Evidence-Based Assessment of Pediatric Injury and Injury Risk

Abstract Purpose Medications are commonly associated with acute kidney injury (AKI). However, in both clinical practice and research, consideration of specific medications as nephrotoxic varies widely. The Nephrotoxic Injury Negated by Just-in-time Action quality improvement collaborative was formed to focus on prevention or reduction of nephrotoxic medication-associated AKI in noncritically ill hospitalized children. However, there were discrepancies among institutions as to which medications should be considered nephrotoxic. The collaborative convened a Nephrotoxic Medication (NTMx) Subcommittee to develop a consensus for the classification of nephrotoxic medications. Summary The NTMx Subcommittee initially included pediatric nephrologists, a pharmacist, and a pediatric intensivist. The committee reviewed NTMx lists from the collaborative and identified changes from the initial NTMx list. The NTMx Subcommittee conducted a literature review of the disputed medications and assigned an evidence grade based on the reported association with nephrotoxicity and the quality of the data. The association between medication exposure and AKI was also determined using administrative data from the Pediatric Health Information Systems database. The NTMx Subcommittee then came to a majority consensus regarding which medications should be included on the list. The subcommittee’s recommendations were presented to the larger collaborative for approval, and consensus was achieved. The list continues to be reviewed and updated annually. Conclusion Formation of a multicenter quality-improvement initiative exposed current limitations as to which medications are considered nephrotoxic in clinical and research settings and presented an opportunity to approach this problem using an evidence-based process. A consensus definition of nephrotoxic-medication exposure was achieved.

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What are the perceptions of runners and healthcare professionals on footwear and running injury risk?

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000767 ◽

2020 ◽

Vol 6 (1) ◽

pp. e000767

Author(s):

Gurmeet K Dhillon ◽

Michael A Hunt ◽

Andrea L Reid ◽

Jean-Francois Esculier

Keyword(s):

Injury Risk ◽

Online Survey ◽

Healthcare Professionals ◽

Perceived Usefulness ◽

Selection Strategy ◽

Evidence Based ◽

Educational Module ◽

Future Studies ◽

Online Module ◽

Running Injury

ObjectivesThere is a gap in research exploring perceptions of runners and healthcare professionals (HCPs) about running footwear and injury risk. The objectives of this study were: (1) to document factors considered by runners when selecting footwear; (2) to compare perceptions on footwear and injury risk in runners and HCPs; and (3) to evaluate the perceived usefulness of an online educational module.MethodsUsing an online survey, we collected information on demographics and perceptions about footwear and injury risk. Runners reported their footwear selection strategy, and HCPs their typical recommendations. An evidence-based educational module was presented, and participants rated its usefulness.ResultsThe survey was completed by 2442 participants, of which 1035 completed the optional postmodule questions. Runners reported relying mostly on comfort and advice from retailers when selecting shoes. Perceptions regarding the effects of specific footwear types (minimalist, maximalist), characteristics (softness, drop) and selection strategy (foot type, transition) on biomechanics and injury risk were different between HCPs and runners. Overall, runners perceived footwear as more important to prevent injury than did HCPs (7.6/10, 99% CI 7.4 to 7.7 vs 6.2/10, 99% CI 6.0 to 6.5; p<0.001). Both runners (8.1/10, 99% CI 7.9 to 8.3) and HCPs (8.7/10, 99% CI 8.6 to 8.9) found the educational module useful. A majority of respondents indicated the module changed their perceptions.ConclusionFootwear is perceived as important in reducing running injury risk. This online module was deemed useful in educating about footwear evidence. Future studies should evaluate if changes in perceptions can translate to behaviour change and, ultimately, reduced injury risk.

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Influence of wet surfaces and fall height on pediatric injury risk in feet-first freefalls as predicted using a test dummy

Medical Engineering & Physics ◽

10.1016/j.medengphy.2004.09.005 ◽

2005 ◽

Vol 27 (1) ◽

pp. 31-39 ◽

Cited By ~ 15

Author(s):

Ernest Deemer ◽

Gina Bertocci ◽

Mary Clyde Pierce ◽

Fernando Aguel ◽

Janine Janosky ◽

...

