Uninjured Children Research Articles

Systolic hypertension and the response to blunt trauma in infants and children

Objectives: To describe age-related systolic blood pressures and pulse rates in children following blunt injury. To compare these variables with standard reference values for uninjured children at rest and with reference ranges from the Advanced Paediatric Life Support (APLS) guidelines. Design: Secondary analysis of a prospective cohort. Setting: Emergency departments throughout England and Wales. Participants: 12 906 children presenting with acute blunt traumatic injury from August 1989 to September 1998. Main outcome measures: Systolic blood pressure and pulse rate on arrival. Results: Injured children had higher systolic blood pressures than the standard quoted ‘norms’. Standard reference values of systolic blood pressure for children at rest always appeared below the 50th percentile for our cohort of injured children (range 7th–27th percentiles). Pulse rates for children at rest were always towards the mid-range for injured children (range 41st–54th percentiles). These results appeared unrelated to injury severity. Age related APLS reference ranges for systolic blood pressure and pulse rate resembled the standard reference values for uninjured children at rest. Conclusions: Injured children have a relative systolic hypertension compared with children at rest. Pulse rates in the two groups are comparable. Following injury, children with apparently ‘normal’ age-specific systolic blood pressures on arrival in the Emergency Department are relatively hypotensive and should be carefully assessed.

ADHD and Accident Proneness

ADHD and Accident Proneness

Attention Following Pediatric Head Injury: A Developmental Perspective

This study investigated the relations between age at injury (AAI) and attentional functioning, and intellectual and academic achievement following pediatric head injury. The theoretical framework of attention proposed by Mirsky, Anthony, Duncan, Ahern, and Kellam (1991) provided the basis for this analysis, and the profile of attention found in uninjured children was evaluated for this sample. Thirty-three moderately head-injured individuals were recruited, with AAI ranging from 1 to 12 years. First, the development of attentional skills in this closed head injury (CHI) sample was found to be comparable to that of Mirsky et al.'s model. Second, AAI did not predict outcome and appeared not to be associated with the finding of mildly delayed acquisition of spelling and arithmetic skills. Also, AAI did not predict the behavioral symptoms of inattention present in this sample as indicated by parental report. It may be that AAI only influences development following severe CHI in which there is permanent cerebral pathology.

Objective Evaluation of Knee Laxity in Children

This study was designed to measure objectively knee laxity in children. Physical examination and the KT 1000 arthrometer were used to test the knee laxity of 150 healthy, uninjured children between 6 and 18 years of age. Data from the knee examinations and the KT 1000 measurements were compared and statistically analyzed to determine the change in knee laxity with age, laxity differences between boys and girls, and the correlation between the KT1000 measurements and subjective tests for laxity described by Carter and Wilkinson. There was no statistical difference in knee laxity between boys and girls of similar ages. We found that knee laxity, determined by measuring the millimeters of tibial translation using the KT 1000 arthrometer, was significantly greater in younger children.

Corpus Callosum Damage and InterhemispherIc Transfer of Information following Closed Head Injury in Children

We evaluated the relationship of corpus callosum atrophy and/or lesions on magnetic resonance imaging (MRI) to functional hemispheric disconnection following closed head injury (CHI) in 51 pediatric patients, including mild CHI, moderate to severe CHI with extracallosal lesions, and moderate to severe CHI with callosal atrophy and/or lesions. Interhemispheric transfer of information was assessed using auditory, motor, tactile, and visual tests in patients and in 16 uninjured children. Total and regional callosal areas were measured from the midsagittal MRI slice by morphometry. The corpus callosum lesion group demonstrated a greater right ear advantage on verbal dichotic listening than all other groups. Areas of the posterior corpus callosum were negatively correlated with laterality indices of verbal dichotic listening performance and tachistoscopic identification of verbal material. The relationship of corpus callosum atrophy and/or lesions to asymmetry in dichotic listening is consistent with previous investigation of posttraumatic hemispheric disconnection effects in adults.

A population based case-control study of agricultural injuries in children.

