Rachel B. Baker

Prospective Evaluation of a Pediatric Inpatient Early Warning Scoring System

PURPOSE The present study evaluated the use of the Pediatric Early Warning Score (PEWS) for detecting clinical deterioration among hospitalized children. DESIGN/METHODS A prospective, descriptive study design was used. The tool was used to score 2,979 patients admitted to a single medical unit of a pediatric hospital over a 12-month period. RESULTS PEWS discriminated between children who required transfer to the pediatric intensive care unit and those who did not require transfer (area under the curve = 0.89, 95% CI = 0.84-0.94, p < .001). IMPLICATIONS The PEWS tool was found to be a reliable and valid scoring system to identify children at risk for clinical deterioration.

Forensic sexual assault examination and genital injury: is skin color a source of health disparity?

PURPOSE The study objectives were to (1) estimate the frequency, prevalence, type, and location of anogenital injury in black and white women after consensual sex and (2) investigate the role of skin color in the detection of injury during the forensic sexual assault examination. METHODS A cross-sectional descriptive design was used with 120 healthy volunteers who underwent a well-controlled forensic examination after consensual sexual intercourse. RESULTS Fifty-five percent of the sample had at least 1 anogenital injury after consensual intercourse; percentages significantly differed between white (68%) and black (43%) participants (P = .02). Race/ethnicity was a significant predictor of injury prevalence and frequency in the external genitalia but not in the internal genitalia or anus. However, skin color variables--lightness/darkness-, redness/greenness-, and yellowness/blueness-confounded the original relationship between race/ethnicity and injury occurrence and frequency in the external genitalia, and 1 skin color variable--redness/greenness--was significantly associated with injury occurrence and frequency in the internal genitalia. CONCLUSIONS Although differences exist in anogenital injury frequency and prevalence between black and white women, such differences can be more fully explained by variations in skin color rather than race/ethnicity. Clinical recommendations and criminal justice implications are discussed.

Health disparities in the forensic sexual assault examination related to skin color

&NA; Little is known about the role of skin color in the forensic sexual assault examination. The purpose of this study was to determine whether anogenital injury prevalence and frequency vary by skin color in women after consensual sexual intercourse. The sample consisted of 120 healthy (63 Black, 57 White) women who underwent a forensic sexual assault examination following consensual sexual intercourse. Experienced sexual assault forensic examiners using visual inspection, colposcopy technique with digital imaging, and toluidine blue application documented the number, type, and location of anogenital injuries. Although 55% of the total sample was observed to have at least one anogenital injury of any type following consensual intercourse, the percentages significantly differed for White (68%) and Black (43%) participants (p = 0.02). When the presence of anogenital injury was analyzed by specific anatomical region, a significant difference between White and Black participants was only evident for the external genitalia (White = 56%, Black = 24%, p = .003), but not for the internal genitalia (White = 28%, Black = 19%, p = .20) or anus (White = 9%, Black = 10%, p = 0.99). A one standard deviation‐unit increase in L* values (lightness) was related to a 150% to 250% increase in the odds of external genitalia injury prevalence (p < 0.001). While Black and White participants had a significantly different genital injury prevalence, dark skin color rather than race was a strong predictor for decreased injury prevalence. Sexual assault forensic examiners, therefore, may not be able to detect injury in women with dark skin as readily as women with light skin, leading to health disparities for women with dark skin.

Physical Injury From Intimate Partner Violence: Measurement Strategies and Challenges

Physical injury that occurs as a result of intimate partner violence needs to be treated to relieve pain, promote healing, and prevent infection. Detection of physical injury is an important component of the forensic examination because of its role in criminal justice proceedings. Better detection and measurement techniques are needed to quantify physical injuries and advance the science. This article addresses current practices of injury identification, challenges in injury measurement, and future directions for research.

Determining optimal waste volume from an intravenous catheter.

Waste is blood drawn from an intravenous (IV) catheter to remove saline or heparin before obtaining a blood sample. This study examines the minimum waste volume resulting in an undiluted sample. A repeated-measures design was used. Investigators placed an IV catheter in 60 healthy adults and obtained samples at baseline and following waste volumes ranging from 0.5 to 3 mL. A random effects mixed model was used to determine the stabilizing point, which was 1 mL of waste. Knowing that only 1 mL of waste is needed will prevent clinicians from obtaining extra waste and discarding blood needlessly.

