H3097- Council on Injury, Violence, and Poison Prevention Program

Topic: Injury

Sponsors: Council on Injury, Violence & Poison Prevention (COIVPP)

Monday, October 24
1:00PM - 6:00PM
Moscone West, 2005/2007

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This program highlights current developments in pediatric injury prevention. A wide range of subjects will be covered that are relevant to both council members and the general pediatrician interested in effective programs for injury prevention. A panel of experts will participate in a moderated discussion on the rise of consumer technology and how it can help or hinder injury prevention, with a focus on developing an agenda for next steps. The session also will include abstract presentations featuring innovative research and programming, and this year’s Fellow Achievement Award will be presented.

Moderators: Benjamin Hoffman, MD, FAAP; Joseph O’Neil, MD, MPH, FAAP
1:00PM Panel: The Intersections of Technology and Injury: How It Can Help, How It Can Hinder
Chih-Hung Wang, MD, PhD; Kristy Arbogast, PhD
3:15PM Abstract Session I: Top Abstracts
3:50PM Business Meeting and Fellow Achievement Award Presentation
4:20PM Abstract Session II: Platform Presentations
5:00PM Abstract Session III: Poster Presentations
6:00PM Adjourn

Abstracts

5:00PM - 5:45PM
5:00PM - 5:45PM

Kristy Arbogast, PhD

Research Professor
Division of Emergency Medicine and Center for Injury Research and Prevention, The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania

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Chih-Hung Wang, MD, PhD

Director, Center for Policy Outcomes and Prevention
Stanford University Department of Pediatrics
Stanford, California

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Mark Rosekind, PhD

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Oral (Podium)

In-flight Medical Events, Injuries and Deaths Affecting Children During Commercial Aviation Flights

Monday, October 24
3:15PM - 3:30PM
Moscone West, 2005/2007

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Introduction: More than 3 billion passengers are transported every year on commercial airline flights worldwide, many of whom are children. The incidence of in-flight medical events (IFMEs) affecting children is largely unknown. This study seeks to characterize these pediatric IFMEs, with focus on injury-related events, cardiorespiratory arrests and deaths.
Methods: We queried all IFMEs between January 2009 and January 2014 reported to the world’s busiest ground-based medical support center, and identified events involving children (0 to 18-years of age). Operational characteristics, basic demographics and detailed case notes were abstracted and analyzed. Cases were categorized as “In-flight Injury” (IFI) or “Other Emergency” (OE). Passengers up to 2 years of age who were allowed to share a seat with an adult were categorized as lap infants. Data were analyzed with dedicated statistical software and are presented as n (%), median (interquartile range), or odds ratio (OR, 95% confidence interval), as appropriate.
Results: Among 114,222 IFMEs, we identified 12,243 pediatric cases (10.7%) from 77 different airlines in 6 continents. Gastrointestinal events were the most common (35.3%), followed by Infectious (20.2%), Neurologic (12.1%), Allergic (8.6%), and Respiratory (6.3%) categories. In addition, 351 cases (2.9%) of IFMEs were found to be IFIs (i.e., trauma and burns). Subjects who sustained IFIs were younger than those involved in OEs (2 [1 - 6.5] years vs 8 [3 - 14] years, respectively), and lap infants were over-represented (38% of IFIs vs 16% of OE). Most cases occurred on international flights (81.1%) and flights longer than 6 hours (53.1%). Examples of IFIs included trauma related to turbulence in unrestrained lap infants, fallen objects from the overhead bin, trauma (contusion, laceration, fracture, amputation) of extremities by the service cart or aisle traffic, and thermal burns. IFMEs involving lap infants were significantly associated with flight diversion (OR: 2.8 [1.9 - 4.1, p < 0.001). There were 15 cases of cardiorespiratory arrest, with 11 (73.3%) involving lap infants. Five of these 11 patients (45.5%) did not have a known pre-existent medical condition and were found pulseless and apneic akin to what is seen in sudden unexpected infant death (SUID).
Conclusions: Pediatric IFMEs are relatively infrequent given the total passenger traffic, but not negligible. Unrestrained children are prone to IFIs. This is particularly true during meal service or turbulence, but not only then. The possible protection from using in-flight child restraints might extend beyond take-off and landing operations, or during turbulence. Children seating in aisle seats are exposed to injury from fallen objects, aisle traffic, and burns from mishandled hot meals and beverages. Lap infants sharing a seat with adults on long-haul flights might be at risk of SUID, similarly to the well-recognized risk of suffocation from co-sleeping with an adult on land.

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Oral (Podium)

Primary School Drop-off Zone Safety Analysis of Hazardous Road Conditions Utilizing Video Review

Monday, October 24
3:30PM - 3:45PM
Moscone West, 2005/2007

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Seventy-six thousand pedestrians were injured by a motor vehicle in the United States in 2012. Children struck by a motor vehicle represent 20% of all pediatric mortalities for those between the ages of 5-15 in 2012. Pedestrian fatalities continue to climb with a 10% increase from 2014-2015 alone. A key part of daily life for children between the ages of 5-15 is being dropped off at school in the morning creating a discrete period of time with many pediatric pedestrians in a concentrated area with a high volume of motor vehicles. We hypothesize that a video surveillance program will permit the establishment of a school drop-off zone hazard score which will guide future injury prevention programs.

