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OBJECTIVE. The goal was to examine the influence of sociodemographic characteristics and health care system factors on the utilization of hospital resources by US children [greater than or equal to] 17 years of age with a diagnosis of traumatic brain injury. METHODS. A retrospective analysis of data from the Healthcare Cost and Utilization Project Kids' Inpatient Database, from January 1, 2000, to December 31, 2000, was performed. National estimates of traumatic brain injury-associated hospitalization rates and resource use were calculated with Kids' Inpatient Database sample weighting methods. RESULTS. Of 2 516 833 encounters between January 1, 2000, and December 31, 2000, 25 783 cases involved patients [greater than or equal to] 17 years of age with a recorded diagnosis of traumatic brain injury. On the basis of these data, there were an estimated 50 658 traumatic brain injury-associated hospitalizations among children [greater than or equal to] 17 years of age in the United States in 2000. The traumatic brain injury-associated hospitalization rate was 70 cases per 100 000 children [greater than or equal to] 17 years of age per year; 15- to 17-year-old patients had the highest hospitalization rate (125 cases per 100 000 children per year). Pediatric inpatients accrued more than $1 billion in total charges for traumatic brain injury-associated hospitalizations in this study. In the multivariate regression models, older age, Medicaid insurance status, and admission to any type of children's hospital were associated with a longer length of stay for pediatric traumatic brain injury-associated hospitalizations. Older age, longer length of stay, and in-hospital death predicted higher total charges for traumatic brain injury-associated hospitalizations. CONCLUSION. Pediatric traumatic brain injury is a substantial contributor to the health resource burden in the United States, accounting for more than $1 billion in total hospital charges annually. Key Words traumatic brain injury pediatrics resource utilization length of stay, total charges, Kids' Inpatient Database Abbreviations CDC--Centers for Disease Control and Prevention CI--confidence interval KID---Kids' Inpatient Database LOS--length of stay OLS--ordinary least-squares TBI--traumatic brain injury, TRAUMATIC BRAIN INJURY (TBI) has been referred to as the "silent epidemic" by the Centers for Disease Control and Prevention (CDC) and others, because of its vast incidence and pressing [...]

OBJECTIVE. To describe the epidemiology of cheerleading-related injuries among children in the United States. DESIGN. A retrospective analysis of data for children 5 to 18 years old from the National Electronic Injury Surveillance System (NEISS) of the US Consumer Product Safety Commission, 1990-2002. METHODS. Sample weights provided by the NEISS were used to make national estimates of cheerleading-related injuries. Injury rates were calculated for the most frequently occurring types of injury using cheerleading participation data. RESULTS. An estimated 208 800 children (95% confidence interval [CI]: 166 620-250 980) 5 to 18 years of age were treated in US hospital emergency departments for cheerleading-related injuries during the 13-year period of 1990-2002. The number of injuries increased by 110% from 10 900 in 1990 to 22 900 in 2002, with an average of 16 100 (95% CI: 12 848-19 352 injuries per year (P < .01). The average age of injured children was 14.4 years (median: 15.0 years); 97% were female; and 85% of injuries occurred to children 12 to 17 years old. The number of injuries per 1000 participants per year was greater for 12- to 17-year-olds (8.1) than for 6- to 11-year-olds (1.2) for all cheerleading-related injuries combined (P < .01; relative risk [RR]: 6.49; 95% CI: 6.40-6.58), as well as for injuries grouped by body part injured and type of injury. The body parts injured were lower extremity (37.2%), upper extremity (26.4%), head/neck (18.8%), trunk (16.8%), and other (0.8%). Injury diagnoses were strains/sprains (52.4%), soft tissue injuries (18.4%), fractures/dislocations (16.4%), lacerations/avulsions (3.8%), concussions/closed head injuries (3.5%), and other (5.5%). Children in the 12- to 18-year age group were more likely to sustain strains or sprains to the lower extremity than 5-to 11-year-olds (P < .01; RR: 1.62; 95% CI: 1.50-1.88). The majority of patients with cheerleading-related injuries was treated and released from the emergency department (98.7%). Patients sustaining fractures or dislocations were more likely to be admitted to the hospital than those sustaining other types of injury (P < .01; RR: 5.30; 95% CI: 3.29-6.43). CONCLUSIONS. To our knowledge, this study is the first to report numbers, rates, and trends of cheerleading-related injuries to children using a nationally representative sample. Cheerleading is an important source of injury to girls. The number of cheerleading-related injuries more than doubled during the 13-year study period. A set of uniform rules and regulations directed at increasing the safety of cheerleading, that are universally enforced, should be implemented. Mandatory completion of a safety training and certification program should be required of all cheerleading coaches. Establishment of a national database for cheerleading-related injuries would facilitate the development and evaluation of injury-prevention strategies based on epidemiologic evidence. www.pediatrics.org/cgi/doi/10.1542/ peds.2005-1139 doi:10.1542/peds.2005-1139 Abbreviations AACCA--American Association of Cheerleading Coaches and Advisors ED--emergency department NEISS--National Electronic Injury Surveillance System CPSC--Consumer Product Safety Commission RR--relative risk CI--confidence interval UNL--University of Nebraska-Lincoln, CHEERLEADING ORIGINATED ON November 2, 1898, when Johnny Campbell led the first cheers at a Minnesota University football game. (1,2) The primary purpose of cheerleading is raising school unity through [...]

