A Pediatric Level III Trauma Center Experience With Dog Bite Injuries.

Dog bite injuries often present to Emergency Departments (ED), and between 2001 and 2003, approximately 4.5 million adults and children were injured. Injuries may range from puncture wounds to deep tissue lacerations or avulsions. Deaths have been described. Our objective was to describe dog bite injuries, the overall location of injuries, and need for vaccination among children who presented to a Pediatric ED designated as a level III trauma center with a robust facial surgical infrastructure. This was a 6-year retrospective study. Charts were identified by International Classification of Diseases, Tenth Revision (ICD-10) codes for lacerations or injuries secondary to animal bites and accessing the hospital's trauma database. Variables abstracted were age, sex, type of injury, location, need for antibiotics, immunization states and requirement of tetanus or rabies vaccine, disposition from ED to the operating room, home, or any in-patient unit. We excluded children older than 17 years of age and children who had a post-bite injury infection or injury not initially managed in our facility or medical system. The final cohort consisted of 152 children. The median age was 52 months and age ranged from 2 to 215 months. Children with a single bite injury were older when compared with those with numerous injuries, 81 and 62 months of age, respectively. Among young children, 75% of injuries occurred above the neck and 15.1% were managed in the operating room. Twenty-four percent of children required either a tetanus or rabies vaccination. Most dog bite injuries occurred to facial structures. Comprehensive care of dog victims included awareness of both dog and injured child vaccination status.

Pediatric Glue-Related Injuries in U.S. Emergency Departments: A 10-Year Overview.

Slime's increasing popularity has caused children to be more frequently exposed to glue. There is no comprehensive literature describing pediatric glue-related injuries. This study's purpose is to characterize pediatric glue-related injuries presented to U.S. emergency departments (EDs). We queried the National Electronic Injury Surveillance System for pediatric glue-related injuries from 2009 to 2018. Data were abstracted from discrete and case narrative data. Odds ratios were calculated to determine age-related differences in injuries. An estimated 18,126 pediatric patients were treated in U.S. EDs for glue-related injuries. Injury incidence increased over time. The most frequently injured body part was the eye, and the most common diagnosis was foreign body without documented sequelae. The most common injury mechanism was unintentional splash/squirt/explosion. Younger children were more likely to accidentally ingest glue; older children were more likely to sustain burns. Preventive efforts should focus on personal protective equipment, proper storage/labeling, and supervision of use.

Comparative Effectiveness of Parent-Based Interventions to Support Injured Children.

OBJECTIVES: A comparative effectiveness trial tested 2 parent-based interventions in improving the psychosocial recovery of hospitalized injured children: (1) Link for Injured Kids (Link), a program of psychological first aid in which parents are taught motivational interviewing and stress-screening skills, and (2) Trauma Education, based on an informational booklet about trauma and its impacts and resources. METHODS: A randomized controlled trial was conducted in 4 children's hospitals in the Midwestern United States. Children aged 10 to 17 years admitted for an unintentional injury and a parent were recruited and randomly assigned to Link or Trauma Education. Parents and children completed questionnaires at baseline, 6 weeks, 3 months, and 6 months posthospitalization. Using an intent-to-treat analysis, changes in child-reported posttraumatic stress symptoms, depression, quality of life, and child behaviors were compared between intervention groups. RESULTS: Of 795 injured children, 314 children and their parents were enrolled into the study (40%). Link and Trauma Education was associated with improved symptoms of posttraumatic stress, depression, and pediatric quality of life at similar rates over time. However, unlike those in Trauma Education, children in the Link group had notable improvement of child emotional behaviors and mild improvement of conduct and peer behaviors. Compared with Trauma Education, Link was also associated with improved peer behaviors in rural children. CONCLUSION: Although children in both programs had reduced posttrauma symptoms over time, Link children, whose parents were trained in communication and referral skills, exhibited a greater reduction in problem behaviors.

Socioeconomic Status and Analgesia Provision at Discharge Among Children With Long-Bone Fractures Requiring Emergency Care.

