Pediatric hospitalizations and in-patient mortality from all-terrain vehicle crashes, 2006–2016

Trauma ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 56-63
Author(s):  
Sarah B Cairo ◽  
Joshua K Burk ◽  
David H Rothstein
Keyword(s):  
Rural Areas ◽  
Demographic Data ◽  
Private Insurance ◽  
Hospital Costs ◽  
The United States ◽  
Vehicle Crashes ◽  
Targeted Interventions ◽  
The Past ◽  
West Region ◽  
National Frequency

PurposeTo evaluate trends in national frequency of hospitalizations and in-patient mortality in the United States for children injured in all-terrain vehicle crashes during the past decade.MethodsRetrospective review of the 2006, 2009, 2012, and 2016 Kids' Inpatient Databases to identify hospitalizations of patients <19 years of age for all-terrain vehicle-related injuries. External-cause-of-injury codes were used to identify patients hospitalized for injuries sustained in all-terrain vehicle crashes. Odds ratios for in-patient mortality were calculated by logistic regression incorporating multiple individual demographic and hospital variables.ResultsEstimated all-terrain vehicle-related hospitalizations ranged from 3666 in 2006 (5.2/100,000 persons <19 years of age) to 2558 in 2012 (3.3/100,000). Crude in-patient mortality was low, and varied slightly from year to year (range, 0.55–1.04%). Patients hospitalized for all-terrain vehicle-related injuries were 76.8–78.4% White and 72.1–77.2% male. Totally 61.0–64.3% had private insurance, 35.3–39.3% were from rural areas, 37.4–38.3% were in the 10–14-year age group, and patients from the West region accounted for 40.4–43.6% of patients. There were no risk factors identified as being consistently associated with mortality in this cohort. Average total charges increased from $26,996 to $67,370 over the course of the study ( p < 0.001).ConclusionsHospitalizations for all-terrain vehicle-related injuries in children have fallen in the past decade although the reasons for this change are unknown. In-patient mortality rates have stayed relatively constant and while no factors were predictive of in-patient mortality, demographic data may provide an opportunity for targeted interventions to further reduce injuries and associated hospital costs.

PRESIDENT'S ADDRESS 1972

PEDIATRICS ◽  
1972 ◽  
Vol 50 (6) ◽  
pp. 961-963
Keyword(s):  
United States ◽  
Rural Areas ◽  
Good Health ◽  
The United States ◽  
The Past ◽  
American Academy Of Pediatrics ◽  
Collective Attention ◽  
Per Capita ◽  
Manpower Needs ◽  
Goals And Objectives

This year marks the 42nd anniversary of the American Academy of Pediatrics. From its original 35 members, in this short span of years, the Academy has become a progressive, rapidly growing, vigorous group of more than 14,000 Fellows-four-fifths of all the United States pediatricians and a representative percentage of the pediatricians in Central and South America and Canada. During this interval, the Academy has consistently developed its programs and activities to advance and promote the health and welfare of children. Yet for the first 35 years we were basically an educational, disease-oriented organization, with little impact on community-oriented medical services, or on the socioeconomics of health care. Fortunately in the past several years there has been a decided change in the policies, priorities, and direction of the Academy. This is best reflected by its recent expanded goals and objectives in a complete revision of Article III, Section I of its Constitution. Even though we are still primarily disease-oriented physicians, we must not forget the problems that are deterrents to good health. We can hardly expect mcdicine to solve every social, political, and economic ill of the ghetto, suburbia, and the rural areas of our country; however, we do have an important role to play and we do have an important contribution to make in our communities. These areas, large or small and wherever they may be, will not have the same medical health and manpower needs, nor the same priorities, and will continually need our individual and collective attention. The United States has more physicians per capita than all but three or four other nations.

scholarly journals 1194. Carbapenem-Resistant Enterobacteriaceae in Kentucky: Initial 6 Months of Mechanism Testing