Methods: Using trauma registry data from the only ACS-verified level one pediatric trauma center serving 4 counties with a population of 7.8 million people, we identified pedestrian injury due to motor vehicle accidents as the third leading cause of pediatric injury from 2014-2015. Of 355 public schools within one county, we identified a primary school with 588 students in a suburban environment with concerns for a high risk for pedestrian injury based on school location and traffic. We conducted multiple field surveys to observe traffic patterns and selected the optimal review period for surveillance to be 30 minutes prior to the start of school at 8:15am. We also established 2 separate locations on the roof for video capture with clear lines of sight of the school drop-off zone that were obscured from view to study participants. The study was approved by the Parent Teacher Association (PTA), school administration and Institutional Review Board (IRB). Three observation periods were conducted during 3 separate weeks from January to March 2016. Videos were evaluated by 2 independent reviewers to identify hazards which could be quantified. We developed a hazard scoring system with each dangerous event being equivalent.
Results: Using video review we were able to identify 9 key hazards (see table). Double parking (29+ 5.5), drop-offs in the bus stop (23+ 7.6), jaywalking (10+ 3.1) occurred with the greatest incidence. Of note, during one observation period, no crossing guard was present. Combining all hazards seen in each observation resulted in an overall hazard score of 79, 84 and 86 for each observation period (mean 84 + 3.6).

Discussion: We report the establishment of a video surveillance program to review school drop-off safety. Our novel school drop-off hazard score provides a baseline against which the impact of future injury prevention interventions can be measured. Evaluation of different schools and different seasons in the future will further refine our understanding of the different hazards identified. Future studies will attempt to impact behavioral factors, road conditions, and traffic flow to improve safety.

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24- The Effect of Massachusetts State Legislation on Off-road Vehicle Injuries in Children

Monday, October 24
4:20PM - 4:27PM
Moscone West, 2005/2007

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PURPOSE: In 2010, the Massachusetts legislature passed a law further restricting off-road vehicle (ORV) use by children. We aimed to: 1) examine the impact of the 2010 Massachusetts law on the rate of emergency department (ED) visits and inpatient hospital (IH) discharges for ORV-related injuries, and 2) assess changes in ED visit and inpatient hospitalization rates across the debate and implementation time periods.

METHODS: A retrospective analysis of annual ED and IH discharges between 2002-2013 using E-codes (External Causes of Injury) specific to ORV-related injuries. Yearly population-based rates were calculated for four age groups: 0-9, 10-13, 14-17 and 25-34. Rates were compared before and after implementation of the law (2002-2010 vs. 2011-2013), as well as during the pre-debate period (2002-2005 vs. 2006-2010) and the debate period (2006-2010 vs. 2011-2013) using a difference-in-difference analysis model.

RESULTS: There were 3,638 ED discharges and 481 IH discharges for ORV-related injuries in residents under the age of 18 across the 12 year study period. The rate of ED discharges declined by 33% in 0-9 year olds, 50% in 10-13 year olds, and 39% in 14-17 year olds in the period following implementation of the law (p < .0001). There was no significant decline in ED discharges for 25-34 year olds. IH discharges were reduced by 41% in 0-17 year olds after implementation (p < 0.001), with no significant reduction in 25-34 year olds. Significant reductions in ED discharge rates were also observed during the debate (2002-2005 vs. 2006-2010) and implementation periods (2006-2010 vs. 2011-2013) for patients 0-17 years old.

CONCLUSIONS: The population-based injury rate of residents under the age of 18 significantly declined following the passage of stricter ORV legislation in the commonwealth of Massachusetts as compared with adults aged 25-34. The largest decline in injury rates was observed in 10-13 year olds. These results suggest that stricter legislation with an age restriction for riding has led to an overall decline in the rates of injuries in those who are most vulnerable.

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25- Comparing Infant Safe Sleep Practices Between Birthing and Children’s Hospitals in Ohio

Monday, October 24
4:27PM - 4:34PM
Moscone West, 2005/2007

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PurposeObjectives: Families tend to model behaviors that they observe within the hospital setting. Unfortunately, recent literature has shown that infants in the children’s hospital setting are rarely observed in the AAP-recommended safe sleep locations and environments. The goal of this study was to compare infant safe sleep practices in birthing hospitals to free-standing children’s hospitals in order to determine where to concentrate safe sleep education and quality improvement efforts.

Design/Methods: One state's AAP chapter recruited hospitalists from three freestanding children’s and six birthing hospitals to participate in a collaborative to improve infant safe sleep behaviors in the inpatient setting. The hospitalists used a standardized data tool to collect information on the infant's age, sleep position, location, and sleep environment. Observations were conducted during typical sleeping hours. Prior to the quality improvement portion of the collaborative, hospitalists collected baseline data for a two-month period on admitted infants ≤ 1 year of age. Appropriate safe sleep was defined as an infant found sleeping in a crib devoid of extraneous items and on his or her back. Each parameter was reviewed individually, and the three were also combined to determine compliance with the appropriate safe sleep behaviors listed above as a bundle. Baseline comparisons between observations in birthing versus children’s hospitals were made.