BACKGROUND: Inadequate treatment of painful conditions in children is a significant and complex problem. The objective of this study was to examine the effect of socioeconomic status on the provision of analgesic medicines at discharge in children treated emergently for a long-bone fracture. METHODS: A retrospective review of all patients during a 1-year period with a long-bone fracture treated in 2 urban pediatric emergency departments (EDs) was performed. RESULTS: Eight hundred seventy-three patients were identified who met our inclusion criteria. Sixty percent of patients received a prescription for an opioid-containing medicine, and 22% received a prescription for an over-the-counter analgesic medicine at ED discharge. Socioeconomic status had no effect on opioid analgesic prescriptions at discharge. Patients in the lowest-income group were younger, presented to the ED longer after an injury, were likely nonwhite, and had higher rates of over-the-counter analgesic medicine prescriptions provided at discharge. Higher-income patients were likely white and non-Hispanic, presented to the ED sooner, and were less likely to receive a prescription for a nonopioid analgesic medicine. CONCLUSIONS: Socioeconomic status is associated with different nonopioid analgesic prescription patterns in children treated in the ED for a long-bone fracture, but had no effect on opioid analgesic prescriptions.

Risk Factors for Compartment Syndrome in Pediatric Trauma Patients.

OBJECTIVE: This study aimed to identify risk factors for compartment syndrome (CS) in pediatric trauma populations. METHODS: We included patients younger than 19 years treated at trauma centers contributing to the National Trauma Data Bank between 2009 and 2012. Multivariable logistic regression was used to examine the association between risk factors and the development of CS. The final model adjusted for age, sex, race, number of comorbidities, Glascow Coma Scale, Injury Severity Score, mechanism of injury, and fracture of the lower limb. RESULTS: A total of 341,238 patients were eligible for analysis, and 896 patients developed CS (0.3%). In adjusted regression models, older patients had significantly higher odds of CS compared with patients 1 years or younger (odds ratio [OR], 3.29 [95% confidence interval [CI], 1.29-8.37; 2-6 years]; OR, 7.55 [95% CI, 3.08-18.55 [7-12 years]; OR, 10.34 [95% CI, 4.26-25.09 [13-18 years]). Male patients had significantly increased odds of CS compared with female patients, as did patients with lower limb fractures compared with patients without lower limb fractures (OR, 1.93 [95% CI, 1.56-2.40]; OR, 7.61 [95% CI, 6.48-8.94]; respectively). Finally, patients with a firearm injury had higher odds of CS compared with other mechanisms of injury (OR, 3.51 [95% CI, 2.70-4.56]). CONCLUSIONS: Older pediatric trauma patients, male patients, and those with lower limb fractures and firearm injuries have increased odds of CS. Information on risk factors can be used to help identify patients most likely to develop CS, facilitating timely diagnosis and treatment.

Who Hurts More? A Multicenter Prospective Study of In-Hospital Opioid Use in Pediatric Trauma Patients in the Midwest.

BACKGROUND: Despite increased national attention on misuse of prescription and nonprescription opioids for adolescents and children, little is known about opioid use in a pediatric population during hospitalization for injury. The purpose of this investigation is to describe opioid administration and magnitude of opioid exposure in the first 48 hours of hospitalization in a pediatric trauma population. STUDY DESIGN: This is a secondary analysis of data collected for a randomized, prospective intervention study at 4 Midwestern children's trauma centers. Participants included children ages 10 to 17 years old, admitted to the hospital for unintentional injury. Descriptive statistics and multivariable modeling were used to characterize demographic factors and measure prevalence and magnitude of opioid use within the first 48 hours of hospitalization. RESULTS: Among 299 participants, 82% received at least 1 opioid administration. Children had increased odds of receiving an opioid (odds ratio [OR] 4.25; 95% CI 2.16 to 8.35) for every log increase of Injury Severity Scores (ISS), yet the majority of children with minor injury (61%) also received an opioid. Children with fractures and older children had higher odds of receiving an opioid. Amount of opioid, expressed as morphine milligrams equivalent (MME), significantly increased with child age, ISS, and fracture. CONCLUSIONS: Most pediatric trauma patients received an opioid in the first 48 hours of hospitalization, although prevalence and exposure varied by age, injury, and acuity. Aggressive pain management can be appropriate for injured pediatric patients; however, study results indicate areas for improvement, specifically for children with minor injuries and those receiving excessive opioid amounts.

