Bicycle-related injuries among children and adolescents in the United States.

The objective of this study is to describe the epidemiology of bicycle-related injuries among children and adolescents 18 years and younger on a national level. This is a retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for patients 18 years and younger who were seen in emergency departments (EDs) between January 1, 1990, and December 31, 2005, for injuries received while operating a bicycle. During the 16-year study period, there were an estimated 6 228 700 individuals 18 years and younger treated in US EDs for bicycle-related injuries. Children with head injuries were more than 3 (relative risk, 3.63) times as likely to require hospitalization and were almost 6 (relative risk, 5.77) times more likely to have their injuries result in death. The large number of annual bicycle related-injuries is evidence that prevention of these injuries should remain an important area of bicycle safety research and practice.

Formal psychological testing in patients with paradoxical vocal fold dysfunction.

OBJECTIVE: The etiology of paradoxical vocal fold dysfunction (PVFD) has been unclear, but it has long been hypothesized that there is a significant psychological component. The purpose of this study was to elucidate the psychological profiles of patients newly diagnosed with PVFD using psychometrically-sound psychological assessment instruments. STUDY DESIGN: Prospective cohort study of 45 adults newly diagnosed with PVFD at a tertiary university referral center. METHODS: The Minnesota Multiphasic Personality Inventory (MMPI-2) was administered to test for psychopathology. The Life Experiences Survey (LES) was administered to investigate levels of stress. Demographic, medical, and social histories were reviewed. MMPI-2 and LES scores for the PVFD cohort were compared with scores previously established for normative populations. RESULTS: The study population included 81% female and 60% who were age 50 or older. Compared to the normative population for the MMPI-2, significant differences were noted for both male and female PVFD patients; on average, scores were highly elevated on the hypochondriasis scale and hysteria scale and less elevated on the depression scale. This pattern was consistent with conversion disorder (P < .01). In MMPI-2 subset analysis, 18 patients had a classic conversion profile while 13 others had elevated scores in the three scales of interest, but not in the classic conversion disorder pattern. Also, 11 patients had normal scores, suggesting no psychopathology. PVFD patients with a psychological history scored significantly higher on the depression and anxiety scales than PVFD patients without a psychological history. Patients with a history of asthma or gastroesophageal reflux disease (GERD) achieved significantly higher scores on the hypochondriasis scale than those without that medical history. On the LES assessment, female PVFD patients had significantly lower levels of positive stress and higher levels of negative stress than the general population; total levels of stress were not significantly different, however. Male PVFD patients had significantly lower levels of positive, negative, and total stress. For the entire cohort, asthma (65%), GERD (51%), and a history of abuse (38%) were common comorbidities. CONCLUSIONS: On average, in both male and female adults, PVFD is associated with conversion disorder, representing a physical manifestation of underlying psychological difficulty. There also appears to be a subset of PVFD that is not associated with psychopathology. PVFD patients with a previous psychological history are prone to more depressive and anxious symptomatology. Patients with PVFD and a history of asthma or GERD are more likely to excessively complain about physical symptoms. Overall levels of stress are not higher in PVFD patients compared to a general population. However, females report more negative stress, and both males and females may have trouble coping with the amount of stress that they do have. PVFD is more common among women, more prevalent among older individuals, and can be comorbid with asthma, GERD, and previous abuse. These results have implications for treatment- psychotherapy directed for somatoform and conversion disorders may be added to traditional speech therapy for increased efficacy.

Factors associated with hospital length of stay and hospital charges of motor vehicle crash related hospitalizations among children in the United States.

OBJECTIVES: To calculate national estimates of motor vehicle crash (MVC)-related hospitalization and associated use of health care resources among patients 20 years and younger and to explore the effects of certain sociodemographic and health care system-related factors and injury severity on use of hospital resources and lengths of stay (LOSs) in the United States. DESIGN: Data from the 2003 Healthcare Cost and Utilization Project Kids' Inpatient Database were used. SETTING: Pediatric inpatient care in 3438 hospitals in 36 US states. Patients Patients 20 years and younger hospitalized with MVC-related injuries. MAIN OUTCOME MEASURES: National estimates of MVC-associated hospitalizations, rates, resource use, Injury Severity Scores, and demographics were calculated. Potentially significant covariate associations were studied using hospital charges and LOS. RESULTS: Sixty-two thousand eight hundred eighty MVC-related hospitalizations occurred among patients 20 years and younger in the United States in 2003, resulting in more than $2.0 billion (SD = $1.2 million) in inpatient charges and 304 196 days (SD = 55,113 days) of hospitalization. Mean (SD) hospital charges and LOS were $33,440 ($55,113) and 4.8 (7.7) days, respectively. The mean (SD) Injury Severity Score was 10.3 (11.4). Adolescents aged 18 through 20 years had the highest hospitalization rates (197 cases per 100,000 children). Older age, being male, urban hospital location, mortality during hospitalization, higher injury severity, and longer LOS were significantly associated with higher total charges. Longer LOS was significantly associated with older age, urban hospital location, higher injury severity, and mortality. CONCLUSION: Motor vehicle crash-related injuries among children burden health care resources, with nationwide charges exceeding $2 billion annually.