Emergency Department Visits for Injury in School-aged Children in the United States: A Comparison of Nonfatal Injuries Occurring Within and outside of the School Environment

Objectives: To compare the demographic and injury characteristics of children visiting the emergency department (ED) for nonfatal injuries occurring at school with those of same‐aged children who were injured outside of school. Methods: Data from a stratified probability sample of U.S. hospitals providing emergency services in the National Electronic Injury Surveillance System (NEISS) were analyzed for 2001 and 2002. School and nonschool injury‐related ED visits were analyzed for patients who were 5 through 19 years of age. Results: There were an estimated 58,147,518 injury visits in all ages to the ED in 2001 and 2002. Injuries to school‐aged children (ages 5–19) accounted for an estimated 15,405,392 (26%) visits overall, of which 1,859,215 occurred at school (16.5% of visits by school‐aged children when location of injury was known). Males accounted for 63% of injuries at school; middle‐school children (ages 10–14 yr) accounted for a significantly greater proportion of injuries (46%) than did primary‐ (5–9 yr, 24%) or secondary‐school (15–19 yr, 30%) children (p < 0.001). In contrast, for injuries outside of school, secondary‐school children were injured most (40%), followed by middle‐ (32%) and primary‐aged children (27%). Nearly 11% of school injuries were classified as violent, whereas only 6.4% of the nonschool injuries in school‐aged children were violent (p < 0.001). Similarly, sports injuries were significantly more common at school (53% of injuries) than outside of school (32.9%; p < 0.001). Conclusions: A significant proportion of injuries to school‐aged children occur at school. Notable differences exist between the epidemiology of in‐ and out‐of‐school injuries. The nature of these injuries differs by age group. Efforts to reduce school injuries will require that these differences be examined further and incorporated into prevention initiatives.     

Sports related fractures in children in north east England

Objective—To describe the epidemiology of fractures among children seen with sports injuries in a district general hospital accident and emergency department.

Methods—A prospective study of children aged 5 to 15 years who presented with sport related fractures from 1 September 1997 to 31 August 1998.

Results—The 255 children who had sport related fractures represent 20% of children seen with sport related injuries in the 5–15 years age group during the study period. The mean age was 12 and the male to female ratio was 2:1. Overall, football, rollerblading, cycling, and netball injuries were the commonest causes of the fractures. However, among the boys, football and rollerblading injuries, and among the girls rollerblading and netball injuries, were the commonest causes of the fractures. The most common place where the injuries were sustained was in residential areas (44%) while falls accounted for 59% of the fractures. The fractures involved the upper limb in 90% of the children and the wrist (43%) and finger (23%) were the commonest sites. Rollerblading and football injuries were the commonest causes of wrist and finger fractures respectively.

Conclusion—A fifth of children who are injured during sport sustain fractures. The various factors associated with an increased incidence of sport related fractures as well as possible preventive measures are discussed.

     

A 6-month study of the efficacy and safety of tadalafil in the treatment of erectile dysfunction: a randomised, double-blind, parallel-group, placebo-controlled study in Australian men

The efficacy and safety of tadalafil for the treatment of erectile dysfunction (ED) were assessed in a 6-month, randomised, double-blind, placebo-controlled study. Australian men with mild, moderate or severe ED of organic, psychogenic or mixed aetiology were randomised to tadalafil 20 mg as needed (n = 93) or placebo (n = 47). Efficacy assessments included the international index of erectile function (IIEF) and the sexual encounter profile (SEP) diary. Tadalafil significantly improved erectile function compared with placebo (p < 0.001, all measures). At the end of the study, the mean per-patient proportion of successful sexual intercourse attempts (SEP question three) was 73.5% for patients treated with tadalafil and 26.8% for placebo-treated patients. Improved erections were reported by 78% of tadalafil-treated patients compared to 12.8% of placebo-treated patients. The most common treatment-emergent adverse events--headache and dyspepsia--were generally mild or moderate. Tadalafil was effective and well tolerated in Australian men with mild to severe ED.     

