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OBJECTIVE: To examine the prevalence of alcohol and/or other psychoactive drugs, such as marijuana and cocaine (AODs), involved in preteen trauma patients. METHODS: Toxicological testing results were analyzed for 1356 trauma patients aged 10-14 years recorded in the National Pediatric Trauma Registry for the years 1990-95. RESULTS: Of the 1356 patients who received toxicological screening at the time of admission, 116 (9%) were positive for AODs. AOD involvement increased with age. Patients with pre-existing mental disorders were nearly three times as likely as other patients to be AOD positive (23% v 8%, p < 0.01). AOD involvement was more prevalent in intentional injuries and in injuries that occurred at home. CONCLUSIONS: AODs in preteen trauma are of valid concern, in particular among patients with mental disorders or intentional injuries. The role of AODs in childhood injuries needs to be further examined using standard screening instruments and representative study samples. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine the epidemiologic characteristics and clinical outcomes of self inflicted pediatric injuries in relation to the method of suicide attempt. METHODS: Using data from the National Pediatric Trauma Registry Phase II, a comparative analysis was conducted for children under 15 years of age who were admitted from 1 October 1988 through 30 April 1996 because of self inflicted injury by firearm (n = 28), hanging (n = 38), or jumping from heights (n = 21). RESULTS: Of the 87 cases under study, 90% occurred at home, and 86% occurred between noon and midnight, with a peak in early evening (between 6 pm and 7 pm)-More than one quarter (29%) had preexisting mental disorders, such as disturbance of conduct and depression. Toxicological tests were conducted on admission on 40 (46%) of the patients; 20% tested positive for alcohol or other illicit drugs. The method of suicide attempt was associated with gender and age of the patients: 75% of the firearm cases and 82% of the hanging cases were boys compared with 29% of the jumping cases (p < 0.01); 79% of the hanging cases were aged 13 years or younger compared with 39% of the firearm cases and 48% of the jumping cases (p < 0.01). The mean injury severity score was 18.6 for the firearm cases and 16.3 for the hanging cases, significantly greater than 8.5 for the jumping cases (p < 0.02). Reflecting the differences in injury severity, firearm cases and hanging cases were more likely than jumping cases to be sent to intensive care units or operating rooms from emergency departments, and to develop complications during hospitalization. The case fatality rate was 50% for the firearm cases, 32% for the hanging cases, and 5% for the jumping cases (p < 0.01). On average, these patients stayed in hospitals for 11 days and 52% of those who were alive at discharge had at least one impairment in communication, cognition, or self care functions. CONCLUSION: Boys and older children tend to use more lethal methods in suicide attempts. Even in this age group, suicide attempts often involve psychiatric disorders and acute abuse of alcohol or other illicit drugs. Firearms are associated with significantly increased risk of inhospital fatality. The clinical outcomes of self inflicted injuries appear to be worse than other injuries treated in the same trauma centers. [ABSTRACT FROM AUTHOR]

Focuses on a retrospective review of medical charts on the wounds and injuries of children caused by toppling television sets. Outcome measure used in the study; Percentage of moderate to critical severity injuries of children; Average length of hospitalization.

Objectives: To explore whether an intervention during mandatory schooling can lead to age-specific changes in water safety knowledge and attitudes., Methods: Age-specific questionnaires were distributed to 202 kindergarten and grade one pupils, 220 elementary school pupils and 337 pupils attending the first three high school grades in Greater Athens. The information was used to design an educational package that was subsequently presented to pupils of the same grades and similar socio-demographic profiles attending different schools in the same area. One month later, a post-exposure evaluation was conducted using the initial questionnaires, in which 115, 205 and 321 pupils from the respective grade categories provided their responses. In order to compare the performance of pupils exposed to the educational intervention with that of pupils who participated only in the initial assessment, mean differences in scores measuring overall knowledge and attitudes were estimated within each of the three grade groups adjusting for age, gender, sibship size, maternal education and swimming knowledge., Results: Among kindergarten and grade one pupils, those who received the intervention scored significantly higher for knowledge (17.40%, 95% CI 6.41% to 28.39%) and attitudes (23.64%, 95% CI 4.48% to 42.79%). Among elementary school pupils the gains in knowledge were less evident (14.58%, 95% CI -3.05% to 32.21%)) and almost null in attitudes (5.64%, 95% CI -11.47% to 22.77%). Further advancement of age showed no improvement in knowledge (-0.15%, 95% CI -5.30% to 4.99%) and a minimal, insignificant increase in attitudes (6.32%, 95% CI -1.87% to 14.52%) among exposed high school pupils., Conclusion: The school-based intervention resulted in considerable positive changes in knowledge and attitudes among very young pupils. Elementary schooling seems to provide meagre opportunities to simply improve knowledge. Alternative/complementary approaches should be sought in any attempt to modify behavior.

Background: Identification of children after traumatic brain injury (TBI) likely to have functional deficits at trauma center discharge will facilitate care., Methods: Two logistic regression models were derived from data on 4,439 children after TBI 7 to 14 years old enrolled in the National Pediatric Trauma Registry between 1994 and 2001 to predict physical and cognitive disabilities., Results: Children with open or multiple fractures or closed fractures or injured by motor vehicles were 8.2, 3.5, or 2.5 times more likely, respectively, than those without those circumstances to have discharge physical disabilities. Likelihood of cognitive impairment was increased by factors of 3.2 and 5.8 in children obtunded or comatose on arrival. Preexisting cognitive deficits, injury severity, and intubation predicted physical and cognitive disabilities. The C statistic was 0.862 for the motor model and 0.860 for the cognitive model., Conclusion: Predicting the likelihood of morbidity after acute management of childhood TBI can provide information pertinent to providing effective care.

