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Background:
Unintentional injuries are the leading cause of death in children > 1 year of age. These injuries can vary by age, race, gender and location. Literature regarding the location of injuries, urban versus rural, has not been clearly established in the US. The purposes of this study were to determine the rates of severe unintentional injuries in children aged 0-14 years in urban versus rural Ohio counties to see if significant differences exist and to examine urban/rural differences in types of injuries and injury severity.
Methods:
Demographic and injury data on children 0-14 years old who suffered unintentional injuries, from 1/1/2003-12/31/2012 were extracted retrospectively from the Ohio Trauma Acute Care Registry. We calculated injury rates using county of residence and US census data. We assigned each county to an urbanization level based on population density (“A” = most urban; “B” = less urban, “C” = more rural, “D” = most rural). Rates are per 100,000 children <14 years old per year. Frequencies, Chi-square analysis and ANOVA were used to characterize the populations and look for differences between groups.
Results:
45,347 patients were included from the 88 Ohio counties; the overall injury rate was 202.1. The mean age was 6.8 years (SD 4.5); 29,122 (64.2%) were male and 35,166 (75.5%) Caucasian. 611 (1.3%) died. Specific Ohio county of injury was not documented in 4,722 patients leaving 40,625 patients for analysis by urbanization level; overall injury rate for this cohort was 231.9. Injury rates by urbanization level were: A: 120.4, B: 196.8, C: 249.1 and D: 247.4 (p=0.04). Mean Injury Severity Score was highest for those from the most urban areas (A 6.4, B 5.2, C 5.4, D 5.7 (p<0.001). Mean LOS (days) was also highest for those from the most urban areas (A 3.4, B 2.4, C 2.7, D 2.5, p<0.001). Those in the most urban areas were more likely to suffer burns, gunshot wounds, drownings, and suffocations and less likely to suffer animal bites and motor vehicle collisions (p<0.001); they were also more likely to be Hispanic or African American (p<0.001). In addition, 45% (273) of deaths occurred in children living in the most urban areas.
Conclusions:
We found a significant association between unintentional injury rate and urbanization level in young Ohio children. Rural counties experienced more injuries than urban; however, those from the most urban areas had more severe injuries.
Objectives:
Background:
It is well established that correct use of a child safety seat (CSS) can reduce the risk of fatal injury by up to 71% in the event of a motor vehicle crash. Misuse rates for CSS have been shown to be as high as 70% and CSS use drops in older age groups and is estimated to be only 47% for children between the ages of 4 – 7 years. Pediatricians play a critical role in educating parents about CPS, however formal CPS training during residency is lacking.
Methods:
We conducted a quasi-experimental study looking at the effect of a 2-hour CPS training module on the reported CPS related knowledge, attitude and behaviors in the primary care setting among pediatric interns. Hasbro Children’s Hospital (HCH) interns functioned as the intervention group. Interns at Yale-New Haven Children’s Hospital (YNHCH) and Connecticut Children’s Medical Center (CCMC) served as controls. All study subjects were surveyed between month 2 and 4 of their first year of pediatric residency. HCH interns attended a CPS training module which included viewing the American Academy of Pediatrics CPS Continuing Medical Education video, observing a car seat inspection appointment, and hands on practice installing car seats. Study interns completed a survey immediately after the training module and all subjects completed a follow up survey approximately 6 months post baseline.
Results:
All 16 HCH interns completed the initial survey, participated in the intervention and completed the immediate post questionnaire. Thirteen HCH interns (81%) completed the 6-month follow up. The baseline survey was completed by 27/40 (67%) of interns at the control sites; 28/40 (70%) submitted a follow up. Knowledge increased with the intervention and was maintained over the 6-month follow up period: compared to baseline 31% (95% CI 21.3-41.3%) more intervention interns correctly identified the recommended criteria for transition from a rear- to forward-facing car seat at 6 months, while the control group demonstrated a 3.6% (95% CI 2.6-4.6%) increase over the same time period. We observed changes in attitudes in the intervention group. For example, the proportion of intervention interns who agreed that booster seat use is ‘very important’ increased by 29.5% (95% CI 19.5-39.5%) from baseline to 6-month follow up, compared to an increase of 1.6% (95% CI 0.9-2.3%) in the control group. Finally, the intervention influenced self-reported behaviors in that group: the proportion of interns that self-reported giving CPS guidance at all well child visits increased by 18.8% (95% CI 18.8%-26.8%) from baseline to 6 months after intervention, while the control group had no change in CPS anticipatory guidance.
Conclusions:
A 2-hour CPS training module increases pediatric interns’ knowledge, improves attitudes, and self-reported behaviors regarding CPS-related anticipatory guidance during well child visits. The effects were sustained over 6-months and exceed general practice improvement related to training experiences at two control academic centers.
