Background: The initial evaluation of suspected pediatric thoracolumbar fractures can be challenging. We aimed to describe the clinical presentation of thoracolumbar fractures in children and adolescents including an evaluation of physical examination sensitivity and specificity, and a description of injury severity and disposition.Methods: This was a case control, retrospective study. All patients with radiologically proven fractures (January 1997-June 2001) were studied. Data were collected in a standardized fashion, as part of the trauma registry, and extracted for retrospective analysis, including: patient demographics, clinical acuity, mechanism of injury, injury scores, and length of stay.Results: There were 96 patients with thoracolumbar fractures (TLF) and 96 control patients (NTLF) enrolled in our study. The groups were significantly different (p < 0.05) regarding several variables including: median age (11 years TLF, 7.5 years NTLF), Revised Trauma Score (7.84 for TLF, 7.55 for NTLF), need for hospital admission (60% TLF, 86% NTLF), PICD admission (23% TLF, 56% NTLF), general surgical procedures (18% TLF, 34% NTLF), Injury Severity Score (8 TLF, 10 NTLF). Patients were not different regarding gender, Glasgow Coma Scale, hospital days, or mortality. An abnormal thoracolumbar spine examination was noted in 77 TLF patients and 20 NTLF patients, the sensitivity was 87% (95% CI: 78-93) and the specificity was 75% (95% CI: 65-84). The most common thoracolumbar spine abnormality was tenderness.Conclusions: Thoracolumbar spine fractures are more common in older children and adolescents. The physical examination has a sensitivity of 87% in this retrospective analysis. Mortality was low and few patients required operative intervention for a thoracolumbar fracture.

BACKGROUND:Complementary and alternative medical therapies are becoming increasingly popular in the general population.OBJECTIVE:To describe the cultural differences in the use of herbal and dietary supplements in the Hispanic and non-Hispanic-Caucasian outpatient pediatric populations.METHODS:Questionnaires were administered over a 2-month period to a convenience sample of adolescents and parents of patients younger than 12 years, presenting to an emergency department, an urban private pediatric practice, and a community-based clinic.RESULTS:There were 643 surveys completed. Ethnic distribution was 65% Caucasian, 27% Hispanic, 2% Pacific Islander, and 1% each Asian, African American and Native American. Mean respondent age was 30.8 years. Mean child age was 4.6 years; 51% were male. Use of nonprescribed dietary supplements was significantly greater in Hispanic (33%) versus Caucasian children (9%) (P < 0.01); most commonly used supplements were herbal teas (56%) and echinacea (14%). More Hispanic respondents reported receiving information on herbal preparations from a family member compared with non-Hispanic patients (56.0% vs. 18.7%). Complementary and alternative medicine use had not been discussed with a health care provider by 38% of the total users and 47% of those thought it not important to do so.CONCLUSIONS:There is significant use of complementary and alternative medicine in the pediatric population, and herbal and dietary supplement use varies between Hispanic and Caucasian children. In addition, this dietary supplement use is often not discussed with health care providers. These factors should be taken into consideration by all health care providers.

OBJECTIVES To describe the epidemiology of repeat users of the emergency department (ED) using a statewide database. METHODS Probabilistic linkage was used to convert three years of statewide ED visit data into a longitudinal, patient-based data set. Patients were classified as single, repeat (at least two visits within three years), or serial (four or more visits within a 365-day period) users of the ED. Serial patients were further stratified by the number of EDs attended. Descriptive statistics were used to assess differences between patient types. RESULTS There were 1,370,607 separate visits associated with 780,074 patients from 1996 to 1998. While repeat and serial patients represented 33% of the patients, they accounted for 62% of the ED visits during the study period. Repeat and serial patients were younger and had smaller median ED charges per visit than single-use patients. Serial patients attending five or more EDs were more likely to be coded as self-pay than other serial patients. Diagnosis codes relating to sprains, back problems, and headaches were prevalent among serial patients who visited five or more EDs. Approximately 30% of serial patients during the first year remained serial patients in the second year. CONCLUSIONS Due to the high turnover in serial patients, control groups in future studies are necessary to evaluate interventions aimed at decreasing serial ED use. The likelihood of serial ED users to use multiple EDs indicates that those studying serial ED use should collect data from multiple EDs.

