Thomas Swain

Laundry pod and non-pod detergent related emergency department visits occurring in children in the USA

Objective Previous studies have reported that children are at risk of severe injuries from exposure to laundry detergent pods. For the first time, this study sought to compare demographic and exposure characteristics and risk among children exposed to pod and non-pod laundry detergents presenting to emergency departments (EDs). Methods Data from the National Electronic Injury Surveillance System (NEISS) from 2012–2014 were used. All observations with injuries involving laundry detergent (NEISS code 0949) were included in this study. The χ2 test was used for bivariate analysis and logistic regression was used to determine the OR and 95% CI of hospitalisation for pod related versus non-pod laundry detergent exposures. Results From 2012–2014, there were an estimated 26 062 non-pod and 9814 pod laundry detergent related exposures among those aged 18 years and younger. For pod detergent, children aged 0–5 years had the most injuries. Poisoning (71.3%) was the most common diagnosis for pod detergent while contact dermatitis (72.2%) was most common for non-pod detergent. Hospitalisation occurred in 12.5% of pod detergent cases and just 3.0% of non-pod cases. Compared with non-pod detergent, those exposed to pod detergent were 4 times as likely to be hospitalised (OR 4.02; 95% CI 1.96 to 8.24). Conclusions A greater effort should be made to appropriately educate the public about the dangers of laundry detergents, specifically pods, so a safe home environment can be established. While new regulations such as childproof containers, opaque packaging, and less appealing and colourful pods could reduce the number of pod related ED visits for children, caregivers should store detergents, along with other chemicals, in a secure location where children cannot easily access them.

Early Coagulopathy is Associated with Increased Incidence of Ventilator-Associated Events Among Burn Patients.

Objective: Coagulopathy is known to be associated with burn injury. Our group has shown that, in spinal cord injury patients, coagulopathy is associated with an increase in ventilator-associated pneumonia (VAP). We hypothesized that the same association exists between coagulopathic burn patients and ventilator-associated events. Methods: Patients admitted for burn care between January 1, 2011 and December 31, 2015 who required mechanical ventilation were included in the study. Ventilator-associated events (VAEs) as defined by the Center for Disease Control were categorized as no event, ventilator-associated condition, infection-related ventilator-associated complication, and possible VAP. Demographic, injury characteristics were compared among four international normalized ratio (INR) categories using analysis of variance and chi-square tests. Results: Four hundred four patients were admitted for burn care, of whom 263 met the inclusion criteria. One hundred eleven had normal INR, 59 had a slightly elevated INR (1.2–1.4), 33 had a moderately elevated INR (1.4–1.6), and 60 had a severely elevated INR (>1.6). Those with moderately and severely elevated INR were ventilated for a longer period (P = 0.0034), had more days in the ICU (P = 0.0010), and had longer hospital stay (P = 0.0016). After adjusting for inhalation injury and total body surface area, patients with severely elevated INR were over four times as likely to have any VAE (OR: 4.16, 95% CI: 1.33–13.05) and 4.5 times as likely to develop infection-related ventilator-associated complication or possible ventilator-associated pneumonia combined (OR: 4.59, 1.35–15.67). Conclusions: Early coagulopathy is associated with a significantly increased incidence of VAEs in burn patients. While additional studies need to be conducted to verify these findings, early recognition and treatment could decrease VAEs.

Yoga-Related Injuries in the United States From 2001 to 2014

Background: Yoga has become more popular among people in the United States and has been touted by both yoga participants as well as some physicians and researchers for its health benefits. While the health benefits have been studied, the frequency of injury among yoga participants has not been well documented. Purpose: Injury incidence, rates, and types associated with yoga in the United States have not been quantified. This study estimates US yoga-associated injury incidence and characterizes injury type over a 13-year period. Study Design: Descriptive epidemiology study. Methods: Data from the National Electronic Injury Surveillance System (NEISS) from 2001 to 2014 were used to estimate the incidence and type of yoga-associated injuries. The number and age distribution of yoga participants was estimated using data from National Health Statistics Reports. These national population estimates were applied to the NEISS data to determine injury rates overall and stratified according to age categories. Results: There were 29,590 yoga-related injuries seen in hospital emergency departments from 2001 to 2014. The trunk (46.6%) was the most frequent region injured, and sprain/strain (45.0%) accounted for the majority of diagnoses. The injury rate increased overall from 2001 to 2014, and it was greatest for those aged 65 years and older (57.9/100,000) compared with those aged 18 to 44 years (11.9/100,000) and 45 to 64 years (17.7/100,000) in 2014. Conclusion: Participants aged 65 years and older have a greater rate of injury from practicing yoga when compared with other age groups. Most injuries sustained were to the trunk and involved a sprain/strain. While there are many health benefits to practicing yoga, participants and those wishing to become participants should confer with a physician prior to engaging in physical activity and practice only under the guidance of certified instructors.

Validity of the Braden Scale in grading pressure ulcers in trauma and burn patients

BACKGROUND Pressure ulcers are a costly hospital-acquired condition in terms of clinical outcome and expense. The Braden Scale was developed in 1987 as a risk scoring method for pressure ulcers and uses six different risk factors: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. A score of ≤18 is considered high risk. To date, research on the utility of the Braden Scale has focused on general medicine and nontrauma/burn surgery patients. We hypothesize that the Braden Scale does not accurately discriminate who will get a pressure ulcer among trauma and burn patients. METHODS We collected data from medical records regarding documented Braden scores and presence of pressure ulcers regardless of staging. Patients with ulcers present on admission were excluded from analysis. For each patient, the lowest Braden score documented before the occurrence of the pressure ulcer was determined. A logistic regression was used to estimate odds ratios and associated 95% confidence intervals for the association between pressure ulcer likelihood and lowest Braden Scale measurement. To determine the discriminatory ability of the Braden Scale on pressure ulcer risk, four measures of performance (i.e., sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio) were calculated for four nonmutually exclusive groups: a Braden Scale measurement ≤18, ≤14, ≤12, and ≤9. RESULTS From 2011 through 2014, a total of 2660 patients were admitted to the trauma/burn intensive care unit. Of these patients, 63 (2.3%) subsequently developed a pressure ulcer. A Braden Scale of ≤18 as the threshold for being at-risk of pressure ulcer had a sensitivity of 100% and specificity of 6%, whereas a Braden Scale of ≤9 had a sensitivity of 28.6% and a specificity of 90%. For all Braden Scale measurements, the positive likelihood ratio never reached the value of 10 that suggests high likelihood of an ulcer. CONCLUSIONS The Braden scale has mediocre discriminatory ability among the trauma/burn population. In addition, the low positive likelihood ratio suggests that the Braden scale may not be a useful clinical tool as it may result in unnecessary expenditure of time and personnel resources in preventing pressure ulcer formation.

Hair removal-related injuries in the United States, 1991-2014.

Hair removal practices have changed in frequency and location on the body. Previous research on hair removal injuries has focused on a specific body region, age, or gender.