Background Traumatic brain injuries (TBI) in children result in significant morbidity and mortality. There are many mechanisms, both sport and non-sport related, which cause these injuries. Studies have reported that Emergency Department (ED) visits for pediatric TBI caused by sports are increasing; however, no subsequent study has evaluated the trend in non-sport TBI. The objective of this study was to evaluate ED visits, admissions, and deaths for non-sport TBI compared to those caused by sports. Methods A retrospective study of children 5–19 years of age was performed at a pediatric, level 1 trauma center from 2002 to 2012. Subjects with a primary or secondary diagnosis of TBI were identified from the hospital’s trauma registry, and mechanism of injury, disposition, injury severity score, and length of stay were recorded. Frequencies were used to characterize the population, Chi-square analysis was performed to determine differences between groups, and linear trend lines were calculated for sport-related and non-sport TBI by year. Results Thirteen thousand two hundred ninty one subjects were seen in the ED between 2002 and 2012 for a TBI; 9527 (72%) were from a non-sport mechanism, and 3764 (28%) were from a sport mechanism. Subjects with a non-sport TBI were more likely to be younger ( p < 0.001), African American ( p < 0.001), and have Medicare/Medicaid ( p < 0.001). Subjects with a non-sport TBI were admitted to the hospital 15% of the time, and subjects with a sport-related TBI were admitted 10% of the time ( p < 0.001). When evaluating all TBI by mechanism of injury, sport had the lowest injury severity score (mean 4.4) and the shortest length of stay (mean 1.6 days) of any mechanism. There were six deaths reported from non-sport TBI and none from sport-related TBI. ED visits for sport-related TBI increased 92%, and non-sport TBI increased 22% over 10 years. There was a peak in TBI, in both groups, seen in 2009. Conclusions ED visits for both sport and non-sport TBI have increased over the past 10 years. TBI from a non-sport mechanism was more likely to result in hospitalization or death. Prevention efforts should be expanded to include all high-risk TBI mechanisms, not just sports.
WHAT'S KNOWN ON THIS SUBJECT: Traumatic brain injury (TBI) in children causes significant morbidity and mortality. Parental and coach awareness about brain injury due to sports has recently increased. Since 2001, pediatric emergency departments have seen a significant increase in sports-related TBI.WHAT THIS STUDY ADDS: Pediatric, sports-related TBIs cared for in the emergency department and admitted to the hospital have both increased, resulting in no change in the percentage being admitted. However, patients admitted have had a significant reduction in injury severity. abstract BACKGROUND: Emergency department (ED) visits for sports-related traumatic brain injuries (TBIs) have risen. This study evaluated how the number and severity of admissions have changed as ED visits for sports-related TBIs have increased.METHODS: A retrospective study of children aged 0 to 19 years at a level 1 trauma center was performed. Patients from 2002 to 2011 with a primary or secondary diagnosis of TBI were identified from the hospital' s inpatient and outpatient trauma registries. Frequencies were used to characterize the population, x 2 analysis was performed to determine differences between groups, and regression analysis looked at relationship between year and injury severity score or length of stay.RESULTS: Sport was responsible for injury in 3878 (15.4%) cases during the study period; 3506 (90.4%) were discharged from the hospital, and 372 (9.6%) were admitted. Seventy-three percent were male patients and 78% Caucasian; mean age was 13 6 3.5 years. ED visits for sports-related TBIs increased 92% over the study period, yet there was no significant change (x 2 = 9.8, df = 9, P = .37) in the percentage of children admitted. Mean injury severity score for those admitted decreased from 7.8 to 4.8 (b = -0.46; P = .006); length of stay trended downward (b = -0.05; P = .05). CONCLUSIONS:The percentage of children being admitted from the ED with sports-related TBI has not changed over the past 10 years. The severity of admitted sports-related TBI is decreasing. Additional research is needed to correlate these trends with other TBI mechanisms. Pediatrics 2013;132:e859-e864
OBJECTIVES: To determine the prevalence of invasive bacterial infections (IBIs) and adverse events in afebrile infants with acute otitis media (AOM). METHODS: We conducted a 33-site cross-sectional study of afebrile infants ≤90 days of age with AOM seen in emergency departments from 2007 to 2017. Eligible infants were identified using emergency department diagnosis codes and confirmed by chart review. IBIs (bacteremia and meningitis) were determined by the growth of pathogenic bacteria in blood or cerebrospinal fluid (CSF) culture. Adverse events were defined as substantial complications resulting from or potentially associated with AOM. We used generalized linear mixed-effects models to identify factors associated with IBI diagnostic testing, controlling for site-level clustering effect. RESULTS: Of 5270 infants screened, 1637 met study criteria. None of the 278 (0%; 95% confidence interval [CI]: 0%–1.4%) infants with blood cultures had bacteremia; 0 of 102 (0%; 95% CI: 0%–3.6%) with CSF cultures had bacterial meningitis; 2 of 645 (0.3%; 95% CI: 0.1%–1.1%) infants with 30-day follow-up had adverse events, including lymphadenitis (1) and culture-negative sepsis (1). Diagnostic testing for IBI varied across sites and by age; overall, 278 (17.0%) had blood cultures, and 102 (6.2%) had CSF cultures obtained. Compared with infants 0 to 28 days old, older infants were less likely to have blood cultures (P < .001) or CSF cultures (P < .001) obtained. CONCLUSION: Afebrile infants with clinician-diagnosed AOM have a low prevalence of IBIs and adverse events; therefore, outpatient management without diagnostic testing may be reasonable.
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