Does the Addition of Dexamethasone to Standard Therapy for Acute Migraine Headache Decrease the Incidence of Recurrent Headache for Patients Treated in the Emergency Department? A Meta‐analysis and Systematic Review of the Literature

Objectives: Neurogenic inflammation is thought to play a role in the development and perpetuation of migraine headache. The emergency department (ED) administration of dexamethasone in addition to standard antimigraine therapy has been used to decrease the incidence of recurrent headaches at 24 to 72 hours following evaluation. This systematic review details the completed trials that have evaluated the use of dexamethasone in this role. Methods: The authors searched MEDLINE, EMBASE, CINAHL, LILACS, recent emergency medicine scientific abstracts, and several prepublication trial registries for potential investigations related to the research question. The authors included studies that incorporated randomized, double‐blind, placebo‐controlled methodology and that were performed in the ED. A fixed‐effects and random‐effects model was used to obtain summary risk ratios (RRs) and 95% confidence intervals (CIs) for the self‐reported outcome of moderate or severe headache on follow‐up evaluation. Results: A pooled analysis of seven trials involving 742 patients suggests a modest but significant benefit when dexamethasone is added to standard antimigraine therapy to reduce the rate of patients with moderate or severe headache on 24‐ to 72‐hour follow‐up evaluation (RR = 0.87, 95% CI = 0.80 to 0.95; absolute risk reduction = 9.7%). The treatment of 1,000 patients with acute migraine headache using dexamethasone in addition to standard antimigraine therapy would be expected to prevent 97 patients from experiencing the outcome of moderate or severe headache at 24 to 72 hours after ED evaluation. The sensitivity analysis yielded similar results with sequential trial elimination, indicating that no single trial was responsible for the overall result. Adverse effects related to the administration of a single dose of dexamethasone were infrequent, mild, and transient. Conclusions: These results suggest that dexamethasone is efficacious in preventing headache recurrence and safe when added to standard treatment for the management of acute migraine headache in the ED.     

儿童缺铁性贫血危险因素及影响贫血程度的相关因素分析

目的对儿童缺铁性贫血(IDA)危险因素及影响贫血程度的相关因素进行分析。方法回顾性分析该院2010年1月至2015年12月收治并明确诊断为IDA的280例1~5岁患儿临床资料(IDA组),并根据其外周血血红蛋白(Hb)水平将贫血程度分为轻度、中度、重度及极重度。同时选取同期280例非贫血患儿为对照组。对可能的儿童IDA危险因素进行多因素Logistic回归分析,筛选儿童IDA的危险因素及影响贫血程度的相关因素。结果 280例IDA患儿轻度贫血者134例,占47.8%,中度贫血者122例,占43.6%,重度及极重度贫血者24例,占8.6%。家庭人均月收入、母亲孕期贫血、母亲未接受育儿指导、母亲文化程度、儿童既往病史及喂养方式是导致患儿发生IDA的危险因素。年龄、病程、母亲文化程度、孕周、出生体质量、喂养方式、儿童既往病史、母亲孕期贫血、母亲未接受育儿指导与贫血严重程度有关(P0.05)。年龄、孕周、出生体质量、儿童既往病史是影响IDA患儿贫血程度的相关因素。结论对于儿童IDA应着重以预防为主,应加大儿童营养保健知识宣教普及力度,定期培训基层儿童保健医护人员,同时制订符合我国儿童饮食特点及含铁丰富食物饮食方案,以降低儿童IDA发病率。     

Best Guess method for age-based weight estimation in paediatric emergencies: validation and comparison with current methods