Objective. To compare mini- and full-sized trampoline-related injuries in the United States. Methods. A retrospective analysis of data was conducted for all ages from the National Electronic Injury Surveillance System (NEISS) of the US Consumer Product Safety Commission from 1990 to 2002. We compared 137 minitrampoline-related injuries with 143 full-sized trampoline-related injuries, randomly selected from all full-sized trampoline-related injuries reported to the NEISS during the study period. Results. Patients ranged in age from 1 to 80 years (mean [SD]: 13.9 [17.7]) and 2 to 52 years (mean [SD]: 11.0 [8.0]) for mini- and full-sized trampoline-related injuries, respectively. Most patients were younger than 18 years (82% mini, 91% full-sized). Thirty-two percent of minitrampoline- and 19% of full-sized trampoline-related injuries were to children who were younger than 6 years; girls predominated (63% mini, 51% full-sized). Children who were younger than 6 years were more likely to be injured on a minitrampoline than on a full-sized trampoline, when compared with 6- to 17-year-olds (odds ratio [OR]: 2.43; 95% confidence interval [CI]: 1.33-4.47). The majority of injuries occurred at home (87% mini, 89% full-sized). All patients who were injured on a minitrampoline were treated and released, whereas 5% of patients who were injured on a full-sized trampoline were admitted to the hospital. On minitrampolines, children who were younger than 6 years were at risk for head lacerations (OR: 4.98; 95% CI: 1.71-16.03), and children who were 6 to 17 years were at risk for lower extremity strains or sprains (OR: 6.26; 95% CI: 1.35-59.14). Children who were 6 to 17 years and injured on a full-sized trampoline were at risk for lower extremity strains or sprains (OR: 4.85; 95% CI: 1.09-44.93). Lower extremity strains or sprains were the most common injury sustained by adults (18 years and older; 33% mini, 15% full-sized). Conclusions. Injury patterns were similar for mini- and full-sized trampolines, although minitrampoline-related injuries were less likely to require admission to the hospital and more commonly resulted in head lacerations among children who were younger than 6 years. Risk for injury could not be determined because of the lack of data regarding duration of exposure to risk. We therefore conclude that the use of full-sized trampolines by children should follow the policy recommendations of the American Academy of Pediatrics. Trampolines, including minitrampolines, should be regarded as training devices and not as toys. Until more data are available regarding exposure to risk, we caution against the use of the minitrampoline as a play device by children in the home, which is where most minitrampoline-related injuries occur. trampoline, minitrampoline, injury. ABBREVIATIONS. AAP, American Academy of Pediatrics; CPSC, United States Consumer Product Safety Commission; ED, emergency department; NEISS, National Electronic Injury Surveillance System; OR, odds ratio; CI, confidence interval., George Nissen was inspired to invent the "bouncing table," later renamed the trampoline, in 1937 after watching tightrope walkers and trapeze artists perform twists, spins, and somersaults into safety nets [...]

