Safe at home: prevention of pediatric unintentional injuries.

BACKGROUND: Unintentional injuries are the leading cause of death in children in the United States. Studies have shown that parent adherence to safety guidelines is improved when education is provided in conjunction with safety equipment. METHODS: This study surveyed parents about specific injury prevention behaviors regarding medication and firearm storage and provided education and safety equipment for safe practice of these behaviors. The project took place in a pediatric emergency department (PED) and partnered with the hospital foundation and the school of medicine. Inclusion criteria were families visiting a freestanding PED in a tertiary care center. Participants completed a survey conducted by a medical student approximately 5 min in length. The student then provided each family with a medication lock box (if children ≤ 5 years old lived in the home), firearm cable lock, and education for safe storage of medications and firearms in the home. RESULTS: The medical student researcher spent a total of 20 h in the PED from June to August 2021. 106 families were approached to participate in the study, of which 99 agreed to participate (93.4%). A total of 199 children were reached with ages ranging from less than 1 year old to 18 years old. A total of 73 medication lockboxes and 95 firearm locks were distributed. The majority (79.8%) of survey participants were the mother of the patient and 97.0% of participants lived with the patient > 50% of the time. For medication storage, 12.1% of families store medications locked and 71.7% reported never receiving medication storage education from a healthcare professional. Regarding firearms, 65.2% of participants who reported having at least 1 firearm in the home stored firearms locked and unloaded with various methods of storage. 77.8% of firearm owners reported storing ammunition in a separate location from the firearm. Of all participants surveyed, 82.8% reported never receiving firearm storage education from a healthcare professional. CONCLUSIONS: The pediatric ED is an excellent setting for injury prevention and education. Many families are not storing medications and firearms safely, demonstrating a clear opportunity to increase knowledge in families with young children.

Self-Reported Usage of Safety Equipment Provided Through a Community Partnership Approach to Injury Prevention in the Pediatric Emergency Department.

OBJECTIVES: Previous studies have shown that educational programs in conjunction with provision of free or low-cost safety equipment increases the likelihood of parents changing behaviors at home. This project surveyed caregivers in the pediatric emergency department (ED) about safety behaviors before and after provision of education and safety equipment related to medication storage, firearm storage, and drowning. METHODS: A convenience sample of families presenting to the ED for any complaint with a child of any age were approached for participation in this feasibility study. Exclusion criteria included patients presenting for a high acuity problem (Emergency Severity Index 1 or 2) and non-English-speaking caregivers. Enrollment, surveys, and educational intervention were performed by the graduate student investigator from the School of Public Health. Participants were surveyed regarding presence of firearms and medications within the home and their storage practices. Additional questions included relationship to the patient, number and age of children younger than 18 years in the home, and zip code of residence. Educational handouts were reviewed, and participants were provided with a medication lock box, trigger lock, toilet lock, and/or pool watcher tag as indicated by answers given to the survey questions. Process measures were collected for number of products given out, number of children potentially affected by the intervention, and time spent by the investigator. Follow-up calls assessed use of the products provided. RESULTS: The student investigator spent a total of 180 hours and enrolled 357 caregivers accounting for 843 children. Fifty-seven percent of the participants answered the follow-up phone call. Only 9% initially reported that they stored medications in a locked or latched place. Medication lock boxes were given to 316 participants. On follow-up, 88% of those who received a lock box reported using it to store medications and 86% reported satisfaction with the lock box and how it worked. Of the 161 participants who admitted to gun ownership, 45% reported storing their guns locked and unloaded. Of those who reported unsafe manners of gun storage, 96% also reported unsafe manners of medication storage. Although only 161 participants endorsed gun ownership, 236 participants took a gun lock when offered. At follow-up, 66% of participants had used the gun lock and 67% of participants who took the gun lock reported satisfaction with the device. For water safety, 195 toilet latches and 275 drowning prevention lanyards were provided. On follow-up, 48% of those who had received a toilet latch were using it and 62% reported satisfaction with the device. Data were not collected on use of or satisfaction with the drowning prevention lanyards. CONCLUSIONS: Families often report unsafe home storage of medications and firearms, which together account for a large amount of morbidity and mortality in pediatrics. Drowning risk for young children is ubiquitous in the home setting, and low rates of use of home safety devices indicates need for further education and outreach on making the home environment safe. Despite relying on self-reported behaviors and the risk of reporting bias skewing the data, the behaviors reported in the preintervention survey were still very unsafe, suggesting that children may have a much higher risk of injury in the actual home environments. The ED is traditionally thought of as a place to receive care when injuries happen, but any encounter with families should be seen as an opportunity for injury prevention messaging. Partnering with a local school of public health and other community resources can result in the establishment of a low-cost, consistent, and effective injury prevention program in the pediatric ED that reaches a large number of individuals without the added burden of additional tasks that take time away from already busy ED providers and staff.

