The properties of the International Classification of the External Cause of Injury when used as an instrument for injury prevention research.

OBJECTIVE: To demonstrate properties of the International Classification of the External Cause of Injury (ICECI) as a tool for use in injury prevention research. METHODS: The Childhood Injury Prevention Study (CHIPS) is a prospective longitudinal follow up study of a cohort of 871 children 5-12 years of age, with a nested case crossover component. The ICECI is the latest tool in the International Classification of Diseases (ICD) family and has been designed to improve the precision of coding injury events. The details of all injury events recorded in the study, as well as all measured injury related exposures, were coded using the ICECI. This paper reports a substudy on the utility and practicability of using the ICECI in the CHIPS to record exposures. Interrater reliability was quantified for a sample of injured participants using the Kappa statistic to measure concordance between codes independently coded by two research staff. RESULTS: There were 767 diaries collected at baseline and event details from 563 injuries and exposure details from injury crossover periods. There were no event, location, or activity details which could not be coded using the ICECI. Kappa statistics for concordance between raters within each of the dimensions ranged from 0.31 to 0.93 for the injury events and 0.94 and 0.97 for activity and location in the control periods. DISCUSSION: This study represents the first detailed account of the properties of the ICECI revealed by its use in a primary analytic epidemiological study of injury prevention. The results of this study provide considerable support for the ICECI and its further use.     

Definition and classification of childhood injuries

Injuries have emerged as the leading cause of child and adolescent morbidity and mortality in developed countries. Efforts to control injuries require injury surveillance and research, creating the need for standard variable definitions and categorizations. Advantages of such standardization include increased comparability of data sets, avoidance of spurious conclusions based on idiosyncratic definitions and categories and the potential to combine data sets (e.g. on injuries and population counts) to yield new information. Pertinent standards will differ depending on the purposes for which the data are collected. More limited (core) data are appropriate to surveillance and more extensive data to research. Existing standards that are likely to be most useful to pediatric injury investigators are the International Classification of Diseases External Cause (E) codes (which provide mechanism-of-injury diagnoses and are the international gold standard for injury data reporting) and the Standard Definitions for Childhood Injury Research recently released by the United States National Institute for Child Health and Human Development, which include both core and complete variable listings. Some key core definitions from the latter report are presented.     

Completeness of cause of injury coding in healthcare administrative databases in the United States, 2001

OBJECTIVES: To determine the completeness of external cause of injury coding (E-coding) within healthcare administrative databases in the United States and to identify factors that contribute to variations in E-code reporting across states. DESIGN: Cross sectional analysis of the 2001 Healthcare Cost and Utilization Project (HCUP), including 33 State Inpatient Databases (SID), a Nationwide Inpatient Sample (NIS), and nine State Emergency Department Databases (SEDD). To assess state reporting practices, structured telephone interviews were conducted with the data organizations that participate in HCUP. RESULTS: The percent of injury records with an injury E-code was 86% in HCUP's nationally representative database, the NIS. For the 33 states represented in the SID, completeness averaged 87%, with more than half of the states reporting E-codes on at least 90% of injuries. In the nine states also represented in the SEDD, completeness averaged 93%. Twenty two states had mandates for E-code reporting, but only eight had provisions for enforcing the mandates. These eight states had the highest rates of E-code completeness. CONCLUSIONS: E-code reporting in administrative databases is relatively complete, but there is significant variation in completeness across the states. States with mandates for the collection of E-codes and with a mechanism to enforce those mandates had the highest rates of E-code reporting. Nine statewide ED data systems demonstrate consistently high E-coding completeness.     