Though nonoperative management of stable children with blunt solid organ injury has been shown to be effective, we hypothesize that hepatic injuries represent a higher mortality risk than splenic injuries and that combination hepatosplenic injury is a marker of even greater mortality potential. A multi-institutional pediatric trauma registry was queried for all children with blunt injuries to the liver (H) or spleen (S), excluding those with severe brain injury. Incidence and mortality of H, S, and all combinations of H/S were compared. The mortality rate for patients with H was significantly higher (2.5%) than in patients with S (0.7%), and the overall mortality of H/S (8.6%) was significantly higher than both. Furthermore, the mortality of H/S injuries was associated with increasing severity of either the hepatic or splenic injury. In childhood injury, H and S occur with almost equal frequency but with different mortality, and H/S is less common but associated with increased mortality.

Objectives: To compare outcomes by intent of nonfatal firearms-related injuries in a hospitalized population, newborn to 19 years of age, and estimate the national incidence of ensuing disability., Methods: Descriptive statistics and comparative analysis using chi(2), odds ratio, and t test were applied to data from the National Pediatric Trauma Registry (NPTR) and the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission. Demographics, preinjury medical history, scene of injury, primary body part injured, severity of injury, utilization of resources, short-term and long-term disability, medical cause of disability, and disposition at discharge were studied., Results: NPTR unintentional (n = 268) and assault-related firearms-related injuries (n = 506) were compared. In both groups, the majority of patients were male (80%). Compared with the unintentionally injured, the assaulted children were older and more frequently black (59.3% vs 32.5%). Approximately 17% in both groups had a preinjury history of medical/psychosocial problems. Unintentional injuries occurred mainly in private dwellings (75.7%), and assaults occurred in public places/street (53.8%). In both groups, injuries to multiple body regions were prevalent, and a substantial proportion sustained injuries of serious to critical level. Most children were transported by ambulance, but a significant proportion in the unintentional group were transported by helicopter. The rate of admission to the intensive care unit was approximately 40% for both groups. The unintentionally injured had a higher rate of surgical intervention (66.8% vs 50.8%) and stayed in the hospital longer than the assaulted ones (median: 5 days vs 3 days). Almost half of the children in both groups were discharged with disability, and approximately 87% returned to their home. Applying the NPTR disability rate to National Electronic Injury Surveillance System estimates of hospitalization suggests that approximately 3200 children nationwide develop disability from firearms-related injuries annually., Conclusions: Nonfatal firearms-related injuries in a pediatric population are associated with a high use of medical resources and lasting disability. Public policies should be developed and implemented to reduce the occurrence of these catastrophic events.

This study sought to evaluate injury causes and patient outcomes in young children with abdominal injuries. Cases of blunt abdominal injury (N = 927) to children ages 0 to 4 years were extracted from the National Pediatric Trauma Registry. Measures included hospital utilization (days hospitalized, intensive care unit use, and surgery) and patient outcome (in-hospital fatality, discharge to rehabilitation facility, home rehabilitation, and home nursing). The three most common mechanisms of abdominal injury were motor vehicles (61.27%), child abuse (15.75%), and falls (13.59%). Hospital utilization was higher in patients with multisystem injuries. Patient outcomes were more severe in abused children or those with concomitant central nervous system (CNS) injury; these were the only variables independently associated with increased mortality in this sample. Pediatric abdominal trauma leads to intense use of hospital resources and a high risk of in-hospital mortality. Child abuse, compared to falls, is independently associated with a 6-fold increase in in-hospital mortality.

Background/purpose: Evidence indicates that young adults are at significant risk for powered personal watercraft (PWC)-related injuries. This article examines the nature of PWC injuries sustained in the pediatric population over a 10-year period., Methods: Retrospective analysis was conducted of trauma registry charts on 66 pediatric patients, aged 5 to 19 years, hospitalized for PWC-related injuries between 1990 and 1999. The keywords PWC and Jet Ski were used to extract anonymous data from the National Pediatric Trauma Registry, which then were analyzed using descriptive statistics., Results: The most common mechanism of injury was a collision with another PWC, a boat, or a fixed object (70%). A total of 55.1% of all the injury diagnoses involved the head, face, and/or neck, and 72.7% of the injuries occurred to the operator of the PWC. A total of 83.3% of the patients required at least 1 surgical procedure, and 42.2% required admission to the intensive care unit. Four children (6.1%) died, and 28 (42.4%) of the children had disabilities as a consequence of the injury., Conclusions: Operation of PWCs can result in severe injures, death, and long-term disability in the pediatric population. Possible safety recommendations include minimum age regulations, operator training, operating regulations, design improvements, and required helmet use.