Mapa de la situación actual de la atención a la sepsis en los servicios de urgencias españoles / Current situation of sepsis care in Spanish emergency departments

Objetivo. Describir el abordaje que se realiza a los pacientescon sospecha de sepsis en los servicios de urgencias hospitalarios (SUH) españoles y analizar si existen diferencias atendiendoal tamaño del hospital y la afluencia a urgencias en el territorio.Método. Encuesta estructurada a los responsables de los282 SUH públicos que atienden adultos 24 horas/día, 365 días/año. Se preguntó sobre asistencia y manejo en urgencias en laatención a pacientes con sospecha de sepsis. Los resultados secomparan según tamaño del hospital (grande ≥ 500 camas vsmedio-pequeño < 500) y afluencia en urgencias (alta ≥ 200visitas/día vs media-baja < 200).Resultados. Respondieron 250 SUH españoles (89%). En163 (65%) SUH se dispone de protocolos de sepsis. La medianade sepsis semanales atendidas variaban desde 0-5 por semana en 39 (71%) SUH, 6-10 por semana en 10 (18%), 11-15por semana en 4 (7%), y más de 15 activaciones por semanaen 3 centros (3,6%). Los criterios utilizados para la activacióndel código sepsis (CS) fueron el qSOFA/SOFA en 105 (63,6%) delos hospitales, SIRS en 6 (3,6%), mientras que en 49 (29,7%)utilizaban ambos criterios de forma simultanea. En 79 centrosel CS estaba informatizado y en 56 existían herramientas deayuda a la toma de decisiones. Un 48% (79 de 163) de los SUHdisponían de datos de cumplimiento de medidas. En el 61%(99 de 163) de SUH existía formación en sepsis y en el 56% (55de 99) ésta era periódica. Atendiendo al tamaño del hospital,los hospitales grandes participaban más frecuentemente comoreceptores de enfermos con CS y disponían de servicio/unidadde infecciosas, de sepsis y de corta estancia, microbiólogo einfectólogo de guardia.Conclusión. la mayoría de los SUH disponen de protocolos de CS, pero existe margen de mejora. La informatización ydesarrollo de alertas para el diagnóstico y tratamiento tienenaún un gran recorrido en los SUH. (AU)

