassles were more likely to report behaviors that were not adherent to AAP guidelines. Addressing CSS hassles may provide solutions for nonadherence of AAP child passenger safety guidelines.
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Affiliation(s)
- Sadiqa Kendi
- Children's National Medical Center (S Kendi and JM Chamberlain), Washington, DC; George Washington University School of Medicine and Health Sciences (S Kendi and JM Chamberlain), Washington, DC.
| | - Jessica L Winkels
- University of Michigan Medical School (JL Winkels), Ann Arbor, Mich; Department of Emergency Medicine, Washington University St. Louis (JL Winkels), St. Louis, Mo
| | - James M Chamberlain
- Children's National Medical Center (S Kendi and JM Chamberlain), Washington, DC; George Washington University School of Medicine and Health Sciences (S Kendi and JM Chamberlain), Washington, DC
| | - Michelle L Macy
- Department of Emergency Medicine, Michigan Medicine (ML Macy), Ann Arbor, Mich; Division of General Pediatrics, The Susan B. Meister Child Health Evaluation and Research (CHEAR) Unit, Michigan Medicine (ML Macy), Ann Arbor, Mich; University of Michigan Injury Prevention Center (ML Macy), Ann Arbor, Mich; Ann & Robert H. Lurie Children's Hospital of Chicago (ML Macy), Chicago, Ill; Northwestern University Feinberg School of Medicine (ML Macy), Chicago, Ill. Dr Kendi is now with Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Mass
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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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