Purpose: We define the risk of kidney or testicle injury in children who play contact sports., Materials and Methods: National Pediatric Trauma Registry data from 50 United States pediatric trauma centers for 1990 to 1999 were analyzed. The data were from age groups 5 to 11, 12 to 14 and 15 to 18 years. Major abdominal injuries, injuries due to team and individual contact sports, and the site of injury were examined., Results: Of the 81,923 cases 5,439 were sports related. Abdominal injuries occurred in 459 patients (0.56%), and were due to contact sports in 191. Team sports were involved in 184 cases, including football in 44%, hockey in 19%, baseball in 15%, soccer in 12% and basketball in 6%. Abdominal injury rate by age was 16% for 5 to 11-year olds, 42% for 12 to 14-year-olds and 42% for 15 to 18-year-olds. Most common was splenic injury at 50% of cases, kidney injuries occurred in 22% and no testicle injuries were reported. Football accounted for the most kidney injuries (62%). Kidney injuries were more common among older teenagers. No injuries led to nephrectomy., Conclusions: Abdominal injuries are rare in children who play team and individual contact sports. No testicular injuries were reported. Kidneys are most at risk in football. Splenic injuries are most common overall, although the risk to kidney and spleen is equal in basketball. No kidneys were reported as lost. These data should help families and schools when assessing risk to genitourinary organs during these activities.

Purpose: We estimate the incidence of recreation related pediatric abdominal, testis and kidney injuries., Materials and Methods: Trauma registry data at the regional pediatric trauma center for 1993 to 2000 were analyzed for recreational injuries. The data were divided into the 3 age groups of 5 to 11, 12 to 14 and 15 to 18 years. The recreation, and site and severity of injury were cross referenced. Injury incidence was calculated using United States census data., Results: Of 4,921 children 34 boys and 2 girls (0.73%) had a genitourinary or abdominal injury due to recreation. Kidney injuries were the most common (44.4%), followed by spleen (36.1%) and liver (19.5%). No testicle injuries were reported. Skiing was the most common cause of injury (22.2%). Hockey, football, snowboarding, sledding and bicycling accounted for 83% of all injuries. There were no injuries related to basketball and soccer. The 12 to 14-year-old group had 50% of the injuries. Records were available for 15 kidney injuries, of which 11 were on the left side, 1 was bilateral, 3 required transfusion and 1 required nephrectomy. Injury grades were I in 2 cases, II in 5, III in 4, IV in 3 and V in 1. Kidney and spleen injury incidence due to recreation per year per million children was 6.9 and 5.6, respectively., Conclusions: Kidney injuries were more common than spleen injuries. Skiing, sledding and snowboarding accounted for more injuries than team sports. Testicle injuries were not seen and are rare. Basketball and soccer caused no injuries. Middle school-age children appear to be at greatest risk.

Objective: The evolution of nonoperative management of certain solid visceral injuries has stimulated speculation that management of the severely injured child is no longer a surgical exercise. The authors hypothesized that the incidence of injuries that require surgical evaluation is disproportionately high in children at risk of death or disability from significant injury., Methods: National Pediatric Trauma Registry data were queried for all patients with ICDA-9-CM diagnoses requiring at least surgical evaluation. Selected diagnoses included CNS: 800 to 804, 850 to 854; thoracoabdominal: 860 to 870; pelvic fracture: 808; and acute vascular disruption: 900 to 904. Operative intervention was identified by ICDA-9-CM operative codes less than 60 and selected operative orthopedic codes between 79.8 and 84.4. At-risk patients were identified as those with at least one of the following: Glasgow Coma Scale score less than 15, Glasgow Coma Scale motor score less than 6, initial systolic blood pressure less than 90, or Injury Severity Scale score more than 10. The incidence of a surgical diagnosis in at-risk children was compared to the incidence in the population with no identifiable risk. Within the population undergoing surgical evaluation, resource utilization, as reflected by operative intervention and ICU days, and outcome, as reflected by mortality, were compared between the at-risk group and the group with no identifiable risk., Results: From 1987 to 2000, 87,424 records were complete enough for analysis. Of those, 48,687 (55.6%) patients sustained at least one injury requiring a surgical evaluation and 28,645 (32.7%) children were determined to be at risk. Mortality for at-risk children was 5.8% versus 0.02% for those with no identifiable risk. Of the children at risk, 24,706 (86.2%) had at least one injury requiring a surgical evaluation. Of the 58,779 children with no risk, 23,981 (40.8%) also had at least one injury requiring a surgical evaluation. Operative intervention for surgical injuries was required in 20.5% of cases (n = 10,015). Of these, 5,562 (56%) were at-risk children, and they had a mortality rate of 11.5%. Of the children not at risk, 4,453 required operative care, and they had a mortality of 0.1%. At-risk children undergoing surgery required an average of 5.02 days of ICU care compared to 1.2 for cases performed on children without risk., Conclusions: These data clearly demonstrate the primacy of surgical pathology as the major determinant of outcome in pediatric injury. Operative intervention and the option of timely operative care remain major components of clinical management of children with injuries that pose a significant risk of morbidity or mortality.

Chromosome 14 is one of five acrocentric chromosomes in the human genome. These chromosomes are characterized by a heterochromatic short arm that contains essentially ribosomal RNA genes, and a euchromatic long arm in which most, if not all, of the protein-coding genes are located. The finished sequence of human chromosome 14 comprises 87,410,661 base pairs, representing 100% of its euchromatic portion, in a single continuous segment covering the entire long arm with no gaps. Two loci of crucial importance for the immune system, as well as more than 60 disease genes, have been localized so far on chromosome 14. We identified 1,050 genes and gene fragments, and 393 pseudogenes. On the basis of comparisons with other vertebrate genomes, we estimate that more than 96% of the chromosome 14 genes have been annotated. From an analysis of the CpG island occurrences, we estimate that 70% of these annotated genes are complete at their 5' end.

