Racial and ethnic differences in pediatric unintentional injuries requiring hospitalization.

BACKGROUND/OBJECTIVE: This study aims to comprehensively examine racial and ethnic differences in pediatric unintentional injuries requiring hospitalization by age across injury mechanisms. STUDY DESIGN: This was a retrospective, nationally representative cross-sectional analysis of discharge data within the 2016 Kids' Inpatient Database for 98,611 children ≤19 years with unintentional injuries resulting in hospitalization. Injury categories included passengers and pedestrians injured in a motor vehicle crash, falls, drownings, burns, firearms, drug and nondrug poisonings, suffocations, and other injuries. Relative risk (RR) for injuries requiring hospitalization were calculated for children of Black, Hispanic, and Other races and ethnicities compared with White children, and then RR were further stratified by age. Excessive hospitalizations were calculated as the absolute number of hospitalizations for each race and ethnicity group that would have been avoided if each group had the same rate as White children. RESULTS: Black children were significantly more likely to be hospitalized compared with White children for all injury mechanisms except falls, and in nearly all age groups with the greatest RR for firearm injuries (RR 9.8 [95% confidence interval: 9.5-10.2]). Differences were associated with 6263 excessive hospitalizations among all racial and ethnic minority children compared with White children. CONCLUSIONS: Racial and ethnic minority children represent populations at persistent disproportionate risk for injuries resulting in hospitalization; risk that varies in important ways by injury mechanism and children's age. These findings suggest the importance of the environmental and societal exposures that may drive these differences, but other factors, such as provider bias, may also contribute.

Brief Motivational Intervention to Improve Adolescent Sexual Health Service Uptake: A Pilot Randomized Controlled Trial in the Emergency Department.

OBJECTIVE: To test the hypothesis that our motivational sexual health intervention (SexHealth) would increase health service uptake when compared with control. STUDY DESIGN: In a randomized controlled trial at a pediatric emergency department, sexually active adolescents received either the SexHealth intervention or printed materials (control). SexHealth, delivered by a health educator, was a tablet-based, interactive intervention that included motivational techniques to promote sexual health, condom skills training, and tailored service recommendations. We assessed feasibility (eg, intervention completion, recommendations discussed, intervention duration), acceptability (ie, proportion enrolled and rating intervention as satisfactory), and efficacy; secondary outcomes were sexual and care-seeking behaviors at 6 months. The efficacy outcome was completion of ≥1 service at the index visit (ie, counseling, condoms, emergency contraception for immediate or future use, pregnancy/sexually transmitted infection/HIV testing, sexually transmitted infection treatment, and clinic referral). RESULTS: We enrolled 91 participants (intervention = 44; control = 47). The intervention demonstrated high feasibility: 98% completed the intervention; 98% of recommendations were discussed; duration was 24.6 minutes, and acceptability: 87% of eligible adolescents enrolled and 93% rated the intervention as fairly to very satisfactory. Compared with controls, intervention participants were more likely to complete ≥1 service (98% vs 70%, P < .001) including HIV testing (33% vs 6%, P = .02) and emergency contraception (80% vs 0%, P = .01). There were no meaningful differences between arms in behaviors at follow-up. CONCLUSIONS: SexHealth was feasible to implement, acceptable to youth, and resulted in increased uptake of health services during the emergency department visit. Additional strategies may be needed to extend intervention effects over time. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; NCT03341975.

Pediatric Emergency Department Challenges and Response to COVID-19.

Severe acute respiratory syndrome coronavirus 2, the virus causing the pandemic illness coronavirus disease 2019, was first detected in the United States in January 2020. As the illness spread across the country, all aspects and venues of health care were significantly impacted. This article explores the challenges and response of one children's emergency medicine division related to surge planning, personal protective equipment, screening, testing, staffing, and other operational challenges, and describes the impact and implications thus far. [Pediatr Ann. 2021;50(4):e172-e177.].

Universal Intimate-Partner Violence Assessment in the Pediatric Emergency Department and Urgent Care Setting: A Retrospective Review.