Injury Region and Risk of Hospital-Acquired Pneumonia Among Pediatric Trauma Patients.

OBJECTIVE: To describe the relationship between injury region and risk of hospital-acquired pneumonia (HAP) in pediatric trauma patients. METHODS: Analyses included patients <19 years of age from the National Trauma Data Bank, during 2009-2011. Multivariable logistic regression was used to examine the association between injury region and odds of developing HAP stratified by age group. RESULTS: A total of 71 377 patients were eligible for analysis, and 1818 patients developed pneumonia. In adjusted regression models both younger (11-15 years) and older (16-18 years) adolescents with multisite injuries including the head and neck had higher odds of developing HAP compared with adolescents with isolated head and neck injuries (odds ratio [OR] = 2.04, 95% confidence interval [CI] 1.34-3.10; OR = 1.47, 95% CI 1.14-1.89, respectively), and younger adolescents with multisite injuries not involving the head and neck also had higher odds of developing HAP (OR = 1.97, 95% CI 1.08-3.60). We found no significant association between injury region and risk of HAP in children <11 years of age. Younger and older adolescents with firearm (OR = 1.85, 95% CI 1.00-3.42; OR = 1.39, 95% CI 1.02-1.88, respectively) or pulmonary (OR = 3.78, 95% CI 1.26-11.3; OR = 2.56, 95% CI 1.01-6.51, respectively) injuries had higher odds of developing HAP compared with those with motor vehicle collision injuries. CONCLUSIONS: Adolescent trauma patients with multisite injuries including the head and neck have a higher risk of developing HAP compared with those with isolated head and neck injuries. We identified several risk factors that can be used to inform future research focused on identifying subgroups at high risk for the development of HAP.

Grill-Related Injuries in Children Treated in US Emergency Departments, 1990-2009.

OBJECTIVE: The aim of the study was to describe grill-related injuries in pediatric patients seeking emergency treatment. METHODS: Data from the National Electronic Injury Surveillance System from 1990 through 2009 were investigated. Sample weights were used to calculate national estimates. United States Census Bureau data were used to calculate injury rates per 100,000 individuals. Linear regression and computation of relative risks (RRs) with 95% confidence intervals (CIs) were performed. RESULTS: An estimated 308,560 children were treated in US emergency departments for grill-related injuries during the study period, with an average of 15,428 cases per year. The rate of injuries increased by 32.3% during the study period. Males (62.8%) and children aged 11 to 18 years (55.8%) sustained the largest number of injuries. Children younger than 5 years were more likely to injure the head and neck (RR, 1.26 [95% CI, 1.21-1.33]), be injured by impact with a grill (RR, 1.97 [95% CI, 1.88-2.07]), and sustain burns (RR, 1.39 [95% CI, 1.35-1.45]) when compared with other age groups. Children aged 11 to 18 years were more likely to experience a fracture or dislocation (RR, 2.07 [95% CI, 1.58-2.72]) and more likely to sustain a grill-related injury while the grill was not in use (RR, 7.95 [95% CI, 6.25-10.12]). CONCLUSIONS: The rate of grill-related injuries among children is increasing, which underscores the need for increased prevention efforts. Prevention strategies should address measures such as lighting a grill and grill location in addition to burn prevention.

Hospital-acquired pneumonia among pediatric trauma patients treated at national trauma centers.

