Project UJIMA: working together to make things right.

OBJECTIVE: The purpose of this paper is to describe a group of pediatric patients who utilize services of Project UJIMA, a collaborative, community-based violence intervention/prevention program serving the greater Milwaukee metropolitan area. Program goals are to (1) reduce the rates of re-injury and premature death; and (2) minimize adverse psychological consequences of violence. METHODS: Retrospective observation of 218 patients who presented to an urban pediatric Emergency Department in 1998 as a result of interpersonal violent injury and received some level of service from Project UJIMA. RESULTS: Patient age ranged from 10 to 18 years with an average of 15 years. Sixty-nine percent (69%) of patients were male. The majority of patients were African-American (69%), followed by caucasian (21%), and Latino (8%). Physical assault was the leading type of injury (62%). Nearly one-third of cases were due to firearms (31%). Three youths required a repeat ED visit due to interpersonal injury. One hundred fifty-six (72%) were referred for mental health services to address adverse psychological effects. CONCLUSION: Project UJIMA is approaching its goals of (1) reducing injury recidivism rates in this population; and (2) providing services to address related mental health issues.

Violence and associated high-risk health behavior in adolescents. Substance abuse, sexually transmitted diseases, and pregnancy of adolescents.

The intricate relationship between the social and health behaviors of persons of all ages has long been described. In adolescent health care, the risk-taking behaviors that are recognized in the areas of sexuality, drug and alcohol abuse, and violence need to be addressed. This article discusses adolescent risk behaviors and their relationships to violence. Health care providers need to consider these risk behaviors as they care for adolescents.

PIP: High-risk health behaviors in adolescents such as alcohol, tobacco, and drug use, early onset of sexual behavior, STDs, and early parenthood have been linked with violence. Analysis of the 1991 Youth Risk Behavior Survey revealed that adolescents who were using alcohol were twice as likely to carry weapons or engage in fights compared to non-alcohol users. In a study of male youth offenders accused of violent crimes, 88% admitted weekly alcohol intoxication. A survey conducted on 10,645 youths age 12-21 years regarding risk-taking behaviors also established a significant association between violent behavior and cigarette smoking although it could not determine the sequence of events in connection with smoking and violence. Furthermore, a 1995 survey of high school students in the US reported that 42% had used marijuana in their lifetime while 7% had tried cocaine at some time in their life. The 1991 Youth Risk Behavior Survey (n = 12,272) also revealed that the rate of weapon-carrying increased with the use of marijuana (48% vs. 22%, P 0.001) and the use of cocaine (71% vs. 25%, P 0.001). 63% of marijuana users and 74% of cocaine users reported physical fighting. The same survey when conducted in 1995 showed that 53% of high school students had had sexual intercourse at some time in their life, 17% had had 4 or more sexual partners, and 7% reported having been pregnant or impregnated someone else. Another study reported the influence of drugs and alcohol on unwanted sexual experiences among high school students. Having described the interrelationship of high-risk health behaviors and violence, the author urges health-care providers to develop skills that will adequately assess adolescents for these risk factors so that appropriate treatment can be provided.

False-positive preliminary radiograph interpretations in a pediatric emergency department: clinical and economic impact.

A prospective, case control study at a university-affiliated, academic pediatric emergency department was undertaken to determine the clinical impact and cost of false-positive preliminary radiograph interpretations and to compare the cost of false-positive interpretations with the estimated cost of a 24-hour on-site pediatric radiologist. Data were collected on all patients undergoing radiography of the chest, abdomen, lateral (soft tissue) neck, cervical spine, or extremities during a 5-month period. A total of 1,471 radiograph examinations was performed, and 200 (14%) misinterpretations (false-positive and false-negative) by the pediatric emergency medicine physicians were identified. As reported previously, 20 (10%) of the false-negative interpretations were noted to be clinically significant, in the current analysis, 103 (7%) false-positive radiograph interpretations were identified. False-positive interpretations were noted more frequently (14%) for soft tissue lateral neck radiographs than for any other radiograph type. Of the 103 total false-positive radiographs, nine (0.6%) resulted in an increased patient cost totaling $764.75. These data show that false-positive radiograph interpretations have limited economic and clinical impact.

Clinical impact of radiograph misinterpretation in a pediatric ED and the effect of physician training level.

Radiograph interpretation in the pediatric emergency department (ED) is commonly performed by pediatric emergency medicine (PEM) attendings or physicians-in-training. This study examines the effect of physician training level on radiograph interpretation and the clinical impact of false-negative radiograph interpretations. Data were collected on 1,471 radiographs of the chest, abdomen, extremity, lateral neck, and cervical spine interpreted by PEM attendings, one PEM fellow, one physician assistant, and emergency medicine, pediatric and family practice residents. Two hundred radiographs (14%) were misinterpreted, including 141 chest (16%), 24 extremity (8%), 20 abdomen (12%), 14 lateral neck (18%), and 1 cervical spine radiograph (2%). Physicians-in-training misinterpreted 16% of their radiographs versus 11% for PEM attendings (P = .01). Twenty (1.4%) radiographs had clinically significant (false-negative) misinterpretations, including 1.7% of physician-in-training and 0.8% of attending interpretations (P = 0.15). No morbidity resulted from the delay in correct interpretation. Radiograph misinterpretation by ED physicians occurs but is unlikely to result in significant morbidity.