OBJECTIVE: The aim of this study was to examine universal intimate-partner violence (IPV) assessment in the pediatric acute care setting. METHODS: We reviewed universal IPV assessment over 1 year in 2 emergency departments and 3 urgent care centers within a children's hospital system. Written IPV assessment used 2 questions (ie, safety concerns at home, information desired); "yes" to either was considered positive. We identified positive assessments via preexisting quality report. We collected demographics, resource utilization, and reason for positive screen by chart review. Positive assessment for IPV was determined by chart documentation. RESULTS: Intimate-partner violence assessment was documented in 169,399 visits (96% of all visits); 511 (0.3%) were positive. Four hundred ninety cases were reviewed; 21 cases were excluded (incomplete data). One hundred twenty positive assessments were classified as misunderstood ("yes" marked in error); these were associated with nonwhite race (P < 0.001). We identified IPV in 169 (46%) of the remaining 370 positive assessments. Intimate-partner violence identification was associated with white race (P = 0.004), female caregiver (P < 0.001), and English as primary home language (P = 0.045). Non-IPV concerns triggered 239 positive assessments; concerns included child maltreatment (n = 125), mental/behavioral health (n = 46), other violence (n = 33), and parenting (n = 21). Intimate-partner violence was identified by social work in 82 cases triggered by non-IPV concerns. Resources utilized included social work (99%), non-IPV resources (59%), IPV advocate (21%), law enforcement (0.8%), and child protective services (1.6%). CONCLUSIONS: Universal IPV assessment in the pediatric acute care setting is feasible and may enable resource provision for IPV and non-IPV concerns.

The Relevance of Parental Adverse Childhood Experiences in Pediatric Practice.

Adverse childhood experiences affect a vast number of people, including the parents of the children we see as patients in our practices. Importantly, the trauma one experiences as a child affects not only health but also parenting style and ability, and thus is relevant in pediatric practice. Recent research has now established the significant relationship between adverse childhood experiences (ACEs) parents have before age 18 years and their children's health. However, considering a parent's past trauma and the toxic stress that may result is typically not considered by the pediatric health care provider. This article reviews new research investigating the relationship between parental ACEs and children, and its implications for pediatric practice. [Pediatr Ann. 2019;48(12):e463-e465.].

Choking in Children: What to Do and How to Prevent.

Choking happens when a child's airway is blocked by a foreign substance that impairs oxygenation and ventilation. It is one of the most frightening scenarios a parent can imagine. It happens suddenly and can have the direst of consequences. Small objects, such as food and candy, are the usual offenders. Child-related risk factors are largely developmental due to physical and cognitive immaturity. This article describes the magnitude of the problem, delineates some of the risks, and outlines prevention. [Pediatr Ann. 2019;48(9):e338-e340.].

Treatment and Prevention of Pediatric Sunburn.

Skin cancer is the most common cancer in the United States, and risk for melanoma is greatly increased with a serious sunburn in childhood or adolescence. Skin cancer also is one of the most preventable cancers, as sun exposure is an almost entirely modifiable risk factor. Proper skin protection should start early in life when infants begin to be exposed to the outdoors. [Pediatr Ann. 2019;48(6):e213-e214.].

Shared Decisions in Pediatrics.

Shared decision-making (SDM) is a structured approach to engaging patients in discussion in medical therapy when there is more than one viable option for care. SDM may decrease decisional conflict between providers and patients, increase trust, and possibly even help decrease health care costs. Much more is known about this approach in adult health care environments, but research on SDM in child health care settings is growing. This article explores unique features of SDM in pediatrics and gives examples of applications. [Pediatr Ann. 2019;48(3):e98-e100.].

Opioid Prescribing Practices in Pediatric Acute Care Settings.

OBJECTIVES: Deaths due to prescription opioid overdoses are at record-high levels. Limiting the amount of opioid prescribed has been suggested as a prevention strategy. The purpose of this study was to describe the opioid prescribing practices in the emergency departments and urgent care sites of a Midwestern tertiary care children's hospital system. METHODS: This retrospective medical record review examined the visits from the 2 pediatric emergency departments and 2 pediatric urgent care sites in the system from June 1, 2012, to May 31, 2013, during which an outpatient opioid prescription was written. The primary outcome was number of days of opioid prescribed. Other data collected included patient demographics, diagnosis, and prescriber information; factors associated with prescriptions written for more than 5 days were identified. RESULTS: A total of 4075 opioid prescriptions were included in the 1-year study period, and 3991 of these had complete data for analysis. The median amount prescribed was 3.3 days with an interquartile range of 2.5 days. Odds of receiving a prescription of more than 5 days' duration were higher for children younger than 1 year (odds ratio [OR], 12.3; 95% confidence interval [CI], 7.3-21.0), 1 to 4 years of age (OR, 7.7; 95% CI, 5.5-10.8), and 5 to 9 years of age (OR, 2.4; 95% CI, 1.7-3.4); for children with noninjury diagnoses (OR, 1.4; 95% CI, 1.2-1.7); or if prescribed by a resident physician (OR, 1.4; 95% CI, 1.1-1.8) or from the urgent care (OR, 1.4; 95% CI, 1.1-1.7). CONCLUSIONS: Opioid prescriptions of more than 5 days were more frequently prescribed for younger patients, noninjury diagnoses, or if prescribed by a resident physician or from the urgent care. We need to focus on medical student, resident, and provider education as well as further opioid research in order to decrease unnecessary prescribing.

