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We describe a case of chondroblastic osteosarcoma of the vertebral column in a 67-yr-old male in whom the preoperative diagnosis was made by fine-needle aspiration biopsy (FNAB). This diagnosis was subsequently confirmed in the T8 corpectomy specimen. Although the smears of the aspirate revealed only occasional markedly atypical spindle-shaped nuclei, the cell block was diagnostic of malignancy. It showed a well-preserved fragment of neoplastic cartilage populated by markedly atypical hyperchromatic cells and a crushed fragment of anaplastic spindle-shaped cells surrounded by opaque collagenous matrix reminiscent of osteoid. The surgically resected specimen exhibited comparable histological features as well as colonies of gram-positive bacilli within the necrotic tumor. Culture confirmed the presence of Corynebacterium species. It is likely that these skin organisms were introduced at the time of FNAB. This case demonstrates the value of FNAB in the diagnosis of primary bone tumors and reports a rare complication of this procedure. Diagn. Cytopathol. 1999;20:38–43. © 1999 Wiley-Liss, Inc.

OBJECTIVE. The purpose of this study was to investigate transportation practices of caregivers who transport children diagnosed with autism spectrum disorders (ASD). METHOD. We reviewed documented transportation evaluations of children with ASD. The evaluations were conducted by pediatric occupational therapists at an outpatient center of a large children’s hospital. RESULTS. A review of 82 charts of patients diagnosed with ASD revealed that 74% of children with ASD were escaping their child safety restraint. More than 20% of parents reported that their child demonstrated aggressive or self-injurious behavior during travel, affecting not only their own safety but also that of others in the vehicle, including the driver. CONCLUSION. Escaping from a child restraint can be a life-threatening problem among children with ASD. Parents, caregivers, and health care professionals should be aware of services available from trained therapists, certified child passenger safety technicians, or both to maximize safety during personal travel in the family vehicle.

Published literature on fractures of the femoral shaft has reported results of treatment stratified by fracture type or treatment type. The current study analyzes the outcome of fractures of the femoral shaft in elderly patients. One hundred thirty-eight patients older than the age of 65 years sustained femoral shaft fractures. Ten percent of the patients had associated injuries. The majority of the patients had significant prefracture medical problems. Nonsurgical treatment was used in 29 cases. Surgical treatment in 109 patients consisted of cerclage wires in 13 cases, plates and screws in 58 cases, intramedullary nails in 26 cases, and long stem prostheses in 12 cases. Complications of treatment occurred in 46% of patients. The type of treatment did not influence the frequency of complications. Twenty percent of patients died within 6 months of the fracture. There was a significant difference in the age of the patients who survived compared with those who did not survive. The mental status of the patient was also a major determinant of survival. Alert and oriented patients had a much better chance of survival. The outcome of fractures of the femoral shafts cited in the literature is different from the results seen in this population of elderly patients. The observed complication rate of 46% and mortality rate of 20% in this series is similar to those reported for intertrochanteric fractures and femoral neck fractures. Age and mental status are important determinants in the survival of the patient regardless of the treatment administered.

Background Crashes among US novice young drivers remain too high. Addressing this problem, one effective program for parents is Checkpoints, which raises parents’ awareness of risks to their young drivers and offers ways to reduce those risks. But its most effective approach was in driver education classrooms and not widely available. A federally-funded study adapted Checkpoints to a website that could be promoted in several ways. This study promoted the Checkpoints website in brief interventions by Primary Care Practitioners (PCPs), and examined dissemination to/implementation by parents. Methods The website, youngdriverparenting.org (with an interactive parent-teen driving agreement, PTDA) , and brief intervention protocol were developed in collaboration with leadership of Paediatric Research in Office Settings at the American Academy of Paediatrics. PCPs delivered interventions and materials to parents, referred them to the website, and completed follow-up surveys. Google Analytics was used to assess parents’ website use. Results Focus groups of parents/teens determined the website adaptation successful. Most of the 133 PCPs from 16 states reported delivering interventions with fidelity, and thought the program important and feasible. Brief interventions/website referrals, averaging 4.4 minutes, were delivered to 3,465 (87%) of 3,990 eligible parents over an 18-week average in 2012–2013. Website visits (1,453) were made by 42% of parents exposed to the intervention, who spent on average 3.53 minutes viewing an average of 4.2 pages. The PTDA was viewed by 24%, and 10% registered for an interactive PTDA. Conclusions Translation of an evidence-based parent program to a PCP-promoted website was demonstrated. Delivering the brief intervention/website referral was feasible and acceptable to PCPs. This program costs little (its website, training and promotional materials are available) and could be one component of a comprehensive approach to reducing young driver crashes.

