Pediatric dog bite injuries in the USA: a systematic review.

Introduction: Dog bites are one of the leading causes of non-fatal emergency room visits in children. These injuries not only cause physical harm but can lead to long-term psychological stress. This study evaluated the current literature related to pediatric dog bite injuries to identify research gaps which should be prioritized to improve a major public health concern. Methods: We performed a keyword search of PubMed, Scopus, and OVID Medline databases (January 1980- March 2020) for all published studies focused on dog bite injuries in the pediatric population (≤18 years of age) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results: Out of 1859 abstracts screened, 43 studies involving 86 880 patients were included. Twenty-nine studies were retrospective chart reviews characterizing the epidemiology of dog bites and their associated treatment outcomes; six were prospective cohort studies; two were cross-sectional studies; and six were experimental studies. Synthesized results demonstrate that children <9 years of age suffer the greatest burden of injuries, with children <6 years of age at higher risk of more severe injuries involving the head, neck, and face. Conclusion: Studies analyzing the prevention or psychosocial consequences of dog bites injuries are needed.

Alcohol and drug screening of adolescent trauma alert patients at a level 1 pediatric trauma center.

BACKGROUND: Adolescent trauma patients are reported to have increased incidence of alcohol and other drug (AOD) use, but previous studies have included inadequate screening of the intended populations. A Level 1 Pediatric Trauma Center achieved a 94% rate of AOD screening. We hypothesized that a positive AOD screening result is associated with males, increasing age, lower socioeconomic status, violent injury mechanism, higher Injury Severity Score (ISS), lower GCS, need for operation and increased hospital length of stay. METHODS: After achieving high rates of screening among admitted trauma alert patients 12-17 years old, we evaluated patients presenting during 2014-2015. Chi-square tests were used to compare the percentage of patients with positive test results across sociodemographic, injury severity measures and patient outcomes. RESULTS: Three hundred and one patients met criteria for AOD screening during the study period. Ninety-four percent of these patients received screening and 18% were positive. Males (21.4%) were more often positive than females (11.6%). Increasing age was directly correlated with AOD use. Race was associated with a positive screen. Black patients more often had positive screens (40.9%), as compared with White patients (13.8%) and other races (23.5%). Patients with commercial insurance (6.6%) were less likely to be positive than those with no insurance (19.0%) or Medicaid (30.9%). Lower median household income was associated with positive AOD screening. Patients with violent injury mechanisms were more likely to screen positive (36.2%) than those with non-violent mechanisms (18.0%). No statistical differences were found with injury severity scores, the need for operation, or hospital length of stay. CONCLUSIONS: With near universal screening of adolescent trauma alert admissions, positive AOD results were more often found with males, increasing age, lower socioeconomic status, and violent injury mechanism. LEVEL OF EVIDENCE: Level III, Retrospective comparative study without negative criteria. STUDY TYPE: Prognostic.

Exercise Treadmills: A Cause of Significant Hand Burns in Young Children.

A pediatric nurse practitioner and an occupational therapist were impressed by the number and severity of treadmill-related hand burns encountered in their outpatient burn clinic. They observed that treadmill burns appeared to be deeper compared with other contact hand burns. Literature review revealed that research was inadequate in this area. A retrospective chart review was conducted, and a total of 384 patients were found to receive treatments at a regional level 1 pediatric burn center for treadmill and contact hand burns from 2010 to 2014. Age distribution, severity, and negative outcomes were compared between treadmill hand burns and contact hand burns. Recommendations for primary caregivers to prevent treadmill hand burns were given. Treadmill burns were the second most common hand injury mechanism after stovetop burns. Both hot surface contact burns and treadmill burns were more frequently seen in patients 0 to 4 years of age. Treadmill hand burns were more severe than contact hand burns in depth of injury (24.5 vs 1.4% full thickness), need for operative intervention (6.4 vs 0.0%), mean number of burn appointments (4.9 vs 1.9), median time to skin closure (25.2 days vs 11.0 days), and median length of care (51.0 days vs 11.0 days). Treadmill hand burns were frequently seen, and they were more severe and required an increased level and duration of care in comparison with other contact hand burns.

Acute care nurse practitioners in trauma care: results of a role survey and implications for the future of health care delivery.

The role of acute care nurse practitioners (ACNPs) in trauma care has evolved over time. A survey was performed with the aim of describing the role across the United States. There were 68 respondents who depicted the typical trauma ACNP as being a 42-year-old woman who works full-time at a level I American College of Surgeons verified trauma center. Trauma ACNPs typically practice with 80% of their time for clinical care and are based on a trauma and acute care surgery service. They are acute care certified and hold several advanced certifications to supplement their nursing license.

Screening, brief intervention, and referral to treatment in the adolescent trauma population: examining barriers to implementation.

Adolescence is a critical stage in human development in which individuals gain independence from parents. This vulnerable period of life often involves experimentation with intoxicating substances and other risky behaviors. This combination of factors may lead to traumatic injury that requires emergency department treatment and hospitalization. This scenario presents an opportunity for screening, education and treatment regarding substance abuse. Policies that support such measures have been shown to be poorly followed. The aim of this manuscript is to identify and discuss some of the barriers to implementation of an alcohol and drug screening policy for adolescent trauma patients admitted for inpatient hospital care.