Objectives:
Background:
Sleep-related deaths are one of the leading causes of infant mortality in the United States. In Arizona, an unsafe sleep environment was the leading preventable factor for sudden unexpected infant death in 2013. There were 74 sudden unexpected infant deaths; of those, 88 percent were preventable. Within the hospital setting, Social Learning Theory should inform direct patient care practice by aiming to model safe sleep environments in the hospital and educating families regarding the importance of safe sleep practice at home. Staff beliefs and practices directly impact successful adherence to safe sleep practices during hospitalization.
Methods:
Three types of data will be used in the analysis: environmental observations, focus groups measuring the beliefs and barriers of nursing staff, and a knowledge survey of all direct care staff. Safe sleep environment quality observations were conducted at Phoenix Children’s Hospital between January and March 2015. Each unit was observed for adherence to the American Academy of Pediatrics guidelines. Six focus groups will be used to examine and understand the behaviors and beliefs among registered nurses and patient care technicians about safe sleep environments at the hospital. The anticipated enrollment is a minimum of 36 nurses and technicians. Focus group participants will be recruited by email and flyers posted in break rooms; each focus group will last about 60 minutes. Once completed, they will be coded and themes identified. A knowledge survey examining the current infant sleep practices, beliefs, knowledge and confidence with implementation will be distributed to all direct care staff to gather additional information.
Results:
Safe sleep environment observations were conducted on 54 patient rooms with infants <1 year old. Almost all sleeping environments in the hospital required at least one adjustment to follow the AAP guidelines for safe sleep. Extra blankets were found in 88.7 %of cribs, 60% of cribs had toys, 60% had medical supplies inside the crib, and over 68 percent had the head of bed elevated. Results from the safe sleep environment observations indicated that further information was required to identify why staff is unable to practice safe sleep within the hospital. The focus groups and knowledge survey among staff will be administered to gather this information in order to develop and implement a safe sleep education program and policy. The knowledge survey will provide baseline data for future evaluation of the educational program for clinical staff. The results from these activities are pending.
Conclusions:
Based on the information collected from the safe sleep environment observations to date, there is a demonstrated need for a safe sleep education curriculum for staff and the implementation of a policy. In order to develop and implement such a program, further information will be gathered about the barriers and beliefs of nursing staff as well as overall knowledge on safe sleep practices with direct care providers at the hospital.
Objectives:
1) To review the American Academy of Pediatrics Safe Sleep Guidelines. 2) To identify unique barriers to implementing a hospital-based safe sleep program. 3) To describe the Quality Improvement initiatives implemented to create a safe sleep culture within a hospital.
Background:
Injuries cause more deaths to the pediatric population than all diseases combined. This program teaches pediatricians injury prevention principles, how to use tools in their office setting, and how to engage families to make changes in their behavior so their children are safer and injuries can be reduced. While performing this work, pediatricians can obtain maintenance of certification (MOC) credit.
Methods:
Both MOC 2 and 4 program development over the past 3 years will be reviewed. The Ohio AAP became an American Board of Pediatric's (ABP) portfolio sponsor. As injuries cause significant morbidity, the Ohio Chapter worked to develop a screening tool to assess current family behaviors for children in the household < 1 year of age. Pediatric practices were recruited nationally to implement the tool into every WCC visit for appropriate aged children and providers were given talking points to discuss inappropriately answered topics. Surveys are provided at multiple visits to assess behavior changes by families over time. All participating providers submit their data to a centralized database and behavior changes are assessed for all families. Frequencies for screening tool use and appropriate injury prevention discussions are calculated. Also, an MOC 2 program was developed by study staff and approved by the ABP. Discussions of how articles were chosen and questions developed will be discussed. Within only a 10-month period physicians earn 25 points of MOC 4 credit and 20 points of MOC 2 credit; enabling them to complete half of their ABP requirements.
Results:
Over 23 practices and 100 providers have participated over the past 3 years. Implementation of the screening tool is easily incorporated into an everyday pediatric practice in just 1-2 months. Pediatrician injury prevention discussion increased by 70% for all recommended injury prevention topics for children < 1 year of age. Family behavior change by age of child and mechanism of injury will be reviewed. Finally, the ease of obtaining MOC 2 credit by participating pediatricians while participating in the quality improvement program will be discussed.
Conclusions:
Participation in a MOC Part 2 and 4 QI program within pediatric offices can increase screening and discussion of injury prevention practices. As a result of these programs, pediatricians learned injury prevention principles, increased discussions with families, and instigated more reported behavior changes by families at later visits.
Objectives:
1) Describe how MOC 2 and 4 programs are developed 2) Demonstrate how to work with office staff to incorporate injury QI in the office to obtain MOC 4 credit 3) Discuss how our team has evaluated the success and spread the program nationally
Background:
A 2005 AAMC report called for improved focus on principles of injury prevention to ensure that medical professionals recognize their important role. In response to this report, the medical curriculum at UAMS was modified to include injury prevention during M1 (overview lecture), M2 (social history workshop), and M3 (pediatric clerkship workshop). The. M3 workshop was modified in 2013 to include use of the Pediatric Understanding and Learning using Simulation Education (PULSE) Center at Arkansas Children’s Hospital (ACH). Simulation education methods include the use of high fidelity manikins and clinic facilities under audio and visual surveillance. In addition, standardized patients (SPs) are trained to accurately portray a clinical situation or problem and consistently recreate the scenario in each encounter.