Results: Hospitalist teams collected more than 600 audits during the baseline period (67% birthing hospital versus 33% children’s hospital). Only 77/221 (34.8%) of sleeping infants observed in children’s hospitals were found to follow current AAP recommendations, compared to 248/428 (57.9%) in birthing centers. Much of the discrepancy was due to the percentages of bare cribs at the birthing hospitals (314/428, 73.4%) versus the children’s hospitals (96/221, 43.4%). There were no significant differences in locations and positions of sleeping infants in the two types of hospitals. Of note, family reports of safe sleep education during admission were also significantly higher in birthing hospitals (269/314, 85.7%) than in children’s hospitals (16/57, 28.1%).

Conclusions/Discussion: This study demonstrated that infants in participating birthing centers were more commonly observed in appropriate sleep environments than were infants in participating children’s hospitals. Families of infants in birthing hospitals also reported more safe sleep education during admission than did families in children’s hospitals. The study emphasizes the need for children’s hospitals to emphasize and to model safe sleep practices for admitted infants. Pediatricians in both the inpatient and outpatient settings should also routinely counsel about sleep safety, as these behaviors seem to dissipate following discharge from birthing centers.

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26- All Terrain Vehicle Injuries in Pediatric Patients in a Statewide Sample from 2004 to 2014: A Retrospective Case Series

Monday, October 24
4:34PM - 4:41PM
Moscone West, 2005/2007

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INTRODUCTION: All terrain vehicle (ATV) injuries remain a significant financial burden on the American healthcare system. In 2011, the U.S. Consumer Product Safety Commission (CPSC) estimated 107,500 injuries in patients of all ages requiring treatment at emergency rooms, and at least 57 children younger than 16 years of age killed1. Thus, the need to continue to investigate the trends in ATV injuries and modification of treatment protocols for pediatric patients remains critical.

METHODS: Data was obtained from our state Trauma System Foundation for patients, ages 0-17 years, with E-Code 821 and all its subsets. Pediatric and Adult Trauma Centers within the state were evaluated from January 1, 2004 to December 31, 2014. Demographic information, incidence, injury severity score, length of stay, anatomical location of injuries, appropriateness of trauma alert, fatalities, and functional status at discharge were evaluated.

RESULTS: There were a total of 3,152 patients injured during the study period, with an average of 286 cases per year. The mean age was 12.5 years (median 14 years of age). Those below the age of 16 accounted for 77% of the cases in this cohort. Males disproportionately accounted for 79% of those injured. In 15.8% of the cases, an ATV passenger was injured. There were 15 fatalities resulting from injuries while using an ATV. The average hospital length of stay was 4 days. A helmet was being used in 55% of the cases and it did not significantly affect the length of stay when compared to those who did not wear a helmet (p= 0.370). Extrication was required in 5% of the cases. In the majority of the cases (68%), a trauma activation was required. Approximately 80% of the patients had available data regarding functional status at discharge for locomotion and transfer mobility. Of those, 8% had complete dependence in locomotion, 24% had modified dependence, 12% had independence with a device, and 56% had complete independence. Four percent of patients had complete dependence on transfer mobility, 9% modified dependence, 14% had independence with a device, while 73% had complete independence.

CONCLUSION: Despite current guidelines by the AAP, patients younger than 16 years of age still account for the majority of ATV injuries reported within this cohort. Had the current AAP guidelines been followed, at least 77% of the cases in this cohort would have been prevented. A robust campaign is needed to educate caregivers about the significant effects of ATV injuries as the incidence remains high. The campaign should include TV ads, social media, and school nurses and primary care providers promoting awareness about the importance of restricting ATV usage to those older than 16 years of age.

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27- A Safer Place to Ride: Regulations and Dnr Enforcement in Ohv Parks Increases Safety Behaviors

Monday, October 24
4:41PM - 4:48PM
Moscone West, 2005/2007

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Purpose: Iowa off-highway vehicle (OHV) parks have regulations regarding youth users and helmet use that do not apply outside of parks, and have Department of Natural Resources (DNR) personnel who patrol the parks and provide enforcement. In previous studies, we found Iowa all-terrain vehicle (ATV) crash victims at OHV parks had better safety behaviors as compared to off-road crashes outside the parks. Our objective in this study was to determine the demographics and prevalence of safety behaviors among OHV park users, and how regulations and enforcement affect rider safety behaviors.
Methods: From May to September of 2014, motion-activated cameras captured photos of users at the entrances of Iowa’s eight OHV parks. Riders were coded by vehicle type, estimated age, sex, and safety behaviors. Descriptive and multivariable logistic regression analyses were performed.
Results: A total of 6,718 vehicles and 9,083 riders were analyzed. Riders on ATVs comprised 44% of OHV park users, 51% were on dirt bikes and 5% were on side-by-sides (SxSs). Helmet use was 94.4% overall. Just 6% of single-rider ATVs and 0.8% of dirt bikes had passengers. While only 11% of park users on ATVs were < 16 years old, 59% of the child operators were driving adult sized ATVs. Of those riding SxSs, 64% were not using their restraints. Multivariate modeling controlling for important covariates showed that in comparison with young adults (16-39 years) on ATVs, children were nearly 6 times as likely to wear a helmet, whereas middle aged adults (40-60 years old) were half as likely to wear one. When DNR officers were patrolling the parks, there was a 3.6 times higher likelihood of helmet use and a 40% lower likelihood of passengers on dirt bikes and ATVs.
Conclusion: Regulated safety behaviors such as helmet use and riding without passengers were highly practiced by OHV park users. However, unregulated behaviors such as children only driving youth sized vehicles and restraint device use in SxSs had lower compliance. Moreover, regulated safety behaviors were significantly increased when the parks were patrolled by DNR officers. This study shows that a combination of regulation and enforcement is effective in ensuring compliance with rider safety behaviors in OHV parks. The establishment of similar safety regulation and enforcement outside of parks would likely have a more far-reaching effect on decreasing OHV-related deaths and injuries.