Background: During paediatric resuscitation, drug doses are calculated based upon weight. Age‐based weight estimates are used when weighing children is impractical. The average weight of Australian children has increased, and widely used paediatric age‐based formulae might underestimate weight. A modified age‐based method for paediatric weight calculation, the ‘Best Guess’, has been described. Objective: To validate the Best Guess formulae on a new population of paediatric emergency patients, and to compare the accuracy of this method with Advanced Paediatric Life Support (APLS) and Australian Resuscitation Council (ARC) formulae for age‐based weight calculations. Methods: A retrospective study was performed of Australasian Triage Scale (ATS) category 1 or 2 patients presenting to a tertiary paediatric ED over a 12 month period. Calculated weights using each method (APLS, ARC and Best Guess) were compared with true weights for infants (<1 year), preschool‐aged (1–4 years) and school‐aged (5–14 years) children. Mean actual error and mean percentage error for each was calculated. Results: A total of 1843 patient weights were included in the study. The Best Guess Infant formula accurately estimated weight (mean percentage error +4.2%). The Best Guess formulae more accurately estimated weight than both APLS and ARC formulae for both preschool‐aged children (mean percentage error +2.6% vs?12.1% vs?12.1%) and school‐aged children (mean percentage error +7.7% vs?19.9% vs?12.4%). Conclusion: The Best Guess formulae is a valid method for age‐based weight estimation in acutely unwell or injured children presenting to the ED and more accurately predicts mean weight than either APLS or ARC formulae.     

School accidents to children: time to act.

OBJECTIVE: To describe the profile of injuries sustained by children in school accidents and suggest preventive measures. DESIGN: A five month prospective study of children attending an urban accident and emergency (A&E) department. SUBJECTS: 500 children who sustained injuries in school due to a variety of activities. RESULTS: 10 and 12 year old pupils suffered most injuries in school grounds/playgrounds, on concrete, or on grass/soil surfaces due to random activities resulting in striking or being struck by objects/persons, tripping or slipping, and sports (mainly football); 65.5% of these activities were not supervised and 67.4% occurred "out of lessons"; 22% sustained fractures or dislocations, 28.2% needed follow up treatment, and 1.4% were admitted. CONCLUSIONS: Injuries to children in school are a cause for concern. Effective preventive measures should concentrate on (a) specific target areas using schemes based on individual school, and (b) establishing a credible system of monitoring of their effectiveness.     

Sports-related Injuries in Children

OBJECTIVE: To describe the demographics and types of sports-related injuries (SRIs) in children. METHODS: The authors performed a retrospective chart review of children 5-18 years of age diagnosed as having an SRI in a pediatric emergency department (ED) during a two-year period. Patients were identified by ICD-9 codes. Data collected were age, sex, sport, ED interventions, consultations, mechanism, location, and injury type. Pairwise comparisons were reported as odds ratios with 95% confidence intervals. RESULTS: Six hundred seventy-seven SRIs fit the inclusion criteria; 480 of the patients were male (71%). The mean ages of the males and females were 13.0 years (SD +/- 3.0 yr) and 12.4 years (SD +/- 2.9 yr), respectively. The six most common sports implicated were basketball (19.5%), football (17.1%), baseball/softball (14.9%), soccer (14.2%), in-line skating (Rollerblading)/skating (5.7%), and hockey (4.6%). Sprains/strains (32.0%), fractures (29.4%), contusions/abrasions (19. 3%), and lacerations (9.7%) accounted for 90% of injury types. Pairwise comparison of the four injury types in the six sports listed showed significant associations for contusions/abrasions in baseball, sprains/strains in basketball, fractures in Rollerblading/skating, and lacerations in hockey. Age variance, including all sports, of the younger group (5-11 yr) in fractures and the older group (12-18 yr) in sprains was significant. The most common injury location was wrist/hand (28%), followed by head/face (22%) and ankle/foot (18%). Each had significant sport-specific predilections. Contact with person or object was the mechanism for >50% of the SRIs. Sport-specific mechanisms followed lines drawn from the sport-specific injury types and locations. CONCLUSIONS: The pediatric age group incurs a variety of injuries in numerous sports with diverse sex, age, mechanism, location, injury type, and sport-specific differences.     