Study objective: We describe the efficacy of propofol sedation administered by pediatric emergency physicians to facilitate painful outpatient procedures.Methods: By using a protocol for patients receiving propofol sedation in an emergency department-affiliated short-stay unit, a prospective, consecutive case series was performed from January to September 2000. Patients were prescheduled, underwent a medical evaluation, and met fasting requirements. A sedation team was present throughout the procedure. All patients received supplemental oxygen. Sedation depth and vital signs were monitored while propofol was manually titrated to the desired level of sedation.Results: There were 291 separate sedation events in 87 patients. No patient had more than 1 sedation event per day. Median patient age was 6 years; 57% were male patients and 72% were oncology patients. Many children required more than 1 procedure per encounter. Most commonly performed procedures included lumbar puncture (43%), intrathecal chemotherapy administration (31%), bone marrow aspiration (19%), and bone biopsy (3%). Median total propofol dose was 3.5 mg/kg. Median systolic and diastolic blood pressures were lowered 22 mm Hg (range 0 to 65 mm Hg) and 21 mm Hg (range 0 to 62 mm Hg), respectively. Partial airway obstruction requiring brief jaw-thrust maneuver was noted for 4% of patient sedations, whereas transient apnea requiring bag-valve-mask ventilation occurred in 1% of patient sedations. All procedures were successfully completed. Median procedure duration was 13 minutes, median sedation duration was 22 minutes, and median total time in the short stay unit was 40 minutes.Conclusion: Propofol sedation administered by emergency physicians safely facilitated short painful procedures in children under conditions studied, with rapid recovery.

To describe the epidemiology of serious winter sports-related injuries resulting in hospitalization in children and adolescents, we prospectively collected and analyzed records of all winter sports-related injuries requiring hospitalization at our respective institutions from 1996 to 2000. We identified 101 patients with a mean age of 10.7 years, of whom 68% were male and 32% female. Skiers accounted for 71% and snowboarders 26% of injuries; 3% of injuries were snowmobile-or luge-related. Leading mechanisms of injury were ground level falls (50%), crashes into trees, (18%), and falls from ski lift (13%). Approximately 26% of the patients met criteria for trauma-team activation. Leading diagnoses were head injury (20%), femur fracture (18%), and concussion (11%). Five patients required admission to the intensive care unit. The median injury severity score (ISS) was 7; 8% of patients had an ISS score > 15. Abbreviated Injury Scale-1990 scores of > or = 3 were noted in 34% of the patients. We conclude that Injuries sustained through participation in winter sports may be severe, especially in the case of injuries involving the head. Injury-prevention strategies should focus on head injuries.

Objective To compare flavoring agents added to activated charcoal (AC) to determine which mixture is most palatable to children. Design Healthy volunteers between the ages of 3 and 17 years participated in a prospective masked trial. Five identical pitchers were prepared containing AC alone, AC with chocolate milk, AC with Coca-Cola (Coca-Cola Corp, Atlanta, Ga), AC with cherry-flavored syrup, and AC with sorbitol. Subjects tasted all 5 substances in random order. Children younger than 8 years rated taste on a 10-point Faces Scale. Children 8 years and older used a 100-point visual analog scale to rate taste and, separately, ease of swallowing. All children were asked which mixture was best. Ratings were compared using 1-way analysis of variance, and comparisons for all pairs were made using the Tukey test.P<.05 was considered significant. Results Mean age among the 53 children enrolled was 8.3 years; 23 children were younger than 8 years. Girls made up 52% of the group. Taste scores for chocolate milk, Coca-Cola, and cherry-flavored syrup were significantly better than those for no flavoring agent. The scores for ease of swallowing for Coca-Cola, chocolate milk, and cherry-flavored syrup were significantly better than those for either no flavoring agent or sorbitol. When asked to choose a single best flavoring agent, 39% chose chocolate milk, 23% picked Coca-Cola, and 23% chose cherry-flavored syrup. Conclusion The addition of chocolate milk, Coca-Cola, or cherry-flavored syrup to AC improves palatability for children and is favored over no flavoring agent or sorbitol.

