A Change from a Spinal Immobilization to a Spinal Motion Restriction Protocol was Not Associated with an Increase in Disabling Spinal Cord Injuries.

BACKGROUND: Over the past decade, Emergency Medical Service (EMS) systems decreased backboard use as they transition from spinal immobilization (SI) protocols to spinal motion restriction (SMR) protocols. Since this change, no study has examined its effect on the neurologic outcomes of patients with spine injuries. OBJECTIVES: The object of this study is to determine if a state-wide protocol change from an SI to an SMR protocol had an effect on the incidence of disabling spinal cord injuries. METHODS: This was a retrospective review of patients in a single Level I trauma center before and after a change in spinal injury protocols. A two-step review of the record was used to classify spinal cord injuries as disabling or not disabling. A binary logistic regression was used to determine the effects of protocol, gender, age, level of injury, and mechanism of injury (MOI) on the incidence of significant disability from a spinal cord injury. RESULTS: A total of 549 patients in the SI period and 623 patients in the SMR period were included in the analysis. In the logistic regression, the change from an SI protocol to an SMR protocol did not demonstrate a significant effect on the incidence of disabling spinal injuries (OR: 0.78; 95% CI, 0.44 - 1.36). CONCLUSION: This study did not demonstrate an increase in disabling spinal cord injuries after a shift from an SI protocol to an SMR protocol. This finding, in addition to existing literature, supports the introduction of SMR protocols and the decreased use of the backboard.

Using peer crowds to segment Black youth for smoking intervention.

Studies of peer crowds show promise for enhancing public health promotion and practice through targeting. Distinct images, role models, and social norms likely influence health behaviors of different peer crowds within health disparity groups. We describe peer crowds identified by Black young people and determine whether identification with them is associated with smoking. Data from Black young people aged 13 to 20 years in Richmond, Virginia, were collected via interview and online survey (N = 583). We identified the number and type of peer crowds using principal components analysis; associations with smoking were analyzed using Pearson chi-square tests and logistic regression. Three peer crowds were identified--"preppy," "mainstream," and "hip hop." Youth who identify with the hip hop peer crowd were more likely to smoke and have friends who smoke and less likely to hold antitobacco attitudes than those identifying with preppy or mainstream crowds. Identifying with the hip hop crowd significantly increased the odds of smoking, controlling for demographic factors (odds ratio = 1.97; 95% confidence interval = 1.03-3.76). Tobacco prevention efforts for Black youth and young adults should prioritize the hip hop crowd. Crowd identity measures can aid in targeting public health campaigns to effectively engage those at highest risk.

Computed tomography scanning in pediatric trauma: opportunities for performance improvement and radiation safety.

BACKGROUND: Recently, pediatric CT scanning protocols have reduced radiation exposure in children. Because evaluation with CT scan after trauma contributes to significant radiation exposure, we reviewed the CT scans in children at both initial presentation at a non-pediatric facility and subsequent transfer to a level I pediatric trauma center (PTC) to determine the number of scans, body area scanned, radiation dosage, and proportion of scans at each facility. METHODS: The trauma database was retrospectively reviewed for children aged 0 to 17 y initially evaluated for trauma at another facility and then transferred to our PTC for pediatric specialty care between January 2000 and December 2010. RESULTS: A total of 1562 patients with 1335 CT scans were reviewed over an 11-y period. The majority of CT scans occur at the referring facility compared to the PTC in a ratio of 7:3. CT of the head was the most frequent scan obtained (52%), and 17.9% of CT scans were repeated at the PTC. Less than 1% of CT scans performed at the non-pediatric centers contained radiation dosage information, precluding analysis of radiation exposure. CONCLUSIONS: The majority of CT scans for trauma occur at non-pediatric facilities, which demonstrates the need for referring facilities to perform optimal CT scans with the least amount of radiation exposure to the child. We believe this provides an opportunity for PTC performance improvement by facilitating the transfer of images and educating referring facilities about indications for CT scans, dosage amounts, and radiation reduction protocols.