Dysphonia in preterm children: Assessing incidence and response to treatment

BackgroundMild dysphonia in childhood is surprisingly common, yet moderate to severe dysphonia is rare. The latter has been associated with complex medical conditions and congenital abnormalities. Intubation injury has also been documented as a cause of childhood dysphonia. Children born very preterm may be intubated as part of the intensive care administered in the perinatal and neonatal periods, yet there are few studies investigating dysphonia in this population. This study will be the first to: use an objective acoustic voice assessment in a paediatric study, document the incidence of dysphonia in very preterm children at school age, and conduct a controlled trial of behavioural voice therapy in this population.DesignThis study will consist of three phases: assessment of voice quality and its impact on quality of life in up to 200 children born at less than 32 weeks' gestation: assessment of the nature and extent of laryngeal pathology in children with moderate to severe dysphonia; and a non-blinded, randomised controlled trial of behavioural voice therapy in children with moderate to severe dysphonia.DiscussionThis study will be the first to use clinical assessment to examine the voice quality of very preterm children, and to use fibre optic endoscopic evaluation of laryngeal function to determine the nature and extent of any laryngeal pathology in such children. Those participants with significant voice difficulties will be randomised to receive treatment immediately or after the eight week assessment.Trial registrationThis study is registered on the Australian New Zealand Clinical Trials Registry (ACTRN12613001015730/ACTRN12613001012763).     

New approaches to respiratory infections in children. Bronchiolitis and croup

Croup is a disease that is commonly seen in children younger than the age of 6 years. The cause is viral, with parainfluenza viruses and RSV being the two most common pathogens. Treatment consists primarily of supportive care, and parents usually have tried humidification and cool air exposure before the child presents to the ED. Children with moderate to severe croup are usually seen in the ED. The use of steroids in an oral preparation results in a clinical improvement of outpatients with mild to moderate croup and reduces the need for hospitalization. The dosage range for oral dexamethasone is 0.15 mg/kg to 0.6 mg/kg. Nebulized budesonide may also be used. Racemic or L-epinephrine, both of which are equally effective, can be used for symptomatic treatment in severe croup. After administration of racemic or L-epinephrine, hospitalization is not automatic and patients can be discharged safely from the ED after a 3-hour of observation period. There should be no respiratory distress, and the patient should have access to follow-up and emergency care if needed.     

Screening for Adolescent Depression in a Pediatric Emergency Department

Objectives: To describe the prevalence of depressive symptoms in adolescents presenting to the emergency department (ED) and to describe their demographics and outcomes compared with adolescents endorsing low levels of depressive symptoms. Methods: The Beck Depression Inventory–2nd edition (BDI‐II) was used to screen all patients 13–19 years of age who presented to the ED during the period of study. The BDI‐II is a 21‐item self‐report instrument used to measure the presence and severity of depressive symptoms in adolescents and adults. Demographics and clinical outcomes of screening‐program participants were abstracted by chart review. Patients were categorized into one of four severity categories (minimal, mild, moderate, or severe) and one of three presenting complaint categories (medical, trauma, mental health). Results: Four hundred eighty‐seven patients were approached, and 351(72%) completed the screening protocol. Participants endorsed minimal (n= 192, 55%), mild (n= 52, 15%), moderate (n= 41, 11%), or severe depressive symptoms (n= 66, 19%). Those with moderate or severe depressive symptoms were more likely to be hospitalized. Of patients completing the BDI‐II, 72% with psychiatric, 12% with traumatic, and 19% with medical chief complaints endorsed either moderate or severe depressive symptoms. Conclusions: Depressive symptoms are prevalent in this screening sample, regardless of presenting complaint. A substantial proportion of patients with nonpsychiatric chief complaints endorsed moderate or severe depressive symptoms. A screening program might allow earlier identification and referral of patients at risk for depression.     

