Injured children treated at ATCs and MTCs had higher in-hospital mortality compared with those treated at PTCs. This association was most evident in younger children and remained significant in severely injured children. Quality improvement initiatives geared toward ATCs and MTCs are required to provide optimal care to injured children.

Objectives. We analyzed urban–rural differences in intentional firearm death. Methods. We analyzed 584629 deaths from 1989 to 1999 assigned to 3141 US counties, using negative binomial regressions and an 11-category urban–rural variable. Results. The most urban counties had 1.03 (95% confidence interval [CI]=0.87, 1.20) times the adjusted firearm death rate of the most rural counties. The most rural counties experienced 1.54 (95% CI=1.29, 1.83) times the adjusted firearm suicide rate of the most urban. The most urban counties experienced 1.90 (95% CI=1.50, 2.40) times the adjusted firearm homicide rate of the most rural. Similar opposing trends were not found for nonfirearm suicide or homicide. Conclusions. Firearm suicide in rural counties is as important a public health problem as firearm homicide in urban counties. Policymakers should become aware that intentional firearm deaths affect all types of communities in the United States.

Appendiceal perforation continues to be a common occurrence in the young child and increases in frequency as the age of the patient decreases and the duration of symptoms lengthens. Perforation results in a significant increase in hospital length of stay and rate of abscess formation.

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This study demonstrates that ultrasound-guided RSB provides superior analgesia in the perioperative period compared with infiltration of the surgical site after umbilical hernia repair. In comparing only the postoperative period, analgesia provided by an ultrasound-guided RSB showed a trend towards statistically significant improvement compared with infiltration of the surgical site.

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