Background: Little published data are available concerning the death and disability of adolescent girls resulting from interpersonal violence (adolescents are defined as those aged 12-18 years in this study)., Objectives: To determine whether there were sex differences in (a) the characteristics of those who were injured or died, (b) injury severity and outcomes, and (c) injury mechanism; and to describe time trends in these differences., Design: Analysis of data concerning serious injuries due to assaults, recorded in the National Pediatric Trauma Registry (from January 1, 1989, through December 31, 1998), and homicides, recorded in the Web-Based Injury Statistics and Query Reporting System database (from January 1, 1990, through December 31, 1997)., Setting: Patient data from participating pediatric trauma centers (National Pediatric Trauma Registry) in 45 states and national death certificate data (Web-Based Injury Statistics and Query Reporting System)., Patients: Six hundred twelve adolescent girls who were seriously injured because of an assault were compared with 2656 adolescent boys who were seriously injured because of an assault. Three thousand four hundred eighty-seven adolescent girls who died due to a homicide were compared with 17 292 adolescent boys who died due to a homicide., Results: Assaulted adolescent girls were more likely to have preexisting cognitive or psychosocial impairments than were adolescent boys (odds ratio, 1.68; 95% confidence interval, 1.12-2.51). Adolescent girls trended toward more injury-related impairments at discharge from the hospital (odds ratio, 1.16; 95% confidence interval, 0.92-1.47). Adolescent girls were more likely to have been stabbed, and less likely to have been shot. Also, adolescent girls were more likely to have been injured at a home or a residence. Compared with all National Pediatric Trauma Registry admissions, assaults declined at the same rate for adolescent girls and boys. The proportion resulting from penetrating trauma declined more slowly for adolescent girls., Conclusions: Interpersonal violence causes considerable morbidity and mortality for young women. Research and interventions should be developed to respond to adolescent girls who experience interpersonal violence.

Objective: To assess outcomes of trauma caused by television sets falling onto children., Methods: Retrospective review of medical charts of 183 children aged 7 years and younger hospitalized for injuries caused by falling television sets. Descriptive statistics were applied., Data Sources: Phase 2 (1988-1995) and phase 3 (1995-1999) of the National Pediatric Trauma Registry., Outcome Measures: Demographics, injured body region, injury severity measured by the Injury Severity Score, length of hospital stay, admission to the intensive care unit, surgical intervention, in-hospital death rate, disability resulting from the injury, and disposition at discharge from the hospital., Results: The sample population represented 0.5% of all National Pediatric Trauma Registry admissions in this age group. More than half (57.4%) of the children were boys, and more than three quarters (76.0%) were 1 to 4 years of age. In most cases (95.1%), the injury occurred at home. Most children (68.3%) sustained head injury, and 43.7% sustained injuries to multiple body regions. More than a quarter (28.4%) of the children had injuries of moderate to critical severity (Injury Severity Score, 10-75), about a third (31.1%) required admission to the intensive care unit, and 20.2% needed 1 or more surgical interventions. The average length of hospitalization was 3.3 days. Five children (2.7%) died, and 48 (26.2%) developed functional limitations, which required discharge to a rehabilitation facility in 5 cases. Most (94.0%) of the children returned to their home. The proportion of television set-related injuries increased more than 100% during the study period., Conclusions: The injuries reported are not trivial. Not only did they require hospitalization, but they also resulted in an in-hospital death rate comparable to the 2.5% rate observed in children of the same age group injured by unintentional blunt trauma, inclusive of motor vehicle traffic-related injuries. Since virtually all American children are at risk for such injury, we suggest that television set designs be modified to reduce the incidence and severity of the problem.

Controversy exists regarding the efficacy of prehospital assisted ventilation by endotracheal intubation (ETI) versus bag-valve-mask (BVM) in serious pediatric head injury. The National Pediatric Trauma Registry (NPTR-3) data set was analyzed to examine this question. NPTR-3 (n = 31,464) was queried regarding the demographics, injury mechanism, injury severity, prehospital interventions, transport mode, mortality rate, injury complications, procedure and equipment failure or complications, and functional outcome of seriously head-injured patients (n = 578) with comparable injury mechanisms and injury severity who received endotracheal intubation (ETI) (n = 479; 83%) versus those who received BVM (n = 99; 17%). Mortality rate was virtually identical between the 2 groups (ETI = 48%, BVM = 48%), although children receiving ETI were significantly older (P < .01), more often transported by helicopter (P < .01), and more often received intravenous fluid in the field (P < .05). However, injury complications affecting nearly every body system or organ (except kidney, gut, and skin) occurred less often in children receiving ETI (ETI = 58%, BVM = 71%, P < .05). Procedure and equipment failure or complications, and functional outcome, were similar between the 2 groups. Prehospital endotracheal intubation appears to offer no demonstrable survival or functional advantage when compared with prehospital bag-valve-mask for prehospital assisted ventilation in serious pediatric head injury. Injury complications appear to occur somewhat less often among patients intubated in the field.