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1- Factors Associated with the Use of Wandering Prevention Measures for Children with Autism Spectrum Disorders

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Purpose: Concerns about wandering, or elopement, may impose significant stress on the families of children with autism spectrum disorders (ASDs). However, little is known about the extent to which these families utilize measures for preventing their children from becoming lost. The purpose of this study was to examine the prevalence and correlates of the use of elopement prevention measures (EPM) for children with ASDs.

Methods: Data were obtained from the CDC's Survey of Pathways to Diagnosis and Services, a nationally representative survey of the parents and guardians of 4032 U.S. children ages 6-17 who were ever diagnosed with an autism spectrum disorder (ASD), intellectual disability (ID), or developmental delay (DD). The present analysis was limited to respondents whose children had an ASD at the time of survey administration (n=1420). EPM use was assessed based on two questions about whether the respondent had utilized an electronic tracking device (ETD) or physical barriers (PB) such as gates, locks, and alarms within the previous year to prevent their child from becoming lost. Rao-Scott chi-square tests were used to examine associations between ETD/PB use and 1) ASD severity, 2) comorbid ID/DD, 3) elopement history, and 4) demographic factors.

Results: Among all children with an ASD, PB (31.0%) were more commonly used than ETD (3.2%). Parent-rated ASD severity was significantly associated with the use of both PB (mild: 17.8%, moderate: 34.5%, severe: 66.2%; p < .001) and ETD (mild: 1.2%, moderate: 2.5%, severe: 14.2%; p < .001). Children that had a comorbid ID/DD diagnosis were more likely than those with ASD-only to have utilized PB (36.9% vs. 19.4%; p < .001), but not ETD (p=.643). Likewise, PB use differed according to age (6-10: 39.8%, 11-13: 26.9%, 14-17: 20.1%; p < .001), while ETD use did not (p=.954). Compared to the parents of non-wanderers, the parents of children who had eloped in the previous year were more likely to report use of PB (47.7% vs. 22.6%; p < .001) and ETD (5.9% vs. 1.8%; p=.006). No associations were identified between preventive measure use and household income or parental education level.

Conclusions: The high incidence of preventive measure use in this nationally representative sample suggests that elopement is a major concern for the families of children with ASDs. More research is needed to determine whether these strategies are effective in preventing children from becoming lost.

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2- Medication Errors with Anticonvulsant Drugs in the United States, 2000-2012

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Objective: To investigate the epidemiology of out-of-hospital medication errors involving anticonvulsant drugs.
Methods: Using data from the National Poison Data System (NPDS), a retrospective analysis of all out-of-hospital medication errors with anticonvulsant drugs that were reported from 2000 through 2012 was conducted.
Results: During the years 2000 through 2012, 108,446 individuals experienced out-of-hospital medication errors with anticonvulsant pharmaceuticals, averaging 9,037 cases annually. The annual frequency and rate per 100,000 people rose significantly by 96.6% and 76.9% (p < 0.001), respectively, over the study period. The rate of exposures that required health care facility use increased by 83.5% and the rate of exposures that resulted in serious medical outcome increased by 62.7%. The category of anticonvulsants comprised mostly of new generation anticonvulsants accounted for 52.1% of all the cases. The rate of healthcare facility use in this drug category increased by 559.3% and the rate of serious medical outcome increased by 330.8%.
Conclusions: The rate of out-of-hospital medication errors involving anticonvulsant drugs is increasing, and with this we see an increase in healthcare facility use and serious medical outcome. The drug category comprised mainly of new generation anticonvulsants is responsible for a large majority of these increases in rates seen over the study period. This finding indicates that the new generation anticonvulsants, although often considered safer and more easily tolerated, still need to be used with caution. Prevention strategies include: improvements in labeling, packaging, and naming of medications, clear distribution instructions on mediation packaging, and thorough medication education given to patients by their health care providers.  

