Objectives: Fatalities due to being left in motor vehicles is an important cause of pediatric mortality. Few studies in the medical literature focus on this topic. This study aims to describe the circumstances surrounding these deaths, to determine their geographic distribution, and to evaluate the legal consequences for those responsible.Methods: This is a retrospective cohort study of individuals ≤14 years old who died of heatstroke after being left in motor vehicles from 1990 through 2016 using a database provided by KidsAndCars.org. Descriptive data and specified outcomes regarding victims and responsible individuals were recorded.Results: Of the 541 cases included for analysis, 528 fatalities involved a single victim and 26 fatalities involved 2 or more victims left in a vehicle. Of all fatalities, 54.4% were male and the mean age was 16.4 (±13.7) months. The responsible individual(s) unknowingly left the victim(s) in the vehicle in 78.2% of cases and knowingly left the victim(s) in 16.6% of cases. A single individual was responsible for leaving the victim(s) in 88.9% of cases. The cases were noted in 45 of 50 states and most commonly occurred in Texas (15%), Florida (12%), and California (7%). Criminal charges against the responsible individual(s) occurred in 58.2% of cases.Conclusions: Pediatric fatalities due to being left in motor vehicles most commonly occur when a caregiver leaves a child unknowingly in a home parking area. These fatalities occur most often in Texas, Florida, and California. Responsible individuals are frequently charged with a crime.

Direct oral anticoagulants (DOACs) have been shown to be as effective or superior to warfarin, but warfarin use remains constant. Knowledge regarding the patient population who have switched from a DOAC to warfarin is limited. The objective of this study was to identify clinical predictors which may influence a patient's likelihood of switching from a DOAC to warfarin for atrial fibrillation (AF) or venous thromboembolism (VTE). MeThODS: In this single-center, case-control study, patients who switched from a DOAC to warfarin were compared with patients who remained on a DOAC. Baseline demographics were compared between the switch and control groups. Independent factors that increased the likelihood of switching from a DOAC to warfarin were analyzed using logistic regression. ReSulTS: A total of 150 patients were included in the control (n = 100) and switch (n = 50) groups. Patients switched from a DOAC to warfarin had more medications at baseline (9 [7, 13] vs 11 [8, 18], P = 0.009). The presence of heart failure (HF) increased the likelihood of switching (odds ratio [OR] = 3.95, confidence interval [CI] = 1.70-9.21, P = 0.002), and for every 10 mL/min increase in creatinine clearance (CrCl), the likelihood of switching decreased (R = 0.89 [0.80-0.99], P = 0.026). Patients with pulmonary embolism (PE) were less likely to switch from a DOAC to warfarin (OR = 0.20, CI = 0.05-0.86, P = 0.031). Explicitly listed reasons for switching included left ventricular assist device (LVAD) implantation (20%) and valve replacement procedures (20%). COnCluSIOn: Congestive HF was a clinical predictor associated with an increased likelihood of switching from a DOAC to warfarin. Anticoagulation therapy for PE and higher CrCl was associated with a decreased likelihood in switching from DOAC to warfarin.

Implementation of a simplistic bivalirudin-warfarin transition protocol significantly increased the frequency of therapeutic INR results on bivalirudin discontinuation. Additionally, patients treated according to this protocol were less likely to have warfarin doses withheld or require reversal agents. Larger studies testing this transition strategy are warranted.