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S361-S361
Author(s):  
Kevin Spicer ◽  
Katelyn Cox ◽  
Rachel Zinner ◽  
Andrea Flinchum
Keyword(s):  
Public Health ◽  
Rural Areas ◽  
Demographic Data ◽  
Acute Care Hospital ◽  
The United States ◽  
Care Hospital ◽  
Local Data ◽  
Carbapenem Resistant ◽  
State And Local ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background A global rise in carbapenem-resistant Enterobacteriaceae (CRE) has been noted over the past two decades. State and local data on CRE are necessary to better inform public health interventions. Methods Reporting of CRE (i.e., Enterobacteriaceae resistant to any carbapenem or shown to produce a carbapenemase) was mandated in Kentucky in 2015. Voluntary submission of isolates to the Antibiotic Resistance Laboratory Network regional laboratory for carbapenemase testing began September 2017. Demographic data collected as part of reporting included age, sex, county of residence, and inpatient/outpatient status. Descriptive and chi-square analyses were performed. Results Between September 1, 2017 and February 28, 2018, 149 CRE were reported to the Kentucky Department for Public Health. Testing for presence of a carbapenemase was performed on 115 isolates (77.2%); 44 (38.3%) were carbapenemase producing (CP)-CRE and Klebsiella pneumoniae carbapenemase (KPC) was identified from 38 (86.4%). Also identified were Verona integron-encoded metallo-β-lactamase (VIM; 5, 11.4%) and New Delhi metallo-β-lactamase (NDM; 1, 2.3%). Identification of carbapenemase varied among genera: Citrobacter (3/4, 75%), Klebsiella (21/40, 52.5%), Serratia (2/5, 40%), Escherichia (6/20, 30%), Enterobacter (11/41, 26.8%), Proteus (0/4, 0%), other genera (1/2, 50%). CRE isolates from urban or suburban areas were more likely CP-CRE than were those from rural areas (30/65, 46.2% vs. 14/50, 28%, P = 0.047). Carbapenemase was identified more often among CRE isolates from currently hospitalized patients than from patients whose cultures were collected outside of an acute care hospital (37/70, 52.8% vs. 7/45, 15.6%; P &lt; 0.001). Conclusion The percentage of CRE that were CP-CRE in Kentucky was comparable with that reported for the United States (38 vs. 32%). Klebsiella spp., the genera historically associated with CP-CRE, made up less than half of CP-CRE. CP isolates were identified from urban, suburban, and rural settings and more frequently from isolates collected in hospitals compared with the community. The additional epidemiology obtained as part of this reporting system has identified metropolitan areas of the state as targets for CRE prevention efforts. Disclosures All authors: No reported disclosures.

scholarly journals “QEP”–A New Method of Rural Planning

1974 ◽  
Vol 3 (1) ◽  
pp. 125-133
Author(s):  
Frederic O. Sargent
Keyword(s):  
United States ◽  
Regional Planning ◽  
Rural Areas ◽  
The United States ◽  
Land Uses ◽  
Rural Planning ◽  
Rural Land ◽  
The Past ◽  
Country Planning

Since its emergence in the early part of this century, planning in the United States has been predominantly urban. Regional planning of watersheds, has received some attention but planning for rural areas has not been widely practiced, nor has it been taught in planning schools. Support for this generalization may be found in planning texts which consider 50,000 population a “small” municipality. Further evidence is found in town plans prepared through support of federal “701” funds during the past decade. These plans are usually for expansion of urban facilities and services and ignore exclusively rural land uses. Planning in England presents a contrast. It is appropriately referred to as “town and country planning” as it covers the range of land use intensities from agricultural to the highest value urban block as interrelated and interconnected parts of a single fabric.

scholarly journals Measurements of Economic Growth and Development of Various Sized Central Place Areas in Pennsylvania, 1960-70

1972 ◽  
Vol 1 (01) ◽  
pp. 336-347
Author(s):  
R. Gar Forsht ◽  
J. Dean Jansma
Keyword(s):  
United States ◽  
Economic Growth ◽  
Rural Areas ◽  
Economic Activity ◽  
Growth And Development ◽  
The United States ◽  
Central Place ◽  
Economic Growth And Development ◽  
The Past ◽  
Urban And Rural Areas

There has been increasing concern over the past decade about the lack of economic activity in a number of major cities, many intermediate and small sized cities, and a significant number of rural areas within various regions of the United States. This concern about the depressed conditions in these urban and rural areas, relative to the nation, has attracted country-wide attention.

