Car seat inspection among children older than 3 years: Using data to drive practice in child passenger safety.

BACKGROUND: Motor vehicle crashes are the leading cause of unintentional death and disability among children 4 years to 12 years of age in the United States. Despite the high risk of injury from motor vehicle crashes in this age group, parental awareness and child passenger safety programs in particular may lack focus on this age group. METHODS: This is a retrospective cross-sectional analysis of child passenger safety seat checklist forms from two Safe Kids coalitions in Michigan (2013) to identify restraint type upon arrival to car seat inspections. Other variables were included if the coalition provided a new child safety seat and if the child had a sibling who underwent a car seat inspection. χ statistics were used to compare change in restraint use on arrival and at departure, the proportion of children attending a car seat inspection event by age, the age category of children by site, the proportion of children with siblings also undergoing a car seat inspection by age, and the distribution of a new child safety seat by age. RESULTS: Data were available from 1,316 Safe Kids Huron Valley and 3,215 Safe Kids Greater Grand Rapids car seat inspections. Just 10.8% of the total seats inspected were booster seats. Child safety seats for infant and young children were more commonly inspected (rear-facing carrier [40.3%], rear-facing convertible [10.2%], and forward-facing [19.3%] car seats). Few children at inspections used a seat belt only (5.4%) or had no restraint (13.8%). Children 4 years and older were found to be in a suboptimal restraint at least 30% of the time. CONCLUSION: Low proportions of parents use car seat inspections for children in the booster seat age group. The proportion of children departing the inspection in a more protective restraint increased with increasing age. This highlights an area of weakness in child passenger safety programs and signals an opportunity to strengthen efforts on The Booster Age Child. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III.

Inpatient health care utilization by children and adolescents with systemic lupus erythematosus and kidney involvement.

OBJECTIVE: To evaluate inpatient health care utilization for children with systemic lupus erythematosus (SLE) with and without kidney disease. METHODS: The Healthcare Cost and Utilization Project Kids' Inpatient Database for the years 2000, 2003, and 2006 was used for this analysis. SLE hospitalizations from the 2006 cohort were identified and classified as those with versus without kidney involvement by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Analyses were performed to examine determinants of hospitalization charges and changes in charges over time. RESULTS: In the US, 7,390 SLE-related pediatric hospitalizations generated $267 million in total charges in 2006. Of these, 4,193 discharges had kidney involvement. The average hospitalization charge was greater for SLE patients with kidney involvement compared to those without kidney involvement ($43,100 versus $28,500; P < 0.0001). In multivariate analysis, kidney involvement remained a significant predictor of hospitalization charges, independent of demographic and hospital characteristics (P < 0.0001). SLE-associated acute kidney failure, transplant, and end-stage kidney disease resulted in greater hospitalization charges than SLE without kidney involvement by $74,900 (P < 0.0001), $32,700 (P = 0.0002), and $27,400 (P < 0.0001), respectively. CONCLUSION: In the US, >7,000 hospitalizations occurred in 2006 among children with SLE, with nearly 57% demonstrating kidney involvement. Kidney involvement is a major determinant of hospitalization charges for these children. This study represents one of the first large-scale assessments of in-hospital health care utilization by children with SLE.

Recent trends in healthcare utilization among children and adolescents with hypertension in the United States.

The objective of this study was to evaluate the healthcare utilization of hospitalized children with hypertension. The Healthcare Cost and Utilization Project Kids' Inpatient Database, years 1997, 2000, 2003, and 2006, was used to identify hypertension hospitalizations. We examined the association of patient and hospital characteristics on hypertension charges. Data from each cohort year were used to analyze trends in charges. We found that 71282 pediatric hypertension hospitalizations generated $3.1 billion in total charges from 1997 to 2006. Approximately 68% were 10 to 18 years old, 55% were boys, and 47% were white. Six percent of claims with a diagnosis code for hypertension also had a diagnosis code for end-stage renal disease or renal transplant. The frequency of hypertension discharges increased over time (P=0.02 for each of age groups 2-9 years and 2-18 years; P=0.03 for age group 10-18 years), as well as the fraction of inpatient charges attributed to hypertension (P<0.0001). Length of stay and end-stage renal disease were associated with increases in hospitalization associated charges (P<0.0001 and P=0.03, respectively). During the 10-year study period, the frequency of hypertension-associated hospitalizations was increasing across all of the age groups, and the fraction of charges related to hypertension was also increasing. The coexisting condition of end-stage renal disease resulted in a significant increase in healthcare charges.