Accuracy of injury coding under ICD‐9 for New Zealand public hospital discharges

OBJECTIVE: To determine the level of accuracy in coding for injury principal diagnosis and the first external cause code for public hospital discharges in New Zealand and determine how these levels vary by hospital size. METHOD: A simple random sample of 1800 discharges was selected from the period 1996-98 inclusive. Records were obtained from hospitals and an accredited coder coded the discharge independently of the codes already recorded in the national database. RESULTS: Five percent of the principal diagnoses, 18% of the first four digits of the E-codes, and 8% of the location codes (5th digit of the E-code), were incorrect. There were no substantive differences in the level of incorrect coding between large and small hospitals. CONCLUSIONS: Users of New Zealand public hospital discharge data can have a high degree of confidence in the injury diagnoses coded under ICD-9-CM-A. A similar degree of confidence is warranted for E-coding at the group level (for example, fall), but not, in general, at higher levels of specificity (for example, type of fall). For those countries continuing to use ICD-9 the study provides insight into potential problems of coding and thus guidance on where the focus of coder training should be placed. For those countries that have historical data coded according to ICD-9 it suggests that some specific injury and external cause incidence estimates may need to be treated with more caution.     

Unspecified falls among youth: predictors of coding specificity in the emergency department.

BACKGROUND: Deficiencies in emergency department (ED) charting is a common international problem. While unintentional falls account for the largest proportion of injury related ED visits by youth, insufficient charting details result in more than one third of these falls being coded as "unspecified". Non-specific coding compromises the utility of injury surveillance data. OBJECTIVE: To re-examine the ED charts of unspecified youth falls to determine the possibility of assigning more specific codes. METHODS: 400 ED charts for youth (aged 0-19 years) treated at four EDs in an urban Canadian health region between 1997 and 1999 and coded as "Other or unspecified fall" (ICD-9 E888) were randomly selected. A structured chart review was completed and a blinded nosologist recoded the cause of injury using the extracted data. Differences in coding specificity were compared with the original data, and logistic regression was undertaken to examine variables that predicted assignment of a specific E-code. RESULTS: A more specific code was assigned to 46% of cases initially coded as unspecified. Of these, 73% were recoded as "Slips, trips, and stumbles" (E885), which still lacks the specificity required for injury prevention planning; 2% of charts had no fall documented. Multivariate analysis revealed that dichotomized injury severity (adjusted odds ratio (OR) = 1.75 (95% confidence interval, 1.11 to 2.78)), arrival at the ED by ambulance (adjusted OR = 5.41 (1.07 to 27.0)), and the availability of nurse's notes or triage forms, or both, in the chart (adjusted OR = 3.75 (2.17 to 6.45)) were the strongest predictors of a more specific E-code assignment. CONCLUSIONS: Deficiencies in both chart documentation and coding specificity contribute to the use of non-specific E-codes. More comprehensive triage coding, improved chart documentation, and alternative methods of data collection in the acute care setting are required to improve ED injury surveillance initiatives.     

SOCIAL ADJUSTMENT AND FUNCTIONING OF CHRONICALLY ILL AND IMPARED CHILDREN AND ADOLESCENTS

A cluster sample of 532 children aged 8 to 19 years with certain impairments were compared to a matched sample of 316 healthy children of the same age. Almost half (46 %) of the impaired had a disability, which was mostly in the domain of body disposition ability (in 88 %), behaviour (63 %) and situational functioning (54 %). In the controls, where 12 % had some kind of disability, the corresponding figures were 13 %, 11 % and 15 %. The most disabling conditions were CP (67 % handicapped), MBD (52 %) and epilepsy (42 %). The most frequent non-compènsated handicaps were those of occupation (44 % of impaired), mobility (31 %) and social integration (22 %). More than one handicap was associated most frequently with CP (76 %) and with epilepsy (36 %). Neurological impairments are more disabling and handicapping than non-neurological ones, with the exception of mobility and occupation handicaps in asthmatics.     