Bicycle Helmets save More than Heads: Experience from a Pediatric Level I Trauma Hospital

2017 ◽  
Vol 83 (9) ◽  
pp. 1007-1011 ◽  
Author(s):  
Patrick D. Michael ◽  
Daniel L. Davenport ◽  
John M. Draus
Keyword(s):  
Brain Injuries ◽  
Injury Severity ◽  
Demographic Data ◽  
Private Insurance ◽  
Hospital Costs ◽  
Study Cohort ◽  
Level I ◽  
Minor Injuries ◽  
Trauma Activation ◽  
Activation Criteria

We studied pediatric bicycle accident victims (age ≤ 15 years) who were treated at our pediatric Level I trauma center during a 10-year period. Demographic data, injury severity, hospital course, and hospital cost data were collected. We compared the children who were helmeted to those who were unhelmeted. Our study cohort consisted of 516 patients. Patients were mostly male (70.2%) and white (84.7%); the median age was nine years. There were 101 children in the helmet group and 415 children in the unhelmeted group. Helmeted children were more likely to have private insurance (68.3% vs 35.9%, P < 0.001). Unhelmeted children were more likely to sustain multiple injuries (40% vs 25.7%, P = 0.008), meet our trauma activation criteria (45.5% vs 16.8%, P < 0.001), and be admitted to the hospital (42.4% vs 14.9%, P < 0.001). Helmeted children were less likely to sustain brain injuries (15.8% vs 25.8%, P = 0.037), skull fractures (1% vs 10.8%, P = 0.001), and facial fractures (1% vs 6%, P = 0.040). Median hospital costs were more expensive in the unhelmeted group. Helmet usage was suboptimal. Although most children sustained relatively minor injuries, the unhelmeted children had more injuries and higher costs than those who used helmets. Injury prevention programs are warranted.

scholarly journals HYPERTENSION: THE SILENT KILLER

2020 ◽  
pp. 1-2
Author(s):  
Mohammad Maaz Ahmad
Keyword(s):  
United States ◽  
Blood Pressure ◽  
High Blood Pressure ◽  
Rural Areas ◽  
Causes Of Death ◽  
Developed Countries ◽  
The United States ◽  
Epidemiological Studies ◽  
The Past ◽  
Increasing Trend

Today world face one of the biggest problem is hypertension in adults. Hypertension, also known as high blood pressure, increases the risk for heart disease and stroke, two leading causes of death for people in the United States [1]. In the United States, about 77.9 million (1 out of every 3) adults have high blood pressure. A global brief on hypertension by WHO reported that, the prevalence of hypertension in adults aged 25 and above was about 40% around the world in 2008, rising from 600 million in 1980 to 1 billion in 2008 during the past 28 years [2]. Similarly, this prevalence among the adults aged 18 and above in China has risen from 18.8% in 2002 to 25.2% in 2015, presently, there are more than 200 million hypertensive patients in China [3]. Epidemiological studies show a steadily increasing trend in hypertension prevalence over the last 40 years, more in urban than in the rural areas. This is converse to findings reported from developed countries where there is a significant decrease in its prevalence.

scholarly journals Does the Use of Psychotropic Medication Adversely Affect the Outcomes of Hip Arthroscopy?

2018 ◽  
Vol 46 (14) ◽  
pp. 3423-3428 ◽  
Author(s):  
Sylvester T. Youlo ◽  
Brian E. Walczak ◽  
James S. Keene
Keyword(s):  
Hip Arthroscopy ◽  
Demographic Data ◽  
The United States ◽  
Senior Author ◽  
Psychotropic Medications ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
The Past ◽  
Poor Outcomes ◽  
Modified Harris Hip Score