The DBcat (http://www.infobiogen.fr/services/dbcat ) is a comprehensive catalog of biological databases, maintained and curated at Infobiogen. It contains 500 databases classified by application domains. The DBcat is a structured flat-file library, that can be searched by means of an SRS server or a dedicated Web interface. The files are available for download from Infobiogen anonymous ftp server.

Objective: To assess functional outcome and describe disability at discharge in children who have had trauma without significant head injury., Design: Retrospective cohort., Setting: National Pediatric Trauma Registry, 1988-1994., Participants: Patients of ages 7 to 18 years with Glasgow Coma Scale (GCS) 13 to 15 without significant anatomic head inJury., Results: Functional Independence Measure (FIM) at discharge was used to assess patient outcome. There were 13,649 children meeting study criteria who had sustained 34,254 injuries. Fractures constituted 30% of all injuries. As measured by FIM, 1,522 (11.2%) patients had mild disability at discharge; 1,983 (14.5%) had moderate disability. After adjustment for age and injury severity, children with lower extremity fractures were more likely to be discharged with functional limitations than those without (relative risk, 5.43; 95% confidence interval: 5.06, 5.84). Of children with moderate disability at discharge, less than 50% were referred for rehabilitation evaluation and less than 25% for physical therapy., Conclusion: Functional dependence is present in a large proportion of injured children, even without significant head injury. Rehabilitation and other services may be underused in this population. Further study is required to fully assess the degree and duration of disability in these patients.

Background/purpose: Trauma centers (TC) are certified based on widely accepted criteria. These specific criteria rarely are scrutinized individually. The purpose of this study was to analyze the individual components of a pediatric trauma center for their effect on outcome., Methods: Members of the National Pediatric Trauma Registry were queried about the following: (1) separate pediatric emergency department (ED), (2) pediatric intensive care unit (PICU), (3) pediatric intensivist as PICU director, (4) pediatric surgeon as TC director, (5) in-house attending surgeon, (6) in-house pediatric emergency physician, (7) 24-hour operating room, (8) 24-hour computed tomography (CT) scan. Outcomes analyzed included mortality, length of stay, time in ED, days in PICU, and disability. Victims were stratified based on age (<7 or > or = 7 years) and severity of injury (ISS < or = 16, 17-35, > or = 36). Results were compared using Student's t test and chi2 analysis., Results: A total of 59 of 74 centers responded, 18 were dropped because of low enrollment (mean, 1.6 patients). Questions 3, 4, 6, and 7 were eliminated because of skewed data. An in-house surgeon reduced the amount of time a mildly injured patient (ISS < or = 16) spent in the ED (210 v434 minutes), as did the separate pediatric ED (333 v592 minutes) and pediatric emergency physicians (344 v 507 minutes) in younger patients (> or = 7 years). An in-house surgeon reduced the morality rate in older (> or = 7) severely injured (ISS > or = 36) patients (46.7% v 56.8%; P < .05 for all). No other differences were significant., Conclusions: In-house personnel improved efficiency for the less severely injured, and an in-house attending surgeon reduced mortality in the severely injured older patient. None of the other variables were found to have a significant impact on outcome.

The DBcat (http://www.infobiogen.fr/services/dbcat) is a comprehensive catalog of biological databases, maintained and curated on a daily basis at GIS Infobiogen. It contains more than 400 databases classified by application domains. The DBcat is a structured flat file library, that can be searched by means of an SRS server or a dedicated Web interface. The files are available for downloading from Infobiogen anonymous ftp server.

Objectives: To determine differences between hospital admitted injuries to children with preinjury attention deficit hyperactivity disorder (ADHD) and injuries to those with no preinjury conditions (NO)., Design: Comparative analysis, excluding fatalities, of ADHD patients (n = 240) to NO patients (n = 21 902), 5 through 14 years of age., Outcome Measures: Demographics, injury characteristics, length of stay, admission to the intensive care unit, surgical intervention, disability, and disposition at discharge., Data Source: Retrospective review of charts submitted by more than 70 hospitals participating in the National Pediatric Trauma Registry between October 1988 and April 1996., Results: Compared with the NO children, the children with ADHD were more likely to be boys (87.9% vs 66.5%), to be injured as pedestrians (27.5% vs 18.3%) or bicyclists (17.1% vs 13.8%), and to inflict injury to themselves (1.3% vs 0.1%). They were more likely to sustain injuries to multiple body regions (57.1% vs 43%), to sustain head injuries (53% vs 41%), and to be severely injured as measured by the Injury Severity Score (12.5% vs 5.4%) and the Glasgow Coma Scale (7.5% vs 3.4%). The ADHD mean length of stay was 6.2 days versus 5.4 in the NO group. In both groups, 40% had surgery, but the ADHD children were admitted more frequently to the intensive care unit (37.1% vs 24.1%). The injury led to disability in 53% of the children with ADHD vs 48% of the NO children. Children with ADHD with any disability were twice as likely to be discharged to rehabilitation/extended care than were the NO children., Conclusions: Injured children with ADHD are more likely to sustain severe injuries than are children without ADHD. More research is needed to identify prevention efforts specifically targeted at this population.