HEIGHT AND WEIGHT OF SCHOOL CHILDREN AND ADOLESCENT GIRLS AND BOYS IN OSLO 1970

ABSTRACT: Brundtland, G. H., Liestö1, K. and Wallöe, L. (Oslo City Health Department and Departments of Physics and Physiology, University of Oslo). Height and weight of school children and adolescent girls and boys in Oslo 1970. Acta Paediatr Scand, 64:565, 1975.–Height and weight measurements of the school children of Oslo in 1970 (aged 7 to 19 years) are reported. Weights show considerably skewed distributions with long tails towards higher weights. Weight percentiles are calculated by interpolation in the empirical distributions. Percentiles and tables for both sexes, showing height for age, weight for height and weight for age, are presented. A comparison with existing Norwegian data from Sundal, 1956, Bergen shows that the application of statistics based on normal distribution for weight, has introduced considerable error in these percentiles. Oslo children in 1970 are taller by 5–6 cm at age eighteen, than USA (Iowa) standards and 4–5 cm taller compared to Tanner's English percentiles. Oslo children are also taller than Swedish children, and have reached a stature higher than found in any other comparable study.     

PHYSICAL EXERCISE AND JUVENILE DIABETES—SUMMARY AND CONCLUSIONS

Abstract. Larsson, Y. (Department of Pediatrics, University Hospital, Linköping, Sweden). Physical exercise and juvenile diabetes.—Summary and conclusions. Acta Paediatr Scand, Suppl. 283: 120, 1980.—The various metabolic effects of physical exercise in ketotic diabetics, non-ketotic diabetics and non-diabetics are summarized. A favorable metabolic effect is only observed during optimal insulin administration, while in ketotic diabetics exercise may aggravate the metabolic situation. The use of exercise as a tool in the routine treatment of young diabetics is described. Activity-produced hypoglycemia should be prevented through an adequate food intake and through patient education. Regular exercise may postpone the appearance of diabetic microangiopathy.     

ABETALIPOPROTEINEMIA TREATED WITH PARENTERAL AND ORAL VITAMINS A AND E, AND WITH MEDIUM CHAIN TRIGLYCERIDES

ABSTRACT. An 11-year-old girl with abetalipoproteinemia was treated with parenteral vitamin A and vitamin E for two and a half years. Some improvement in neurological and visual deficits was noted. On changing to oral vitamin E and later with addition of medium chain triglycerides (MCT) to the diet, a considerable improvement in her general wellbeing, neuromuscular lesions and ophthalmological symptoms was noted. This regimen is being adhered to for five and a half years. The condition is stable with no further improvement.     

MECONIUM ILEUS AND INTESTINAL ATRESIA IN FETUSES AND NEONATES

A collaborative study was performed to determine the different types and mechanisms of intestinal abnormalities during gestation. Cases had to fulfill one or more of the following three criteria: (1) meconium ileus, (2) intestinal stenosis or atresia, and (3) meconium peritonitis. Esophageal atresia, anorectal atresia, and abdominal wall defects were excluded. One hundred two cases were reviewed from the autopsies of 42 induced abortions, 22 stillborns, and the surgical findings in 38 neonates. Meconium ileus was detected mainly during the second trimester (28/38), and was associated with cystic fibrosis (15), fetal blood deglutition (4), infection (6), or multiple abnormalities (10), in which three chromosomal aberrations were found. Intestinal stenosis or atresia was more commonly detected during the third trimester of gestation (46/56). Sixteen of the 30 duodenal malformations were associated with trisomy 21, whereas in the 26 small intestinal atresias, signs of distress or ischemia were most frequently detected. Only 8 of 25 meconium peritonitis cases were isolated. A total of 20 cystic fibrosis cases could be proved. In this series, functional abnormalities were observed predominantly in the second trimester and associated mainly with cystic fibrosis or amniotic fluid abnormalities. Anatomic lesions were commonly detected later on and associated with ischemic conditions, chromosomal aberrations, and even cystic fibrosis.     

MATERNAL CARETAKING AND PLAY WITH FULL-TERM AND PREMATURE INFANTS

The contribution of past psychological experiences of the mother and medical complications of the infant to differences in caretaking of pre- and full-term infants are examined. Twenty full- and 20 pre-term matched mother-infant dyads were studied during a feed and play 1, 2 and 3 months after the expected date of birth. Full-term infants were more active than pre-terms at 4 weeks only. Mother of pre-terms showed differences in their interactions at all times. Interactions were related to maternal experiences in full-term infants only. Degree of neonatal illness was correlated with behavioral disorganization of premature infants, leading to differences in caretaking style.     