Objective. This study compares injuries, especially head injuries, among ice-skaters with those among skateboarders, rollerskaters, and in-line skaters, to determine the need for helmet use during recreational ice-skating by children. Design. A comparative study of a consecutive series of patients. Setting. The emergency department of a large, urban, academic, children&apos;s hospital. Participants. Children treated for injuries related to recreational ice-skating, skateboarding, rollerskating, and in-line skating. Results. During a 31-month period, 419 consecutive children were evaluated in the emergency department for skating-related injuries. Children were predominately male (53.9%), with a mean age of 10.0 years (SD: 3.0 years; median: 10.0 years; range: 1-18 years). The most frequent mechanism of injury was a fall. Overall, 76.5% of children (215 of 281 children) were reported to be wearing no protective equipment, such as a helmet or padding on the elbows or knees, at the time of injury. Ice-skaters were more likely to have adult supervision than were skateboarders (relative risk [RR]: 5.16; 95% confidence interval [CI]: 2.13-12.46), rollerskaters (RR: 1.21; 95% Ch 1.09-1.35), and in-line skaters (RR: 2.08; 95% Ch 1.72-2.51). Ice-skaters were at greater risk of injury to the head (20.0%) than were in-line skaters (4.9%) (RR: 4.09; 95% CI: 1.81-9.23); a weak difference was noted between ice-skaters and rollerskaters (9.9%) (RR: 2.18; 95% CI: 1.04-4.57), with no significant difference in head injuries between ice-skaters and skateboarders (15.9%) (RR: 1.60; 95% CI: 0.54-2.93). Ice-skaters demonstrated lacerations to the head in 68.8% of abnormal head examinations, compared with 37.0% for rollerskaters (RR: 1.86; 95% CI: 1.08-3.20) and 50.0% for in-line skaters (RR: 2.06; 95% CI: 1.35-3.16); however, there was no significant difference in lacerations to the head between ice-skaters and skateboarders (53.3%) (RR: 1.29; 95% Ch 0.76-2.19). Injuries to ice-skaters occurred more often in an indoor skating facility (92.9%, 52 of 56 cases), compared with injuries to skateboarders (3.6%, 1 of 28 cases) (RR: 13.96; 95% CI: 2.01-96.76), rollerskaters (63.4%, 59 of 93 cases) (RR: 1.46; 95% CI: 1.23-1.74), and in-line skaters (10.9%, 15 of 137 cases) (RR: 8.48; 95% CI: 5.23-13.75). Conclusions. The proportion of head injuries among ice-skaters in this study was greater than that observed for participants in other types of skating, for which helmet use is recommended and often required. Children should wear a helmet during recreational ice-skating, Mandatory helmet use by pediatric ice-skaters at indoor rinks should be implemented. Use of other types of protective equipment, such as wrist guards, knee pads, and elbow pads, should be considered for prevention of injuries to the extremities during ice-skating, Caution should be used when allowing young children to participate in recreational ice-skating. Additional research should be conducted in other populations, to corroborate these findings and to evaluate ice-skating safety recommendations for children. Pediatrics 2004;114:124-128; skating, injuries, helmet, pediatric, trauma, head injury. ABBREVIATIONS. ED, emergency department; RR, relative risk; CI, confidence interval., In 2001, an estimated 56 300 children 5 to 14 years of age were treated in hospital emergency departments (EDs) for injuries related to skateboarding. Rollerskating was associated with 28 [...]