Background Few studies have addressed the presentation and clinical impact of pediatric pelvic fractures. We sought to describe pediatric blunt trauma patients with pelvic fracture (PF) and to evaluate the sensitivity and specificity of physical examination at presentation for diagnosis. Methods Retrospective analysis of all PF and control (NPF) patients from our pediatric institution over an 8-year period. Results A total of 174 patients (88 PF, 86 NPF) were included. Median patient age was 8 years (range, 3 months to 18 years), with 54% males. The most common mechanisms of injury for PF patients were automobile-related accidents (75%). There were 140 patients (87%) who were transported by air or ground medical services. At presentation, approximately 16% of PF patients had a Glasgow Coma score of <15, a mean Revised Trauma Score of 7.49, and a median Injury Severity Score (ISS) of 9. Thirty-one PF patients (35%) had an ISS of >15 indicating severe, multiple injuries. Sixty-eight PF patients (77%) had severe isolated injuries (Abbreviated Injury Scale 1990 value of >3); 11% of PF patients required transfusions, and 2% died. Fifteen PF patients (17% ) had no pelvic ring disruption; 39 (43%) had a single pelvic ring fracture, 22 (2%) had two pelvic ring fractures, 2 (2%) had acetabular fractures, and 10 (11%) had a combination of pelvic fractures. An abnormal physical examination of the pelvis was noted in 81 patients with PF (92% sensitivity, 95% confidence interval [CI] = 0.89–0.95), 15 NPF patients had an abnormal examination (79% specificity, 95% CI = 0.74–0.84). The positive predictive value of the pelvis examination was 0.84, and the negative predictive value was 0.89. The most common abnormal pelvis examination finding was pelvic tenderness in 65 PF patients (73%). A total of seven PF patients had a normal examination of the pelvis; four had a depressed level of consciousness (defined as GCS <15), and six patients had a distracting injury. Conclusions Pediatric blunt trauma patients with pelvic fracture represent a severely injured population but generally have lower transfusion rates and mortality than noted in adult studies. The pelvis examination appears to be sensitive and specific in this retrospective study. However, an altered level of consciousness and/or distracting injuries may affect examination sensitivity and specificity. Based on this retrospective study, we cannot advocate eliminating pelvic radiographs in the severely injured, blunt trauma patient. Prospective studies are recommended.

OBJECTIVE:To describe the epidemiology of school injuries resulting in emergency department (ED) visits, hospital admission, or death.METHODS:Utah statewide school injuries from 1992 to 1996 were probabilistically linked to statewide ED records (1996 only), inpatient hospital records (1992-1996), and death certificate records (1992-1996).RESULTS:There were 43,881 school injuries for the years 1992 through 1996. In 1996, 1,534 of 6,354 total school injuries (17.5%) resulted in ED evaluation. Between 1992 and 1996, 354 school injuries (0.8%) necessitated hospital admission. The overall rates of school injuries (per 1,000 students) of primary (kindergarten-grade 6) and secondary (grades 7-12) school students requiring ED evaluation were 3.29 and 3.28, respectively; for hospital admission, 0.165 and 0.139. Abbreviated Injury Scale-1990 (AIS-90) regions identified in ED patients were the upper extremity (39.2%), face (20.8%), and lower extremity (17.1%), while AIS regions among inpatients were lower extremity (29.1%), upper extremity (26.6%), and head (22.6%). There were a total of 1,123 hospital days, and total charges of $2.16 million. The ED charges totaled $545,000. Median length of hospital stay was 1 day, and median hospital charge was $3,080. There were four fatalities.CONCLUSIONS:This study emphasizes the significance of school injuries and the need for interventions to prevent these injuries

BACKGROUND:We sought to describe pediatric, blunt trauma patients with pelvic fracture (PF) and to evaluate pelvis examination sensitivity and specificity. METHODS:We conducted a prospective study of blunt trauma patients at a Level I pediatric trauma center. A pediatric emergency medicine physician attempted to diagnose a PF, solely on the basis of the history and pelvis examination. Patients with blunt trauma but no pelvic fracture (NPF) were used as controls. RESULTS:We enrolled 140 patients (16 PF, 124 NPF), and no significant differences were found regarding median age, gender, injury mechanism, acuity, and medical outcome. Approximately 25% of PF patients had iliac-wing fractures; 37%, single pelvic ring; 25%, double pelvic ring; and 13%, acetabular fractures. Eleven patients with PF had an abnormal pelvis examination (69% sensitivity), compared with six NPF patients (95% specificity, negative predictive value 0.91). CONCLUSION:Pediatric patients with PF have low mortality and few complex fractures. The pelvis examination appears to have both high specificity and negative predictive value.

