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Purpose: The purpose of this study was to evaluate the internal consistency and construct validity of the Traumatic Brain Injury Quality of Life Communication Item Bank (TBI-QOL COM) short form as a parent-proxy report measure. The TBI-QOL COM is a patient-reported outcome measure of functional communication originally developed as a self-report measure for adults with traumatic brain injury (TBI), but it may also be valid as a parent-proxy report measure for children who have sustained TBI. Method: One hundred twenty-nine parent-proxy raters completed the TBI-QOL COM short form 6 months postinjury as a secondary aim of a multisite study of pediatric TBI outcomes. The respondents' children with TBI were between 8 and 18 years old (M[subscript age] = 13.2 years old) at the time of injury, and the proportion of TBI severity mirrored national trends (73% complicated-mild; 27% moderate or severe). Results: The parent-proxy report version of the TBI-QOL COM displayed strong internal consistency (ordinal [alpha] = 0.93). It also displayed evidence of known-groups validity by virtue of more severe injuries associated with more abnormal scores. The instrument also showed evidence of convergent and discriminant validity by displaying a pattern of correlations with other constructs according to their conceptual relatedness to functional communication. Conclusions: This preliminary psychometric investigation of the TBI-QOL COM supports the further development of a parent report version of the instrument. Future development of the TBI-QOL COM with this population may include expanding the content of the item bank and developing calibrations specifically for parent-proxy raters.

OBJECTIVE. The popularity of sport utility vehicles (SUVs) is growing, and they are increasingly being used as family vehicles. Because of the large size of SUVs, relative to passenger cars, parents may perceive that they are safer family vehicles. However, little is known about the safety of children in SUVs, compared with passenger cars. The objective of this study was to determine the relative risk of injury to children involved in crashes in SUVs, compared with those in passenger cars. DESIGN. From an on-going motor vehicle crash surveillance system, a probability sample of 3922 child occupants 0 to 15 years of age, representing 72 396 children in crashes of either SUVs or passenger cars (model year 1998 or newer), from 3 large US regions, was identified between March 1, 2000, and December 31, 2003. Injuries were defined as concussions and other brain injuries, spinal cord injuries, facial fractures and lacerations, internal organ injuries, extremity fractures, and scalp lacerations. Logistic regression modeling was used to compute the odds ratio (OR) of injury for children in SUVs versus passenger cars, both unadjusted and adjusted for several potential confounders, including differences in child seating position, restraint use, vehicle weight, exposure of the child to a passenger airbag, and whether the vehicle rolled over. RESULTS. A total of 38.2% of children were in SUVs and 61.8% were in passenger cars. The average weight of SUVs was 1317 lb greater than the average weight of passenger cars. Among all children in the study, those restrained appropriately were less likely to be injured (OR: 0.25; 95% confidence interval [CI]: 0.15-0.45) and those in the front seat were more likely to be injured (OR: 2.06; 95% CI: 1.33-3.21). In both vehicle types, children exposed to a passenger airbag were more likely to be injured than were those who were not (OR: 4.70; 95% CI: 2.36-9.37). Rollover crashes increased the risk of injury in both vehicle types (OR: 3.29; 95% CI: 1.88-5.76) and occurred more than twice as frequently with SUVs (2.9%, compared with 1.2% with passenger cars). There was a trend for increasing vehicle weight being a protective factor with both vehicle types (OR: 0.86; 95% CI: 0.73-1.01). After adjustment for all of the aforementioned factors, the risk of injury was not significantly different for children in SUVs versus passenger cars (adjusted OR: 1.50; 95% CI: 0.88-2.57). Especially detrimental for children in SUVs was being unrestrained versus restrained in a rollover crash (OR: 24.99; 95% CI: 6.68-93.53). CONCLUSIONS. Despite the greater vehicle weight of SUVs, the risk of injury for children in SUVs is similar to that for children in passenger cars. The potential advantage offered by heavier SUVs seems to be offset by other factors, including an increased tendency to roll over. Age-appropriate child restraint and rear seat positioning are important, particularly for children in SUVs, given the very high risk of injury for children restrained inappropriately in rollover crashes. www.pediatrics.org/cgi/doi/10.1542/ peds.2004-1364 doi:10.1542/peds.2004-1364 Key Words sport utility vehicles, accidents, motor vehicle safety Abbreviations SUV--sport utility vehicle OR--odds ratio CI--confidence interval PAB--passenger airbag AIS--Abbreviated Injury Scale, SPORT UTILITY VEHICLES (SUVs) are growing in popularity in the United States and increasingly are being used as family vehicles. (1) The number of SUV registrations rose 250% between 1995 [...]