Three new topical anesthetics that do not contain cocaine may be as effective, and possibly safer, than the commonly used tetracaine-adrenaline-cocaine (TAC) preparation. A total of 240 children requiring sutures received a new anesthetic or TAC. Pain during stitching was scored by three observer groups and the patient, if over four years of age. Two additional scoring scales were used by the observers, and one group completed a third. All of the new agents performed well, with one, tetraphen, consistently showing no statistical difference in any of the rating methods, as compared to TAC., ABSTRACT. Objective. To compare the effectiveness of three new topical anesthetics that do not contain cocaine (prilocaine-phenylephrine, tetracaine-phenylephrine [tetraphen], and tetracaine-lidocaine-phenylephrine) to that of tracaine-adrenaline-cocaine (TAC) during laceration repair in children. Design. Prospective, randomized, double-blind clinical trial. Setting. The emergency department of an urban children&apos;s hospital. Participants. Children 1 year of age or older with a laceration [is less than or equal to] 5 cm in length that required suturing. Intervention. A total of 240 children were randomly assigned to one of four treatment groups. Outcome Measures. Pain felt during suturing was scored by suture technicians, research assistants, parents, and patients [is greater than or equal to] 5 years of age using a visual analogue scale (VAS). Suture technicians, research assistants, and parents also scored pain using a seven-point Likert scale. In addition, suture technicians completed an anesthetic effectiveness scale. Results. There was consistently no difference demonstrated between the effectiveness of tetraphen and that of TAC for each outcome measure of each observer group. A statistically significant difference was seen among anesthetics when comparing VAS and Likert scale scores of suture technicians and Likert scale scores of research assistants. Based on post hoc analyses, these statistically significant differences were between TAC and prilocaine-phenylephrine (suture technician VAS and Likert scale) and between TAC and tetracaine-lidocaine-phenylephrine (suture technician Likert scale), but not between TAC and tetraphen. When power analyses were performed using [alpha] = 0.05 and [beta] = 0.20, it was possible to detect a difference of 1.2 VAS units for each of the observer groups. Based on anesthetic effectiveness scale scores, the three new topical preparations collectively performed significantly better on the face and scalp than on the extremities (relative risk = 1.83; 95% confidence interval 1.20 < relative risk < 2.79). Conclusion. This study demonstrated the effectiveness and safety of three new non-cocaine-containing topical anesthetics. Consistently, there was no statistical difference demonstrated between the effectiveness of tetraphen and that of TAC for each outcome measure of each observer group. Tetraphen offers an effective alternative to TAC during laceration repair in children., Pediatrics 1997; 100:825-830; prilocaine, tetracaine, lidocaine, TAC, topical anesthesia, laceration, pediatric emergency department ABBREVIATIONS. TAC, tetracaine--adrenaline--cocaine; Prilophen, prilocaine--phenylephrine; Tetraphen, tetracaine--phenylephrine; Tetralidophen, tetracaine--lidocaine--phenylephrine; VAS, visual analogue scale; RR, relative risk. Use [...]

Fireworks may cause serious pediatric injuries. Over a 22-year period, 316 children were treated for injuries caused by fireworks at a Kansas City children's hospital. Almost all injuries occurred between June 22 and July 14. Three quarters of the injuries were burns. Eleven percent required hospital admission, one child died, and 10% had permanent injuries, including seven children who lost vision in an eye. Firecrackers caused 42% of the injuries, but other types of rockets, Roman candles, sparklers, fountains, jumping jacks, and illegal fireworks such as cherry bombs also caused injuries., Objective. To describe the epidemiology of fireworks-related injuries to children treated in a pediatric emergency department. Design. A descriptive study of a consecutive series of patients. Setting. The emergency department of a large urban children&apos;s hospital. Participants. Children treated for injuries associated with fireworks during the 22-year period from 1972 through 1993. Results. Three hundred sixteen children were treated for fireworks-related injuries. Ninety-five percent of patients were injured during the 3-week period of June 22 to July 14 during the study years. Seventy-one percent of patients were male, and the average age was 8.5 years, with a range of 1 month to 17 years. The child was a bystander in 26% of cases, and adult supervision was present in 54% of cases. One patient died, and 11% of children required admission to the hospital, with an average length of stay of 7.8 days (range, 1 to 37 days). Fifteen children (5%) went to the operating room for treatment of injuries. Thirty-three patients (10%) had permanent sequelae from their injuries, including 7 children (2%) with complete or partial loss of vision in one eye. The eyes were injured in 29% of cases, followed by hands and fingers (22%), other head and face sites (18%), and lower extremities (16%). The primary injury was a burn in 72% of cases. Firecrackers were associated with 42% of injuries, followed by bottle rockets (12%), other types of rockets (7%), Roman candles (11%), sparklers (7%), fountains (5%), jumping jacks (4%), and class B (illegal) fireworks (4%). Sixty-seven percent of sparkler-related injuries occurred among children 5 years and younger (Fisher&apos;s exact test, P = .000002; odds ratio [OR] 10.00, 95% confidence interval 3.52 < OR < 29.24). Permanent sequelae were more common for eye injuries caused by rockets than eye injuries caused by other types of fireworks (Fisher&apos;s exact test, P = .03; OR = 6.72, 95% confidence interval 1.18 < OR < 38.18). Charges for medical care of a fireworks-related injury averaged $1385 per patient (range, $44 to $15 071). Conclusions. Fireworks are associated with serious injuries. Findings of this large consecutive series describe the epidemiology of these injuries. Children and their families should be encouraged to enjoy fireworks at public fireworks displays conducted by professionals. Fireworks for individual private use should be banned. Pediatrics 1996,98:1-9, fireworks, pediatric trauma emergencies, burns, eye injuries, injury prevention., ABBREVIATIONS. ED, emergency department; OR, odds ratio; CI, confidence interval; TBSA, total body surface area. Fireworks are devices designed for the purpose of producing a visible or audible effect by [...]