BACKGROUND: Injury is the leading cause of hospitalization in children, and as many as 5% of hospitalized injured children require mechanical ventilation. Despite this, little is known about the complications associated with mechanical ventilation, including pneumonia. METHODS: This is a retrospective analysis of trauma patients younger than 19 years from the National Trauma Data Bank from 2009 to 2011. Descriptive statistics were used to examine the patient population. Baseline characteristics were compared between subgroups using t tests and χ tests. Generalized linear models were used to identify risk factors for hospital-acquired pneumonia adjusting for clustering of patients by hospital. RESULTS: A total of 252,187 patients were eligible for analysis, and 1,915 patients were diagnosed with pneumonia. Most patients were male (66.3%), were white (54.2%), had no comorbidities (88.9%), and were not considered severely injured (85.5% with an Injury Severity Score [ISS] < 16). The mean (SD) length of stay was 2.9 (5.2) days. Patients who developed pneumonia were older (16-18 years, 61.7% vs. 31.1%, p < 0.0001), had an increased length of stay (20.9 days vs. 2.8 days, p < 0.0001), more intensive care days (13.9 days vs. 0.7 days, p < 0.0001), and more ventilation days (9.5 days vs. 0.3 days, p < 0.0001) compared with those who did not develop pneumonia. The rate of pneumonia nearly doubled in patients spending 2 days on a ventilator (odds ratio [OR], 5.52; 95% confidence interval [CI], 3.45-8.84), doubled again for patients spending 3 days (OR, 10.59; 95% CI, 6.38-17.61), and doubled again for patients spending 5 days (OR, 23.72; 95% CI, 13.36-42.15) mechanically ventilated. The presence of two comorbid conditions was associated with twice the odds of developing pneumonia (OR, 2.10; 95% CI, 1.47-1.78). CONCLUSION: Prolonged mechanical ventilation, increased injury severity, older age, and presence of multiple comorbid conditions all increase the risk of pneumonia in injured children. Preventive measures should be aggressively used in injured children at high risk for the development of pneumonia. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Emergency Department Visits for Self-Inflicted Injuries in Adolescents.

OBJECTIVES: To describe emergency department (ED) visits for self-inflicted injury (SII) among adolescents, examine trends in SII mechanisms, and identify factors associated with increased risk. METHODS: Analyses included patients aged 10 to 18 years from the National Trauma Data Bank, years 2009 to 2012. We used Cochran-Armitage trend tests to examine change over time and generalized linear models to identify risk factors for SII. RESULTS: We examined 286,678 adolescent trauma patients, 3664 (1.3%) of whom sustained an SII. ED visits for SII increased from 2009 to 2012 (1.1% to 1.6%, P for trend ≤ .001), whereas self-inflicted firearm visits decreased (27.3% to 21.9%, P for trend = .02). The most common mechanism in males was firearm (34.4%), and in females, cut/pierce (48.0%). Odds of SII were higher in females (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.13-1.77), older adolescents (OR 2.73, 95% CI 2.38-3.14), adolescents with comorbid conditions (OR 1.64; 95% CI 1.49-1.80), and Asian adolescents (OR 1.67, 95% CI 1.35-2.08) and lower in African American adolescents (OR 0.78, 95% CI 0.70-0.87). Adolescents in the public or self-pay insurance category had higher odds of SII (OR 1.44, 95% CI 1.27-1.64) than those in the private insurance category (OR 1.15, 95% CI 1.01-1.31). Adolescents with an SII had higher odds of death than those with other injuries (OR 12.9, 95% CI 6.78-24.6). CONCLUSIONS: We found a significant increase in the number of SIIs by adolescents that resulted in ED visits from 2009 to 2012. Although SIIs increased, we found a significant decrease in the percentage of adolescents who self-injured with a firearm. SIIs reflect a small percentage of ED visits, but these patients have dramatically higher odds of death.

Throw rug-related injuries treated in US EDs: are children the same as adults?

BACKGROUND: Various characteristics of floors and floor coverings are well established as injury hazards. Loose carpeting, such as rugs, is often cited as a hazard leading to injury. PURPOSE: To describe the epidemiology and patterns of rug, mat, and runner-related injuries in patients seeking emergency treatment. METHODS: Data from the National Electronic Injury Surveillance System from 1990 through 2009 were investigated. Sample weights were used to calculate national estimates. US Census Bureau data were used to calculate injury rates per 100 000 individuals. Linear regression and computation of relative risks (RRs) with 95% confidence intervals (CIs) were performed. RESULTS: An estimated 245 605 patients were treated in US emergency departments for rug-related injuries during the study period, with an average of 12 280 cases per year. Females (72.3%) and individuals older than 64 years (47.1%) sustained the largest number of injuries. Patients younger than 6 years were more likely to injure the head or neck region (RR, 3.52 [95% CI, 3.26-3.81]) compared with all other groups. Patients older than 18 years were more likely to experience a fracture or dislocation (RR, 2.52 [95% CI, 2.13-2.88]) and sustain an injury as a result of tripping or slipping on a rug (RR, 1.36 [95% CI, 1.26-1.41] compared with other age groups. Increasing age was associated with increased risk of hospitalization in this study. Patients who sustained an injury from a rubber or plastic mat/rug were significantly less likely to be admitted (RR, 0.67 [95% CI, 0.55-0.83]). Injuries occurring in kitchens or bathrooms resulted in significantly higher admission rates (RR, 1.45 [95% CI, 1.34-1.54]). CONCLUSIONS: Rug-related injuries are an important source of injury for individuals of all ages.

