Lara Beth McKenzie

Bicycle-Related Injuries Among Children and Adolescents in the United States

The objective of this study is to describe the epidemiology of bicycle-related injuries among children and adolescents 18 years and younger on a national level. This is a retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for patients 18 years and younger who were seen in emergency departments (EDs) between January 1, 1990, and December 31, 2005, for injuries received while operating a bicycle. During the 16-year study period, there were an estimated 6 228 700 individuals 18 years and younger treated in US EDs for bicycle-related injuries. Children with head injuries were more than 3 (relative risk, 3.63) times as likely to require hospitalization and were almost 6 (relative risk, 5.77) times more likely to have their injuries result in death. The large number of annual bicycle related—injuries is evidence that prevention of these injuries should remain an important area of bicycle safety research and practice.

Mountain Biking–Related Injuries Treated in Emergency Departments in the United States, 1994-2007

Background: Injury research on mountain biking has been mostly limited to examining professional riders and off-road biking. Mountain bikes represent the largest segment of bike sales in the United States. Recreational mountain bike use is popular and understudied. Purpose: To describe the scope, distribution, and trends of mountain bike–related injuries treated in US emergency departments. Study Design: Descriptive epidemiologic study. Methods: A retrospective analysis was conducted with data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for patients aged ≥8 years from 1994 through 2007. Sample weights provided by the system were used to calculate national estimates of mountain bike–related injuries based on 4624 cases. Bivariate comparisons between categorical variables were assessed with injury proportion ratios and 95% confidence intervals. Results: Nationwide, an estimated 217 433 patients were treated for mountain bike–related injuries in US emergency departments from 1994 to 2007, an average of 15 531 injuries per year. The annual number of injuries decreased 56%, from a high of 23 177 in 1995 to 10 267 in 2007 (P < .001). The most common injuries were upper extremity fractures (10.6%) and shoulder fractures (8.3%). Patients aged 14 to 19 years sustained a greater proportion of traumatic brain injuries (8.4%) than did patients aged 8 to 13 years and ≥20 years combined (4.3%). A greater proportion of female riders (6.1%) than male riders (4.5%) were hospitalized. Conclusion: Mountain bike–related injuries decreased from 1994 to 2007. Upper extremity fractures were the most common injury. Girls and women may be more likely than boys and men to sustain more severe injuries requiring hospitalization. Despite the decline over the past decade, more can be done to improve safety and reduce injuries in this popular recreational activity.

Football-Related Injuries Among 6- to 17-Year-Olds Treated in US Emergency Departments, 1990-2007

Football is one of the most popular youth sports in the United States despite the high rate of injuries. Previously published studies have investigated football-related injuries that occurred in organized play but have excluded those that occurred during unorganized play. Through use of the National Electronic Injury Surveillance System database, cases of football-related injuries were identified for analysis. Sample weights were used to calculate national estimates. An estimated 5 252 721 children and adolescents 6 to 17 years old were treated in US emergency departments for football-related injuries. The annual number of cases increased by 26.5% over the 18-year study period. The 12- to 17-year-old age group accounted for 77.8% of all injuries and had nearly twice the odds of sustaining a concussion. The findings suggest the need for increased prevention efforts to lower the risk of football-related injury in children and adolescents.

Injuries From Furniture Tip-overs Among Children and Adolescents in the United States, 1990-2007

Objective. To describe the epidemiology of pediatric injuries associated with furniture tip-overs in the United States. Methods. Data from the National Electronic Injury Surveillance System were analyzed for patients ≤17 years treated in emergency departments for a furniture tip-over-related injury from 1990 through 2007. Results. An estimated 264 200 furniture tip-over-related injuries occurred during the study period, yielding an average of 14 700 injuries annually, or 20.7 per 100 000 population per year. There was a significant increase in the number and rate of these injuries during the 18-year period. Three-quarters of injuries were to children ≤6 years. Televisions were the item most commonly involved (47.4%). Head/neck injuries were the most common (42.2%) injury type among children 0 to 9 years of age. Conclusions . The number and rate of injuries to children associated with furniture tip-overs are increasing. Pediatricians and caregivers should be aware of this important source of pediatric injury and the strategies for prevention.

Assessing public opinion regarding potential ATV-related policies

PROBLEMnStates with laws regarding ATV use and safety have lower mortality and injury rates than states with few or no restrictions. Our objective was to assess the attitudes of registered Ohio voters concerning potential legislation regarding ATV use and safety to determine the feasibility of its enactment.nnnMETHODnA statewide telephone survey of 838 registered Ohio voters was conducted and results were weighted by region to accurately represent all Ohio voters.nnnRESULTSnRegistered voters were in favor of restricting the use of ATVs by children <16 years (81%), prohibiting passengers on ATVs (81%), requiring helmets (78%), and requiring all ATV owners and users to take a safety class (77%). ATV riders indicated that a mandatory helmet law would increase helmet use.nnnIMPACT ON INDUSTRYnAssessing public opinion regarding public health and safety laws is a critical first step when considering legislation to improve ATV safety.

Does Health Literacy Level Influence the Effectiveness of a Kiosk-Based Intervention Delivered in the Pediatric Emergency Department?

Objective. This study assesses parents’ literacy skills and evaluates how literacy levels influenced the effectiveness of a health communication intervention designed to improve safety knowledge in low-income, urban families. Methods. A total of n = 450 parents of children aged 4 to 66 months completed the Rapid Estimate of Adult Literacy in Medicine (REALM) and participated in a randomized trial of an injury prevention intervention delivered via computer kiosk in a pediatric emergency department. A safety knowledge test was administered by telephone 2 to 4 weeks later. Results. More than one-third of parents were assessed by the REALM to have marginal (30%) or inadequate (8%) reading levels; the remaining 62% of parents had adequate reading levels. REALM scores were independently associated with knowledge gains for poison storage and smoke alarms. Conclusions. Participants reading level had an independent and significant effect on safety knowledge outcomes. Literacy level should be considered in all patient education efforts.

