The importance of a preclinical trial: a selected injury intervention program for pediatric trauma centers.

BACKGROUND: Trauma centers are an ideal site to conduct screening and intervention programs that target risk taking behaviors. We hypothesized that a parent/child-centered intervention is a feasible method of injury prevention for a level one pediatric trauma center. METHODS: The study was conducted in children aged 7 years to 17 years at two level one pediatric trauma centers. The high-risk behaviors targeted were (i) not always using a seat belt, (ii) not always using a bicycle helmet, or (iii) placing children under 12 in the front seat of the car. Those patients who had a positive screening test underwent a brief intervention. Experimental end points included accrual rates, acceptability of protocol by patients and medical staff, knowledge retention. RESULTS: Eighty-eight of the 101 families approached participated. The mean age was 13.3 +/- 2.8 years. The time to consent and screen was 2.7 +/- 0.2 minutes and 9.5 +/- 0.54 minutes. Fifty-three of 88 (60%) children had a positive screening test to one or more of the high risk behaviors. It took 11.5 +/- 1.2 minutes for intervention. Ninety-two percent of healthcare professionals felt that program fit into the trauma center routine. Forty-nine of the 53 families who had a positive screen were successfully contacted 3 months after the intervention. Ninety-seven percent of the follow-up group remembered talking about how seat belts and helmets save lives and about placing children in the back seat of a car. Seventy-nine percent of the families found the information helpful, 53% felt they learned something from the intervention. CONCLUSIONS: Screening and brief intervention is a well-accepted and operationally practical injury prevention intervention. Further controlled injury intervention trials are justified.

Outcomes of posterior spinal fusion and instrumentation in patients with continuous intrathecal baclofen infusion pumps.

STUDY DESIGN: In this retrospective study, 20 spastic quadriplegic cerebral palsy (CP) patients with baclofen pumps, who underwent spinal fusion and instrumentation for neuromuscular scoliosis, were matched for weight, age, and type of fusion with patients without pumps. OBJECTIVE: The objective of this study is to determine the rate of complications, adverse outcomes, and curve correction after spinal fusion in patients with CP and baclofen pumps compared with similar patients without pumps. SUMMARY OF BACKGROUND DATA: CP patients treated with continuous intrathecal baclofen (ITB) can develop neuromuscular scoliosis and may require spinal fusion with instrumentation. ITB pumps may increase complications with this procedure. METHODS: Medical records were examined, and preoperative risks, intraoperative complications, postoperative complications, and pump-specific complications were documented. Cobb angles were measured throughout the treatment to determine surgical correction. RESULTS: Pump patients more frequently required reoperation (9 vs. 4, P = 0.039) and rehospitalization (8 vs. 2, P = 0.008). There was a trend toward more wound infections in pump patients (5 vs. 0, P = 0.063). Nine pump patients (45%) had a pump-related complication; 5 of these patients required pump removal or revision. Complications included durotomy, tubing problems, and deep spinal infection. Average surgical correction in pump patients was 42% (81 degrees -48 degrees ) versus 50% (81 degrees -39 degrees ) in nonpump patients, with no significant difference between pairs (P = 0.11). CONCLUSION: CP patients with baclofen pumps who underwent spinal fusion had more complications compared with similar patients without pumps. There was no significant difference in surgical correction between matched pairs. Physicians and families should be aware of the increased risks of reoperation and rehospitalization after spinal fusion in the presence of baclofen pumps.