Trends in Pediatric Emergency Department Utilization for Mild Traumatic Brain Injury Before and After Legislation.

OBJECTIVE: To examine the effect of state youth traumatic brain injury (TBI) legislation on pediatric emergency department (ED) utilization for sports and recreation-related mild TBIs (mTBIs). PARTICIPANTS: ED visits by children ages 5 to 18 years between 2006 and 2014 in the Pediatric Health Information System database (N = 452 900). DESIGN: Retrospective analysis. MAIN MEASURES: Rates of ED visits, and injury comparison groups (mTBI, moderate to severe TBI, minor head injury, and long bone fracture). RESULTS: Of the 452 900 ED visits, 123 192 (27.2%) were for mTBI, along with visits for moderate to severe TBIs (n = 5190), minor head injuries (n = 54 566), and long bone fractures (n = 269 952). ED visits for mTBIs were more common among males (67.5%), children ages 10-14 years (42.1%), and the privately insured (50.6%). The proportion of mTBI ED visits increased significantly, particularly from 5 years prelegislation to immediately postlegislation (57.8 to 94.8 mTBI visits per 10 000 ED visits). A similar trend was observed for minor head injuries; however, no significant changes were observed for moderate to severe TBIs and long bone fractures. CONCLUSION: Pediatric ED utilization trends for the injury comparison groups differed from each other, and from pre- and post-TBI legislation. Further research assessing effects of TBI legislation on healthcare utilization is warranted.

U.S. Estimates of Pediatric Spinal Cord Injury: Implications for Clinical Care and Research Planning.

The aim of this study was to provide accurate estimates and characterizations of children with spinal cord injuries (SCIs) and for the subset that are appropriate for inclusion in clinical trials. We identified children <18 years of age with SCI International Classifications of Diseases, Ninth Revision, Clinical Modification Codes (ICD-9-CM codes) from the 2006, 2009, and 2012 Kids' Inpatient Database. We excluded those with late effects, transfers to other hospitals, unspecified injury levels, and hospital stays <48 h. We then used conventional rationale to identify children who were eligible for SCI clinical trials. Over 3 years, 2484 children had SCI ICD-9-CM codes; 1342 had coding consistent with true SCI and 706 satisfied clinical trial inclusion criteria, yielding national estimates of 2013 and 1062, respectively. Of children with clinical trial eligible SCI, injuries were more common in the cervical region (66.1%), males (65.5%), older children (51.1% were 16-17 years old), and the South (49.8%). The majority were treated at urban teaching hospitals (84.6%); however, only 20.3% were treated at pediatric-specific centers. Of the 445 sample hospitals treating children with SCI, 66.3% treated just 1 child in the 3-year period. Children eligible for SCI clinical trials represented less than one third of children with SCI ICD-9-CM codes. These children were regionally localized to the South, with few receiving treatment at pediatric-specific centers or centers that frequently care for children with SCI. These findings highlight the importance of carefully assessing the national distribution of children with SCI, so that resources are appropriately allocated to optimize clinical care and research outcomes.

EMS Providers' Beliefs Regarding Spinal Precautions for Pediatric Trauma Transport.

OBJECTIVE: Describe prehospital Emergency Medical Services (EMS) providers' beliefs regarding spinal precautions for pediatric trauma transport. METHODS: We randomly surveyed nationally certified EMS providers. We assessed providers' beliefs about specific precautions, and preferred precautions given a child's age (0-4 or 5-18 years) and presence of specific cervical spine injury (CSI) risk factors. RESULTS: We received 5,400 responses (17%). Most were Paramedics (36%) or EMTs (22%) and worked at fire-based services (42%). A total of 47% endorsed responding to pediatric calls more than once per month. Consensus beliefs (>66% agreement) were that rigid cervical collars (68%) and long backboards with soft conforming surfaces (79%) maintain an injured pediatric spine in optimal position. Only 39% believed in the utility of the rigid long backboard to protect the pediatric spine. For most risk factors in both age categories, a rigid cervical collar with a long backboard with a soft conforming surface was the most common response (28-40% depending on age group and risk factor); however, there were no consensus beliefs. Provider-level experience, working as a patient care provider, less education, and parent status were associated with endorsing the rigid cervical collar. Factors associated with endorsing the rigid long backboard included provider level, working as a patient care provider, low pediatric call volume, and less education. CONCLUSIONS: EMS providers believe that rigid cervical collars and long backboards with soft conforming surfaces provide optimal spinal precautions. There were no consensus beliefs, however, for use of particular precautions based on age and risk factors.