Study Objective: To describe the circumstances, severity, and outcome of bicycle-related injuries among hospitalized children younger than 5 years and to compare injuries in young children (< 5 years) and older children (5 to 14 years)., Methods: We studied a case series of children (0 to 14 years) with bicycle-related injuries requiring hospital admission reported to the National Pediatric Trauma Registry (NPTR) between January 1986 and June 1996., Results: Bicycle-related injuries were reported for 4,041 patients; 219 (5%) involved children younger than 5 years. Two young children and 124 older children (3%) wore bicycle helmets. Young children were less likely than older ones to be injured in the street (46% versus 81%, P < .001) and were more likely to be injured at home in the driveway or yard (39% versus 9%, P < .001). Interaction with a motor vehicle contributed to injuries in 31% of young children and 47% of older children (P < .001). Forty-five percent of young children and 56% of older children sustained head injuries (P < .002). The fractions of children in each age group with facial trauma, abdominal or thoracic injury, and fractures were similar. Pediatric Trauma Scores, Glasgow Coma Scale scores, operating room use rates, and median number of hospital days were similar for both age groups. Rehabilitation or extended care was required by 1% of young children and 2% of older children. Two deaths occurred among young children (1%); 2% of older children died., Conclusion: Of patients with bicycle-related injuries reported to the NPTR, a minority are young children, but they have injuries similar in severity and outcome to those of older children. Because young children sustain severe injuries, including head trauma, helmets are indicated for them, as well as for older children.

This analysis of mortality from blunt hepatic injury was performed to define outcome in the adolescent age group in relation to that recorded for children and adults. Children (age 0-10 years) were selected from a multi-institutional trauma registry, adults (age > or = 21 years) from the registry of a Level I trauma center, and adolescents (age 11-20 years) from both. Groups were compared by injury frequency, proportion of severe hepatic injuries (code 864.03 or 864.04 in the International Classification of Diseases, Adapted for Use in the United States 9-CM), immediate laparotomy, mortality, and cause of death. Children had the lowest proportion of severe injury and overall mortality. Torso trauma was the primary cause of death in only three children. Adolescent injury patterns were similar to those of adults in the proportion of severe visceral disruption and incidence of fatal torso trauma. Immediate laparotomy was employed almost twice as commonly in adults as in adolescents. The 64 per cent of adolescents who did not undergo laparotomy had a lower mortality than those who did. Conversely, the 36 per cent of adults without exploration had a significantly higher mortality, which usually occurred before laparotomy could be initiated. Increasing hepatic injury severity brought increasing mortality; however, the cause of death differed with age. Although the incidence of severe liver injury did not differ between adolescents and adults, management and outcome did. These data indicate that individualized management based on overall patient status remains the best approach to care of these injuries.

Objective: To examine the characteristics of unintentional and assaultive firearm-related pediatric injuries treated in trauma centers., Design: Comparative analysis of patients 14 years or younger who were admitted to the trauma centers because of unintentional firearm-related injuries (n = 292) vs assaultive firearm-related injuries (n = 457)., Setting: Sixty-eight trauma centers or children's hospitals in the continental United States and Canada that reported data to the National Pediatric Trauma Registry from January 1, 1990, through December 31, 1994., Main Outcome Measures: Frequency distributions of firearm-related injuries in relation to intent and injury circumstances, odds ratios (ORs) on the intent of injury being assaultive, injury severity scales, and in-hospital fatality rates., Results: The frequency of unintentional firearm-related injuries rose in the afternoons peaking between 4 and 5 PM; they predominantly occurred at home (89%). Assaultive firearm-related injuries peaked sharply between 8 and 9 PM and usually occurred on roads or in other public places (63%). About 3 times as many boys as girls were harmed in firearm-related injuries. Given a firearm-related injury resulting in admission to a trauma center, the adjusted OR of it being assaultive was 2.8 (95% confidence interval [CI], 1.6-4.6) if the victim was a girl, 4.9 (95% CI, 3.1-7.8) if the shooting occurred at night, 2.6 (95% CI, 1.6-4.2) if the shooting occurred on a weekday, and 21.1 (95% CI, 9.1-49.4) if the shooting occurred on a road. Injury patterns and severity were similar between patients with unintentional and assaultive injuries. Overall, 19% of the patients sustained head injuries, which contributed to 90% of the in-hospital deaths., Conclusions: Marked differences in injury circumstances exist between unintentional and assaultive firearm-related injuries among children. The late afternoon hours when many children have come home from school but their parents may still be working have the highest frequency of unintentional firearm-related injuries. The evening peak of assaultive injuries may be related to drug-related and gang-related violence. While it is important to reduce the access of firearms to children, school-based extracurricular and community-based social services should be considered in developing intervention programs.

This study compares outcome from pelvic fractures in children with that of adults. Data for 23,700 children registered in the National Pediatric Trauma Registry (NPTR) were compared with those of 10,720 adults recorded over 5 years in the registry of our level I trauma center. Patients were categorized by open versus closed fracture and by fracture type as defined by a modification of the Key and Conwell system. Outcome was evaluated by mortality rate and incidence of fracture-induced fatal exsanguination. The 722 pelvic fractures recorded in the NPTR represent 3% of the population and is half the frequency represented by the 532 adults evaluated (P < .001). The overall mortality rate was 5% for children and 17% for adults. Two children died of fracture-related exsanguination; there were 18 such deaths among the adults. Pelvic ring disruption was encountered more commonly among adults, and was associated with a significantly higher mortality rate. Patients with initial hemodynamic instability were more likely to die, although children less so than adults. The authors conclude that children do not die of pelvic fracture-associated hemorrhage as often as adults. Massive blood loss in the child occurs most commonly from solid visceral injury rather than from pelvic vascular disruption.

