A taxonomy of childhood pedal cyclist injuries from latent class analysis: associations with factors pertinent to prevention

Background: Studies of pedal cyclist injuries have largely focused on individual injury categories, but every region of the cyclist\u27s body is exposed to potential trauma. Real-world injury patterns can be complex, and isolated injuries to one body part are uncommon among casualties requiring hospitalization. Latent class analysis (LCA) may identify important patterns in heterogeneous samples of qualitative data. Methods: Data were taken from the Trauma Quality Improvement Program of the American College of Surgeons for 2017. Inclusion criteria were age 18 years or less and an external cause of injury code for pedal cyclist. Injuries were characterized by Abbreviated Injury Scale codes. Injury categories and the total number of injuries served as covariates for LCA. A model was selected on the basis of the Akaike and Bayesian information criteria and the interpretability of the classes. Associations were analyzed between class membership and demographic factors, circumstantial factors, metrics of injury severity, and helmet wear. Within-class associations of helmet wear with injury severity were analyzed as well. Results: There were 6151 injured pediatric pedal cyclists in the study sample. The mortality rate was 0.5%. The rate of helmet wear was 18%. LCA yielded a model with 6 classes: \u27polytrauma\u27 (5.5%), \u27brain\u27 (9.0%), \u27abdomen\u27 (11.0%), \u27upper limb\u27 (20.9%), \u27lower limb\u27 (12.4%), and \u27head\u27 (41.2%). Class membership had highly significant univariate associations with all covariates except insurance payer. Helmet wear was most common in the \u27abdomen\u27 class and least common in the \u27polytrauma\u27 and \u27brain\u27 classes. Within classes, there was no association of helmet wear with severity of injury. Conclusions: LCA identified 6 clear and distinct patterns of injury with varying demographic and circumstantial associations that may be relevant for prevention. The rate of helmet wear was low, but it varied among classes in accordance with mechanistic expectations. LCA may be an underutilized tool in trauma epidemiology

Tangential Cranial Gunshot Wound in an Infant in Historical Context: Illustrative Case

BACKGROUND Military neurosurgeons have long known that tangential cranial gunshot wounds can be associated with intracranial complications out of proportion to the external appearance of the injury. This phenomenon seems not to have been described in infancy. OBSERVATIONS An infant suffered a massive, acute subdural hemorrhage from a contralateral tangential gunshot wound that did not facture the skull. LESSONS Similar to adults, infants are subject to catastrophic intracranial injury from gunshots that do not penetrate the skull. The nature of the injury in this case reflected distinctive aspects of the tissue characteristics and proportions of the infant head

Visits to the Pediatric Emergency Department for Eye Conditions Before and During the COVID-19 Pandemic

Introduction: The use of the emergency department (ED) has been increasing, and many visits occur for non-urgent conditions. A similar trend was found among adult visits to the ED for ocular conditions. In this study we analyzed the impact of sociodemographic factors, presentation timing, and the COVID-19 pandemic on pediatric ED (PED) encounters for ophthalmologic conditions. It is important to identify the multifold factors associated with overutilization of the ED for non-urgent conditions. Caring for these patients in an outpatient clinical setting is safe and effective and could decrease ED crowding; it would also prevent delays in the care of other patients with more urgent medical problems and lower healthcare costs. Methods: We retrospectively reviewed electronic health records of PED ocular-related encounters at two children’s hospitals before (January 2014-May 2018) and during the COVID-19 pandemic (March 2020-February 2021). Encounters were categorized based on the International Classification of Diseases codes into “emergent,” “urgent,” and non-urgent” groups. We analyzed associations between sociodemographic factors and degrees of visit urgency. We also compared visit frequencies, degrees of urgency, and diagnoses between pre-pandemic and pandemic data.  Results: Pre-pandemic ocular-related PED encounters averaged 1,738 per year. There were highly significant sociodemographic associations with degrees of urgency in PED utilization. During the 12-month pandemic timeframe, encounter frequency contracted to 183. Emergent visits decreased from 21% to 11%, while the proportions of urgent and non-urgent encounters were mostly unchanged. The most common pre-pandemic urgent diagnosis was corneal abrasion (50%), while visual disturbance was most common during the pandemic (92%). During both time periods, eye trauma was the most frequent emergent encounter and conjunctivitis was the most common non-urgent encounter.  Conclusion: Sociodemographic factors may be associated with different types of PED utilization for ocular conditions. Unnecessary visits constitute major inefficiency from a healthcare-systems standpoint. The marked decrease in PED utilization and differing proportions of ocular conditions encountered during the pandemic may reflect a decrease in incidence of many of those conditions by social distancing; these changes may also reflect altered parental decisions about seeking care

