Adolescent injury in the emergency department: opportunity for alcohol interventions?

STUDY OBJECTIVE: Alcohol, the most commonly used substance among adolescents, is frequently associated with injury. Little is known regarding the drinking characteristics of injured adolescents. Such data are critical for developing emergency department interventions to decrease alcohol-related injury among adolescents. We sought to describe the drinking characteristics of injured adolescents and to describe the relationship of injury severity and mechanisms with drinking characteristics. METHODS: This study was a prospective cohort study performed in a university hospital (sampled May 1, 1995, to July 15, 1995) and a large urban teaching hospital (sampled May 1, 1996, to August 1, 1996). The participants were aged 12 to 20 years, presenting within 6 hours of an injury. We performed a saliva alcohol test and self-administered questionnaire. Age, sex, E-code, injury severity score (ISS), and ED disposition were recorded. An alcohol frequency/quantity index was calculated. Descriptive statistics and 95% confidence intervals were calculated. RESULTS: Two hundred sixty-three patients with a mean age of 17 years and a mean ISS of 2.1 (SD 3.5) were recruited. One hundred fifty-two (50%) were males, and 33 (13%) were admitted. Ten (4%) patients had a positive saliva alcohol test response. On average, within the last year, these adolescents had 1.7 adverse alcohol consequences. Sixty percent drank in unsupervised settings, and 36% reported drinking 5 or more drinks in a row. CONCLUSION: Alcohol use/misuse is a substantial problem among injured adolescents regardless of severity or mechanism of injury. ED physicians should consider screening/intervention or primary prevention of alcohol problems for all injured adolescents.

Neurologic disorders and dermatologic manifestations in HIV-infected children.

Cutaneous manifestations of HIV infections in childhood are common but are not the dermatologic lesions associated with HIV infection in adults. For example, Kaposi's sarcoma, a common finding in adults with AIDS, is rare in children. Other cutaneous manifestations, including bacterial and fungal lesions and viral exanthems, are common in children with AIDS and can be atypical and severe. Because 90% of the pediatric AIDS population acquires the virus via maternal transmission to the fetus, a dysmorphic syndrome associated with intrauterine infection has been described. Physicians caring for and evaluating pediatric patients at risk for AIDS should be aware of these dermatologic manifestations, so that early detection and treatment can be instituted to reduce the morbidity of the complication of HIV infection.