Track-related injuries in children and adolescents treated in US emergency departments from 1991 through 2008.

Abstract Background: Track is a popular sport among children and adolescents. Track participants have a high rate of injury, often from overuse. Purpose: To determine national patterns of track-related injuries among children and adolescents aged 10 to 18 years treated in US emergency departments. Study Design: Descriptive epidemiologic study. Methods: A retrospective analysis was conducted using data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for patients aged 10 to 18 years from 1991 through 2008. Sample weights were used to calculate national estimates of track-related injuries based on 4496 actual cases. Bivariate comparisons between categorical variables were assessed with odds ratios and 95% CIs. Trend significance of the numbers and rates of track-related injuries over time was analyzed using linear regression. Results: From 1991 through 2008, an estimated 159 663 patients aged 10 to 18 years were treated for track-related injuries in US emergency departments, with an average of 8870 cases per year. The overall number of cases increased 36.3%, from 7702 injuries in 1991 to 10 496 injuries in 2008 (P = 0.039). Boys were more likely to sustain pelvic injuries and girls were more likely to sustain ankle injuries. Body parts injured varied by the specific track activity or event performed; hurdling was more likely to result in an injury to the upper extremities and to the head, whereas sprinting was more likely to result in an injury to the pelvis or upper leg. Conclusion: There are several age-, sex-, and activity-specific patterns of track-related injuries. Given the increased participation and corresponding increase in track-related injuries, more research is needed to determine how best to prevent these injuries.

Running-Related Injuries in School-Age Children and Adolescents Treated in Emergency Departments From 1994 Through 2007

Running for exercise is a popular way to motivate children to be physically active. Running-related injuries are well studied in adults but little information exists for children and adolescents. Through use of the National Electronic Injury Surveillance System database, cases of running-related injuries were selected by using activity codes for exercise (which included running and jogging). Sample weights were used to calculate national estimates. An estimated 225 344 children and adolescents 6 to 18 years old were treated in US emergency departments for running-related injuries. The annual number of cases increased by 34.0% over the study period. One third of the injuries involved a running-related fall and more than one half of the injuries occurred at school. The majority of injuries occurred to the lower extremities and resulted in a sprain or strain. These findings emphasize the need for scientific evidence-based guidelines for pediatric running. The high proportion of running-related falls warrants further research.

The National Institute of Neurological Disorders and Stroke and Department of Defense Sport-Related Concussion Common Data Elements Version 1.0 Recommendations

Through a partnership with the National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, and Department of Defense, the development of Sport-Related Concussion (SRC) Common Data Elements (CDEs) was initiated. The aim of this collaboration was to increase the efficiency and effectiveness of clinical research studies and clinical treatment outcomes, increase data quality, facilitate data sharing across studies, reduce study start-up time, more effectively aggregate information into metadata results, and educate new clinical investigators. The SRC CDE Working Group consisted of 32 worldwide experts in concussion from varied fields of related expertise divided into three Subgroups: Acute (<72u2009h post-concussion), Subacute (3 days-3 months post-concussion) and Persistent/Chronic (>3 months post-concussion). To develop CDEs, the Subgroups reviewed various domains, then selected from, refined, and added to existing CDEs, case report forms and field-tested data elements from national registries and funded research studies. Recommendations were posted to the NINDS CDE Website for Public Review from February 2017 to April 2017. Following an internal Working Group review of recommendations, along with consideration of comments received from the Public Review period, the first iteration (Version 1.0) of the NINDS SRC CDEs was completed in June 2017. The recommendations include Core and Supplemental-Highly Recommended CDEs for cognitive data elements and symptom checklists, as well as other outcomes and end-points (e.g., vestibular, oculomotor, balance, anxiety, depression), and sample case report forms (e.g., injury reporting, demographics, concussion history) for domains typically included in clinical research studies. The NINDS SRC CDEs and supporting documents are publicly available on the NINDS CDE website www.commondataelements.ninds.nih.gov . Widespread use of CDEs by researchers and clinicians will facilitate consistent SRC clinical research and trial design, data sharing, and metadata retrospective analysis.

Pediatric injury information seeking for mothers with young children: The role of health literacy and ehealth literacy

Abstract Background: An understanding of preferred sources of injury information among parents is needed to develop best practices for information dissemination. Yet, almost no research examines injury information seeking for a national sample of mothers. Methods: A cross-sectional online survey was conducted in 2013 with 1081 mothers in the United States (U.S.) with at least one child <6 years. We measured self-report health literacy with the Morris Single-Item Screener (18% low), and eHealth literacy using the eHEALS (28% low). Results: The internet was the most preferred source for injury information (76%), followed by health providers (44%), and family/friends (35%). Most mothers selected the internet as the first choice for information about bicycle helmets (65%) and car seats (63%). For poison prevention, preferences were mixed; 48% internet compared with 41% health providers. Mothers with low health literacy were more likely to have discussed injury prevention with their doctors (P = 0.022) and searched for injury information (P = 0.001), but less likely to report the internet as a top source (P < .0001). Mothers with low eHealth literacy were less likely to search for injury information (P < 0.0001) and report the internet as a top source (P < 0.0001), and slightly more likely to rely on health providers for information (P = 0.028). Conclusions: Findings suggest the internet is a common source of injury prevention information, but health providers remain a valuable resource for mothers, especially those with lower literacy skills. Despite widespread internet use, health providers should be sure to communicate injury prevention information to mothers, especially those at risk for low health literacy and eHealth literacy.