Objective. Selective nonoperative management of pediatric blunt splenic injury became the standard of care in the late 1980s. The extent to which this practice has been adopted in both trauma centers and nontrauma hospitals has been investigated sporadically. Several studies have demonstrated significant variations in practice patterns; however, most published studies capture only a selective population over a relatively short time interval, often without simultaneous adjustment for confounding variables. The objective of this study was to characterize the variation in operative versus nonoperative management of blunt splenic injury in children in nontrauma hospitals and in trauma centers with varying resources for pediatric care within a regionalized trauma system in the past decade. Methods. The study population included all children who were younger than 19 years and had a diagnosis of blunt injury to the spleen (International Classification of Diseases code 865.00-865.09) and were admitted to each of the 175 acute care hospitals in Pennsylvania between 1991 and 2000. The proportion of patients who were treated operatively was stratified by trauma-level certification and adjusted for age and splenic injury severity. Multivariable logistic regression models were used to generate probabilities of splenectomy by age, injury severity, and hospital type. Results. From 1991 through 2000 in Pennsylvania, 3245 children sustained blunt splenic injury that required hospitalization; 752 (23.2%) were treated operatively. Generally, as age and splenic injury severity increased, the proportion of patients who were treated operatively increased. Compared with pediatric trauma centers, the relative risk (with associated 95% confidence interval) of splenectomy was 4.4 (3.0-6.3) for level 1 trauma centers with additional qualifications in pediatrics; 6.2 (4.4-8.7) for level 1 trauma centers, 6.3 (5.3-7.4) for level 2 trauma centers, and 5.0 (4.2-5.9) for nontrauma centers. Significant variation in practice pattern was seen among hospital types and over time even after adjustment for age and injury severity. Conclusions. The operative management of splenic injury in children varied significantly by hospital trauma status and over time during the past decade in Pennsylvania. Given the relative benefits of nonoperative treatment for children with blunt splenic injury, these results highlight the need for more widespread and standardized adoption of this treatment, particularly in hospitals without a large volume of pediatric trauma patients. Pediatrics 2005;115:89-94; trauma systems, pediatric trauma care, splenic injury, blunt abdominal injury., ABBREVIATIONS. ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; PHC4, Pennsylvania Health Care Cost Containment Council; PTC, pediatric trauma center; AQTC, level 1 trauma center with additional qualifications in [...]

Objective. To assess the effectiveness of an emergency department (ED)-based home safety intervention on caregivers' behaviors and practices related to home safety. Methods. We conducted a randomized, clinical trial of 96 consecutive caregivers of children who were younger than 5 years and presented to an urban pediatric ED for evaluation of an acute unintentional injury sustained in the home. After completing a structured home safety questionnaire via face-to-face interview, caregivers were randomly assigned to receive either comprehensive home safety education and free safety devices or focused, injury-specific ED discharge instructions. Participants were contacted by telephone 2 months after the initial ED visit for repeat administration of the safety questionnaire. The pretest and posttest questionnaires were scored such that the accrual of points correlated with reporting of safer practices. Scores were then normalized to a 100-point scale. The overall safety score reflected performance on the entire questionnaire, and the 8 category safety scores reflected performance in single areas of home injury prevention (fire, burn, poison, near-drowning, aspiration, cuts/piercings, falls, and safety device use). The main outcome was degree of improvement in safety practices as assessed by improvement in safety scores. Results. The intervention group demonstrated a significantly higher average overall safety score at follow-up than the control group (73.3% [+ or -] 8.4% vs 66.8% [+ or -] 11.1) and significant improvements in poison, cut/ piercing, and burns category scores. Caregivers in the intervention group also demonstrated greater improvement in reported use of the distributed safety devices. Conclusions. This educational and device disbursement intervention was effective in improving the home safety practices of caregivers of young children. Moreover, the ED was used effectively to disseminate home injury prevention information. Pediatrics 2004;113: 1603-1608; injury, prevention, safety counseling, anticipatory guidance, emergency department., ABBREVIATIONS. ED, emergency department; OSS, overall safety score; CSS, category safety score. Each year, millions of US children are injured in their own homes. (1) Injuries from falls, poisonings, fires, [...]