Clinical Factors Associated With Need for Neurosurgical Care in Young Children With Imaging for Macrocephaly: A Case Control Study

BACKGROUND: Macrocephaly is present in 2.3% of children with important neurosurgical conditions in the differential diagnosis. The objective of this study was to identify clinical associations with actionable imaging findings among children with head imaging for macrocephaly. METHODS: We conducted a case-control study of head imaging studies ordered for macrocephaly among children 24 months and younger in a multistate children\u27s health system. Four neurosurgeons reviewed the images, determining cases to be a \u27concern\u27 if neurosurgical follow-up or intervention was indicated. Electronic health records were reviewed to collect patient-level data and to determine if surgery was performed. Controls were matched 3:1 to cases of \u27concern\u27 in a multivariate model using conditional logistic regression. RESULTS: In the study sample (n = 1293), 46 (4%) were concern cases, with 15 (1%) requiring surgery. Significant clinical factors associated with neurosurgical concern were bulging fontanel [aOR 7.47, (95% CI: 2.28-24.44), P \u3c 0.001], prematurity [aOR 21.26, (95% CI: 3.76-120.21), P \u3c 0.001], any delay [aOR 2.67, (95% CI: 1.13-6.27), P = 0.03], and head-weight Z-score difference (W_diff, defined as the difference between the Z-scores of head circumference and weight) [aOR 1.70, (95% CI: 1.22-2.37), P = 0.002]. CONCLUSIONS: Head imaging for macrocephaly identified few patients with findings of concern and fewer requiring surgery. A greater head-weight Z-score difference appears to represent a novel risk factor for neurosurgical follow-up or intervention

Mediators of racial disparities in mortality rates after traumatic brain injury in childhood: data from the Trauma Quality Improvement Program

OBJECTIVESocial disparities in healthcare outcomes are almost ubiquitous, and trauma care is no exception. Because social factors cannot cause a trauma outcome directly, there must exist mediating causal factors related to the nature and severity of the injury, the robustness of the victim, access to care, or processes of care. Identification of these causal factors is the first step in the movement toward health equity.METHODSA noninferiority analysis was undertaken to compare mortality rates between Black children and White children after traumatic brain injury (TBI). Data were derived from the Trauma Quality Improvement Program (TQIP) registries for the years 2014 through 2017. Inclusion criteria were age younger than 19 years and head Abbreviated Injury Scale scores of 4, 5, or 6. A noninferiority margin of 10% was preselected. A logistic regression propensity score model was developed to distinguish Black and White children based on all available covariates associated with race at p &lt; 0.10. Stabilized inverse probability weighting and a one-tailed 95% CI were used to test the noninferiority hypothesis.RESULTSThere were 7273 observations of White children and 2320 observations of Black children. The raw mortality rates were 15.6% and 22.8% for White and Black children, respectively. The final propensity score model included 31 covariates. It had good fit (Hosmer-Lemeshow χ2 = 7.1604, df = 8; p = 0.5194) and good discrimination (c-statistic = 0.752). The adjusted mortality rates were 17.82% and 17.79% for White and Black children, respectively. The relative risk was 0.9986, with a confidence interval upper limit of 1.0865. The relative risk corresponding to the noninferiority margin was 1.1. The hypothesis of noninferiority was supported.CONCLUSIONSData captured in the TQIP registries are sufficient to explain the observed racial disparities in mortality after TBI in childhood. Speculations about genetic or epigenetic factors are not supported by this analysis. Discriminatory care may still be a factor in TBI mortality disparities, but it is not occult. If it exists, evidence for it can be sought among the data included in the TQIP registries.</jats:sec

A taxonomy of childhood pedal cyclist injuries from latent class analysis: associations with factors pertinent to prevention