Objective. To describe the approach to the patients withsuspected sepsis in the Spanish emergency department hospitals (ED) and analyze whether there are differences according to the size of the hospital and the number of visits to theemergency room.Method. Structured survey of those responsible for the282 public EDs that serve adults 24 hours a day, 365 days ayear. It was asked about assistance and management in theemergency room in the care of patients with suspected sepsis.The results are compared according to hospital size (large ≥500 beds vs medium-small <500) and influx to the emergencyroom (discharge ≥ 200 visits / day vs medium-low <200).Results. A total of 250 Spanish EDs responded (89%).Sepsis protocols are available in 163 (65%) EDs median weekly sepsis treated ranged from 0-5 per week in 39 (71%) ED,6-10 per week in 10 (18%), 11-15 per week in 4 (7%), andmore than 15 activations per week in 3 centers (3.6%). Thecriteria used for sepsis diagnosis were the qSOFA/SOFA in 105(63.6%) of the hospitals, SIRS in 6 (3.6%), while in 49 (29.7%)they used both criteria simultaneously. In 79 centers, the sepsis diagnosis was computerized, and in 56 there were tools tohelp decision-making. 48% (79 of 163) of the EDs had dataon bundles compliance. In 61% (99 of 163) of EDs there wastraining in sepsis and in 56% (55 of 99) it was periodic. Considering the size of the hospital, large hospitals participated more frequently as recipients of patients with sepsis and hadan infectious, sepsis and short-stay unit, a microbiologist andinfectious disease specialist on duty.Conclusion. Most EDs have sepsis protocols, but there isroom for improvement. The computerization and developmentof alerts for diagnosis and treatment still have a long way togo in EDs (AU)

When the kids get guns - The effects of lowering the minimum age of firearm possession in Alabama.

At this time, the relationship between firearm minimum age laws and pediatric injury rates remains unclear. In September 2015, Alabama implemented Act 2015-341 (Act 341) which allowed minors to carry guns with parental permission. The purpose of this study was to evaluate the effect that Act 341 had on firearm injury rates. We created a database of all pediatric patients who presented to the Children's of Alabama's (CoA) emergency department and the Jefferson County Coroner's Office (JCCO) with a gunshot wound injury between May 2011 to December 2019. Wilcoxon ranked sum test analysis were used to contrast the average number of monthly patients arriving before and after implementation of Act 341 and Wilcoxon ranked sum test and Fisher Exact were used to evaluate differences in demographic and outcome data. A total of 316 patients presented within the specified time period with 116 arriving prior to Act 341 and 200 arriving after; an average of 2.21 and 3.85 patients per month respectively. We found an increase of 1.63 patients per month (p < 0.001). There was also significant increases in the proportion of patients who died or had a long-term disability following the event as well as the number of days of admission. Our study is suggestive that lowering the minimum age can lead to increased pediatric injury and indicates that further research is needed to fully elucidate the relationship.

Pain Assessment in Pediatric Emergency Departments: A National Survey.

OBJECTIVE: Accurate and consistent assessment of pain is essential in the pediatric emergency setting. Despite recommendations for formal assessment protocols, current data are lacking on pain assessment in pediatric emergency departments (EDs) and, specifically, whether appropriate tools are being used for different age groups. Our aim was to determine the status of pain assessment in US pediatric EDs. METHODS: We disseminated an online cross-sectional survey (after piloting) to pediatric EDs within the Children's Hospital Association. Responses were analyzed for each question owing to incomplete responders. We report descriptive statistics, with categorical variables compared with χ2 (P < 0.05 considered statistically significant). RESULTS: From 120 pediatric EDs, we received 57 responses (48%). Most respondents (28/49, 57%) were from freestanding pediatric centers. All 57 EDs (100%) performed formal pain assessments, with 31 (63%) of 49 using an ED-specific protocol. Freestanding children's hospitals were more likely to have ED-specific protocols (21/31, 68%) than nonfreestanding (10/31, 32%) (P = 0.04). Among 56 responders, 100% stated that nurses are tasked with assessing pain. For children 0 to 2 years, 29 (54%) of 54 used the Face, Legs, Activity, Cry, Consolability scale. Numerical scales were increasingly used with older ages: 3 to 4 years, 40 (80%) of 50; 5 to 10 years, 49 (98%) of 50; and 11 to 21 years, 50 (100%) of 50. CONCLUSIONS: In contrast to prior research, US pediatric EDs are routinely assessing pain with scales that are mostly appropriate for their respective age groups. Further research is needed to explore barriers to implementing appropriate pain ratings for all children and, ultimately, how these assessments impact the care of children in the emergency setting.

