Comparing emergency department versus high school-based recruitment for a hypertension research study with adult-youth dyads.

Dyads can be challenging to recruit for research studies, but detailed reporting on strategies employed to recruit adult-adolescent dyads is rare. We describe experiences recruiting adult-youth dyads for a hypertension education intervention comparing recruitment in an emergency department (ED) setting with a school-based community setting. We found more success in recruiting dyads through a school-based model that started with adolescent youth (19 dyads in 7 weeks with < 1 hour recruitment) compared to an ED-based model that started with adults (2 dyads in 17 weeks with 350 hours of recruitment). These findings can benefit future adult-youth dyad recruitment for research studies.

The Obesity Paradox in the Pediatric Trauma Patient.

BACKGROUND: Obesity is a chronic disease that adversely impacts patient outcomes and increasingly affecting the pediatric population. According to the CDC, in 2020 the prevalence of obesity among children and adolescents was estimated to be as high as 19.7%. The obesity paradox is the increased survival for overweight and obese adult trauma patients when compared to patients with healthy weights. The aim of this study was to analyze the impact of BMI and outcomes in the pediatric trauma population. METHODS: Trauma patients in the 2-18 years age group and reported to the 2017-2019 National Trauma Data Bank were identified. CDC growth charts and z-scores were calculated to categorize patients into four subgroups: underweight (<5th percentile), healthy weight (5th-85th percentile), overweight (85th-95th percentile), and obesity (>95th percentile). Primary outcome studied was the mortality rate. Secondary outcomes included injury severity score (ISS), hospital length of stay (LOS), ICU LOS, and number of days on a ventilator. Continuous and categorical data were analyzed using ANOVA and Chi-squared test, respectively, using the healthy BMI category as reference group. P < 0.05 was considered significant. RESULTS: A total of 161,458 patients [Underweight: 9148 (6%), Healthy weight: 88,009 (55%), Overweight: 26,740 (17%), and Obese: 37,561 (23%)] were included. The mean age was 11 years (SD:5.1). Total mortality for the patient set was 1825 (1.13%). The lowest mortality rate was in the obese group. The ISS was lowest in the obese group, while ICU LOS and days on ventilator were no different than control patients. Hospital LOS and transfer to rehabilitation rates were higher in the obese population. CONCLUSION: Obesity appears to have a protective effect on mortality and significantly better secondary outcomes in the pediatric trauma population. Further study is necessary to evaluate the interplay between body weight and outcomes in pediatric trauma and disease states. LEVEL OF EVIDENCE: III.

Pediatric Blunt Splenic Trauma: Disparities in Management and Outcomes.

INTRODUCTION: While nonoperative management has become widely accepted, whether nonoperative management of blunt splenic trauma is standardized across pediatric trauma centers and different racial groups warrants further investigation. Using the National Trauma Database, the purpose of this study was to quantify the differences in the management of pediatric splenic trauma across different pediatric trauma centers, with respect to injury severity, race, ethnicity, and insurance. METHODS: Patients under 20 y of age with blunt splenic trauma reported to the 2018 and 2019 National Trauma Data Bank were identified. Primary outcomes were splenectomy, embolization, transfusion, mortality, injury severity score (ISS), and length of hospital stay (LOS) and length of intensive care unit stay. Continuous data and categorical data were analyzed using ANOVA and Chi-squared test, respectively. Nearest 1:1 neighbor matching was performed between minority patients and White patients. P < 0.05 for all comparative analyses was considered statistically significant. RESULTS: Of the total cohort (n = 1919), 70.3% identified as White, while 21.6% identified as Black or Hispanic. The mortality rate was 0.3%. Among different race categories, the frequency of spleen embolization (P = 0.99), splenectomy (P = 0.99), blood transfusion (P = 1), and mortality (P = 1), were not significantly different. After controlling for ISS and age with propensity score matching, the mean hospital LOS remained significantly higher in minority patients, with a mean of 5.44 d compared to 4.72 d (P = 0.05). Mean length of intensive care unit stay was not significantly different after propensity matching, with a mean of 1.79 d and 1.56 spent in the ICU for minority and White patients respectively (P = 0.17). While propensity score matching preserved statistical significance, the ISS for the minority group remained 1.12 times higher than the ISS of the Caucasian group. There was no statistically significant difference among races with respect to different payment methods and insurance status, although Black and Hispanic patients were proportionally underinsured. CONCLUSIONS: While minority patients had a relatively higher number of operative interventions and longer hospital and ICU stays, after propensity score matching, mean ISS remained higher in the minority group. Our findings suggest that injury severity is likely to influence the difference in LOS between the two groups. Furthermore, our data highlight how nonoperative management is not standardized across pediatric trauma centers.

Pediatric Melanoma: Geographic Trends in Incidence, Stage, and Mortality in the United States.

INTRODUCTION: Pediatric melanoma is the most commonly diagnosed skin cancer in children, with the annual incidence recently increasing by an average of 2% each year. Ultraviolet (UV) radiation from excessive sun exposure is an important carcinogenic risk factor, with penetration varying greatly throughout the country. Consequently, an individual's geographic location may play a role in how much exposure to high UV index rays they receive throughout their lifetime. The objective of this study was to use the surveillance, epidemiology, and end results SEER database to study geographic trends in incidence, staging, and mortality of pediatric melanoma between 2009 and 2019 and determine their relation to UV index in the United States. MATERIALS AND METHODS: A retrospective analysis of pediatric patients from 0 to 19 years in the surveillance, epidemiology, and end results 22 registries incidence database (17 states) and 17 registries incidence-based mortality database (12 states) was conducted from 2009 to 2019 based on a diagnosis of melanoma of the skin using the International Classification of Childhood Cancer codes for malignant melanoma. Data regarding patient demographics and incidence, staging, and mortality per state were extracted. Incidence data were geographically mapped and mean UV index distribution from www.epa.gov was superimposed. RESULTS: Incidence of pediatric melanoma was stratified regionally, with a total of 1665 new cases from 2009 to 2019. The Northeast had 393 new cases, with 244 (62.1%) localized cases, 55 (14.0%) lymph node-invasive and metastatic (advanced) cases, and 6/146 (4.1%) cases of mortality. The Midwest had 209 new cases, with 123 (58.9%) localized cases, 29 (13.9%) advanced cases, and 1/57 (1.8%) case of mortality. The South had 487 new cases, with 224 (46.0%) localized cases, 104 (21.4%) advanced cases, and 8/232 (3.4%) cases of mortality. The West had 576 new cases, with 364 (63.2%) localized cases, 82 (14.2%) advanced cases, and 23/551 (4.2%) cases of mortality. Mean UV index was 4.4 in the Northeast, 4.8 in the Midwest, 7.3 in the South, and 5.5 in the West from 2006 to 2020. The regional difference in incidence was not statistically significant. There was a statistically significant increased number of advanced cases in the South as compared to the Northeast (P = 0.005), West (P = 0.002), and Midwest (P = 0.02), with a significant correlation coefficient of 0.7204 between advanced cases and mean UV index in the South. CONCLUSIONS: There is a statistically significant increased incidence of lymph node-invasive and metastatic pediatric melanoma cases in the South as compared to the West, Northeast, and Midwest regions of the United States. There is also a significant correlation between the incidence of lymph node-invasive and metastatic pediatric melanoma cases and UV index. In the pediatric population, there is no statistically significant association between total incidence and mortality of melanoma and geographic region. There is an increased prevalence of pediatric melanoma seen in White and female patients. This suggests that an individual's geographic location in the United States during childhood may play a role in their likelihood of malignant melanoma development, advanced-stage melanoma development, and mortality.