LOCALIZATION AND FUNCTIONS OF SP-A AND SP-D AT MUCOSAL SURFACES

Pulmonary surfactant protein A (SP-A) and D (SP-D), members of the collectin family, are implicated in innate host defense of the lung. Collectins consist of a collagen-like domain and a carbohydrate recognition domain. SP-A and SP-D recognize and interact with glycoconjugates on the surface of microorganisms. They protect the lung by interacting with a wide variety of potential pathogens, including viruses, bacteria, and fungi. This may result in enhanced killing and/or clearance by phagocytes. Although most extensively studied in the lung, both SP-A and SP-D, or proteins closely resembling SP-A and SPD, are found in a number of other sites in the body and therefore may play a protective role at other sites than the lung. SP-A and SP-D protein and/or mRNA have been detected at various sites of the body: the respiratory tract, the gastrointestinal tract, the middle ear, and in the peritoneal cavity. The presence of SP-A and SP-D at these mucosal surfaces, in close contact with numerous potentially harmful microorganisms, supports a role for these "lung"-collectins in innate mucosal defense. SP-A and SP-D may be important molecules in a threefold innate defense, particularly in the neonatal period between maternally acquired immunity and a fully developed adaptive immune system; the time interval between first exposure to a pathogen and generation of specific antibodies; and states of impaired immune function.     

RELATIONSHIP BETWEEN HAEMOGLOBIN AND SERUM TESTOSTERONE IN NORMAL CHILDREN AND ADOLESCENTS AND IN BOYS WITH DELAYED PUBERTY

ABSTRACT. The concentrations of haemoglobin and of serum testosterone were measured in 215 normal children and adolescents aged 7–20 years, and in 8 boys with constitutional delayed puberty. From the age of 14 years onward haemoglobin and testosterone rose in normal boys and differed significantly from the stable levels observed in prepubertal children and pubertal girls. In the entire series of normal boys ( n = 118, age 7–20 years) concentrations of haemoglobin and testosterone were found to be closely correlated ( r =0.73, p <0.001). These results provide further evidence for a major role of testosterone in the control of erythropoiesis. Therefore, this correlation suggests the use of serum testosterone determination for the proper selection of haemoglobin reference ranges in boys. The respective reference ranges of haemoglobin corresponding to testosterone levels at 0 and 30 nmol/1 were 120.5–148.5 and 143.5–171.5 g/1 (95% confidence limits). Boys with delayed puberty were found to have significantly reduced median values of haemoglobin and testosterone for their chronological age, and 6 of the 8 boys investigated were truly anaemic on this background. Nevertheless, their haemoglobin concentration did appear appropriate as judged from their testosterone levels. This observation supports the idea that the selection of the relevant reference range for haemoglobin in boys should depend on the state of physical development as expressed by serum testosterone.     

CALCIUM AND PHOSPHORUS CONTENT OF TRANSITIONAL AND MATURE HUMAN MILK

Abstract. Barltrop, D. and Hillier, R. (Paediatric Unit, St. Mary's Hospital Medical School, London, England). Calcium and phosphorus content of transitional and mature human milk. Acta Paediatr Scand 63: 347, 1974.–The mineral content of breast milk is known to vary but the significance of this for the newborn is unknown. The calcium and phosphorus content of breast milk from 58 nursing mothers has been determined at intervals up to 6 weeks post partum . The plasma calcium and phosphorus content of 15 of the infants aged 6 days was also measured. The calcium and phosphorus content of transitional milk increased during the first 6 days of lactation without significant alteration in Ca/P ratio. No relationship between milk composition and infant plasma chemistry could be demonstrated at the 6th day. The data suggest that milk Ca/P ratios are of less significance for neonatal calcium homeostasis at low as opposed to high mineral loads.