Development of a Novel Computerized Clinical Decision Support System to Improve Adolescent Sexual Health Care Provision.

OBJECTIVE: The objective was to develop an acceptable clinical decision support (CDS) system to facilitate evidence-based sexual health care for adolescents in the emergency department (ED). METHODS: In this multiphased iterative process, we engaged an expert group to synthesize evidence on a wide range of sexual health services (e.g., contraception, condoms, identification and treatment of previously diagnosed sexually transmitted infection). We created a computerized questionnaire and embedded our decision tree, utilizing patient-entered responses to create tailored, evidence-based recommendations, and embedded links to study-related resources such as the emergency contraception (EC) quick guide. We utilized mixed methodology to explore perspectives of adolescents aged 14 to 19 years and clinicians at two general and two pediatric EDs after they interacted with the system. Clinicians reported usefulness (Likert scale 1 = not at all, 4 = very); adolescents reported acceptability. We used the chi-square test to compare responses between subgroups. We collected adolescents' verbatim responses to open-ended questions; clinicians self-entered responses. Four authors independently generated themes from qualitative responses before compiling key findings and achieving consensus on final themes. RESULTS: Among 57 clinicians (23 physicians, 23 nurses, 11 nurse practitioners; 54% female; 65% aged < 40 years), the mean system usefulness rating was 3.4 ± 0.7. Sex, age, clinician role, or ED type were not associated with rating the system "somewhat/very" useful. Clinicians identified barriers (e.g., time constraints) that could be overcome by implementation considerations (e.g., training) as well as benefits including improved care. For future assessments, providers preferred computer (65%) over face-to-face interview (26%). Among 57 adolescents (mean age = 16.2 years; 75% female; 56% sexually experienced), nearly all (95%) reported that it was "very/somewhat easy" to complete the computerized questionnaire and to understand the questions. Most adolescents understood the EC quick guide and correctly identified that ulipristal, compared to levonorgestrel, required a prescription and was more effective. For future assessments, adolescents preferred computer (69%) over face-to-face interviews (9%). CONCLUSIONS: We developed a sexual health CDS system that is easy to use and can facilitate evidence-based care to reduce health outcome gaps. Evaluation of system impact on service delivery and, ultimately, health outcomes is needed.

Acute Marijuana Intoxication in Children.

As the number of states legalizing marijuana for medical and/or recreational use continues to grow, there are an increasing number of children exposed to marijuana-containing products in homes and communities. Increased exposure leads to a greater probability of accidental ingestion and toxicity. Because marijuana ingestion can cause a dangerous and potentially life-threatening toxicity for children, pediatric health care providers need an increased awareness of the danger. This article describes the growing problem and outlines clinical management as well as prevention. [Pediatr Ann. 2018;47(12):e474-e476.].

Trampolines: What's the Harm?

Trampolines hold the promise of fun and enjoyment for many children, but they are associated with a significant number of orthopedic and other injuries. Injuries vary from minor to severe, and the most common are extremity injuries. Although most injuries are associated with residential (ie, backyard) trampolines, a growing number of injuries now occur in trampoline parks. Adult supervision has not been effective for prevention. Emerging data on trampoline park-related injuries indicate that caution should be exercised in these settings as well. [Pediatr Ann. 2018;47(10):e385-e387.].

Fireworks-Related Injury in Children.

Many children are attracted to the color, noise, light, and excitement generated by fireworks. Both home and public displays of fireworks are a festive part of American culture, enjoyed on holidays, during sporting events, and on a variety of other occasions. However, fireworks pose a risk of serious injury to children and youth. Each year, thousands of children sustain major and minor injuries due to fireworks, with many resulting in permanent disability. Regulations concerning private sales and use of fireworks vary greatly from state to state, so children's exposure varies geographically. Fortunately, by leaving fireworks to professionals, injuries to both adults and children can be prevented. [Pediatr Ann. 2018;47(6):e227-e229.].

Vehicular Hyperthermia-A Highly Preventable and Potentially Fatal Problem.

A child dying of heat injury due to being left unattended in a motor vehicle is a needless tragedy. Each year in the United States an average of 38 children mostly younger than age 2 years die of vehicular hyperthermia, frequently the result of a parental lapse of attention and not intentional neglect. Serious illness results quickly from exposure to rising heat within the passenger compartment, even on days when the temperature is fairly moderate. Prevention is paramount in addressing this problem and can best be accomplished by a combination of technological means, such as passive warning systems, laws that make leaving a child in a car alone illegal, and public education campaigns. [Pediatr Ann. 2018;47(3):e88-e90.].