Patterns of injury and management of children with pelvic fractures at a non-trauma center.

BACKGROUND: Pelvic injuries in young children are rare, and it has been difficult to establish clinical guidelines to assist providers in managing blunt pelvic trauma, especially in non-Level 1 trauma centers. OBJECTIVE: Our aim was to describe the relationship among clinical findings, mechanism of injury, and the radiographic resources utilized in children with pelvic fractures presenting to a non-Level 1 trauma center. METHODS: A retrospective review of patients with a pelvic fracture treated in two urban pediatric Level 3 emergency departments was performed. RESULTS: Between 2001 and 2010, a total of 208 patients were identified. Avulsion/iliac wing fractures were the most common fractures (58.7%), and sports-related injuries were the most common mechanism of injury (50.0%). Children with sports-related injuries were more likely to sustain an avulsion fracture (p<0.001), less likely to have a computed tomography scan obtained in the emergency department (p<0.001), and less likely to have an associated injury (p<0.001) than other children. Children struck by a motor vehicle (p<0.001) or involved in a motor vehicle accident (p<0.001) were more likely to receive a computed tomography scan (p<0.001) and have associated head and extremity injuries (p<0.001). Mechanism of injury was associated with abnormal computed tomography scans. Nearly all patients were treated nonoperatively (98.1%) and no deaths were reported in this study. CONCLUSIONS: Patterns of injury, based on mechanism of injury, have been reported to assist the assessment and management of children with minor pelvic injuries.

Does age affect analgesia provision at discharge among children with long bone fractures requiring emergency care?

BACKGROUND: Inadequate treatment of painful conditions in children is a significant and complex problem. The wide range of cognitive abilities associated with a child's age is a particular challenge for providers treating children with painful conditions. STUDY OBJECTIVE: To examine the effect of patient age on the provision of analgesic medicines at discharge in children treated emergently for a long bone fracture. METHODS: A retrospective review was performed of all patients during a 1-year period with a long bone fracture treated in two urban pediatric Emergency Departments (EDs). RESULTS: Eight hundred seventy-eight patients were identified who met our inclusion criteria. Nearly 60% of patients received a prescription for an opioid-containing medicine and 19% received a prescription for an over-the-counter analgesic medicine at ED discharge. Patients younger than 4 years old had lower pain scores, less severe fractures, and overall were significantly less likely to receive an opioid-containing prescription compared to children 4 years old or greater. In children with more severe fractures requiring reduction in the ED, no significant age-related differences were noted in opioid prescription rates. No age-related significant differences were noted for over-the-counter prescription analgesic medicines provided at discharge. CONCLUSION: Young patient age is associated with different analgesic prescription patterns in children treated in the ED for a long bone fracture.

Childhood death attributable to trauma: is there a difference between accidental and abusive fatal injuries?