Background: Over the past decade, the use of psychotropic medications (PTMs) in the United States has doubled, and currently 20% of adults are taking 1 or more of these antidepressant, antianxiety, antipsychotic, or mood-altering medications. To date, however, the incidence of PTM use in patients undergoing hip arthroscopy and the results of hip arthroscopy in these patients have not been reported. Purpose: To determine the prevalence of PTM use in patients undergoing hip arthroscopy and to compare the outcomes of patients taking PTMs versus those of patients not taking PTMs. Study Design: Cohort study; Level of evidence, 3. Methods: Medical records of 880 consecutive patients who underwent hip arthroscopy performed by the senior author were reviewed and data were collected, including the number and types of PTMs that these patients were taking at the time of their hip arthroscopy. All hips were assessed with the Byrd modified Harris Hip Score (mHHS) preoperatively; 709 patients (81%) had scores obtained at 12 months and 669 patients (76%) at 24 months after surgery. Demographic data and mHHS of patients taking psychotropic medications (PTM group) were compared with those of patients not taking PTMs (NPTM group). Results: Four hundred twenty-two (48%) of the 880 patients studied were taking PTMs at the time of their hip arthroscopy; significant differences between the PTM and NPTM groups were average age (48 vs 35 years, respectively), and the high percentage of females (53%) and low percentage of males (38%) in the PTM group. Preoperative scores for the PTM and NPTM groups were similar (41 vs 42 points, respectively), but postoperative scores of the PTM group were significantly lower at 6 months (72 vs 89 points), 12 months (77 vs 91 points), and 24 months (79 vs 88 points) after surgery ( P = .01). In contrast, the scores of the subgroups of PTM and NPTM adolescents obtained at 3 months (92.5 vs 88.9 points), 6 months (92.1 vs 90.3 points), 12 months (89.5 vs 92.1 points), and 24 months (90.3 vs 90.1 points) after surgery did not significantly differ. Conclusion: The incidence of PTM use in this series of patients with hip arthroscopy was triple that reported for US adults (48% vs 17%, respectively) and adolescents (23% vs 6.3%), and the PTM group had significantly lower 12- and 24-month mHHS results than the NPTM group. These results suggest that (1) patients undergoing hip arthroscopy who are taking PTMs are at significantly higher risk for poor outcomes and (2) their use of PTMs should be identified and addressed before proceeding with hip arthroscopy.

scholarly journals Relationship Between Physical Activity and Motor Vehicle Crashes Among Older Adult Drivers

2019 ◽  
Vol 10 ◽  
pp. 215013271985999
Author(s):  
Amish Talwar ◽  
Thelma J. Mielenz ◽  
Linda L. Hill ◽  
Howard F. Andrews ◽  
Guohua Li ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adult ◽  
Motor Vehicle ◽  
The United States ◽  
Motor Vehicle Crashes ◽  
Moderate Physical Activity ◽  
Vehicle Crashes ◽  
Cross Sectional ◽  
The Past ◽  
Age Related

Background: There are approximately 42 million licensed drivers aged 65 years or older in the United States, who face unique age-related risks while driving. While physical activity affects several chronic conditions thought to be associated with motor vehicle crashes (MVCs), it is unclear if increased physical activity leads to fewer MVCs. This study explores whether self-reported vigorous and moderate physical activity is associated with MVCs in the previous year. Methods: Using cross-sectional data from the LongROAD study, a large multisite prospective cohort study of 2990 older adult drivers, we examined variables related to physical activity and performed a multivariate regression analysis to examine the association of physical activity health behaviors with self-reported MVCs. Results: Overall, 41.2% of participants reported vigorous and 69.6% of participants reported moderate exercise at least once per week. Eleven percent of participants reported at least 1 MVC in the previous year. Neither vigorous nor moderate physical activity was significantly associated with self-reported MVCs in the previous year. Select variables that were significantly associated with self-reported MVC included self-reported unsafe driving practices (odds ratio [OR] 1.55, confidence interval [CI] 1.05-2.29), and fall in the past 12 months (OR 1.46, CI 1.14-1.85). Conclusions: We were unable to detect a significant association between self-reported physical activity and MVCs in the past year among this group of older drivers. Use of objective measures of activity may better clarify this relationship.

scholarly journals Demographic Variation in the Frequency of Gliomas in Florida

Medicina ◽  
2019 ◽  
Vol 55 (1) ◽  
pp. 5 ◽  
Author(s):  
Dharam Persaud-Sharma ◽  
Joseph Burns ◽  
Jeran Trangle ◽  
Grettel Castro ◽  
Noel Barengo ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Smoking Status ◽  
Demographic Data ◽  
Private Insurance ◽  
Geographical Location ◽  
The United States ◽  
Primary Brain Tumor ◽  
Future Research ◽  
Cancer Data ◽  
Caucasian Men

