Advised follow-up after emergency treatment of adolescents with violence-related injuries.

OBJECTIVE: To compare the rate of advised medical follow-up for adolescents with violence-related, nonsuicidal injuries versus other complaints. DESIGN: Cross-sectional study. SETTING: Pediatric emergency department (ED). PATIENTS: All visits by adolescents, aged 13 to 18 years, during a one-week period from each season during 1992. MAIN OUTCOME MEASURES/RESULTS: Advised medical follow-up for patients sustaining violence-related injuries versus other complaints were compared. Four hundred twenty-six visits were reviewed; 351(82%) resulted in discharge from the ED. Sixty-eight (16%) were classified as violence-related, nonsuicidal. Male adolescents were more likely to sustain violence-related injuries (66% vs 34%, P < 0.01). There were no differences in admission rate or having a primary care provider (PCP) between the violence-related injury group and the group with other complaints. Adolescents with other complaints were twice as likely to have follow-up advised. Presence of PCP and older age were also positively associated with advised follow-up. CONCLUSION: Adolescents sustaining violence-related injuries were less likely to have follow-up advised at the time of their ED visit than were adolescents presenting with other complaints. Violently injured adolescents, at risk for recurrent violent injuries and psychosocial sequelae, were less likely to have follow-up advised at the time of their ED visit than were adolescents presenting with other complaints.

Pediatric pedestrian injuries: a community assessment using a hospital surveillance system.

OBJECTIVE: To provide a descriptive demographic and environmental account of pedestrian injuries among children aged < or =15 years in Jefferson County, Alabama. METHODS: This was a retrospective study with a case definition for inclusion of individuals, aged < or =15 years, who suffered a pedestrian injury and sought care at The Children's Hospital of Alabama between 1989 and 1991. Demographic and injury-related information was obtained from the medical record and analyses were performed using t-test and a simple correlation. RESULTS: The majority of the cases were nonwhite, and nearly half had Medicaid or were uninsured. The most common injuries were fractures and closed head trauma. The geographic locations of injury events were not uniformly distributed: a comparison of areas wherein an injury occurred with those that were injury-free revealed a number of significant differences with regard to specific demographic, socioeconomic, and ecological factors. CONCLUSIONS: Some of the possible manageable environmental risk factors identified in this study were relatively high posted speed limits; sidewalks that were narrow, absent, or in a state of disrepair; vehicular parking on both sides of the street; and the absence of a divided highway. In this community, the most cost-effective educational intervention may best be targeted to elementary-aged schoolchildren living in areas with low-income families and that have a high density of children.

Theoretical frameworks. Developmental psychopathology, the public health approach to violence, and the cycle of violence.

In many disciplines, there are applications of theory to provide strategies for research and practice. But, at this point in time, given the complex nature of violence, few existing theories effectively address all important variables. In order to overcome deficiencies in violence theory development, it will be necessary for violence researchers and practitioners to better define the concept of violence, improve research designs and program evaluations, and make multidisciplinary collaboration a priority.

Comparison of heparin and streptokinase in the treatment of venous thrombosis.

Heparin or streptokinase was administered in a prospective randomized fashion to 50 patients with phlebographically confirmed venous thrombosis of the extremities of 14 days or less duration. A total of 49 patients completed the investigative protocol with 26 receiving heparin and 23 receiving streptokinase. All patients were evaluated with sequential phlebograms. Complete thrombolysis with restoration of venous valve function occurred in one of 26 patients receiving heparin and in six of 23 patients receiving streptokinase. Fifty per cent of the patients treated with streptokinase with a total duration of symptoms of three days or less achieved complete lysis. The total incidence of therapeutic complications was similar in the two groups, but was more severe in the streptokinase treated patients.