BACKGROUND: Trauma is a leading cause of death among children worldwide. Detailed knowledge of the epidemiology of childhood fatal injuries is necessary for preventing injuries. OBJECTIVE: To determine clinical differences between children who were treated in an emergency department for accidental or abusive injuries. METHODS: A retrospective review of all deceased patients who were treated in two urban pediatric emergency departments between 1998 and 2010 was performed. Patients were categorized into two groups, accidental and abusive, for comparison. RESULTS: A total of 1498 patients died during the study period, with 124 deaths being attributable to injury for a rate of 9.5 injury-related deaths per year. Most fatal injuries were accidental. Children with abusive fatal injuries were younger and more likely to have been seen for an injury in a clinic or emergency department within 2 months of their death. Eighty-two percent of abusive fatal injuries had documented subdural hematomas, whereas only 7.2% of accidental fatal injuries had a subdural hematoma documented. Nearly 50% of abusive fatal injuries had retinal hemorrhages reported, although no child with an accidental fatal injury had this type of injury documented. CONCLUSION: Younger children, especially those previously seen in an emergency department or clinic for injury, are more likely to sustain an abusive fatal injury. Sentinel physical findings associated with abusive fatal injuries include subdural hematomas and retinal hemorrhages, and the presence of these findings should prompt an investigation into the circumstances of injury.

Race, ethnicity, and analgesia provision at discharge among children with long-bone fractures requiring emergency care.

BACKGROUND: Inadequate treatment of painful conditions in children is a significant and complex problem. The objective of this study was to examine the effect of race/ethnicity on the provision of analgesic medicines at discharge in children treated emergently for a long-bone fracture. METHODS: A retrospective review of all patients during a 1-year period with a long-bone fracture treated in 2 urban pediatric emergency departments was performed. RESULTS: Eight hundred seventy-eight patients who met our inclusion criteria were identified. Sixty percent of patients received a prescription for an opioid-containing medicine, and 19% received a prescription for an over-the-counter analgesic medicine at emergency department discharge. Patients identified as African American, non-Hispanic, biracial, and Hispanic/Latino had significantly lower rates of opioid analgesic prescriptions when compared with other ethnic groups. White, non-Hispanic patients had lower rates of over-the-counter analgesic medicine prescriptions provided at discharge. Patients identified as white, non-Hispanic had a higher percentage of fractures that required reduction in the emergency department when compared with other ethnic groups. CONCLUSIONS: Race/ethnicity is associated with different analgesic prescription patterns in children treated in the emergency department for a long-bone fracture.

Pediatric lateral patellar dislocation: is there a role for plain radiography in the emergency department?

BACKGROUND: Osteochondral fractures are reported to complicate patellar dislocations in 5-95% of patients. For this reason, post-reduction radiographs are recommended for the routine evaluation of patellar dislocations in all patients. To date, no data have been reported regarding the impact plain radiography has on the Emergency Department (ED) management of pediatric patients with lateral patellar dislocations. STUDY OBJECTIVES: To estimate the incidence of fractures detected by post-reduction plain radiographs in pediatric patients presenting with unreduced lateral patellar dislocations and to examine differences in ED management between patients with and without radiographically apparent fractures. METHODS: Retrospective review of records for pediatric patients who presented to an ED, received a diagnosis of lateral patellar dislocation, and underwent a reduction procedure. RESULTS: Of 80 patients who met criteria for inclusion in the study, 8 patients (10%; 95% CI 3-17) had a fracture identified. All patients, regardless of their radiographic findings, had their dislocation reduced uneventfully and were discharged with knee immobilization and a plan for outpatient follow-up. There were no statistically significant differences between those patients who had a detected fracture as compared to those without in terms of intravenous line placement (p = 1.000), parenteral analgesic administration (p = 0.965), procedural sedation administration (p = 0.922), ED length of stay (p = 0.706), or provision of a prescription for an oral analgesic upon discharge (p = 0.103). CONCLUSION: Osteochondral fractures were detected by plain radiography in 10% of patients presenting with lateral patellar dislocation and did not alter ED management. Pediatric patients with lateral patellar dislocations may be candidates for discharge from the ED after reduction without plain radiography. The modality by which to best determine the presence of a complicating osteochondral fracture (i.e., plain radiography, computed tomography, magnetic resonance imaging, or arthroscopy) may be left to the discretion of the orthopedic surgeon accepting the child in follow-up. Further study is needed to determine if forgoing plain radiographs in the ED decreases length of stay and reduces patient costs.

Traumatic deaths in children: is there a difference between urban and rural populations?