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3- Characterization of Analgesics-related Medication Errors Reported to U.s. Poison Control Centers, 2000-2012

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Purpose: Analgesics are the most commonly used class of medications in the United States and account for the highest number of calls to National Poison Control Centers annually. We wanted to investigate trends and to describe the epidemiology associated with unintentional medication errors involving analgesics.
Methods: Retrospective review of analgesics-related medication errors reported to the National Poison Data System (NPDS) from 2000 through 2012.
Results. From 2000-2012, U.S. poison control centers (PCC) reported 533,763 exposures due to analgesics-related medication errors. During the study period, medication errors due to analgesics increased at an average annual rate of 131.6%. NSAID formulations accounted for more than one third (37.2%) of analgesics-related medication errors, followed by acetaminophen preparations (31.8%). Children ages 0-5 years accounted for 39.3% of all analgesics-related medication errors, followed by 20-49 year olds (22.9%). However, the percent of serious outcomes for children under six years of age was lowest across all classes of analgesics and highest for adults. Ingestion accounted for 99% of exposures; 25.6% of cases were attributed to “inadvertently taking the medication twice”; 7.7% were admitted to a critical care unit; 10.1% were admitted to a non-critical care unit; and 140 deaths were reported. Between 2009 and 2010 there was a decrease in acetaminophen-related medication errors per 100,000 population (R=-0.663, p < 0.05). This decrease in 2010 was more pronounced in children under 6 years of age.
Conclusions. Analgesics are a commonly utilized class of medication; our data show errors with these medications are both common and serious. Our study demonstrated a significant decrease in medication errors due to acetaminophen products in 2009, particularly in those younger than 6 years of age. This decrease may be the result of FDA-mandated labeling changes to NSAID and acetaminophen products in 2009.

Figure 1
Total Number of Analgesics-related Medication Errors by Age Group and Selected Sub-categories, National Poison Center Data System 2000-2012
Figure 2
Annual Rate of NSAID and Acetaminophen-related Medication Errors, by Age Group, National Poison Center Data System 2000-2012

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4- The Relationship Between Severe Injury and Mental Health in a Pediatric Managed-medicaid Population

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Purpose: Few studies have investigated the relationship between traumatic injury and mental health in children with low socioeconomic status. Our objective was to compare mental health diagnoses before and after unintentional, non-fatal traumatic injuries in a managed-Medicaid population.

Methods: We investigated children ages < 18 years treated for injuries at an American College of Surgeons verified pediatric trauma center between 2005 and 2015. Eligible children were enrolled in the hospital’s managed Medicaid program at the time of hospital admission and for at least one healthcare visit in the preceding year. Using the hospital’s Trauma Registry, EPIC, and the Medicaid billing database, we identified all healthcare visits one year pre- and post-injury. Poisson regression models estimated the rate of mental health diagnoses per the time observed.

Results: The median age of the cohort (n=2208) was 5.1 years (range: 0.4-18.9); 59.5% were male; 40.5% were black. Common causes of injury were falls (37.4%), burns (20.7%), and motor vehicle crashes (7.6%). The majority (94.3%) of children had a Glasgow Coma Score (GCS) ≥14 on arrival, while 1.5% had GCS ≤8. Most (72.9%) had minor injuries (Injury Severity Score (ISS): 1-8), while 4.7% suffered severe injuries (ISS >15). The rate of mental health diagnoses pre-injury was 95.9 per 1000 person-years and increased to 156.7 per 1000 post-injury (unadjusted Rate Ratio, CI 95% confidence interval (uRR, CI): 1.6, 1.4-1.9). The following mental health diagnoses were more prevalent post-injury, (uRR, CI): adjustment (9.8, 1.2-78.3), disruptive behavior (2.0, 1.1-3.6), cognitive (2.8, 1.8-4.2), sleep (2.3, 1.1-5.0), other diagnoses (1.9, 1.0-3.6). There were no observed changes in the rates of diagnoses for the following disorders: anxiety, attention-deficit/hyperactivity, bipolar, non-bipolar depressive, pervasive developmental, substance abuse.

The rate of post-injury mental health diagnoses compared to pre-injury varied by age, (uRR, CI): ages 0-4 years (2.9, 1.9-4.3); ages 5-9 (1.4, 1.1-1.8); ages 10-14 (1.1, 0.9-1.5); ages 15-18 (2.1, 1.4-3.3). Adjusted for race/ethnicity, children with burn injuries were more likely to have a mental health diagnosis post-injury compared to those injured by other mechanisms, and this rate varied by age, (adjusted Rate Ratio, CI 95% confidence interval (aRR, CI)): ages 0-4 years (8.6, 3.3-22.2); ages 5-9 (1.2, 0.3-4.7); ages 10-14 (1.0, 0.3-4.1); ages 15-18 (0.9, 0.3-2.9). Adjusted for race/ethnicity, children with head injuries were also more likely to have a mental health diagnosis post-injury, (aRR, CI): ages 0-4 years (3.9, 1.3-11.5); ages 5-9 (3.1, 1.3-7.6); ages 10-14 (2.2, 1.3-3.7); ages 15-18 (5.4, 2.1-13.6).

Conclusion: We identified a significant increase in the rate of mental health diagnoses after injury in this pediatric Medicaid cohort. Young age, head injury, and burns were highly associated with mental health diagnoses post-injury. These results and planned further analyses will inform future studies investigating interventions for mental health in injured children.

