Fall downs should not fall out: Blunt cerebrovascular injury in geriatric patients after low-energy trauma is common.

BACKGROUND: There are limited data examining the impact of screening for blunt cerebrovascular injury (BCVI) in the geriatric population sustaining falls. We hypothesize that BCVI screening in this cohort would rarely identify injuries that would change management. METHODS: A retrospective study (2012-2016) identified patients 65 years or older with Abbreviated Injury Scores for the head and neck region or face region of 1 or greater after falls of 5 ft or less. Patients who met the expanded Denver criteria for BCVI screening were included for analysis. Outcomes were change in management (defined as the initiation of medical, surgical or endovascular therapy for BCVI), stroke attributable to BCVI, in-hospital mortality and acute kidney injury. Univariate analysis was performed where appropriate. A p value less than 0.05 was considered significant. RESULTS: Of 997 patients, 257 (26%) met criteria for BCVI screening after exclusions. The BCVI screening occurred in 100 (39%), using computed tomographic angiography for screening in 85% of patients. Patients who were not screened (n = 157) were more likely to be on preinjury antithrombotic drugs and to have worse renal function compared with the screened group. There were 23 (23%) BCVIs diagnosed in the screened group while one (0.7%) in the nonscreened group had a delayed diagnosis of BCVI. Of the 24 patients with BCVI, 15 (63%) had a change in management, consisting of the initiation of antiplatelet therapy. Comparing the screened to the nonscreened groups, 14% versus 0.7% (p < 0.0001) had a change in management. The screened group had a higher 30-day stroke rate (7% vs. 1%, p = 0.03) but there were no differences in the stroke rate attributable to BCVI (1% vs. 0.7%, p = 0.99), mortality (6% vs. 8%, p = 0.31) or acute kidney injury (5% vs. 6%, p = 0.40). CONCLUSION: In geriatric patients with low-energy falls meeting criteria for BCVI screening, BCVIs were commonly diagnosed when screened, and the majority of those with BCVI had a change in management. These findings support BCVI screening in this geriatric cohort. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.

Sexual behavior and pregnancy among adolescents in foster family homes.

Objective To examine the prevalence of and factors associated with sexual behavior and pregnancy involvement among adolescents in foster family homes. Methods A cross-sectional study was conducted among a random sample of children living in foster family homes. Logistic regression with Firth's correction was used to determine factors associated with sexual risk behavior and pregnancy involvement (i.e. having been pregnant or gotten someone pregnant). Results About half of adolescents (aged 13-18 years) in foster family homes ever had sex, of whom, one third had first sex before the age of 14 and one sixth had two or more sexual partners in the past 3 months. Of adolescents in the study, 9% had ever been pregnant or gotten someone pregnant. Although adolescents in foster family homes had higher rates of sex initiation and pregnancy involvement than those in the general population, the two groups had comparable rates of current sexual risk behavior. Being placed in kin/fictive kin foster homes [odds ratio (OR): 3.04; 95% confidence interval (CI): 1.18-7.80] and number of placement settings (OR: 1.20; 95% CI: 1.02-1.42) were associated with multiple sexual partners, while a history of running away from a foster home (OR: 7.64; 95% CI: 1.87-31.18) was associated with pregnancy involvement. Conclusions Efforts targeting placement stability including prevention of running away may reduce sexual risk behavior and pregnancy involvement among adolescents in foster family homes.

Do simple beside lung function tests predict morbidity after rib fractures?

BACKGROUND: We evaluated if incentive spirometry volume (ISV) and peak expiratory flow rate (PEFR) could predict acute respiratory failure (ARF) in patients with rib fractures. METHODS: Normotensive, co-operative patients were enrolled prospectively. ISV and PEFR were measured on admission, at 24 h and at 48 h by taking the best of three readings each time. The primary outcome, ARF, was defined as requiring invasive or noninvasive positive pressure ventilation. RESULTS: 99 patients were enrolled (median age, 77 years). ARF occurred in 9%. Of the lung function tests, only a low median ISV at admission was associated with ARF (500 ml vs 1250 ml, p = 0.04). Three of 69 patients with ISV of ≥1000 ml versus six of 30 with ISV <1000 ml developed ARF (p = 0.01). Other significant factors were: number of rib fractures, tube thoracostomy, any lower-third rib fracture, flail segment. CONCLUSION: PEFR did not predict ARF. Admission ISV may have value in predicting ARF.

Adolescent fathers involved with child protection: social workers speak.

This study examined adolescent paternity through structured interviews with their social workers. It adds to the literature by exploring if there were young men involved with the child protection services (CPS) system who are fathers, identifying their unique needs, and beginning discussions on working with these young men. CPS social workers from six area offices and one juvenile detention facility completed surveys for each father on their caseload. A 3.5% rate of adolescent paternity was observed across these offices. Information about the nature of the young men's involvement with CPS, their involvement with their children, and their unique needs as fathers are provided. This paper also identifies some practice and policy implications for adolescent fathers and CPS charged with their care.