This study reviews trends, rear facing, top tether use, and seating position for children younger than 13y among motor vehicle passengers in Indiana. This is an observational, cross-sectional survey of drivers transporting children 15 years and younger and drivers collected at 25 convenience locations randomly selected in Indiana during summers 2005 through 2010. Observations were conducted by Certified Child Passenger Safety Technicians (CPST). As the driver completed a written survey collecting demographic data on the driver and children, the CPST recorded the vehicle seating location, the type of restraint, direction the car safety seat (CSS) was facing, and use of the CSS harness or safety belt as appropriate. Data was analyzed for infants younger than twelve months, children in forward facing CSS, and children < 13y. Between 2005 and 2010, 514 infants (age < 12m) were observed in motor vehicles. On average 83.5% (SD 4.8%) of the infants were rear facing. The percent of infants rear facing was 75.5% during 2005 and rose to 88.9% during 2010. Of the 442 vehicles observed with a forward facing car seat, 58% (SD 16.5%) had the top tether attached. In our sample, more than 88.7% (SD 0.8%) children < 13y were seated in a rear seat vehicle position. Driver variables affecting occupant protection are discussed. This information can be used by primary care providers and child passenger safety technicians and other child passenger safety advocates to develop counseling points and educational campaigns.

Physical disabilities may affect a child passenger's fit within a conventional motor vehicle restraint. The aim of this study is to describe and compare injury risk in motor vehicle crashes (MVC) among children with and without special physical health care needs (SPHCN). This analysis, conducted in 2007-2008, utilizes data collected between December 1998 and November 2002 in a cross-sectional study of children ≤15 years old involved in crashes of State-Farm insured vehicles in 15 states and the District of Columbia. Parent reports via telephone survey were used to define pre-crash SPHCN, restraint status, and occurrence of significant injuries using a validated survey. Complete data were collected for 18,852 children aged 0-15 years; 159 children were reported to have a SPHCN (0.8% and 0.7% of children aged 0-8 and 9-15 years, respectively). A greater proportion of children with SPHCN aged 0-8 years were appropriately restrained (P < 0.001), but there was no significant difference in restraint use among children with and without SPHCN aged 9-15 years. There was no significant association between the presence of a SPHCN and injury risk in either age group, after adjustment for child/driver characteristics (children aged 0-8 years: OR 1.27, 95% CI: 0.48-3.33; children aged 9-15 years: OR 1.51, 95% CI: 0.38-6.11). Children with and without SPHCN have similar injury risk in MVC, despite increased age-appropriate restraint usage among children aged 0-8 years. When counseling families about vehicle safety, practitioners should consider the fit of a child with SPHCN in a restraint system.

Dog bites are a significant public health problem among children. The purpose of this study was to examine the hospital incidence, hospital charges, and characteristics of dog bite injuries among children by age group and hospitalization status who were treated at our health care system to guide prevention programs and policies.An electronic hospital database identified all patients younger than 18 years who were treated for dog bites from 1999 to 2006. Demographics, injury information, hospital admission status, length of stay, hospital charges, and payer source were collected. A further review of the narrative part of the inpatient electronic database was examined to identify owner of the dog, type of dog, and circumstances surrounding the incident.During 8 years, 1,347 children younger than 18 years were treated for dog bites. The majority were treated and released from the emergency department (91%). Of the 66 children (4.9%) requiring inpatient admission, the median length of stay was 2 days. Victims were frequently male (56.9%) and8 years (55.2%). Children younger than 5 years represented 34% of all dog bite victims, but 50% of all children requiring hospitalization. Thirty-seven percent of all children admitted to the hospital were bitten by a family dog. The cost of direct medical care during the study was $2.15 million.Dog bite visits comprised 1.5% of all pediatric injuries treated in our hospital system during the study period. The majority (91%) of all dog bite visits were treated and released from the emergency department. Injuries to the head/neck region increased the odds of requiring 23 hour observation (OR, 1.95) and age less than 5 years increased the odds of being admitted as an inpatient (OR, 3.3).