Abstract Background Studies of pedal cyclist injuries have largely focused on individual injury categories, but every region of the cyclist’s body is exposed to potential trauma. Real-world injury patterns can be complex, and isolated injuries to one body part are uncommon among casualties requiring hospitalization. Latent class analysis (LCA) may identify important patterns in heterogeneous samples of qualitative data. Methods Data were taken from the Trauma Quality Improvement Program of the American College of Surgeons for 2017. Inclusion criteria were age 18 years or less and an external cause of injury code for pedal cyclist. Injuries were characterized by Abbreviated Injury Scale codes. Injury categories and the total number of injuries served as covariates for LCA. A model was selected on the basis of the Akaike and Bayesian information criteria and the interpretability of the classes. Associations were analyzed between class membership and demographic factors, circumstantial factors, metrics of injury severity, and helmet wear. Within-class associations of helmet wear with injury severity were analyzed as well. Results There were 6151 injured pediatric pedal cyclists in the study sample. The mortality rate was 0.5%. The rate of helmet wear was 18%. LCA yielded a model with 6 classes: ‘polytrauma’ (5.5%), ‘brain’ (9.0%), ‘abdomen’ (11.0%), ‘upper limb’ (20.9%), ‘lower limb’ (12.4%), and ‘head’ (41.2%). Class membership had highly significant univariate associations with all covariates except insurance payer. Helmet wear was most common in the ‘abdomen’ class and least common in the ‘polytrauma’ and ‘brain’ classes. Within classes, there was no association of helmet wear with severity of injury. Conclusions LCA identified 6 clear and distinct patterns of injury with varying demographic and circumstantial associations that may be relevant for prevention. The rate of helmet wear was low, but it varied among classes in accordance with mechanistic expectations. LCA may be an underutilized tool in trauma epidemiology. </jats:sec

Racial disparities in mortality after severe traumatic brain injury in childhood: mediators identified by Oaxaca-Blinder decomposition of trauma registry data

Abstract Background In the United States social disparities in health outcomes are found wherever they are sought, and they have been documented extensively in trauma care. Because social factors cannot cause a trauma outcome directly, there must exist mediating causal factors related to the nature and severity of the injury, the robustness of the victim, access to care, or processes of care. An understanding these mediators is the point of departure for addressing inequities in outcomes. Findings Data were extracted from the registry of the Trauma Quality Improvement Program of the American College of Surgeons for 2007 through 2010. Inclusion criteria were age less than 19 years and head Abbreviated Injury Scale score of 4, 5, or 6. An Oaxaca-Blinder decomposition was undertaken to analyze the relative contributions of a large set of covariates to the difference in mortality rates between Black and White children. Covariates were aggregated into the following categories: “Severity,” “Structure and Process,” “Mechanism,” “Demographics,” and “Insurance.” Eligible for analysis were 7273 White children and 2320 Black children. There were 1661 deaths (17.3%) The raw mortality rates were 15.6 and 22.8% for White and Black children, respectively. Factors categorized as “Severity” accounted for 95% of the mortality difference, “Mechanism” accounted for 13%, “Insurance” accounted for 5%, and “Demographics” accounted for 2%. The contribution of “Structure and Process” did not attain statistical significance. Conclusions Severity of injury accounts for most of the disparity between Black and White children in traumatic brain injury mortality rates. Mechanism, insurance status, and gender make a small contributions. Because insurance status like other social factors cannot directly affect trauma survival, what mediates its contribution requires further study. </jats:sec

Sorption and Biodegradation of Organic Solutes Undergoing Transport in Laboratory-scale and Field-scale Heterogeneous Porous Media.

The first study focused on the magnitude and rate of sorption of hydrophobic organic compounds by two, well-characterized soils. The composition of organic matter had a small effect on the magnitude of the organic carbon normalized equilibrium distribution coefficients. The sorbates sorbed more strongly to the humic-coated soil, most likely due to the organic matter's less polar nature as compared to the fulvic material. The molecular solute descriptor, ¹Xᵛ, performed slightly better than the empirical solute descriptor, K(ov), in evaluating equilibrium sorption coefficients. Thus, sorbate structure may have a secondary influence on the overall magnitude of equilibrium sorption. Sorbate structure exhibited a greater influence on sorption kinetics than on sorption equilibrium. Distinct differences in the magnitudes of mass transfer coefficients for the humic and fulvic soils were observed when relating them to the molecular solute descriptor, ¹Xᵛ. The differences in mass transfer coefficients were attributed to both sorbate structure and the quantity and morphology of soil organic matter. The intrasorbent diffusion coefficients were believed to be the same for both the humic and fulvic material. The second study focused on using a biodegradable solute to measure processes that affect in-situ biodegradation during well-controlled field and laboratory experiments. Specifically, this study investigated how residence time and scale influence the extent and rate of in-situ biodegradation of an organic solute undergoing transport. The transport of the biodegradable solute was compared to that of bromide and/or pentafluorobenzoic acid, which are conservative, non-degradable tracers. Laboratory experiments were conducted to simulate both the flow velocity and residence time conditions existent in the field. Mass recovery the biodegradable solute decreased as the residence time increased, ranging from 14 to 95 percent for the field sites. Mass recoveries in the laboratory experiments were approximately 30% to 40 % less than in the field experiments. The first-order biodegradation rate constants did not vary with residence time for either field site. In addition, the average rate constant value for both field sites was very similar (0.21 d⁻¹).hydrology collectio