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While the number of motor vehicle crashes has declined over the years, crashes resulting from distracted driving are increasing in the United States resulting in significant morbidity and mortality. The national public seems to be aware of the dangers associated with using technology while driving, but continues to engage in this dangerous behaviour, and may be unaware of or underestimate the impact of cell phone use on their own driving performance. Problems associated with distracted driving are not limited to novice or teenage drivers; multifaceted universal prevention efforts aimed at impacting large segments of the population may have the greatest impact. Legislation limiting drivers’ cell phone use has had little impact, possibly due to low regulation and enforcement. Behaviour change programmes, improved vehicle safety, and public awareness campaigns have been developed as potential preventive efforts to reduce accidents caused by distracted drivers. [ABSTRACT FROM PUBLISHER]

Dog bite injuries in children are a preventable health problem. To characterize this type of injury, we have undertaken to define demographic criteria and patterns of injury inflicted by dogs in our pediatric population. A retrospective chart review was conducted of pediatric patients with dog bite injuries admitted to a Level I pediatric trauma center from January 1986 through June 1998. Patient demographics, canine characteristics, and hospital patient data were collected and analyzed using the Excel program and appropriate statistical methodology. There were 67 patient records reviewed. Thirty-eight (57%) of the patients were male, and 29 (43%) were female. There were 43 (64%) white children, 22 (33%) African-American children, and 2 (3%) Hispanic children. The average age of the children was 6.2 +/- 4.2 years, with an average weight of 23.3 +/- 13.7 kg. More than half the attacks occurred in the afternoon and 55 per cent of these attacks were documented as "unprovoked" attacks. Thirty-one (46%) of these attacks involved family pets, and 30 (45%) dogs were known to the attacked child. The head and neck was involved in greater than 67 per cent of these injuries. Pit bulls caused 25 per cent of the bite injuries. Large dogs were responsible for 88 per cent of the attacks. Forty-four (66%) patients required operative intervention. Twenty-eight of these patients had multiple anatomical areas injured. There were 44 procedures involving the head and neck, 21 involving extremities, and 6 involving other areas of the body. All patients 5 years of age and under had head and neck injuries. Dog bite injuries requiring admission occur more in male children. Caucasian and African American children were the majority of children affected. The children under 5 years of age suffered the most devastating injuries. More than half of these attacks were not provoked. More than two-thirds of the injuries to these children involved the head and neck. We conclude that effective prev... [ABSTRACT FROM AUTHOR]

BACKGROUND: Inadequate follow-up of uninsured trauma patients after discharge remains a major challenge for trauma programs. Local access to care programs (LACPs) have been developed to improve access to health care to the uninsured. We hypothesized that enrollment in LACP would improve postdischarge follow-up of uninsured trauma patients. METHODS: Study population consisted of 5,830 uninsured trauma patients from 2006 to 2011, treated at a large urban level-I trauma center. Patients with burn injuries, transfers to another acutecare facility, and those who died or who left against medical advice were excluded. Patients who enrolled in our LACP were compared with those who did not to determine the relationship between enrollment in LACP and postdischarge follow-up, while controlling for injury severity, demographics, and discharge disposition. RESULTS: Patients in LACP were significantly more likely to schedule follow-up appointments after discharge (odds ratio = 1.78; 95% confidence interval, 1.51 to 2.10) and to comply with them (odds ratio = 2.44; 95% confidence interval, 1.98 to 2.99). However, 30-day readmission rates were similar in the 2 groups (1.1% vs 1.9%). CONCLUSIONS: Enrollment in the LACP was associated with improved postdischarge follow-up but not readmissions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Current practices suggest that patients with mild traumatic brain injuries (MTBI) receive neurosurgical consultations, while less than 1% require neurosurgical intervention. We implemented a policy of selective neurosurgical consultation with the hypothesis that trauma surgeons alone may manage such patients with no impact on patient outcomes METHODS: Data from a level I trauma registry were analyzed. Patients with MTBI resulting in an intracranial hemorrhage of 1 cm or less and a Glasgow Coma Score of 13 or greater were included. Patients with additional intracranial injuries were excluded. Multivariate regression was used to determine the relationship between neurosurgical management and good neurologic outcomes, while controlling for injury severity, demographics, and comorbidities. RESULTS: Implementation of the neurosurgical policy significantly reduced the number of such consults (94% before vs 65% after, P < .002). Multivariate analysis revealed that neurosurgical consultation was not associated with neurologic outcomes of patients CONCLUSIONS: Implementation of a selective neurosurgical consultation policy for patients with MTBI reduced neurosurgical consultations without any impact on patient outcomes, suggesting that trauma surgeons can effectively manage these patients. [ABSTRACT FROM AUTHOR]