OBJECTIVE: Trauma is a leading cause of death among children. Detailed knowledge of the epidemiology of traumatic childhood deaths is necessary for allocating available treatment resources and for preventing injuries at both community and regional levels. To our knowledge, there has been no report comparing urban to rural pediatric deaths of this nature. METHODS: A retrospective review of all deceased patients who were treated in an urban pediatric emergency department was performed. Patients were categorized into 2 groups, namely, urban versus rural, during analyses for comparison in this study. RESULTS: A total of 1498 patients died at our institution during the study period, with 124 being attributable to an injury for a rate of 9.5 injury-related deaths per study period year. Overall, most injury-related deaths were accidental. Urban deaths involved younger patients and were more likely to be abusive and more likely to have been seen for an injury in a clinic or emergency department within 2 months of their death. Rural deaths involved older patients and were more likely to be a result of an accidental injury. CONCLUSIONS: Patterns of injury have been linked with injury locales that can aid the emergency provider in the assessment of children who die as a result of injury. Despite the challenges involved, there is a clear need to further identify differences in patterns of fatal injuries in urban and rural areas and to better translate and evaluate prevention and intervention programs in rural communities.

Ethnicity and reported pain scores among children with long-bone fractures requiring emergency care.

OBJECTIVES: Previous studies have shown that regular pain measurement improves pain management. As the diversity of patients seeking emergency care continues to grow, a better understanding of the potential differences in pain perception and analgesic needs among various cultural groups will be required. The purpose of this study was to describe the differences in pain scores reported among ethnic groups treated for a long-bone fracture. METHODS: A retrospective review of patients with a long-bone fracture treated in an urban pediatric emergency department during a 12-month period was performed. Pain scores were assessed using previously validated pain scales. RESULTS: Eight hundred eighty patients met our inclusion criteria. Wrist fracture was the most common type of fracture in our study. There were significant differences noted in reported pain scores. Patients identified as Hmong had the highest pain scores, and patients identified as Somali had the lowest pain scores reported. Patients with wrist fractures had the highest average pain score when compared with other types of fractures. Children with fractures requiring reduction in the emergency department had higher pain scores than those who had a fracture that did not require reduction. CONCLUSIONS: To our knowledge, this is the first study to investigate the relationships between ethnicity and pain scores reported in children treated emergently for a long-bone fracture.

Incidental findings on computed tomography scans in children with mild head trauma.

BACKGROUND: Computed tomography (CT) scans are frequently used in managing traumatic brain injuries in children. OBJECTIVE: To assess incidental findings in children with head trauma undergoing CT scan and to describe any associated clinical ramifications. MATERIALS AND METHODS: Retrospective review of 524 children treated in 2 emergency departments for closed head injury who received a CT scan. RESULTS: Overall, 137 (26.2%) patients had an incidental finding on CT scan. The most common incidental finding was sinus opacification with an air fluid level (115/137, 83.9%). Thirty-five interventions were reported in children with incidental findings. Children 2 years old or younger were more likely to receive a prescription for antibiotics (relative risk [RR] = 2.66, 95% confidence interval [CI] = 1.08-6.51) and be referred to a specialist (RR = 10.26, 95% CI = 3.56-29.56) than older children. CONCLUSION: Incidental findings in minor head trauma are common. Clinicians should be prepared to address these findings if clinically indicated.

Nondepressed linear skull fractures in children younger than 2 years: is computed tomography always necessary?

BACKGROUND: Current recommendations are that young children with a skull fracture following head injury undergo computed tomography (CT) examination of their head to exclude significant intracranial injury. Recent reports, however, have raised concern that radiation exposure from CT scanning may cause malignancies. OBJECTIVE: To estimate the proportion of children with nondisplaced linear skull fractures who have clinically significant intracranial injury. METHODS: Retrospective review of patients younger than 2 years who presented to an emergency department and received a diagnosis of skull fracture. RESULTS: Ninety-two patients met the criteria for inclusion in the study; all had a head CT scan performed. None suffered a clinically significant intracranial injury. CONCLUSION: Observation, rather than CT, may be a reasonable management option for head-injured children younger than 2 years who have a nondisplaced linear skull fracture on plain radiography but no clinical signs of intracranial injury.