Objective. Injuries in the school environment are a serious public health problem. Injuries occurring within the school shop class are a part of this problem that has received little to no attention. The purpose of our study was to describe the epidemiology of shop class injuries in Utah public schools for the years 1992-1996.Methods. Utah statewide grades 7 through 12 school injury data for 1992-1996 were used. The data were generated from a standardized Student Injury Report form completed by school personnel immediately after the occurrence of an injury on school premises that: 1) caused loss of at least one half of a day of school; and/or 2) warranted medical attention and treatment. Shop injuries were defined as injuries that occurred in industrial art classes, vocational educational classes, or automotive classes. To determine the medical outcome and hospital charges associated with shop class injuries, we linked the Student Injury Report database to Utah statewide emergency department (ED) records (available for 1996 only), and to Utah statewide hospital inpatient discharge records (1992-1996).Results. During 1992-1996, 14 133 students in grades 7 through 12 were injured at school, of which 1008 (7.1%) were injured during a shop class. The majority (88.4%) of shop injuries involved equipment use. Equipment was misused in 37.9% and malfunctioned in 3.5% of the incidents. The leading injuries reported for shop equipment were lacerations (70.9%), burns (6.0%), and abrasions (4.6%), whereas the leading for nonequipment injuries were lacerations (45.4%), fractures (9.2%), and pain/tenderness (6.7%).In 1996, 167 students were injured in a shop class and 45 (26.9%) visited an ED as a result of the shop injury. Equipment was a factor in 88.9% of the shop injuries admitted to the ED. Table saws (15.0%), other saws (15.0%), and band saws (12.5%) were involved in nearly one half of the equipment injuries. Equipment was misused in 44.7% and malfunctioned in 10.5% of the incidents resulting in an ED visit. The majority (64.4%) of students sustained an open wound injury. The total ED charges were $16 571.For 1992-1996, 1008 students were injured in a shop class, 7 (.7%) required inpatient hospital care. Six of the students were injured using a table saw and 1 sustained injuries attributable to automotive cleaning fluid. Equipment was used improperly in 4 of the table saw injuries. Six of the students sustained hand injuries, with 3 suffering a traumatic amputation of a finger or thumb. The total inpatient charges were $26 747.Conclusion. School shop injuries have a great impact on students, their families, and schools because of the loss of productivity for the student and the financial impact. Many of the injuries are preventable. These findings stress the need for school administrators, teachers, and students to develop and improve safety policies and practices in school shop classes. In addition, the findings may provide useful information to pediatricians and enable them to better inform patients of risks in school shop classes.