Bupivacaine-norepinephrine may be an effective topical anesthetic. This gives it an advantage over the other topical anesthetic widely used in children, a mixture of tetracaine, adrenaline, and cocaine (TAC), because if cocaine is misapplied and absorbed, it is highly toxic. Researchers randomly assigned 240 children aged 2 to 17 who needed cuts stitched to one of six groups: bupivacaine-norepinephrine, etidocaine-norepinephrine, mepivacaine-norepinephrine, prilocaine-norepinephrine, TAC, or locally injected lidocaine. Blanching of the wound indicates effective anesthesia. Blanching was judged extensive in 58% of children receiving TAC, 37% of children receiving bupivacaine, 33% of children receiving prilocaine, 23% of patients receiving mepivacaine, and 21% of patients receiving etidocaine. Pain scores as assessed by researchers, suture technicians, parents, and children over age five rated local injection, TAC, and bupivacaine similarly. The rating of the local injection did not take into account the pain of the injection itself., Objective. To compare the effectiveness of four topical anesthetics that do not contain cocaine with that of topical tetracaine-adrenaline-cocaine (TAC) and lidocaine infiltration during laceration repair in children. Design. This was a randomized, blinded trial. Setting. The study was conducted in the emergency department of a large children&apos;s hospital. Participants. Subjects were children 2 years of age or older with a laceration 5 cm or less in length that required suturing. Interventions. Patients were randomly assigned to receive one of four noncocaine-containing topical anesthetics, topical TAC, or lidocaine infiltration anesthesia before laceration repair. Outcome Measures. Outcome measures assessed pain perceptions using a Visual Analogue Scale, Likert scale, and Anesthetic Effectiveness scale. Distress behaviors of patients were measured with the Restrained Infants and Children Distress Rating, Scale. Results. Two. hundred forty patients were enrolled in the study. Using [alpha] = 0.05 and [beta] = 0.2, there was statistical power to detect differences of 0.3 to 1.3 U for the outcome measures used. The bupivacaine-norepinephrine topical solution (Bupivanor) performed better than the other three new topical preparations. It provided effective wound anesthesia during laceration repair, especially for lacerations of the face and scalp, where it was consistently rated as effective as TAC and 1% lidocaine infiltration by all observer groups for all outcome measures. There was a 4% overall wound complication rate, including one wound infection. Conclusion. Bupivanor is an effective alternative to TAC and lidocaine infiltration for local anesthesia during laceration repair, especially on the face and scalp. The effectiveness of Bupivanor on the face is important, because it is here where TAC is most likely inadvertently to come into contact with mucous membranes and result in systemic toxicity. Because pain and distress scores did not take into consideration the pain associated with the initial injection of lidocaine, the findings of this study conservatively estimate Bupivanor&apos;s effectiveness compared with lidocaine infiltration. Pediatrics 1996;97:301-307; bupivacaine, lidocaine, TAC, topical anesthesia, anesthetic, local, laceration, suture techniques, pain, emergency department., Use of topical anesthesia for repair of dermal lacerations in children offers many advantages. The tissue distortion that occurs with infiltration anesthesia is avoided. Anesthesia without a painful injection is [...]