A Source of Healthcare Disparity: Race, Skin Color, and Injuries After Rape Among Adolescents and Young Adults

&NA; Differences in anogenital injury resulting from rape may occur because of racial or skin color differences in adult women. It is critical to determine if these differences also are associated with differences in injury prevalence and frequency in adolescents and young adults. In a retrospective review of medical records, we examined whether Black adolescent/young adult females had different anogenital injuries as compared to White females following rape. Next, we examined whether skin color differences explained a significant amount of the racial difference in injuries. We reviewed charts of 234 female victims of rape ages 14 to 29. Overall injury prevalence was 62.8%. Race was significantly associated with frequency of injuries in several anatomical locations, with White victims having a higher frequency of injuries than Black victims. Skin color was significantly associated with injury frequency in many anatomical locations, with victims with light skin sustaining more injuries than victims with dark skin. Even when skin color was included in the relationship, race remained a statistically significant factor, suggesting that the relationship between race and injuries may be more complicated than merely a skin color difference that has been mislabeled a racial difference.

Intra- and inter-rater reliability of digital image analysis for skin color measurement

We determined the intra‐ and inter‐rater reliability of data from digital image color analysis between an expert and novice analyst.

Randomized Trial Evaluating the Effectiveness of a Leg Crossing and Muscle Tensing Technique on Decreasing Vasovagal Symptoms Among Pediatric and Young Adult Patients Undergoing Peripheral IV Catheter Insertion

&NA; Peripheral intravenous (PIV) catheter insertion is a common procedure that can cause vasovagal symptoms. Lower extremity muscle tensing techniques decrease these symptoms in adults. However, there are no studies examining this technique in the pediatric population. Objective: This study aims to determine whether pediatric patients are able to perform the technique and to determine the effects of this technique on vasovagal symptoms in a pediatric population. Design, Setting, Participants: A parallel‐group randomized controlled trial was conducted with 28 patients cared for in a pediatric surgery unit. Intervention: Patients randomized to the experimental group performed the leg crossing and muscle tensing technique during PIV placement. Patients in the control group received standard care during PIV placement. Primary Outcome Measure: The primary outcome measure was the frequency of experiencing at least one vasovagal sign or symptom which included nausea, vomiting, dizziness, pallor, sweating/diaphoresis, and fainting. Results: Patients randomized to perform the technique were able to perform it without difficulty. There was a lower frequency of experiencing vasovagal symptoms among patients in the experimental group (15%) compared to patients in the control group (62.5%) (Fishers exact test, p = 0.02). The number of vasovagal symptoms experienced by patients in the experimental group (M = 0.3) was significantly lower than the number of vasovagal symptoms experienced by patients in the control group (M = 1.13), t(26) = 2.302, p = 0.03. Conclusion: A leg crossing technique is a low cost, low risk, and effective strategy to teach to pediatric patients resulting in reducing vasovagal symptoms. Highlights:Peripheral intravenous (PIV) catheter insertion can cause vasovagal symptoms in some patients.Muscle tensing techniques have been shown to decrease vasovagal symptoms in adults.Patients who performed the leg crossing technique experienced fewer vasovagal symptoms.A muscle tensing technique effectively decreases vasovagal symptoms in pediatric patients.

Sleep disruption in caregivers of pediatric stem cell recipients

Parents/caregivers of hospitalized patients are at risk of sleep disruption. We performed a cross‐sectional quantitative and qualitative evaluation of sleep in parents/caregivers of children undergoing hematopoietic stem cell transplant (HSCT; n = 17). Additionally, we explored the frequency of room entries for hospitalized patients undergoing HSCT (n = 189 nights). Twelve caregivers (71%) demonstrated significant sleep disturbance, 12 (71%) described sleep quality as poor, 15 (88%) averaged < 6 hours of sleep per night, 14 (82%) awakened at least four times per night. Patient rooms were entered a median of 12 times per night (interquartile range 10–15). Intervention studies to improve caregiver sleep during hospitalization are needed.

Randomized Prospective Clinical Trial Comparing Room Temperature and Warmed Intravenous Fluid Boluses on Pediatric Patients' Comfort.

A common complaint among pediatric patients receiving an intravenous (IV) fluid bolus is that their arm feels cold and uncomfortable. The purpose of this study is to test if administering warmed IV fluids, as compared to room temperature IV fluids, results in increased comfort among pediatric patients seeking care in an emergency department. A blinded randomized controlled trial was conducted and 126 pediatric patients were enrolled. Each patients overall comfort, arm comfort, and arm temperature were measured prior to IV fluid administration, 15 minutes after the beginning of the infusion, and at the end of the 60-minute infusion. After the first 15 minutes of IV fluid administration, the patients who received warmed IV fluids reported higher comfort than the patients who received room temperature IV fluids, t(118)=2.04, p=0.04. Additionally, patients who received the room temperature IV fluids reported that their arms felt cooler than patients who received the warmed fluids, t(118)=3.25, p=0.0015. Warming IV fluids has the potential to improve the experience of IV bolus administration for pediatric patients.