Journal of School HealthVolume 69, Issue 10 p. 409-412 Epidemiology of School Injuries in Utah: A Population-Based Study Edward P. Junkins Jr., Edward P. Junkins Jr. Edward P. Junkins, Jr., MD: , Division of Pediatric Emergency Medicine: Howard M. Corneli, MD, Division of Pediatric Emergency Medicine; J. Michael Dean, MD, Division of Critical Care Medicine; and Stacey Knight, Mstat; and Amy C. Lightfoot, BS, Intermountain Injury Control Research Center, Dept. of Pediatrics, Primary Children's Medical Center, University of Utah School of Medicine. 100 N. Medical Drive, Salt Lake City, UT 84113Search for more papers by this authorStacey Knight, Stacey Knight Edward P. Junkins, Jr., MD: , Division of Pediatric Emergency Medicine: Howard M. Corneli, MD, Division of Pediatric Emergency Medicine; J. Michael Dean, MD, Division of Critical Care Medicine; and Stacey Knight, Mstat; and Amy C. Lightfoot, BS, Intermountain Injury Control Research Center, Dept. of Pediatrics, Primary Children's Medical Center, University of Utah School of Medicine. 100 N. Medical Drive, Salt Lake City, UT 84113Search for more papers by this authorAmy C. Lightfoot, Amy C. Lightfoot Edward P. Junkins, Jr., MD: , Division of Pediatric Emergency Medicine: Howard M. Corneli, MD, Division of Pediatric Emergency Medicine; J. Michael Dean, MD, Division of Critical Care Medicine; and Stacey Knight, Mstat; and Amy C. Lightfoot, BS, Intermountain Injury Control Research Center, Dept. of Pediatrics, Primary Children's Medical Center, University of Utah School of Medicine. 100 N. Medical Drive, Salt Lake City, UT 84113Search for more papers by this authorCalvert F. Cazier, Calvert F. Cazier Calvert F. Cazier, MPH: , Utah Dept. of Health, Violence and Injury Prevention Program, Division of Community and Family Health Services, Salt Luke City, UT 84113.Search for more papers by this authorJ. Michael Dean, J. Michael Dean Edward P. Junkins, Jr., MD: , Division of Pediatric Emergency Medicine: Howard M. Corneli, MD, Division of Pediatric Emergency Medicine; J. Michael Dean, MD, Division of Critical Care Medicine; and Stacey Knight, Mstat; and Amy C. Lightfoot, BS, Intermountain Injury Control Research Center, Dept. of Pediatrics, Primary Children's Medical Center, University of Utah School of Medicine. 100 N. Medical Drive, Salt Lake City, UT 84113Search for more papers by this authorHoward M. Corneli, Howard M. Corneli Edward P. Junkins, Jr., MD: , Division of Pediatric Emergency Medicine: Howard M. Corneli, MD, Division of Pediatric Emergency Medicine; J. Michael Dean, MD, Division of Critical Care Medicine; and Stacey Knight, Mstat; and Amy C. Lightfoot, BS, Intermountain Injury Control Research Center, Dept. of Pediatrics, Primary Children's Medical Center, University of Utah School of Medicine. 100 N. Medical Drive, Salt Lake City, UT 84113Search for more papers by this author Edward P. Junkins Jr., Edward P. Junkins Jr. Edward P. Junkins, Jr., MD: , Division of Pediatric Emergency Medicine: Howard M. Corneli, MD, Division of Pediatric Emergency Medicine; J. Michael Dean, MD, Division of Critical Care Medicine; and Stacey Knight, Mstat; and Amy C. Lightfoot, BS, Intermountain Injury Control Research Center, Dept. of Pediatrics, Primary Children's Medical Center, University of Utah School of Medicine. 100 N. Medical Drive, Salt Lake City, UT 84113Search for more papers by this authorStacey Knight, Stacey Knight Edward P. Junkins, Jr., MD: , Division of Pediatric Emergency Medicine: Howard M. Corneli, MD, Division of Pediatric Emergency Medicine; J. Michael Dean, MD, Division of Critical Care Medicine; and Stacey Knight, Mstat; and Amy C. Lightfoot, BS, Intermountain Injury Control Research Center, Dept. of Pediatrics, Primary Children's Medical Center, University of Utah School of Medicine. 100 N. Medical Drive, Salt Lake City, UT 84113Search for more papers by this authorAmy C. Lightfoot, Amy C. Lightfoot Edward P. Junkins, Jr., MD: , Division of Pediatric Emergency Medicine: Howard M. Corneli, MD, Division of Pediatric Emergency Medicine; J. Michael Dean, MD, Division of Critical Care Medicine; and Stacey Knight, Mstat; and Amy C. Lightfoot, BS, Intermountain Injury Control Research Center, Dept. of Pediatrics, Primary Children's Medical Center, University of Utah School of Medicine. 100 N. Medical Drive, Salt Lake City, UT 84113Search for more papers by this authorCalvert F. Cazier, Calvert F. Cazier Calvert F. Cazier, MPH: , Utah Dept. of Health, Violence and Injury Prevention Program, Division of Community and Family Health Services, Salt Luke City, UT 84113.Search for more papers by this authorJ. Michael Dean, J. Michael Dean Edward P. Junkins, Jr., MD: , Division of Pediatric Emergency Medicine: Howard M. Corneli, MD, Division of Pediatric Emergency Medicine; J. Michael Dean, MD, Division of Critical Care Medicine; and Stacey Knight, Mstat; and Amy C. Lightfoot, BS, Intermountain Injury Control Research Center, Dept. of Pediatrics, Primary Children's Medical Center, University of Utah School of Medicine. 100 N. Medical Drive, Salt Lake City, UT 84113Search for more papers by this authorHoward M. Corneli, Howard M. Corneli Edward P. Junkins, Jr., MD: , Division of Pediatric Emergency Medicine: Howard M. Corneli, MD, Division of Pediatric Emergency Medicine; J. Michael Dean, MD, Division of Critical Care Medicine; and Stacey Knight, Mstat; and Amy C. Lightfoot, BS, Intermountain Injury Control Research Center, Dept. of Pediatrics, Primary Children's Medical Center, University of Utah School of Medicine. 100 N. Medical Drive, Salt Lake City, UT 84113Search for more papers by this author First published: 09 October 2009 https://doi.org/10.1111/j.1746-1561.1999.tb06360.xCitations: 20 Funded in part by cooperative agreement MCH-494003-03-0 from the Maternal and Child Health Bureau, Health Resources and Services Administration, Public Health Services, US Dept of Health and Human Services. AboutRelatedInformationPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessClose modalShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. 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