ABSTRACT
Acute lung injury (ALI) remains a serious threat to critically ill patients and continues to pose challenges to clinicians and investigators as they strive to better identify and treat these patients. Over 30 years of clinical and basic science investigations have led to a better understanding of the pathophysiology, risk factors, and prognosis of this entity but we still lack a "gold standard'' for its identification. The American-European Consensus Conference definition has helped in the effort to standardize the definition of ALI but is still fraught with difficulties in the application of criteria for the chest radiograph, hypoxemia, and left atrial hypertension. As further efforts are undertaken to better define ALI and to more accurately describe its incidence, it is critical that methodology to assess the accuracy and reliability of such definitions be utilized. This union of clinical epidemiology, clinical research, and basic science will not only better describe the population burden of ALI but will also better track the effect of current and future therapeutic interventions.
ABSTRACT
OBJECTIVE: Certain family structures have been identified as putting children at high risk for injury. To further define children at highest risk, we set out to explore the effect of an older sibling and birth interval on the risk of injury related hospital admission or death. METHODS: Data were analyzed using a case-control design. Cases and controls were identified by linking longitudinal birth data from Washington state (1989-96) to death certificate records and hospital discharge data obtained from the Washington State Comprehensive Hospital Abstract Reporting System and frequency matched in a 1:2 ratio on year of birth. Cases consisted of singleton children 6 years of age or younger who were hospitalized or died as a result of injury during the years 1989-96. Multivariate logistic regression was used to identify and adjust for confounding variables. RESULTS: There were 3145 cases and 8371 controls. The adjusted odds ratio for injury in children with an older sibling was 1.50 (95% confidence interval 1.37 to 1.65). The effect was greatest in children under 2 years of age, and in those with a birth interval of less than two years. As the number of older siblings increased, so did the risk of injury, with the highest risk in children with three or more older siblings. CONCLUSION: These data suggest that the presence of an older sibling is associated with an increased risk of injury. The risk is highest in those with very short birth intervals. Potential mechanisms for this increased risk may relate to inadequate parental supervision. Pediatricians and other care providers need to be alert to these identifiable risk factors and then direct preventive strategies, such as home visits and educational programs, toward these families.