Parents can reduce the risk of injury to their young children by 59% by using belt-positioning booster seat for all children between four and seven years of age. This was the conclusion of a study of 4,243 children in this age group who were involved in a car crash. The booster seat also completely prevented injuries to the abdomen, neck, spine, and lower extremities.

Objective. Head injury is the leading cause of death in abused children under 2 years of age. Evidence for establishing guidelines regarding screening for occult head injury in a neurologically asymptomatic child with other evidence of abuse is lacking. This is particularly important given that many children with acute inflicted head injury have evidence of old injury when they are diagnosed. The primary aim of this study was to estimate the prevalence of occult head injury in a high-risk sample of abused children with normal neurologic examinations. The secondary aim was to describe characteristics of this population. Methods. Children under 2 years of age admitted to an urban children's hospital between January 1998 and December 2001 with injuries suspicious for child abuse were eligible for this study if they had a normal neurologic examination on admission. Subjects were selected if they met 1 of the following "high-risk" criteria: rib 1fractures, multiple fractures, facial injury, or age Results. Of the 65 patients who met these criteria, 51 (78.5%) had a head computed tomography or magnetic resonance imaging in addition to skeletal survey. Of these 51 patients, 19 (37.3%, 95% confidence interval 24.2-50.4%) had an occult head injury. Injuries included scalp swelling (74%), skull fracture (74%), and intracranial injury (53%). All except 3 of the head-injured patients had at least a skull fracture or intracranial injury. Skeletal survey alone missed 26% (5/19) of the cases. Head-injured children were younger than non-head-injured children (median age 2.5 vs 5.1 months); all but 1 head-injured child was Conclusions. Our results support a recommendation for universal screening in neurologically asymptomatic abused children with any of the high-risk criteria used in this study, particularly if that child is under 1 year of age. Ophthalmologic examination is a poor screening method for occult head injury, and one should proceed directly to computed tomography or magnetic resonance imaging. Given the high prevalence of occult head injury detected in this study, further study is warranted to estimate the prevalence of occult head injury in lower risk populations of abused children. Pediatrics 2003;111:1382-1386; child abuse, head injury., ABBREVIATIONS. CT, computed tomography; MRI, magnetic resonance imaging; CI, confidence interval. Head injury is the leading cause of death in abused children under 2 years of age, (1,2) and early [...]

Children who sit in the back seat of a compact extended-cab pickup truck have a higher risk of injury than children who sit in other vehicles. These pickup trucks have a small back seat area, but it contains side-facing fold-down seats that are exempt from regulatory safety testing., Context An increasing number of compact pickup trucks can accommodate restrained rear occupants. Rear seats in these pickup trucks are exempt from regulatory safety testing though their relative safety has not been determined. Objectives To evaluate the risk of injury to children in compact extended-cab pickup trucks compared with children in other vehicles and to determine if any unique hazards exist. Design Cross-sectional study of children aged 15 years or younger in crashes of insured vehicles, with data collected via insurance claim records and a telephone survey. Setting and Participants Probability sample of 7192 multirow vehicles involved in crashes, with 11335 child occupants, in 3 large US regions from December 1, 1998, to November 30, 2000. Main Outcome Measure Relative risk of injury, defined as concussions and more serious brain injuries, spinal cord injuries, internal organ injuries, extremity fractures, and facial lacerations, estimated by odds ratios (ORs) adjusting for age, restraint use, point of impact, vehicle weight, and crash severity. Results Injuries were reported for 1356 children, representing 1.6% of the population. Children in compact extended-cab pickup trucks were at greater risk of injury than children in other vehicles (adjusted OR, 2.96; 95% confidence interval [Cl], 1.685.21). Children in the rear seats of compact pickup trucks were at substantially greater risk of injury than rear-seated children in other vehicles (adjusted OR, 4.75; 95% Cl, 2.39-9.43). Children seated in the front seat of compact extended-cab pickup trucks were at greater risk of injury than children in the front seats of other vehicles, but this risk was not statistically significant (adjusted OR, 1.70; 95% Cl, 0.78-3.69). Conclusions Children in compact extended-cab pickup trucks are not as safe as children in other vehicles, primarily due to the increased relative risk of injury in the back seat. For families with another choice of vehicle, clinicians should advise parents against transporting children in compact pickup trucks. The current exemption for regulatory testing for occupant protection in the rear seats of compact pickup trucks should be reconsidered.