To identify preventable risk factors related to agricultural injuries occurring to children on family farms. A geographically defined central region of Wisconsin, USA with nearly 1800 family dairy farms. A two year, population based incidence study of occupational injuries among farm residents was conducted. For cases, trained staff abstracted information on the nature, severity, and treatment of the injury from the patient's medical record. Staff also administered a telephone questionnaire to cases and controls, usually answered by parents. There were 60 cases of farm residents younger than 18 years who sought care for acute agriculture related injuries. Farms on which uninjured children lived served as controls (n = 102). Multivariate analyses of 16 different variables revealed three significantly related to injuries to children: hours worked per week (odds ratio (OR) = 1.05; 95% confidence interval (CI) = 1.01 to 1.08); presence of disabled safety device (OR = 2.64; 95% CI = 1.10 to 6.35); and feeding cows by grazing (OR = 0.22; 95% CI = 0.06 to 8.83). Interventions designed to reduce the risk of agricultural injuries to farm children should acknowledge the participation of children as productive workers on the farm. Although education has been the standard method for encouraging safe practices in farm work, additional approaches, such as limiting the number of hours a child works, avoiding the disabling of safety devices, and using specific methods of managing cows, should also be adopted to minimize injury risks to farm children.

Behavior of injured and uninjured children and their parents in a simulated hazardous setting.

Compared the behavior of parents and their previously injured children with parents and their uninjured children in unstructured play and distracted parent conditions. Injured children were more disruptive, more active, and had more contacts with hazards, whereas uninjured children had more appropriate behavior. Parents of injured children had lower rates of play activities. Observable classes of parent and child behaviors amenable to change were associated with a history of child injury. Further study is needed to assess the use of safe and unsafe behavior as proxy measures for injuries and to identify functional classes of safe and unsafe behavior for which active strategies can be developed to prevent children's injuries.

Cognitive and Behavioral Sequelae of Mild Head Injury in Children

Data from a longitudinal study of 13,000 British children were used to assess the sequelae of mild head injury 1 to 5 years after injury. One hundred fourteen children with parental reports of mild head injury treated with ambulatory care or admission to hospital for one night were compared with 601 children with limb fractures, 605 with lacerations, 136 with burns, and 1726 children without injury. Scores at age 10 were adjusted for intelligence, aggressive and hyperactive behavior at age 5, sex, socioeconomic status, and six other social factors. Children with head injuries were statistically indistinguishable from uninjured children on all outcomes except teacher's report of hyperactivity. After control of hyperactivity at age 5 and the social and personal factors, the head-injured children's mean hyperactivity score was four tenths of a standard deviation above that of the uninjured children. Children with lacerations and burns scored as badly or worse on measures of intelligence, mathematics, reading, and aggression as the children with head injuries. The small magnitude of the hyperactivity association coupled with the overall negative results suggests that mild head injury in school-aged children does not have an adverse effect on global measures of cognition, achievement, and behavior 1 to 5 years after injury.

Hyoid bone position in children following neck injury

Previously described radiographic signs of hyoid bone elevation, seen on the lateral radiograph, suggesting tracheal transection (Polansky et al., 1984) are present in uninjured children. These signs are therefore not reliable indicators of tracheal transection in children.

A case-control study of pedestrian and bicyclist injuries in childhood.

We identified children ages 0 to 14 years injured in traffic as pedestrians or bicyclists in Montreal, Canada. Two hundred children with injuries who received a score of 2 or more on the Maximum Abbreviated Injury Severity scale were considered as cases and compared with 400 uninjured children seen in the same hospitals for non-traumatic reasons. Systematic, blinded interviews and tests were conducted with parents to determine the role of a series of social, familial, personal, and behavioral characteristics. After adjustment for age, gender and socioeconomic area of residence, logistic regression analyses showed higher risks of injury to be related to fewer years of parents' education, a history of accident to a family member, an environment judged as unsafe, and poor parental supervision. Absence of physical health problems, fewer family preventive behaviors and reported lack of cautiousness were also related to a higher risk, whereas neither aggressivity nor behavioral disturbance, whether internalizing or externalizing, showed any such relation. These data suggest that the child's personality and behavior are weaker risk factors for pedestrian and bicyclist injuries than are family and neighborhood characteristics.