Keyword(s):

Injury Risk ◽

Pediatric Injury ◽

Fall Height

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Managing the Training Load in Adolescent Athletes

International Journal of Sports Physiology and Performance ◽

10.1123/ijspp.2016-0334 ◽

2017 ◽

Vol 12 (s2) ◽

pp. S2-42-S2-49 ◽

Cited By ~ 11

Author(s):

Andrew Murray

Keyword(s):

Athletic Performance ◽

Injury Risk ◽

Systematic Approach ◽

Training Load ◽

Evidence Based ◽

Adolescent Athletes ◽

Training Dose ◽

Modern Times ◽

Load Monitoring ◽

Athletic Development

While historically adolescents were removed from their parents to prepare to become warriors, this process repeats itself in modern times but with the outcome being athletic performance. This review considers the process of developing athletes and managing load against the backdrop of differing approaches of conserving and maximizing the talent available. It acknowledges the typical training “dose” that adolescent athletes receive across a number of sports and the typical “response” when it is excessive or not managed appropriately. It also examines the best approaches to quantifying load and injury risk, acknowledging the relative strengths and weaknesses of subjective and objective approaches. Making evidence-based decisions is emphasized, while the appropriate monitoring techniques are determined by both the sporting context and individual situation. Ultimately a systematic approach to training-load monitoring is recommended for adolescent athletes to both maximize their athletic development and allow an opportunity for learning, reflection, and enhancement of performance knowledge of coaches and practitioners.

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How Do Mothers and Fathers Influence Pediatric Injury Risk in Middle Childhood?

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsp130 ◽

2010 ◽

Vol 35 (8) ◽

pp. 806-813 ◽

Cited By ~ 14

Author(s):

D. C. Schwebel ◽

C. M. Brezausek

Keyword(s):

Middle Childhood ◽

Injury Risk ◽

Mothers And Fathers ◽

Pediatric Injury

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Development of a preliminary evidence-based neuromusculoskeletal exercise guideline to reduce injury risk in the lower limb

Physical Therapy in Sport ◽

10.1016/j.ptsp.2016.08.012 ◽

2017 ◽

Vol 25 ◽

pp. 76-83 ◽

Cited By ~ 3

Author(s):

Michael E. Lehr ◽

Devin Kime ◽

Cayce Onks ◽

Matthew Silvis ◽

Megan Streisel

Keyword(s):

Lower Limb ◽

Injury Risk ◽

Preliminary Evidence ◽

Evidence Based ◽

Exercise Guideline

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Kickball and Its Underappreciated Pediatric Injury Burden: An 18-Year Retrospective Epidemiological Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119835894 ◽

2019 ◽

Vol 7 (4) ◽

pp. 232596711983589 ◽

Cited By ~ 4

Author(s):

Kevin Pirruccio ◽

Daniel Weltsch ◽

Keith D. Baldwin

Keyword(s):

Emergency Departments ◽

Injury Risk ◽

Pediatric Population ◽

The United States ◽

Associated Injuries ◽

Injury Surveillance System ◽

Pediatric Injury ◽

National Estimates ◽

Male Patients ◽

Injury Burden

Background: Kickball is a popular childhood game most frequently played during gym class or recess at schools throughout the United States (US). Despite this, the national health burden of injuries associated with kickball has never been explored in the US pediatric population. Purpose: To report national estimates and demographic characteristics of pediatric patients presenting to US emergency departments between 2000 and 2017 with kickball-associated injuries. Study Design: Descriptive epidemiology study. Methods: This study retrospectively analyzed the National Electronic Injury Surveillance System (NEISS) database (2000-2017) to identify annual cases of injuries associated with playing kickball presenting to US emergency departments in the pediatric population (age ≤18 years). Results: On average, 10,644 (95% CI, 8671-12,618) pediatric kickball-associated injuries presented to US emergency departments each year. There was no significant change in the number of injuries between the years 2000 (n = 10,331; 95% CI, 7781-12,881) and 2017 (n = 9407; 95% CI, 7233-11,582) ( P = .64). Patients frequently sustained sprains, strains, or muscle tears (34.4%; 95% CI, 32.4%-36.5%) and fractures (24.8%; 95% CI, 23.1%-26.5%); these injuries most commonly affected the ankle (13.7%; 95% CI, 12.2%-15.2%) and the fingers of the hand (17.1%; 95% CI, 15.5%-18.7%). The greatest proportion of injuries occurred in male patients (60.7%; 95% CI, 58.7%-62.7%) who were 10 to 12 years of age (44.8%; 95% CI, 43.0%-46.6%), with over half of kickball-associated injuries occurring at school (54.1%; 95% CI, 50.7%-57.5%). Conclusion: Despite kickball’s ubiquity as a schoolyard game, its associated injuries remain largely underappreciated. This is particularly unjustified when considering that the annual pediatric injury burden associated with playing kickball surpasses that of other sports acknowledged as carrying a high injury risk, such as martial arts or tennis.

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