Child bicyclist injuries: are we obtaining enough information in the emergency department chart?

OBJECTIVE: The purpose of this study was to assess the range of information relevant to bicyclist injury research that is available on routinely completed emergency department medical records. METHODS: A retrospective chart review of emergency department medical records was conducted on children who were injured as bicyclists and treated at an urban level I pediatric trauma center. A range of variables relevant to bicyclist injury research and prevention was developed and organized according to the Haddon matrix. Routinely completed free text emergency department medical records were assessed for the presence of each of the targeted elements. In addition, medical records of seriously injured patients (for whom a more structured medical record is routinely used) were compared to free form records of less seriously injured patients to identify differences in documentation that may be related to the structure of the medical record. RESULTS: Information related to previous medical history (96% of records), diagnosis (89%), documentation of pre-hospital care (82%), and child traumatic contact points (81%) were documented in the majority of medical records. Information relevant to prevention efforts was less commonly documented: identification of motor vehicle/object involved in crash (58%), the precipitating event (24%), the location of the crash (23%), and documentation of helmet use (23%). Records of seriously injured patients demonstrated significantly higher documentation rates for pre-hospital care and child traumatic contact points, and significantly lower documentation rates for previous medical history, child kinematics, main body parts impacted, and location of injury event. CONCLUSIONS: Routinely completed free text emergency department medical records contain limited information that could be used by injury researchers in effective surveillance. In particular information relating to the circumstances of the crash event that might be used to design or target prevention efforts is typically lacking. Routine use of more structured medical records has the potential to improve documentation of key information.

Constipation as a cause of scrotal pain in children.

Six boys with scrotal pain and constipation were seen at our hospital within the past 5 years. All boys had no clinical findings of structural or infectious derangements, and experienced relief of testicular symptoms after evacuation of the fecal mass. The association between constipation and scrotal pain has not been previously reported, and may represent direct neural stimulation or chronic inflammation of testicular structures in patients with dysfunctional voiding. Recognition of the association between constipation and subacute or chronic scrotal pain can guide the clinician towards appropriate therapy for these patients.

Bias in the gamma delta T cell response to Listeria monocytogenes. V delta 6.3+ cells are a major component of the gamma delta T cell response to Listeria monocytogenes.

Despite extensive research, the role that gamma delta T cells play in the immune response to infectious disease has yet to be established. Here we report the generation of a mAb specific for the V delta 6.3 TCR and investigate the gamma delta+ and V delta 6.3+ T cell responses to the intracellular bacterium Listeria monocytogenes in BALB/c mice. By infecting animals with various doses of Listeria and analyzing the components of the cellular immune response at the two primary sites of infection, the liver and spleen, we have shown that the kinetics, composition, and magnitude of the gamma delta and V delta 6.3 T cell responses are dependent upon the injected dose of bacteria and the organ in which the infection is established. At low doses of infection, the gamma delta T cell response occurs late in the disease course, while at high doses, the response is earlier and of greater magnitude, particularly in the liver. At all infectious doses and in both tissues, the V delta 6.3+ population predominates and together with V delta 4+ cells composes the bulk of the gamma delta T cell response. Changes in the morphology of gamma delta+ and V delta 6.3+ cells at the site of infection are consistent with cellular activation and suggest that these cells are active participants in the Listeria-induced immune response. The results of our study suggest that many features of the gamma delta T cell response to Listeria are dose and tissue related.