Causes and consequences of injuries in children in Western Australia.

OBJECTIVE: To identify the common causes and consequences of pediatric injury-related admission to an Australian children's hospital. METHODS: A retrospective study was conducted at a pediatric teaching hospital. Patients < 18 years of age hospitalized between March 1, 2007 and April 30, 2007 were included. Patient medical records were reviewed if an admission diagnosis was injury related. Data collected included date of birth, gender, date of admission, date of discharge, diagnosis, procedure, and causes and outcomes of the injury. RESULTS: A total of 184 patients were admitted as a result of injury during the study period. Of these, one neonate, six infants, 38 toddlers, 111 children, and 28 teenagers were included in this study. The most common cause of injury-related hospital admission was a fall (n = 109, 59%). Other causes of injury included crushing (8%, n = 15), the spilling of fluids (5.4%, n = 10), and bites (4.3%, n = 8). The most common consequence of an injury for children (43/111, 38.7%) and teenagers (12/28, 43%) was bone fracture. However, head injuries were the most common injury in toddlers (11/38, 29%), infants (5/6, 83.3%), and neonates (1/1, 100%). The radius and/or ulna (36/63, 57%) were the most common bones fractured. The majority (32/37, 86.5%) of patients who suffered head injuries were diagnosed as having a minor injury. CONCLUSION: The main cause of injury-related admission to the hospital for children was a fall, with the most common consequences being fractures and head injuries.

Impact of drug use and comorbidities on in-hospital falls in patients with chronic kidney disease.

BACKGROUND: In-hospital falls are a major problem in healthcare institutions and contribute to morbidity and mortality in this setting. Patients with chronic kidney disease (CKD) were previously found to be at higher risk for experiencing an in-hospital fall. OBJECTIVE: To evaluate the association between comorbidities and drug use with the risk of in-hospital falls in adults with CKD. METHODS: A retrospective case-control study was conducted in patients with CKD hospitalized between January 1, 1998, and June 30, 2003. Cases included patients who experienced an in-hospital fall, were 18 years of age or older, and had been hospitalized for more than 24 hours. For every case, 2 controls were identified and matched for CKD, age, and sex. Information about comorbidities and drug use was collected from an electronic medical data repository. Statistical tests performed were t-tests, chi2 analysis, and multivariate logistic regression, using occurrence of a fall as the dependent variable and race, comorbidities, and drug groups as covariates. RESULTS: There were 635 fall cases that met study criteria. The mean age of patients was 68 +/- 15 years, 54% were female, and 82% were white. There were 1270 matched controls with CKD who were included in the regression analysis. Comorbidities that increased the likelihood of experiencing an in-hospital fall were dementia (OR 2.63), pneumonia (OR 1.72), gastrointestinal disease (OR 1.41), and diabetes (OR 1.31). Drugs associated with an in-hospital fall were antidepressants (OR 1.65) and anticonvulsants (OR 1.52). CONCLUSIONS: Several comorbidities, especially dementia, significantly increase the risk of experiencing an in-hospital fall in patients with CKD. Drugs that place CKD patients at risk include antidepressants and anticonvulsants.

Children's acetaminophen exposures reported to a regional poison control center.

PURPOSE: The patient characteristics, doses taken, and types of exposures in children with acetaminophen-related exposures reported to a regional poison control center (RPCC) were studied. METHODS: A retrospective review was conducted of all acetaminophen exposures that occurred between October 31, 2000, and October 31, 2003, in children younger than 18 years who were managed by an RPCC. Children were grouped into three age categories: less than 6 years (group 1), 6-12 years (group 2), and 13-17 years (group 3). Data collected included patient demographics, drug details, type of exposure, time since exposure, exposure site, and caller site. RESULTS: There were 473 exposures to acetaminophen: 76% in group 1, 3% in group 2, and 21% in group 3. Sex was distributed equally among groups, except group 3 was 83% females. The majority of callers seeking information on acetaminophen ingestion in children younger than 12 years were family members (62%), whereas health professionals (61%) were the most common callers for children over 12 years. Unintentional ingestion was the most common type of exposure in group 1 (100%) and group 2 (93.7%). In group 3, intentional ingestions were more common (91%), with females representing far more of these exposures than males (87% versus 14%, respectively). Acetaminophen doses over 200 mg/kg were ingested by 47% of children in group 3. CONCLUSION: Most acetaminophen exposures reported to an RPCC occurred in children less than six years of age and were unintentional, whereas exposures in children over 12 years were more likely to be intentional overdoses.