Barriers and facilitators of sports in children with physical disabilities: a mixed-method study

Abstract

Purpose: This study explored barriers and facilitators of sports participation of children with physical disabilities from the perspective of the children, their parents and their health professionals. Method: Thirty children and 38 parents completed a questionnaire, and 17 professionals were interviewed in a semi-structured way. Data from the three groups were combined in a mixed-method design, after which the results were triangulated. Results: Mean age (SD) of the children was 14.1 (2.9) years old, 58% were boys. Sixty-seven percent of the children had cerebral palsy and 77% participated in sports after school. Most commonly practiced sports were swimming, cycling and football. Children specifically experienced dependency on others as a barrier, parents did not have enough information about sports facilities, and professionals observed that the family’s attitude had influence on the child’s sports participation. Facilitators were health benefits, fun and social contacts. Conclusion: Sports participation of children with physical disabilities is a complex phenomenon because children, their parents and professionals reported different barriers. Sports participation is more physically challenging for children with severe physical disabilities, as their daily activities already require much energy. However, the psychosocial benefits of sports are applicable to all children with physical disabilities.

• Implication for Rehabilitation

• Perceived barriers seemed to differ for children, parents and health professionals, suggesting that sports participation is a complex phenomenon.

• Sports might be more physically challenging for children with severe physical disabilities, as their daily activities already take much energy.

• The psychosocial benefits of sports should be emphasized by rehabilitation professionals when advising children with physical disabilities about sports.

     

Defining Mild, Moderate, and Severe Pain by Using the Color Analogue Scale with Children Presenting to a Pediatric Emergency Department

Objectives: To define in centimeters what constitutes mild, moderate, and severe acute pain in children by using the Color Analogue Scale (CAS) for pain.
Methods: This was a prospective study, using convenience sampling, of all children presenting to a pediatric ED between the ages of 5 and 16 years with a complaint of pain. Children were excluded if they had altered sensorium, were clinically unstable or required admission to the ICU, or were developmentally delayed. Children were asked to mark their pain severity on the standardized 10-cm CAS. To use this measure, children were asked to slide the marker to the point on the scale that best described the pain they were currently experiencing. They then were asked to describe their pain as "none,""mild,""moderate," or "severe."
Results: A total of 169 children were enrolled with a mean age of 10.1 years (SD ± 3.2 years). Males accounted for 94 (55%); 89 (52.7%) were Hispanic, 63 (37.3%) were white, 8 (4.7%) were African American, and 9 (5.3%) were "others." In children who considered their pain to be mild ( n = 34), the median score was 3.5 cm, and the mean score was 3.47 cm (95% CI = 2.95 to 3.99). For those with moderate pain ( n = 68), the median score was 6.0 cm, the mean score was 6.04 cm (95% CI = 5.67 to 6.41), and if the pain was considered severe ( n = 67) the median score was 8.5 cm, and the mean score was 8.28 cm (95% CI = 7.85 to 8.71).
Conclusions: This study quantifies what constitutes mild, moderate, and severe pain on the CAS scale. This information should be used to properly triage children with painful conditions and to identify appropriate patients for enrollment in analgesic studies.     

Coexisting lower urinary tract symptoms and erectile dysfunction: a systematic review of epidemiological data

Objective: Assess and categorise the available prevalence data on coexistent LUTS and ED in the general population and among individuals consulting a healthcare provider for any reason or when seeking treatment for LUTS and/or ED. Methods: Literature search of English‐language articles published during the last 15 years. Results: Of 23 relevant studies identified, 12 used both the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF) as assessment tools and 11 used alternative approaches. In studies using both IPSS and IIEF, overall prevalence of coexistent LUTS/ED of any severity was not assessable for men in the general population, but rates ranged from 14–37% based on alternative assessments. In the general male population, 13–29% had moderate to severe LUTS and 8–35% had moderate to severe ED. In studies using both IPSS and IIEF, overall prevalence of coexistent LUTS and ED of any severity was 71–80% among men seeking treatment for LUTS, and 74% based on alternative assessments. Among men who sought treatment for either condition, 67–100% had moderate to severe LUTS and 43–59% had moderate to severe ED. Coexistence of LUTS and ED increased with age, ranging from 59–86% among men aged 40s to 60s in primary care to 79–100% in treatment‐seeking men with LUTS aged 50s to 70s. Impact on QoL varied, but health‐related QoL was generally worse in treatment‐seeking men compared with men in the general population. Conclusions: Although less than one‐third of middle‐aged and older men in the general population have coexisting LUTS and ED, most men seeking treatment for either LUTS or ED have both conditions. Symptom severity and impact on QoL in each condition increase when LUTS and ED coexist.     