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5- Underuse of Proper Child Restraints in Taxis: Are Weak Laws Putting Children in Danger?

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Purpose: Motor vehicle (MV) accidents are a leading cause of death among children in the United States (US). A 2012 AAP press release cited a 70% increased risk of death or injury for 7 to 8 year olds not properly restrained. The AAP recommends that infants and toddlers be secured in rear-facing child safety seats (CSS), and that children continue to be secured by CSS or belt-positioning booster seats until they reach the height of 4' 9”. Furthermore, all 50 states legally require young children to be in CSS when travelling in a MV. However, it is concerning that taxis are exempt from these safety regulations. It is unknown whether or not children are properly restrained while riding in taxis. The objectives are 1) to observe the use of CSS for children riding in taxis, and 2) to assess the availability of CSS offered by taxi companies in the New York metropolitan area (NYMA)

Methods: 1) Researchers stationed at 11 locations in the NYMA observed taxis loading or unloading passengers. If taxi passengers included small children—infants, toddlers, or children whose height did not exceed the height of the side view mirror—the following data were recorded: number of adult and child passengers, whether CSS were used, and demographics for all passengers. 2) Availability of CSS in taxis was assessed by anonymous phone inquiries to NYMA-based taxi companies selected from the top search results on yellowpages.com.

Results: In total, 609 taxis were observed, of which 67 taxis had children. Across those taxis, 116 children were evaluated for CSS use. Children were 55% male; 41% white, 16% African American, 16% Hispanic, 26% other. Only 11% of small children were properly restrained, and almost all of these were infants in infant carriers. Of the 97 taxi companies in the NYMA that were called, 39% reported CSS availability. Of those offering CSS, 18% stated that CSS were limited or required a reservation, and 8% stated that there would be an extra fee. Reasons for not providing CSS included health code restrictions, allergies, and hygiene.

Conclusion: Despite awareness of MV safety risks, the vast majority of children using taxis were not properly restrained. Although 39% of all surveyed taxis companies reported CSS availability, actual use of CSS was much lower. Exclusion of taxis from occupant restraint laws greatly increases the risk of child injury or death by MV accident. Changes in law or policy are necessary to protect children in taxis.

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6- Availability of Car Seats Offered by Taxi Companies in Urban U.s. Cities

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Purpose: All state laws require young children to be in car safety seats (CSS) when travelling in a motor vehicle. Inexplicably, taxis are excluded from this important safety requirement. Despite taxi exemption from occupant restraint laws, research shows that children who are secured only by a seat belt in motor vehicles are four times more likely to be injured than those properly restrained in a CSS. In urban areas, where taxis are a major form of transportation, the availability of CSS in taxis could have a significant impact. Although taxis are not required by law to provide child restraints, it is unclear to what extent taxis voluntarily provide car seats for passengers travelling with young children. The objective is to survey the availability of CSS provided by taxis in major urban cities in the United States.

Methods: Anonymous phone inquiries were made to taxi companies (TC) in 20 cities across the U.S. Within each city, TC were chosen from the top 10 search results on yellowpages.com. TC were each asked about their availability of CSS. Comments were recorded.

Results: Of the 200 TC that were called, 41 reported CSS availability (21%) [Table 1]. The cities with most availability were San Francisco, Philadelphia, and Houston (40%). The cities with least availability were Miami and Memphis (0%). Of all TC that offered CSS, 16% required advance reservations, 24% noted limited availability of CSS, and 9% stated that there was an extra fee.

Conclusion: Car safety seats are not readily available for children riding in taxis. As taxis serve a variety of passengers with different needs, it is important, from a safety standpoint, that taxi companies provide car seats for those passengers not travelling with car seats of their own.

Table 1. Percent of Taxi Car Companies with Car Safety Seat Availability (N=200)

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7- Lack of Parental Adherence to Aap Safety Guidelines: Poor Recollection of Anticipatory Guidance by Physicians

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Purpose: Unintentional injuries—such as car accidents, drowning, choking, burns, and falls—are the leading cause of death among young children. The American Academy of Pediatrics (AAP) provides resources addressing prevention of unintentional injury. These are made easily available to primary medical doctors (PMDs) so that they can provide proper anticipatory guidance to parents. The objective is to assess parents' awareness of, and adherence to, safety guidelines (SG) established by the AAP Bright Futures (BF) initiative and to assess parents' recollection of PMD anticipatory guidance regarding five major safety areas.

Methods: At two pediatric specialty clinics, parents of children aged 1-5 completed an anonymous survey about five injury prevention areas: car seat use, bath safety, choking hazards, burn prevention (BP), and baby walker (BW) use. They were then shown the corresponding BF anticipatory SG and asked about prior awareness of SG, pediatrician discussion of guidelines (PDG), and whether they will change their behavior after reading these SG. Chi-square tests were used to compare adherence to SG across report of PDG.