Three data sets describe the pattern of gunshot injuries to children from 1960 to 1993: The Harlem Hospital pediatric trauma registry (HHPTR), the northern Manhattan injury surveillance system (NMISS) a population-based study, and the National Pediatric Trauma Registry (NPTR). A small case-control study compares the characteristics of injured children with a control group. Before 1970 gunshot injuries to Harlem children were rare. In 1971 an initial rise in pediatric gunshot admissions occurred, and by 1988 pediatric gunshot injuries at Harlem Hospital had peaked at 33. Population-based data through NMISS showed that the gunshot rate for Central Harlem children 10 to 16 years of age rose from 64.6 per 100,000 in 1986 to 267.6 per 100,000 in 1987, a 400% increase. The case fatality for children admitted to Harlem Hospital (1960 to 1993) was 3%, usually because of brain injury, but the majority of deaths occurred before hospitalization. During the same period, felony drug arrests in Harlem increased by 163%. The neighboring South Bronx experienced the same increase in gunshot wound admissions and felony arrests from 1986 to 1993. The NPTR showed a similar injury pattern for other communities in the United States. In a case-control analysis. Harlem adolescents who had sustained gunshot wounds were more likely to have dropped out of school, to have lived in a household without a biological parent, to have experienced parental death, and to have known of a relative or friend who had been shot than community adolescents treated for other medical or surgical problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Using data from the National Pediatric Trauma Registry, this study examined the characteristics of bicycle-related head injury, factors related to the presence of head injury, and different outcomes of head injury up to the time of discharge. Of the 2,333 patients ages 0 to 14 years who were admitted to trauma centers because of bicycle-related injury during 1989 through 1992, more than one-half (54%) sustained head injury, predominantly concussions and skull fractures. With adjustment for age, sex, and motor vehicle involvement, children who had pre-existing mental disorders, who did not wear a helmet at the time of injury, or who were injured on roads had a significantly increased likelihood of sustaining head injuries. Patients with a head injury were four times as likely as patients with no head injury to be treated in intensive care units, and were almost twice as likely to develop complications. Head injury was associated with an increased risk of inhospital fatality and high prevalence rates of communication and behavior impairments at discharge. Although it is urgent to increase helmet use substantially by child bicyclists, special attention should be paid to high-risk groups, such as children with mental disorders and children who are likely to ride in traffic.

To determine the extent and consequences of major truncal injury in children, we analyzed data collected prospectively by the National Pediatric Trauma Registry (NPTR) from 1985 to 1991. Of the 25,301 patients entered into the study, 1,553 (6%) had thoracic injuries (T); 2,047 (8%) had abdominal injuries (A). Blunt mechanisms predominated for both groups (86% T, 83% A), with the automobile being the most frequent blunt agent (74% T, 59% A); gunshot wounds were responsible for the majority of penetrating injuries (60% T, 56% A). Fifteen percent (195) of those with blunt thoracic injuries died; however, in only 14% of these cases (27) was thoracic injury the cause of death. Fourteen percent (33) of those with penetrating thoracic injuries died, with thoracic injury the cause of death in 97% of these cases (32). Only 9% (161) of those with blunt abdominal injuries died; in 22% (35) abdominal injury was the cause of death. Likewise, only 6% (15) of those with penetrating abdominal injuries died, but abdominal injury was the cause of death in 67% (10). The pleural space, lung, and ribs were the most frequently damaged thoracic organs; with the exception of lung contusion, injuries to these structures were associated with fatality rates in excess of 50%. The liver, spleen, kidneys, and gastrointestinal tract were the most frequently damaged abdominal organs; injuries to these structures were associated with fatality rates of 15% or less, except for injuries involving major blood vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

A subset of the National Pediatric Trauma Registry was analyzed to describe causes and outcomes of blunt trauma among children younger than age 15 years. This subset, of 8639 children with blunt trauma, was divided into three groups according to the injured body region: a group with extracranial injury only (ECI) accounted for one half of the population, and the remainder were equally distributed between a group with head injury only (HI) and one with both conditions (ECI + HI). The three groups were compared with respect to demographic characteristics, external cause of injury, injury severity, and outcomes. Falls were the leading cause of injury in the HI group, where children were younger, whereas traffic-related injuries predominated in children with ECI or ECI + HI. Pedestrian injuries accounted for a significant share of poor outcomes. The highest proportions of deaths and severe injuries were observed in the mixed group (ECI +HI), and the lowest, in the ECI group. In contrast, functional impairments at discharge were most frequently noted in the ECI group, where 60% of the children were discharged with at least one impairment. While only 6% of children with HI were discharged with impairment, those affected exhibited more deficits in cognition and behavior, which are expected to persist longer than dysfunction in activities of daily living.