OBJECTIVES. Special health care needs associated with behavioral conditions may influence a child's safety in motor vehicle crashes. The aim of this study was to describe and compare variation in restraint use, seating position, and injury risk in motor vehicle crashes among children with and without special health care needs likely to affect behavior. PATIENTS AND METHODS. This study uses data collected between December 1, 1998, and November 30, 2002, in a cross-sectional study of children RESULTS. Complete data were collected for 14654 children aged 4 to 15 years, representing 171633 children in crashes. Of these, 152 children were reported to have a special need likely to affect behavior, representing 1883 children. A greater proportion of children with special needs likely to affect behavior were appropriately restrained, particularly among children aged 4 to 8 years. Drivers of children with special needs likely to affect behavior were more often restrained and more often were the child passenger's parent. There were no differences in the rates of front-row seating. There was no significant association between the presence of a special need likely to affect behavior and risk of injury, after adjustment for child/driver characteristics and crash severity. CONCLUSIONS. Despite a greater proportion of children with special needs likely to affect behavior using proper vehicle restraint, their injury risk was similar to that of children without these special needs. Primary care pediatricians providing best practices for vehicle safety should consider the unique riding experience and risk of injury among children with special health care needs likely to affect behavior.

Objective Observe and report seat belt use among children transported in belt-positioning booster seats. Design We conducted a cross-sectional, observational survey of children transported in motor vehicles between 2006 and 2007. While drivers completed a survey reporting the child's age, weight and gender, and the driver's age, gender, race, income, education, and relationship to the child; a child passenger safety technician recorded vehicle seating location, restraint type, and use of the car safety seat harness or seat belt as appropriate for the child. Setting Twenty-five fast food restaurants and discount department stores throughout Indiana. Participants A convenience sample of drivers transporting children younger than 16 years. Main exposure Seat belt use among children transported in belt-positioning booster seats. Outcome measure Seat belt misuse. Results Overall, 1446 drivers participated, 2287 children were observed with 564 children in belt-positioning booster seats. At least one seat belt misuse was observed for 64.8% of the children transported. Common misuses were the shoulder belt being placed over the booster seat armrest (35.8%); shoulder belt not at mid-shoulder position (28.5%), seat belt was too loose (24.5%), and the shoulder belt was either behind the child's back (9.1%) or under their arm (10.0%). Conclusion There is a high frequency of seat belt misuses among children transported in booster seats. Advice to parents on appropriate car seat selection, and encouragement to parents to supervise seat belt use may decrease misuse.

Objective To understand clinician influence on use of home and automobile smoking bans in homes of children living with a smoker. Methods Parents were surveyed on tobacco use, smoking bans, demographics and opinions about tobacco, including harm from environmental tobacco smoke (ETS). Responses from 463 diverse households with smokers were analyzed. Results 42% of respondents smoked; 50% had a home smoking ban and 58% an automobile smoking ban. Nonsmokers living with a smoker, those who strongly agreed in ETS harm, and those having a child ≤5 years more often had a home smoking ban. Those recalling their child's doctor ever asking the respondent about their smoking status and African American respondents less frequently had a home ban. Automobile smoking bans were more often held by those with strong agreement in ETS harm and less often found in families having a child receiving Medicaid/uninsured. Conclusions Having a strong perception of harm from ETS exposure was associated with having smoking bans. Aspects of health encounters not measured by this study may be negatively influencing adoption of home smoking bans or lead to recall bias. Practice implications Clinicians should examine the strength, focus, and response to their messages to parents about tobacco.

BACKGROUND: Suicide is an important public health concern. Firearms are the most common mechanism of suicide death. This study describes the epidemiology of fatal and nonfatal firearm suicide injuries (FSI) in one metropolitan area from 2002 through 2004 using a firearm injury surveillance system. METHODS: Records were obtained of all victims of firearm injuries from hospitals, police, and the coroner. All injuries categorized as suicide were included. RESULTS: Local age adjusted suicide rates were significantly higher than state or national rates for ages 15 to 24, and significantly higher than national rates for ages 25 to 44. Men were FSI victims more than five times as often as women were. There was no seasonal pattern identified. Handguns were used nearly three out of four times. Eighty-six percent of FSI victims died, two-thirds at the scene. Most wounds were in the head or chest. Mental illness or relationship problems were common. Most suicides occurred in a residence. CONCLUSIONS: Community level firearm injury surveillance effectively identifies local trends that may differ from national statistics. Collaboration among various groups is used to support injury prevention programs. These data can both complement and contribute to national statistics. Language: en