Emergency Physician Recognition of Adverse Drug-related Events in Elder Patients Presenting to an Emergency Department

Objectives: The authors examined the ability of emergency physicians (EPs) to recognize adverse drug‐related events (ADREs) in elder patients presenting to the emergency department (ED). Methods: This was a prospective observational study of patients at least 65 years of age who presented to the ED. ADREs were identified using a validated, standardized scoring system. EP recognition of ADREs was assessed through physician interview and subsequent chart review. Results: A total of 161 patients were enrolled in the study. Thirty‐seven ADREs were identified, which occurred in 26 patients (16.2%; 95% confidence interval [CI] = 10.5% to 22.0%). The treating EPs recognized 51.2% (95% CI = 35.2% to 67.4%) of all ADREs. There was better recognition of those ADREs related to the patient's chief complaint (91%; 95% CI = 74.1% to 100%) as compared with recognition of ADREs that were not associated with the chief complaint (32.1%; 95% CI = 14.8% to 49%). EPs recognized six of seven severe ADREs (85.7%), 13 of 23 moderate ADREs (56.5%; 95% CI = 36.8% to 77%), and none of the mild ADREs. Recognition of ADREs varied with medication class. Conclusions: EP performance was superior at identifying severe ADREs relating to the patients' chief complaints. However, EP performance was suboptimal with respect to identifying ADREs of lower severity, having missed a significant number of ADREs of moderate severity as well as ones unrelated to the patients' chief complaints. ADRE detection methods need to be developed for the ED to aid EPs in detecting those ADREs that are most likely to be missed.     

Curricula oriented inclusion of children and adolescents with haemophilia in school sports - A new approach within the project "fit for life"

Inclusive paedagogic thinking and acting is a modern and increasingly important topic in school sports. It will affect teachers as well as parents and students. The new international guidelines and national curricula enable new ways of inclusion especially for students with chronic illnesses like haemophilia. Special help from the sport teachers is of vital importance. In our project "fit for life" where we advice children and young adults with haemophilia to find their appropriate sport, we developed a new approach for an optimised inclusion of children with haemophilia into sport lessons. The whole project is running in corporation with the German Sport Teachers Association/Hessen. We analysed and rated the actual curricula of the different school years and looked at the specific needs, risks and necessary abilities for persons with haemophilia. By this means we gathered about 600 typical movements and/or exercises for school sports and developed individual advice and adapted exercise solutions for sport lessons.     

Making Sense of Head Injuries in Young Athletes

Nurse practitioners are at the forefront of efforts to increase health within our communities and thus play a vital role in the prevention of head injuries among children and adolescents engaging in sports. In recent times, the media have increased public awareness regarding the long-term effects of concussive injuries in professional athletes in sports such as football and hockey, which are traditionally classified as contact sports. The purpose of this article is to highlight the risk of concussion among children and adolescents engaging in traditionally high contact sports and sports that are less often considered in the context of concussion.     

Return to activity considerations in a football player predisposed to exertional heat illness: a case study

CONTEXT: Heat illness is the third leading cause of death in athletics and a leading cause of morbidity and mortality in exercising athletes. Once faced with a case of heat related illness, severe or mild, the health care professional is often faced with the question of when to reactivate the athlete for competitive sport. Resuming activity without modifying risk factors could lead to recurrence of heat related illness of similar or greater severity. Also, having had heat illness in and of itself may be a risk factor for future heat related illness. The decision to return the athlete and the process of risk reduction is complex and requires input from all of the components of the team. Involving the entire sports medicine team often allows for the safest, most successful return to play strategy. Care must be taken once the athlete does begin to return to activity to allow for re-acclimatization to exercise in the heat prior to resumption particularly following a long convalescent period after more severe heat related illness.