Distribución anatómica de la arteria peronea y su uso en el colgajo vascularizado de peroné / Anatomical distribution of the peroneal artery and its use in the fibula vascularized flap

Introducción: Realizando la elevación de un colgajo libre de peroné vascularizado se han observado múltiples variaciones anatómicas en el origen de la arteria peronea, así como en su distribución, lo cual plantea algunas dificultades en la elección de la zona de la cual se tomará el pedículo para el colgajo por ello nos planteamos examinar especímenes cadavéricos locales con la finalidad de obtener una descripción local de la anatomía de este segmento arterial importante para los que realizamos colgajos libres. Nos planteamos la pregunta: ¿Cuál es la distribución anatómica de la arteria peronea en especímenes cadavéricos? Objetivo: "Describir la distribución anatómica de la arteria peronea" Metodología, el presente es un estudio anatómico descriptivo transversal. Se realizarán disecciones anatómicas buscando elevar el colgajo peroneo según la técnica de abordaje lateral de Gilbert en piernas amputadas por encima de la rodilla (supracondilea) y que no presenten lesiones en el territorio peroneo. Resultados: Se desarrollaron 50 disecciones de piernas amputadas. La arteria peronea nace del tronco tibioperoneo de forma oblicua. La distancia de la base del músculo popliteo al nacimento de la arteria peronea es 52 mm. El pedículo vascular tuvo un promedio de 50 mm. La distribución de la arteria a partir del tercio medio fue intramuscular en 44 casos (88 por ciento) y en 6 casos (12 por ciento) la arteria se distribuía por debajo del músculo flexor largo del pulgar. La arteria nutricia se encontró en la cara posterior y a una distancia de 86,1 mm desde el inicio de la arteria. La primera perforante nace a una distancia promedio de 13,94 cm desde el borde superior del peroné. El total de perforantes es variable siendo en promedio 2,22 la última perforante nace en promedio a 125 mm de la punta del maleolo lateral del tobillo. El promedio de longitud de colgajo óseo es de 21.83 cm. Discusión: La disección del colgajo peroneo tiene una anatomía constante en cuanto a la...

Introduction: Throughout the surgical practice of a free vascularized fibula flap elevation observed multiple anatomic variants in the origin of the artery Peroneal, as well as its distribution, which raises some difficulties in the choice of the area from which the pedicle to the flap will be taken by this we ask to examine local cadaveric specimens with the purpose of obtaining a local description of the anatomy of this important arterial segment for what we do flaps free. We ask the question. What is the anatomical distribution of the artery Peroneal in cadaveric specimens? Objective: "Describe the anatomical distribution of the peroneal artery" Methodology, present is a cross-sectional descriptive anatomical study. Conducted dissections anatomical looking for raising the flap Peroneal according to the technique of lateral approach of Gilbert legs that have been amputated above the knee (supracondylar) and showing no injuries throughout the peroneal zone. Results: 50 dissections of amputated legs were developed. Peroneal artery is born of tibiofibular trunk obliquely. The distance from the base of the popliteal muscle to the birth of the artery Peroneal is 52 mm. The vascular pedicle had an average of 50 mm. The distribution of the artery from the middle third was intramuscular in 44 cases (88 per cent) and in 6 cases (12 per cent) the artery are distributed under the flexor long thumb muscle. Nutricial artery is found on the back side and at a distance of 86.1 mm from the start of the artery. The first cutaneus branch was born to an average distance of 13.94 cm from top of the fibula. The variable being in average 2.2 the last cutaneus branch is born on average 125 mm from the tip of the lateral malleolus of the ankle. The average length of flap osseous is 21.83 cm. Discussion: Flap dissection Peroneal has a constant Anatomy in terms of location, birth, length of the artery and presence of vessels comitantes, therefore agree with the works of k. d. Wolf...