This study describes the epidemiology of escalator-related injuries among adults age 65 and older in the U.S. between 1991 and 2005, through a retrospective analysis of data from the National Electronic Injury Surveillance System of the U.S. Consumer Product Safety Commission. There were an estimated 39,850 escalator-related injuries and no fatalities. The overall injury rate was 7.8/100,000 population. During the study period 1991-2005, the rate of escalator-related injuries doubled. The mean age of the study population was 80.1 years (S.D.=8.5 years) with 73.3% female. The most frequent cause of injury was a slip, trip or fall (84.9%, 95% CI: 82.7-87.2%). The most frequently injured body parts were the lower extremities (25.9%, 95% CI: 21.5-30.2%) and the head (25.0%, 95% CI: 20.5-29.5%). The leading type of injury was soft tissue injuries (54.2%, 95% CI: 49.7-58.7%) followed by lacerations (22.3%, 95% CI: 18.4-26.1%) and fractures (15.6%, 95% CI: 13.1-18.1%). The rate of head injuries and the rate of hospitalizations increased with age. Escalator-related injuries occur infrequently but may result in significant trauma. These injuries are often associated with a slip, trip or fall. Awareness of the risks and the circumstances leading to escalator injuries allows for better direction of intervention strategies on the part of injury prevention specialists.

This pilot study determines whether NASCAR racing teams demonstrate exposure to lead from exhaust by evaluation of blood lead levels (BLL). Participants were stratified by proximity to fuel exhaust or whether they worked on an engine. Each participant completed a self-reported survey recording demographics, lead exposure (occupational or in-home environment), and any physical symptoms of lead toxicity. Blood lead levels were then measured. BLL of 47 individuals ranged from 1-22 microg/dL with a median of 9.4 microg/dL. Nineteen of 47 (40.4%) had BLLor = 10 microg/dL. Participants exposed to exhaust gas had the highest relative risks (RR) for elevated lead, followed by working on brakes and radiator repair. The RR of having an elevated BLL and self-reported adverse health outcomes or symptoms was increased. This study of NASCAR racing teams demonstrates lead exposure.

The purpose of this study was to examine the characteristics of multiple-level burst fractures in teenaged patients. Five teenaged patients were identified with this injury pattern. The mean age at injury was 17.6 years. All five patients underwent a posterior fusion and an attempted decompression through ligamentotaxis. One of the five went on to have an anterior decompression. Four of the five patients had spinal instrumentation. Neurologic deficit was present in four patients. The proximal fracture was most often responsible for the neurologic deficit when present. The average length of follow-up was 4.5 years. There was no significant neurologic recovery after hospital discharge. Three of the five patients had minimal or no back pain at latest follow-up. The authors conclude that multiple burst fractures should be treated individually based on their clinical and radiographic characteristics.

Background and Aims Children with diverse medical problems are transported daily to school, medical appointments and family events. One-in-ten children worldwide have conditions that may require special consideration to ensure optimal transportation safety. How to safely transport this population is poorly understood. This initiative enhances understanding of correct occupant protection for children with disabilities. Method Positioning problems and physiologic stability of children with developmental, skeletal, and physiologic abnormalities and behavioral concerns were reviewed and where needed special restraints were identified. Biomechanical principles were investigated and applied where possible. Solutions were sought for each condition involving a unique concern. A literature review was conducted and resources identified, many of which were developed by the authors. Results Many infants and children with low birth weight or born prematurely, cerebral palsy, hypotonia, or spina bifida, and skeletal problems including children in casts following injury or surgery frequently cannot be safely transported in conventional car seats. Even within developed nations children with disabilities are suboptimally restrained. Solutions for difficult transportation problems have been developed and identified. Some problems remain unresolved and safety remains suboptimal for some conditions. Conclusions Motor vehicle crashes are a leading cause of mortality and morbidity worldwide and children are often severely injured or killed. Appropriate use of child restraints has been shown to save lives and reduce injury. Solutions exist for many conditions and families benefit from assistance in identification and access to these solutions. Transportation options will be explained and care improved by the information in this presentation.