To determine concordance between regional outcome and national norms with respect to pediatric injury diagnosis, severity, and mortality in a state lacking a well-organized trauma system, we compared summary data from all pediatric trauma-related hospital discharge abstracts compiled by the [New York State Department of Health] Statewide Planning and Research Cooperative [Mandatory Hospital Reporting] System (SPARCS), with comparable data from pediatric trauma centers participating in the National Pediatric Trauma Registry (NPTR), for similar epochs in the late 1980s. Analysis was based on 14,234 cases from SPARCS and 17,098 cases from NPTR. Data were grouped by principal anatomic diagnosis (ICD-9-CM N-code) and injury severity score (ISS), for each of which incidence and mortality were calculated, both individually and collectively, then compared item by item for sources of variance. Overall, the two data sets showed the expected discordance, with NPTR being skewed toward more complex and severe injury. However, when analyzed cell by cell, a striking degree of concordance emerged in both incidence and mortality for injuries of comparable severity in all but a few selected subsets. Isolated skeletal injuries were treated less frequently in pediatric trauma centers, and combined system injuries to the skeleton, brain, and internal organs were treated more frequently in pediatric trauma centers. However, while the fatality rates were similar between SPARCS and NPTR for most diagnoses, given comparable ISS, survival was some ten times greater in pediatric trauma centers for patients with either brain or internal injuries--the leading causes of pediatric injury mortality--and for skeletal injuries, when the injuries sustained were of moderately great severity.(ABSTRACT TRUNCATED AT 250 WORDS)

The records of 10,098 children entered into the National Pediatric Trauma Registry (NPTR) were analyzed to define the characteristics of pediatric head injury and the impact of extracranial trauma on Central Nervous System (CNS) injury. The 4,400 NPTR head injuries were then compared with 16,524 head injuries recently reported from a predominantly adult trauma registry to illustrate potential population differences. Results indicate that children have a lower mortality, that the addition of extracranial injury significantly reduces recovery potential, that CNS injury is the predominant and most common cause of pediatric traumatic death, and that the automobile is the most lethal component of a child's environment.

Among the elderly, those at highest risk are the chronically ill, inactive patients. Assessing macronutrient requirements and outcome depends on longitudinal studies. Seven chronically ill, elderly female patients suffering from persistent infections, were studied monthly, over a 6-month period to determine their protein and energy requirements. Calorie and protein requirements were based on clinical status. The results of the nutrition support program were monitored using: weight change, nitrogen balance, serum albumin levels, alterations in anthropometric measurements (triceps skinfold thickness and arm muscle circumference), and immune function tests. Based on the 6-month study period data, the calculated mean energy requirement for weight maintenance was 98% of calculated basal energy expenditure (BEE) and the mean protein required for nitrogen balance, 0.8 g/kg desired body weight (DBW). Excess caloric administration resulted in weight gain, determined to be fat (and/or fluid) but not lean body mass. When surgery is contemplated, there should be a 30% (factorial) increase over these base-line values. It is inadvisable to allow elderly patients to sustain any starvation, period given their inability to produce increases in body cell mass even in this 6-month period.

A nonpatient population of air traffic controllers, all of whom remained employed during the observation period, was examined monthly for one year for level of depression using the Zung Self-Rating Depression Scale. The average monthly prevalence of depression was 9.1%, with 7.0% at the symptom level, 1.9% at a level comparable to outpatients, and 0.2% with moderately severe levels. These figures were generally similar to those for other reported population groups, although exact comparisons were difficult because of the preselection for health in this population. Two patterns of depression were observed. One was characterized by an acute, episodic symptomatology returning to nonsymptomatic levels for most of the year, similar to Research Diagnostic Criteria (RDC) category "episodic minor depressive disorder." The other showed a chronic, fluctuating course with significant depressive symptomatology over half the year, similar to RDC category "chronic and intermittent minor depressive disorder."

The National Pediatric Trauma Registry (NPTR) is a multi-institutional database designed to compile information concerning all aspects of pediatric trauma care. The registry is designed and operated in a manner that maximizes data accuracy and provides this information to all participating investigators. The growth of the database has allowed the NPTR to provide the first accurate epidemiologic description of pediatric trauma as a national disease, as well as to develop national norms for pediatric trauma care. The registry presently contains 10,177 patients, and is undergoing revisions (phase II) to allow a more focused evaluation of various aspects of the clinical care and rehabilitation of the pediatric trauma patient.

The ability of the Pediatric Trauma Score (P.T.S.) to predict injury severity and mortality was evaluated by analysis of its relationship with the Injury Severity Score (I.S.S.) of 615 children entered into the National Pediatric Trauma Registry (N.P.T.R.). Mean age was 8.2 years and mortality was 3.5%. Mean I.S.S. of survivors was 8.1 in comparison to 59.7 for nonsurvivors. Linear regression coefficient determined from analysis of these variables produced a slope of -3.7 with a statistically significant correlation of P.T.S. to I.S.S. (p less than 0.001; r2 = 0.89). Analysis of the mortality for each cohort of patients with the same P.T.S. identified three categories of mortality potential. Children whose P.T.S. was greater than 8 had a 0% mortality. Children whose P.T.S. was between 0 and 8 had an increasing mortality related to their decreasing P.T.S. (r2 = 0.86), and children whose P.T.S. was below 0 had 100% mortality. This study documents the direct linear relationship between P.T.S. and injury severity, and confirms the P.T.S. as an effective predictor of both severity of injury and potential for mortality.