RESUMO
PURPOSE: Minority and disadvantaged children are evaluated for nonaccidental trauma (NAT) at higher rates than other children. At our institution, we implemented a guideline to perform skeletal surveys to screen for occult fractures in all infants with unwitnessed head injury (UHI). The goal was to determine if this guideline decreased disparities in the screening of African American (AA) and uninsured children. PATIENTS AND METHODS: For 54 months, rates of skeletal surveillance and abuse determination were compared between AA and white infants admitted with UHI before and after implementation of our guideline. Logistic regression was used to control for confounders. RESULTS: Before the guideline, AAs underwent skeletal surveillance more than whites (n = 208; 90.5% vs 69.3%; P = .01), with 20% of screened infants determined to be probable victims of NAT. Whites with private insurance were less likely to be screened compared to those without private insurance (50.0% vs 88.1%; P < .001). After the guideline, AA and whites were surveyed equally (n = 52; 92.3% vs 84.6%; P = 1.0), with 22% found to be probable cases of NAT. CONCLUSIONS: This is the first report of a successful policy-based intervention to decrease disparity in care. The maintenance of a stable rate of NAT determination despite increased screening suggests more victims of abuse may be identified with guideline use, and therefore, this may be an additional benefit of the guideline.
Assuntos
Osso e Ossos/diagnóstico por imagem , Maus-Tratos Infantis/diagnóstico , Traumatismos Craniocerebrais/diagnóstico , Negro ou Afro-Americano , Algoritmos , Feminino , Disparidades em Assistência à Saúde , Humanos , Lactente , Recém-Nascido , Cobertura do Seguro , Masculino , Programas de Rastreamento , Pessoas sem Cobertura de Seguro de Saúde , Radiografia , População BrancaRESUMO
We hypothesized that using the teachable moment associated with an injured classmate, school-aged children would demonstrate improved retention of injury prevention education. The injured child's class and one control with presentation class received an injury prevention presentation. Prospective evaluation was performed using pre, immediate post, and 1-month posttesting. Immediately following the presentation, 83% of classes in both groups demonstrated significant improvement in test scores. At 1 month, 100% of the injured child's and only 66% of control with presentation classrooms maintained significant improvements. This unique program results not only in immediate but also in long-term retention of injury prevention information.
Assuntos
Atitude Frente a Saúde , Educação em Saúde/organização & administração , Grupo Associado , Gestão da Segurança/organização & administração , Serviços de Saúde Escolar/organização & administração , Ferimentos e Lesões/prevenção & controle , Centros Médicos Acadêmicos , Análise de Variância , Criança , Avaliação Educacional , Feminino , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Pediátricos , Humanos , Masculino , Pesquisa em Avaliação de Enfermagem , Ohio , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Psicologia da Criança , Comportamento de Redução do Risco , Inquéritos e Questionários , Ferimentos e Lesões/psicologiaRESUMO
This prospective research study evaluated the parent's perception of their child's quality of life at 1 and 6 months following injury, using the Child Health Questionnaire to measure outcomes. At both 1 and 6 months postinjury, the physical summary and psychosocial summary scores were significantly lower than US norms for all levels of injury severity. Predictors of lower physical and psychosocial scores, such as the Injury Severity Score and specific location of injury, were determined. This study demonstrates the long-term impact of injury and validates the need for earlier intervention and anticipatory guidance for the child and family.
Assuntos
Família , Qualidade de Vida , Percepção Social , Ferimentos e Lesões/epidemiologia , Escala Resumida de Ferimentos , Adolescente , Criança , Pré-Escolar , Família/psicologia , Feminino , Nível de Saúde , Humanos , Escala de Gravidade do Ferimento , Masculino , Saúde Mental , Análise Multivariada , Estudos Prospectivos , Valores de Referência , Análise de Regressão , Estados Unidos/epidemiologia , Ferimentos e Lesões/classificação , Ferimentos e Lesões/reabilitaçãoAssuntos
Vértebras Cervicais , Enfermagem em Emergência/normas , Guias de Prática Clínica como Assunto , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/enfermagem , Algoritmos , Vértebras Cervicais/diagnóstico por imagem , Criança , Pré-Escolar , Educação Continuada em Enfermagem/organização & administração , Enfermagem em Emergência/educação , Avaliação de Desempenho Profissional/métodos , Humanos , Avaliação em Enfermagem/normas , Ohio , RadiografiaRESUMO
Traumatic pancreatic injury is infrequently encountered in children. Diagnosis and treatment of this injury can be complicated. Signs and symptoms are often subtle with presentation frequently delayed leading to increased morbidity and mortality. This delay is compounded by lack of specific diagnostic tools to aid diagnosis. Clinicians should maintain a high index of suspicion for pancreatic injury in any child who sustains blunt abdominal trauma. Ongoing clinical evaluation is essential. This article presents a case study of a child with a traumatic pancreatic injury and discusses tools utilized to aid diagnosis of pancreatic injury, treatment options, and potential complications.