Results: 76 parents participated: 88% female. Table 1 shows parental report of injury prevention practices, awareness of BF guidelines, and parental report of PDG. Parents who reported PDG about BW safety were less likely to use BW (30 vs. 66%, p=.012). Those who reported PDG about BP were more likely to set their water heater to ≤ 120ºF (38 vs. 13%,p=.028). Among parents who had not followed ≥3 SG, 86% reported that they will change some or all of their habits after taking the survey.

Conclusion: Given the availability of AAP resources, it is disconcerting that a significant number of parents did not recall receiving anticipatory guidance. Most parents with incorrect safety habits were willing to change their behavior after reading the SG. PMDs should continually reinforce SG so that parents understand the importance of adhering to injury prevention guidelines.

Table 1: Parental Report Regarding Safety Guidelines

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8- Peanut-containing Products in Children's Hospitals: Putting Pediatric Patients at Risk

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Purpose: Peanut allergy is the most common allergy among children in the US. In 2013, the CDC published an in-depth guide for managing food allergies in schools, citing peanut bans and peanut-free zones. Although steps have been taken to prevent food allergic reactions in schools, hospital precautions have yet to be addressed. In the presumed safety of a pediatric hospital setting, the presence of peanuts in vending machines (VM) and nutritional closets (NC) poses an unnecessary risk to children's health. The objective is to examine the prevalence of peanut-containing products (PP) found in close proximity to pediatric units and emergency departments (ED) of hospitals in the U.S.

Methods: All pediatric residency programs in the U.S. were contacted via email and asked to have one resident complete an online survey about their hospital. The survey asked if there were PP in the NC on pediatric floors and, if so, what the products were. Residents were also asked to send in a picture of the VM closest to the Pediatric ED. Based on the pictures, research personnel calculated the frequency of hospitals that carried at least one PP in their ED VM. Comparisons across categorical variables (e.g. geographic region) were performed using Chi-square analysis.

Results: In total, 52 pediatric hospitals were represented; 19 in the Northeast, 14 in the Midwest, 12 in the South, and 7 in the West. Of the 42 hospitals that submitted a photo of the VM, 41 (98%) had at least one PP in the VM nearest the Pediatric ED. Of all surveyed hospitals, 60% had PP in the NC on the patient floors themselves, with the majority carrying peanut butter or peanut butter crackers. There was no significant difference in the presence of PP in VM or in NC across geographic region.

Conclusion: Despite the prevalence of peanut allergy, the overwhelming majority of surveyed children's hospitals unnecessarily exposed their patients to peanut products. While many schools and early care and education centers have banned all peanut-containing products, most hospitals have yet to do so. The AAP and the Children's Hospital Association should address this simple precautionary step that could have significant implications for child safety.

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9- Pediatric Firearm Injuries: Demographics and Context of Injuries in Urban and Rural Communities

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Background:
Pediatric firearm injuries carry significant morbidity and mortality. Previous studies have shown the majority of pediatric firearm injuries occur in adolescents, generally from handguns, and mortality is not affected based on rural versus urban areas. To our knowledge, the impact of rural and urban environment on shooter demographics, intent, and types of firearm is not well described in the published literature.

Purpose:
To describe the epidemiology of firearm injuries in a pediatric tertiary care level 1 trauma center and the context of injuries in urban and rural communities.

Methods:
A retrospective chart review of the electronic medical record and the trauma registry to identify all children admitted to our hospital emergency department (ED), inpatient service, or clinics from 2009-2014 for firearm related injuries. E-codes E992.0-E992.2, E922.8, E922.9, E955.0, E965.0, E965.1, and E965.4 were used to determine firearm injuries. Data points included demographics, admission date, length of stay, discharge status, geographical data, firearm type and caliber, intent, access, ownership, shooter relationship and age, and circumstance. Geographical data was stratified by zip code to designate a rural versus urban area based on second edition rural-urban commuting area codes (RUCA2).

Results:
We identified 94 eligible patients during the study period. The mean age of injured children was 9.32 years, and the mean age of children who were shooters was 8.6 years. Statistical differences were found for intent between large urban centers and all other areas (p < 0.01). Handguns were the most commonly used firearm in all injuries (50%, n=47). Regardless of intent or location, statistical differences were found for the type of gun and the specific RUCA2 codes with shotguns and rifles accounting for more injuries (p < 0.01). Approximately half of unintentional injuries occurred while the shooter was playing with the firearm. Adults were more often the shooters in urban areas, in situations of assault, and when the gun was being cleaned. 46% of all injuries (n = 46) occurred in the victim’s home regardless of location or intent.

Conclusion:
This study is the first to look at the differences and similarities of pediatric firearm injuries between urban and rural areas. Rural firearm injuries were more likely to be unintentional, and related to shotguns and rifles. There were 2 distinct differences between our study and previously published studies. Specifically, the age of children injured is younger, and more injuries occurred in the victim’s home. This study is also the first to highlight the mean age of children as shooters, and that children as young as 2 years of age can access and discharge a firearm. This study re-enforces that firearm injuries in children are complex and prevention strategies should be designed to address some of these specific circumstances.

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10- Is the Label “not Recommended for Children” a Deterrent or Dangerous Attraction for Teenagers?