Methods:
A recorded overview lecture is provided online as preparatory material for the students rotating through the pediatric clerkship. Upon arrival at the PULSE Center, students complete a pre-test of injury prevention knowledge, attitudes, and self-efficacy using an audience response system. This is followed by a brief orientation by faculty and staff of the Injury Prevention Center (IPC). During a facilitated 15-minute primary care interaction, SPs present in the clinic with concerns and risk factors M3 students to interview and provide recommendations. Standardized scripts have been written on leading injury mechanisms: motor vehicle crashes for children and teens, sports-related concussions, infant mortality (unsafe sleep and abusive head trauma), and suicide. Students rotate in 5-person groups through the simulated clinic scenarios. A trained factilitator is present in each room to keep the session on track. Sessions are monitored using closed-circuit video to address issues that arise and to assess clinical interactions. A debriefing session led by IPC staff reviews key messages for each scenario and provides feedback before an electronic post-test is conducted.
Results:
A total of 164 students have completed the PULSE Center workshop since initiation in December 2013. The workshop has been modified to fit the timeframes of the clinic sessions and now runs smoothly for the approximately 2.5 hour session. Survey data are available for 164 pre- and 179 post-workshop students. Overall, the workshop has been well-received with 73% of students indicating their medical education has provided exposure to injury prevention after the training. Students felt more confident in detecting injury risk factors after training (69% pre, 75% post). Knowledge also improved: correct on all injury mechanisms (62% pre, 77% post) as did overall self-efficacy (57% pre, 77% post) after training. Student knowledge about specific mechanisms demonstrated up to 56% improvement.
Conclusions:
A novel simulation workshop for M3 students covering important injury risk scenarios has been well-received by the students, who demonstrate improved short-term knowledge and perceived self-efficacy after the session. Standard scripts for the cases and training materials for SPs are available and may be appropriate for adoption in other training programs to improve patient counselling on common pediatric injury risks.
Objectives:
Background:
The American Academy of Pediatrics recommends car seats and booster seats to be used for children < 8-12 years old and less than 57 inches when in a motor vehicle. In the state of Massachusetts the laws require children < 8 years old and less than 57 inches to be restrained in a car seat or booster seat. Hospital programs can be important sources of child passenger safety (CPS) information, and they can also provide child safety seats to those in need. In 2010 we established a CPS program on the inpatient units, and in 2011 we established one in the emergency department (ED). In the inpatient unit, CPS screening is a voluntary computerized field completed during the initial nursing assessment and recorded in the medical record. In the ED it is a mandatory computerized field in the initial nursing assessment. Child safety seats are distributed if a need is identified. The objective of this program evaluation is to analyze compliance with the CPS nursing screening in the inpatient and ED setting and to describe patterns of car seat distribution over the time periods of the programs.
Methods:
This is a retrospective record review of children < 8 years old screened for CPS needs at a tertiary care children’s hospital. Records for children in the inpatient units and those discharged from the ED were reviewed from August 1, 2011 through December 31, 2014. Frequencies of car seat screenings and child safety seat distribution by type of seat were calculated. We conducted Poisson regression to analyze CPS screening over time.
Results:
From 2011-2014, 27% (7,179/26,967) of children< 8 years old admitted to the inpatient unit had CPS nursing screening completed. Of those screened, 3.7% (265/7,179) needed a car seat for discharge home. Of children discharged from the ED, 77% (89,182/115,601) had CPS nursing screening completed, with 93% (31,112/33,537) screened in 2014. Among those screened, 2.0% (1,746/89,182) did not have a car seat for discharge home. Through the two CPS programs 116 seats were distributed in 2013 (4 infant, 25 convertible, 16 combination, 18 boosters, 29 Hippos, 7 car beds, and 17 vests) and 155 in 2014 (5 infant, 49 convertible, 12 combination, 26 boosters, 33 Hippos, 10 beds, 20 vests). Poisson regression revealed increased CPS screening in the ED (p < 0.0001), but not in the inpatient units over time.
Conclusions:
Inpatient and ED CPS programs with computerized nursing screening may be useful to assess patients < 8 years old for CPS needs. Increased compliance was observed in the ED with the mandatory computerized nursing assessment field. Various types of child safety seats can be provided as the need is determined, including specialty car seats for children.
Objectives:
1) Understand the importance of program evaluation for hospital based child passenger safety programs. 2) Describe the types of child safety seats needed for patients served by hospital based child passenger safety programs. 3) Illustrate differences in compliance by types of computerized screening for child passenger safety.