Shopping cart accidents can cause serious injuries to young children. Sixty-two children ranging in age from 4 months to 10 years were treated in a children's hospital emergency room for shopping cart injuries over a 15-month period. Eighteen percent of the children had fractures, including five skull fractures. Fourteen percent had deep cuts. One child dislocated teeth and another an elbow. Five children with head injuries had a definite or probable loss of consciousness. In over half of cases, the child fell out of the cart, and in one-quarter, the cart was tipped, often by a sibling attempting to climb in or out or stand up. In over one-third of cases, the child was seated, and over one-third of these had a fastened seat belt. Shopping cart design makes tipping likely, seating children or placing an infant carrier in the top of the basket makes tipping more likely, and the child generally falls onto a hard surface, all of which increase injury potential., Study Objective. To describe the epidemiology of shopping cart-related injuries among children and to consider targeted prevention strategies based on these epidemiologic findings. Design. A consecutive series of patients. Setting. The emergency department of a large, academic children&apos;s hospital. Participants. Sixty-two children treated for shopping cart-related injuries during a 15-month period. Results. Children ranged in age from 4 months to 10 years (mean, 2.8 years). Thirty-three children (53%) were boys. Twelve patients (19%) arrived via ambulance. Forty-nine children (79%) had injuries to the head, including one child admitted to the hospital. Eleven children (18%) had fractures, including 5 (8%) with skull fractures. Nine patients (14%) had lacerations, and 30 patients (48%) had superficial injuries (ecchymoses or abrasions). The most common mechanism of injury was falling out of the carts (58% of children), followed by cart tip-overs (26% of children), injuries caused by falls from the carts occurred across the entire age range, whereas injuries caused by cart tip-overs were most frequent among children 1 year of age or younger. The sitting position was associated with tip-over injuries, and standing in the cart basket was associated with falling from the cart. Conclusions. Shopping cart-related injuries cause serious, pediatric morbidity, especially among children younger than 5 years of age, and are potentially fatal. Based on identified age-specific mechanisms of injury, currently used prevention strategies are not sufficient. The use of infant seats and restraining belts is an inadequate strategy for prevention of shopping cart-related injuries among children 1 year of age or younger, because cart tip-over is an important mechanism of injury in this age group. Shopping carts should be redesigned to decrease the tip-over hazard. Transportation of children in shopping carts of current design should be prohibited. Pediatrics 1996;97:161-165, pediatric trauma, falls, injury epidemiology, injury prevention, shopping carts., ABBREVIATION. CT, computed tomography. Young children often accompany their parents during shopping trips and are transported in shopping carts. The US Consumer Product Safety Commission estimates that 21 000 children [...]

Objective. To examine the characteristics of children with traumatic amputations and the products associated with these injuries. Methods. Data regarding amputation injuries to children younger than 18 years treated in US emergency departments from 1990 to 2002 were obtained from the National Electronic Injury Surveillance System. Data included demographics, product involved, and body region injured. Results. An estimated 111 600 children younger than 18 years with amputation injuries were treated in US emergency departments from 1990 to 2002. The average age was 6.18 years (median: 4 years; mode: 1 year old). Males experienced 65.5% of these injuries. Finger amputations accounted for 91.6% of all amputations, ranging from 95.2% among 0- to 2-year-olds to 87.9% among 13- to 17-year-olds. Complete amputations accounted for 70.2% of all amputations among 13- to 17-year-olds compared with 52.6% of amputations among 0- to 2-year-olds. Adolescents also had the highest proportion of amputations resulting in hospital admission (26.6% for 13- to 17-year-olds compared with 11.9% for 0- to 2-year-olds). Adolescents had the highest proportion of amputation injuries involving lawn mowers (14.1% for 13- to 17-year-olds compared with 1.4% for 0- to 2-year-olds) and the highest proportion of amputations involving tools (29.3% for 13- to 17-year-olds compared with 2.5% for 0- to 2-year-olds). The percentage of amputations involving doors peaked in the youngest age group and decreased as age increased (65.8% of all amputations for 0- to 2-year-olds compared with 14.1% for 13- to 17-year-olds). Conclusions. To our knowledge, this is the first study to use a nationally representative sample to broadly investigate amputation injuries among children. The majority of traumatic amputation injuries occur to young children, to males, and to fingers and the majority involve doors. Adolescents experience a higher proportion of more serious amputation injuries. Effective interventions exist but are inadequately used to prevent many of these injuries, including door stops and modifications, bicycle-chain and spoke guards, wearing closed-toe footwear while bicycling, a no-mow-in-reverse default feature on ride-on lawnmowers with the override switch located behind the mower operator, and a SawStop system on power saws. Use of these technical countermeasures and changes in relevant product standards to promote their implementation and use could lead to a decrease in pediatric traumatic amputations. URL: www.pediatrics.org/cgi/doi/ 10.1542/peds.2004-2143; trauma, amputation, injury, door, bicycle, lawn mower, power saw, children.