Background and objectives: Glial brain cancers affect nearly 20,000 individuals in the United States (USA) annually. SEER database data exploring the relationship between race and gliomas is now available and have shown that cerebral gliomas occur at a higher frequency in Caucasian men. However, such analyses did not include demographic data specific to the state of Florida. This study assessed the association between race and glial vs. non-glial Central Nervous System (CNS) cancers in Florida, USA. Materials and Methods: This case-control study utilized the Florida Cancer Data Registry (FCDS), in which race was considered the exposure and development of glioma as the measured outcome. The sample was comprised of patients in Florida diagnosed with brain tumors from 1981 to 2013. Relative racial frequencies were compared between patients with glial brain tumors and those with other CNS tumors. Data was analyzed using logistic regression in order to determine any associations between race and frequency of diagnosis adjusting for several confounders (age, sex, smoking status, year of diagnosis, and insurance status). Results: Between 1981 and 2013 a total of 14,092 patients meeting the inclusion and exclusion criteria were diagnosed in Florida with a primary brain tumor. Being of non-white race was associated with 60% decreased odds of glioma diagnosis compared to the reference white population (adjusted OR 0.4, 95% CI 0.34–0.47). Secondary findings include associations between increasing age and male sex with increased odds of glioma diagnosis. Decreased adjusted odds of glioma diagnosis were found with former smoking status (reference non-smokers), diagnosis between 2001 and 2010 (reference 1981–1990), and Medicaid or Medicare insurance (reference private insurance). Hispanic ethnicity, current smoking status, no insurance/self-pay, and geographical location (urban vs. rural) all had no association with glioma diagnosis. Conclusions: These findings are consistent with and help reinforce previous studies utilizing national databases (SEER) which also showed increasing odds of glioma diagnosis in older white males. Various potential explanations for these findings include genetic predisposition, lifestyle and behavioral factors, and socioeconomic status, including access to healthcare. Future research aims at identifying potential genetic etiologies.

scholarly journals 772. Access Denied: Impact of Insurance Denials for High-Cost Outpatient Parenteral Antimicrobial Therapy

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S343-S343
Author(s):  
Monica L Bianchini ◽  
Rachel Kenney ◽  
Robyn Lentz ◽  
Marcus Zervos ◽  
Manu Malhotra ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Private Insurance ◽  
Hospital Costs ◽  
The United States ◽  
Delay Group ◽  
Transitions Of Care ◽  
Insurance Companies ◽  
Institutional Perspective ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
The Impact

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) allows patients to receive prolonged antimicrobial therapy while reducing the length of hospitalization and healthcare costs. In the United States, most public and private insurance companies require prior authorization (PA) for OPAT. The impact of OPAT PA delays is not known. This study aimed to characterize discharge barriers and authorization delays associated with high-cost OPAT antibiotics. Methods IRB-approved study of adult patients discharged with high-cost OPAT antibiotics from January to December 2017. Antibiotics were included based on the frequency of OPAT use and average sales price (ASP) greater than $100 per day, including: daptomycin, ceftaroline, ertapenem, and the novel β-lactam β-lactam inhibitor combinations. Patients with an OPAT authorization delay >24 hours were compared with patients without an OPAT authorization delay. Primary endpoint: total direct hospital costs, starting from the start of treatment with the OPAT antibiotic, from the institutional perspective using Healthcare Cost and Utilization Project and Center for Medicare and Medicaid Services 2019 ASP Drug Pricing data. Secondary outcomes: discharge delay and 30-day readmission or mortality. Results Two-hundred patients included: 151 (76%) no OPAT delay vs. 49 (25%) OPAT delay. The use of antibiotics was similar between groups, except ertapenem was more common in the no OPAT delay group: 60 (43%) vs. 15 (25%), P = 0.022. Patients with no OPAT delay were more commonly discharged with home infusion and less commonly to a facility: 75 (53%) vs. 19 (32%), P = 0.007, and 52 (37%) vs. 37 (63%), P = 0.001, respectively. Discharge delays were more common in patients with OPAT delays: 21 (15%) vs. 31 (53%), P < 0.001. The median total direct hospital costs were higher in patients with OPAT delays: $7,770 (3,031–13,974) vs. $19,576 vs. (10,056–37,038), P < 0.001. Table 1 compares the total direct hospital costs of patients with and without an authorization delay. Conclusion OPAT with high-cost antibiotics requires significant care coordination. Authorization delays for these antibiotics are common and may contribute to a delay in discharge. OPAT transitions of care represent an important opportunity for Infectious Diseases providers to improve care and address access barriers. Disclosures All authors: No reported disclosures.

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