An evaluation of comparability between NEISS and ICD-9-CM injury coding.

To evaluate the National Electronic Injury Surveillance System's (NEISS) comparability with a data source that uses ICD-9-CM coding.A sample of NEISS cases from a children's hospital in 2008 was selected, and cases were linked with their original medical record. Medical records were reviewed and an ICD-9-CM code was assigned to each case. Cases in the NEISS sample that were non-injuries by ICD-9-CM standards were identified. A bridging matrix between the NEISS and ICD-9-CM injury coding systems, by type of injury classification, was proposed and evaluated.Of the 2,890 cases reviewed, 13.32% (n = 385) were non-injuries according to the ICD-9-CM diagnosis. Using the proposed matrix, the comparability of the NEISS with ICD-9-CM coding was favorable among injury cases (κ = 0.87, 95% CI: 0.85-0.88). The distribution of injury types among the entire sample was similar for the two systems, with percentage differences ≥1% for only open wounds or amputation, poisoning, and other or unspecified injury types.There is potential for conducting comparable injury research using NEISS and ICD-9-CM data. Due to the inclusion of some non-injuries in the NEISS and some differences in type of injury definitions between NEISS and ICD-9-CM coding, best practice for studies using NEISS data obtained from the CPSC should include manual review of case narratives. Use of the standardized injury and injury type definitions presented in this study will facilitate more accurate comparisons in injury research

Feeding tube use is associated with severe scoliosis in patients with cerebral palsy and limited ambulatory ability

PurposeCerebral palsy (CP) is the most common motor disorder in childhood. Scoliosis is a common complication of CP that can reach clinically severe levels, but predictors for scoliosis in CP are not well understood. Some variables identified in the literature involve the severity of the brain injury and the presence of hip deformity. We aimed to identify associations with developing severe scoliosis in a prospective cohort of patients with cerebral palsy at higher risk for severe curve progression.MethodsThis study reviewed a prospectively collected database at a tertiary children's hospital. We evaluated a panel of potential associations with severe scoliosis-including age, sex, Gross Motor Function Classification System (GMFCS) class, history of hip surgery, epilepsy, and feeding tube presence-in a population of children with limited ambulatory ability defined as GMFCS level IV or V CP. Univariate analysis and multivariate logistic regression with stepwise selection was used for analysis.ResultsDescriptive analysis showed that female sex, higher GMFCS class, history of hip surgery, non-upright seating, pelvic obliquity, presence of epilepsy, and presence of a feeding tube were associated with an increased risk for scoliosis. Multivariate logistic regression analysis revealed that the presence of a feeding tube was associated with severe scoliosis even when controlling for GMFCS and age.ConclusionsFeeding tube use may stratify risk for severe scoliosis progression in patients with GMFCS IV or V CP

Medical errors in hospitalized pediatric trauma patients with chronic health conditions

Objective: This study compares medical errors in pediatric trauma patients with and without chronic conditions. Methods: The 2009 Kids’ Inpatient Database, which included 123,303 trauma discharges, was analyzed. Medical errors were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The medical error rates per 100 discharges and per 1000 hospital days were calculated and compared between inpatients with and without chronic conditions. Results: Pediatric trauma patients with chronic conditions experienced a higher medical error rate compared with patients without chronic conditions: 4.04 (95% confidence interval: 3.75–4.33) versus 1.07 (95% confidence interval: 0.98–1.16) per 100 discharges. The rate of medical error differed by type of chronic condition. After controlling for confounding factors, the presence of a chronic condition increased the adjusted odds ratio of medical error by 37% if one chronic condition existed (adjusted odds ratio: 1.37, 95% confidence interval: 1.21–1.5), and 69% if more than one chronic condition existed (adjusted odds ratio: 1.69, 95% confidence interval: 1.48–1.53). In the adjusted model, length of stay had the strongest association with medical error, but the adjusted odds ratio for chronic conditions and medical error remained significantly elevated even when accounting for the length of stay, suggesting that medical complexity has a role in medical error. Higher adjusted odds ratios were seen in other subgroups. Conclusion: Chronic conditions are associated with significantly higher rate of medical errors in pediatric trauma patients. Future research should evaluate interventions or guidelines for reducing the risk of medical errors in pediatric trauma patients with chronic conditions

Accuracy of Prehospital Care Providers in Determining Total Body Surface Area Burned in Severe Pediatric Thermal Injury

Accurate measurement of total body surface area (TBSA) burned is a key factor in the care of pediatric patients with burn, especially those with large thermal injuries. There is a paucity of data on the accuracy of these measurements by prehospital, nonburn center, and emergency department (ED) providers, which can have drastic implications for patient management and outcomes. We sought to determine the accuracy of these estimates for large pediatric burns. A retrospective chart review was conducted of patients with TBSA >= 10% admitted to an American Burn Association (ABA)-verified pediatric burn center from 2007 to 2015. Final TBSA was determined by pediatric burn surgeons and compared with prehospital emergency medical service providers, outside hospital physicians for transferred patients, and burn center ED physicians. Statistical significance was determined using a paired t-test with P < 0.05. A total of 139 patients <= 18 years of age met inclusion criteria, with an average TBSA of 18.9 +/- 1.1%, weight 23.7 +/- 1.6 kg and age of 5.4 +/- 0.41 years. When compared in a pairwise fashion to the TBSA values determined by pediatric burn surgeons, estimates of TBSA were higher by: prehospital emergency medical service providers, 40.0% (n = 67, P < 0.0001); outside hospital physicians, 18.7% (n = 46, P = 0.0009), and burn center ED physicians, 7.2% (n = 120, P = 0.0117). TBSA burn estimates for pediatric patients by prehospital, nonburn center, and ED providers are significantly higher than those recorded by burn surgeons at an ABA-verified pediatric burn center. These inaccuracies in TBSA measurement may have profound clinical implications

Features and risk factors of nonfatal injury among the rural children: a survey of seven schools in a mountain area in Southwest China.

We aimed to investigate the patterns and risk factors of nonfatal injuries among rural mountain-area children in southwest China.A stratified sampling method was used to recruit rural children aged 8 to 17 years (mainly 9-14 years) from 7 schools. Self-reported injuries during the past 12 months and relevant concerns were collected from June to December 2012 by using a structured questionnaire in a class interview.The mean age of the 2,854 children was 12.2 ± 1.5 years. The probability of annual injury was 16.7% (95% confidence interval [95% CI] 15.3-18.1%), with slightly higher injury risk for boys than girls (17.7% vs. 16.0%; P>0.05). The top 3 causes of injuries were falls (37.3%), animal-related incidents (20.6%), and burns (14.9%). The main injury risk factors included being involved in a violent episode (odds ratio [OR] 1.34, 95% CI 1.08-1.66, P = 0.007), maltreatment by parents or guardians (1.42, 1.17-1.72, P<0.001), and being from a single-child family (1.30, 1.10-1.66, P = 0.039). Older age was a protective factor (0.81, 0.76-0.87, P<0.001).The incidence of nonfatal injury among rural children was high, and falls were the leading cause. Younger children and boys from poor-care and poor-living environments were at increased risk of injury, which requires urgent attention. Injury prevention programs targeting these issues are needed in this mountain area and similar rural regions of China