Burns resulting from child maltreatment are tragic causes of significant morbidity and mortality, most commonly affecting children under 3 years of age. More than one third of nonaccidental burns occur in single-parent homes or have parents with history of mental illness, substance abuse, incarceration, or Department of Children and Family Services (DCFS) involvement. The authors sought to profile pediatric burn injuries associated with DCFS investigations. They performed a retrospective chart review of pediatric burn patients, admitted between January 1, 2011 and December 31, 2014. They analyzed patient and household demographics, family composition, employment, zip code, insurance, etiology, percent TBSA burned, surgical interventions, length of hospital stay, disposition, prior DCFS involvement, and DCFS investigation outcomes. There were 126 DCFS investigations involving patients with average age of 2.6 ± 3.2 years and 5 ± 5.6% TBSA burn. Scalds were the most prevalent etiology at 76%. Parents involved with DCFS were 5 years younger than those without DCFS. Factors associated with increased odds of DCFS investigation were non-Caucasian race, single-parent homes, unemployed primary caretaker, Medicaid utilization, and prior DCFS involvement. A majority of DCFS investigations were initiated at outside hospitals, and they found one third to be substantiated cases of abuse. Non-Caucasian children, under 3 years of age, from lower socioeconomic or single-parent homes, are associated with higher rates of DCFS investigations. The majority of DCFS investigations were unsubstantiated and there were no significant epidemiological differences between unsubstantiated and substantiated cases of abuse. Improved understanding of sociodemographic risk factors for children at higher risk for negligence or intentional abuse warrants focused public health programs on regional prevention and education.
Cochlear implant (CI) users are affected more than their normal hearing (NH) peers by the negative consequences of background noise on speech understanding. Research has shown that adult CI users can improve their speech recognition in challenging listening environments by using dual-microphone beamformers, such as adaptive directional microphones (ADMs) and wireless remote microphones (RMs). The suitability of these microphone technologies for use in children with CIs is not well-understood nor widely accepted.To assess the benefit of ADM or RM technology on speech perception in background noise in children and adolescents with cochlear implants (CIs) with no previous or current use of ADM or RM.Mixed, repeated measures design.Twenty (20) children, ten (10) CI users (mean age 14.3 yrs) who used Advanced Bionics HiRes90K implants with research Naida processors, and ten (10) NH age-matched controls participated in this prospective study.CI users listened with an ear-canal level microphone, T-Mic (TM), an ADM, and a wireless RM at different audio-mixing ratios. Speech understanding with five microphone settings (TM 100%, ADM, RM + TM 50/50, RM + TM 75/25, RM 100%) was evaluated in quiet and in noise.Speech perception ability was measured using children’s spondee words to obtain a speech recognition threshold for 80% accuracy (SRT80%) in 20-talker babble where the listener sat in a sound booth 1 m (3.28′) from the target speech (front) and noise (behind) to test five microphone settings (TM 100%, ADM, RM + TM 50/50, RM + TM 75/25, RM 100%). Group performance-intensity functions were computed for each listening condition to show the effects of microphone configuration with respect to signal-to-noise ratio (SNR). A difference score (CI Group minus NH Group) was computed to show the effect of microphone technology at different SNRs relative to NH. Statistical analysis using a repeated-measures analysis of variance evaluated the effects of the microphone configurations on SRT80% and performance at SNRs. Between-groups analysis of variance was used to compare the CI group with the NH group.The speech recognition was significantly poorer for children with CI than children with NH in quiet and in noise when using the TM alone. Adding the ADM or RM provided a significant improvement in speech recognition for the CI group over use of the TM alone in noise (mean dB advantage ranged from 5.8 for ADM to 16 for RM100). When children with CI used the RM75 or RM100 in background babble, speech recognition was not statistically different from the group with NH.Speech recognition in noise performance improved with the use of ADM and RM100 or RM75 over TM-only for children with CIs. Alhough children with CI remain at a disadvantage as compared with NH children in quiet and more favorable SNRs, microphone technology can enhance performance for some children with CI to match that of NH peers in contexts with negative SNRs.
Introduction With increased focus amongst hospital systems regarding the quality of care provided, there has been augmented awareness on minimizing unplanned 30 day hospital readmission rates. As part of our burn center’s internal quality improvement process, a discharge readiness checklist was developed to identify patients at high risk for readmission. Methods A 20 item checklist of potential risk factors was developed, and was then cross referenced to all patients readmitted within 30 days of discharge over a one year period (September 2018-August 2019). Retrospective chart review was used to determine how many checklist factors were positive for each patient. The primary outcome was determining the main risk factors leading to a high risk for readmission. Results During this time period, there were 683 admission to our burn center. A total of 13 patients led to a sum of 14 readmissions (2.0%). The age range of patients was between 37 and 84 years old, with a median and average age of approximately 59 years. The distribution of patients included 7 with burn injuries (50%), 6 with soft tissue infections (42.9%) and 1 with frostbite (7.1%). Traditional LACE (Length of stay, Acuity, Co-morbidities, ED visits) score calculation would have identified only 1 of 14 readmissions in the high risk category. Average LACE score was 8.1 for all patients. Of the 20 item checklist, the risk factors most commonly associated with readmission were lack of family support (12/14, 85.7%), surgery performed during index hospitalization (11/14, 78.6%), significant co-morbidities (11/14, 78.6%), location of injuries in difficult to access anatomical regions (8/14, 57.1%), poor nutritional status (6/14. 42.8%) and length of stay greater than 1 day per percent of total body surface area burn involvement (5/7, 71.4%). The average number of identifiable risk factors was 5.38 per patient (ranging from 2 to 9 risk factors per patient). Conclusions Traditional risk assessment scores (i.e. LACE) do not capture patients at high risk for readmission in a burn center. Development of an alternative checklist may help to identify these patients prior to discharge, with the potential to allocate additional resources to ultimately decrease 30 day readmission rates. Applicability of Research to Practice Decreased 30 day readmission rates would lead to overall cost savings and improved patient outcomes.
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