Presenter Profile
Jennifer E. McCain, MD
University of Alabama at Birmingham
jennifermccain@uabmc.edu
Jennifer E. McCain, MD is an Assistant Professor of Pediatrics at UAB where she is a board certified Pediatric Emergency Medicine physician in the Children’s of Alabama Emergency Department. She has been the representative from District 3 (the counties directly surrounding Birmingham) to the board of the Alabama Chapter of the AAP for the last seven years and is a voting member of COPEM (Committee on Pediatric Emergency Medicine) with the national AAP. After 12 years as a general pediatrician, she returned to this academic position where she actively cares for patients in the ED, participates in education of residents and students, and participates in research. Dr. McCain has a specific interest in injury prevention. She has been actively involved in developing relationships in urban Birmingham as well as in rural Alabama counties to address safe sleep for infants.
Presentations
Golf Cart-related Injuries to Children in a Single Institution
Jennifer E. McCain, MD
Ashley E. Bridgmon, MPH, MBA
William D. King, DrPH
Michele Nichols, MD
Kathy Monroe, MD, MSQI
Golf carts have become a popular mode of transportation and many cities allow operation of these by children as young as 14 years old. Unfortunately, children can be seriously injured from activities surrounding the use of golf carts. Our study aims to identify the descriptive epidemiology of golf cart-related injuries in our institution in order to develop prevention measures for this injury type.
Golf cart-related injury visits were identified using an injury surveillance system in the emergency department (ED) of a pediatric tertiary hospital. All children 18 years and younger evaluated in the ED and given an ICD10 code range within V86, V87 and V09 external cause of injury code in 2022 were included. Confirmatory searches of the History of Present Illness (HPI) section of provider notes containing “golf” were performed. Basic descriptive statistics, frequency tables, and T-test of means were performed using Epi Info Version 7.2.4.0 (CDC).
In 2022, 44 children ranging in age from 2 -16 years old (mean 10.5, median 11.0) were treated for golf cart-related injuries. Males (n=29, 65.9%) accounted for the majority of these injuries. The majority of these patients had private insurance (n=31, 70.4%). Trauma code criteria were met by six patients (13.6%) while 12 patients (27.3%) were admitted to the hospital (13.5% of all injury visits result in admission). Patient mean age did not differ significantly between admitted and discharged patients (mean age 11.7 yrs vs 9.9 yrs, respectively) (t=1.2, p=0.23). Among those admitted, 5 patients (41.7%) had a one day admission while 7 patients (58.3%) had stays from two to 21 days (median 2 days).
Injuries sustained included: lacerations/abrasions (33), skull fractures (8), extremity fractures (7), intracranial hemorrhages (3), concussions (3), pulmonary contusions (2), pneumothorax (1), vertebral fracture (1), orbital injury (1), and degloving of foot (1). Mechanisms for those more severely injured included ejection from cart (6), golf cart rollover (4), hit by vehicle while riding cart (1), and pedestrian hit by cart (1).
Children playing in and around golf carts can result in significant injuries- many of which require hospital admission. Golf cart laws vary from state to state and even community to community and it is important that these laws are enforced. Golf cart owners should be aware of the age a child can legally drive a golf cart in their area. Injury prevention efforts should highlight behaviors increasing the risk for rollover while using these vehicles. All golf cart operators should understand the risk of serious injury when riding on uneven ground, when riding near motor vehicles, and when children are unrestrained.
1. Children can be seriously injured when playing in and around golf carts.
2. The most frequent mechanisms for serious golf cart-related injuries are rollovers and ejections.
3. Existing laws should be enforced and pediatricians should advocate for more stringent laws.
Safe Sleep
Jennifer E. McCain, MD
Lorrie Lynn, MA, CPSTI
Shelby Crespi, MPH, CPST
Intentional self-harm (ISH) Injuries in a Pediatric Emergency Department
Ashley E. Bridgmon, MPH, MBA
Jennifer E. McCain, MD
Kathy Monroe, MD, MSQI
William D. King, DrPH
Intentional self-harm (ISH) injuries are an increasing reason for visits to emergency departments (ED). ISH injuries are often the result of various forms of cutting, toxin ingestion, and other acts of bodily harm. Our study was conducted in an effort to quantify the numbers of ISH ED visits in our pediatric tertiary care hospital, and to identify the descriptive epidemiology of this important issue. Through an epidemiologic model approach, we seek to develop important primary and secondary public health interventions for responding to this ever growing child health issue.
A convenience sample of 2022 ED visits for ISH injuries were identified for analysis using an injury surveillance system at our pediatric tertiary hospital. Inclusion criteria included all children evaluated in the ED with ICD 10 codes ranging from X60 – X84. Confirmatory searches of the history of present illness (HPI) containing “intentional injury” were also performed. A nested case-control design was used to compare and contrast the ISH injury visits to non-ISH injury visits. A random selection of non-ISH visits were used as the control group. An Excel datafile was used for data entry and management while MedCalc and Epi info Version 7.2.4.0 (CDC) statistical program were used for data analysis. Odds ratio determinations with 95% Confidence Intervals, t test for means (comparisons) and Z test of proportions were used when appropriate for analysis.
Our study found 368 ISH ED visits during 2022. ISH visits had 4.7 times the odds of being female compared to controls, (OR=4.7, 95%CI (3.4, 6.4)). Specifically, white females accounted for the highest gender-race proportions, 51.9% vs 22.6%, (z=8.4, p<0.00001). Children with ISH visits were significantly older than controls (mean ages, 14.1 yrs vs 7.1 years, respectively), (t=25.8, p<0.00001). ISH visits had a high rate of admission (59.2%) and 71.2% had ESI’s of 2. Mean length of stay among admitted was 7.1 days compared to 2.5 days among controls (t=2.6, p<0.0001). The leading mechanism of ISH injury was poison ingestion (68.8%) which was 5.1 times the proportion of poison among controls, (z=15.6, p<0.00001). Other mechanisms of ISH injury included forms of cutting (glass, knife, sharp objects) at 26.9%.
Intentional self-harm injuries continue to be a growing concern for pediatric ED visits, with children as young as five years old presenting with ISH injuries. These visits more commonly result in admission than other injury types and when admitted, patients have significantly longer lengths of stay than children with non-ISH injuries. With poison ingestion being the leading cause of ISH injury, continuing to advocate for safe storage practices is necessary. Preventative public health interventions that increase awareness and target the at-risk population are needed to combat intentional self-harm injuries.
1. Intentional self-harm injuries are a growing cause for pediatric emergency department visits.
2. A comprehensive Public Health Model approach is needed to combat ISH injuries in our youth.
3. Primary care providers should be alert to this common problem of intentional self-harm and seek early psychiatric care for their patients.