Although most generic drugs can be substituted for brands cost-effectively, the following case suggests that this may not be possible for some patients on fluoxetine. A 38-year-old woman presented to [...]

OBJECTIVE. We describe the epidemiology of escalator-related injuries among children 0 to 19 years of age in the United States, with a focus on the pediatric population that is younger than 5 years. METHODS. We conducted a retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission. Reported cases were used to project national estimates and rates of escalator-related injuries in the United States. The analysis included all patients who were 0 to 19 years of age in the National Electronic Injury Surveillance System database and were seen in an emergency department for an escalator-related injury during the 13-year period 1990-2002. RESULTS. There were an estimated 26 000 escalator-related injuries among children who were 0 to 19 years of age in the United States during 1990-2002, yielding an average of 2000 of these injuries annually (rate = 2.6 per 100 000 population per year). The mean age was 6.5 years at the time of injury, and 53.4% of the patients were male. When comparing cases by 5-year age groups, children who were younger than 5 years had the highest estimated number of injuries (12 000), as well as the highest annual escalator-related injury rate (4.8 per 100 000). The most common mechanism of injury for all age groups was a fall, accounting for 13 000 (51.0%) injuries. Entrapment accounted for 29.3% of all injuries and 36.5% of injuries among children who were younger than 5 years. Six percent (723) of injuries to children who were younger than 5 years involved a stroller, with most injuries occurring when a child fell out of the stroller while on the escalator. The most common body part injured for all ages was the leg, accounting for 27.7% of all injuries. Among children who were younger than 5 years, the hand was the most common injury site (40.6%), with hand injuries frequently occurring as a result of entrapment (72.4%). A laceration was the most common type of injury, accounting for 47.4% of escalator-related injuries. Amputations and avulsions were uncommon; however, 71.4% (595 of 833) occurred among children who were younger than 5 years. CONCLUSIONS. There was a disproportionate number of escalator-related injuries among children who were younger than 5 years. Entrapment occurred more frequently among children who were younger than 5 years than in any other age group, which may explain the increased number of hand injuries in this age group. Escalator designs that reduce the gap between the steps and sidewall or shield against access to the gap may decrease entrapment risk. Young children should be supervised properly and should not be transported in a stroller while riding on an escalator. All passengers should use caution and remain alert when riding an escalator to avoid injuries related to falls or entrapment. Additional research is needed to determine the relationship among passenger behavior, escalator design, and escalator-related injury. KEY WORDS. child, escalator, injury., URL: www.pediatrics.org/cgi/doi.1542/peds.2005-1822 Jennifer McGeehan, MPH, Brenda J. Shields, MS, J. R. Wilkins, III, BCE, DrPH, Amy K. Ferketich, PhD, Gary A. Smith, MD, [...]

OBJECTIVE. Here we describe the epidemiologic characteristics and secular trends of infant walker-related injuries among children who are younger than 15 months in the United States. METHODS. A retrospective analysis was conducted of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission, 1990-2001. Sample weights that were provided by the National Electronic Injury Surveillance System were used in all analyses to adjust for the inverse probability of case selection and make national projections regarding infant walker-related injuries. RESULTS. An estimated 197 200 infant walker-related injuries occurred among children who were younger than 15 months and treated in US emergency departments from 1990 through 2001. Five percent of these children required admission to the hospital. The number of infant walker-related injuries remained relatively constant from 1990 through 1994, averaging 23 000 cases per year. After the introduction in 1994 of stationary activity centers as an alternative to mobile infant walkers and the implementation of the revised American Society for Testing and Materials F977 voluntary infant walker standard in 1997, there was a marked decrease in the number of infant walker-related injuries. Overall, there was a 76% decrease in the number of injuries from 1990 to 2001 from 20 900 injuries in 1990 to 5100 in 2001. Soft tissue injuries and lacerations represented 63% of the injuries. Trauma to the head region occurred in 91% of cases. Skull fractures were the most common (62%) type of fracture. Falls down stairs was the mechanism of injury in 74% of cases. CONCLUSIONS. The adoption of passive injury-prevention strategies, such as use of stationary activity centers as alternatives to mobile infant walkers and redesign of infant walkers to prevent falls down stairs, were associated with a marked decrease in the number of infant walker-related injuries. KEY WORDS. children, infant walker, injuries, injury prevention., URL: [...]