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Purpose: Age restriction labels such as “not recommended for use in minors” began with cigarettes in 1966 in and now are found on many products that have been deemed by either the FDA or the manufacturer themselves as being unsafe for minor use. It is unclear whether these labels are acknowledged by adolescents, and if so, are they considered a deterrent or an enticement.

Methods: To examine this, 150 adolescents (14-17 age range) attending an upper socioeconomic suburban high school were given an anonymous three part survey. Section one collected demographics and purchasing history. Section two asked the subject to view seven different novel similarly themed product dyads, and to choose one of each dyad. In each product dyad, one of the products contained a age restriction warning label product. Warning label placement and order of product presentation was randomized but two of each product except the novel power bar were included for inter-test reliability . The third part asked teens to categorize each dyad choice using the variables, “The age restriction label encouraged my choice”, “The age restriction label discouraged my choice” or “I did not notice the age restriction label.” Finally teens were asked about parental permissiveness of age restricted products.

Results: 150 subjects participated, mean age: 15.15 years, 51% male. Overall underage teenagers chose age restricted products 55% of the time. When examined in categories, striking similarities were found in inter-test reliability. Mature video games were chosen an average of 56% of the time, restricted energy drinks 46% and rated R movies 64.5% and restricted power bars 55%. Eighty six percent of parents were reported “permissive” of mature movies, 80% permissive of mature video games and 32% of age restricted energy drinks. Teens reported that for both mature movies and video games they either “didn't notice or were encouraged” by the age restriction label 73% of the time, and 63% for both energy drink and powerbar. When teens indicated their parents were not permissive, warning labels were either “not noticed” or “encouraged” age restricted choice an average of 74%. When analyzed by gender there was no significant differences between male and female age restriction choices ( 3.77 vs. 3.96 p=0.34) or whether products discouraged, ( 1.66 vs 1.79 p=0.70) or encouraged ( 2.21 vs 2.53 p= 0.40) product choice.

Conclusion: Age restriction warning labels should be considered ineffective for adolescents and may conversely contribute to product appeal. In order to help protect adolescents against injury or violence exposure, age restricted warning labels should be reconsidered and revised. Further research should be done on a larger sample to determine how to make age restriction warning labels more visible and effective.

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11- Goods for Guns (g4g) Is Good for the Community: A 2015 Update of a Community Gun Buyback

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Introduction:
Though the United States represents four percent of the world’s population, its citizens constitute 44% of private gun ownership worldwide. The Worcester G4G Buyback was instituted in 2002; offering those with unwanted firearms an opportunity to dispose of them without challenging their 2nd Amendment rights. Voluntary surveys offer insight into participants of the program and were modified in 2015.

Methods:
We administered an anonymous survey via paper or electronic format (REDCap; performed in Worcester only) during the December 2015 Worcester G4G Buyback. In previous years, the survey was performed via face-to-face, structured interview. This was the first event where the survey was offered anonymously, and available in electronic format. Participants received gift cards ranging from $25-$50/gun. We retrospectively compared survey responses using univariate statistical analysis.

Results:
In December 2015, 186 citizens from Central/Western Massachusetts turned in weapons at one of 13 locations, with 339 total weapons (70 from Worcester) collected, with an average cost of $41/gun. White/Caucasian > 55 turned in the majority of weapons. We had a 60% response rate, with 109 participants completing the survey, 99 on paper. The electronic survey was available to 21 respondents, with 48% completing it in this modality. Respondents were mostly white (99%) and over 55 (90%). A total of 92 (85%) reported being first-time participants in the program. Of all respondents, 58 (54%) turned in their firearm “for safety reasons”, and 45 (43%) felt their homes would be safer. A majority of participants reported that they no longer needed their weapons (n=51, 47%) and 14 (13%) were concerned the firearm(s) were accessible to children. Almost all (87%) respondents felt the G4G program encouraged neighborhood awareness. In all, 62% of participants reported guns remaining in their homes: 21% where children could potentially access them and 8.6% with a history of mental illness, suicide or domestic violence in the home.

Conclusion:
The Worcester G4G Buyback provides a low-cost means of removing unused/unneeded weapons from our community while still honoring the 2nd Amendment. Most participants feel that their homes are safer as a result. In homes still possessing guns, emphasis on secure gun storage should continue, increasing the safety of children and families. The anonymity and electronic format of the survey provided new insight into mental illness/suicide/domestic violence present in the homes of the respondents.

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12- Rear-facing Car Seat Use for Children 18 Months of Age: Prevalence and Determinants

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Purpose: Motor vehicle crashes (MVCs) are the leading cause of death for children ages 1-14 years in the United States. Car safety seats are effective in decreasing the risk of injury and death, and rear-facing car safety seats (RFCSSs) are significantly more effective than forward-facing seats in protecting children less than 24 months of age. While the American Academy of Pediatrics (AAP) recommends that children remain in a RFCSS until at least 2 years of age, many families turn their children forward-facing before their second birthday. We examined the prevalence and determinants of RFCSS use in a sample of children 17-19 months of age born at a university hospital.

Methods: Participants were caregivers of children born November 2013-May 2014. Participants completed a telephone survey in 2015-2016 focused on car seat knowledge, attitudes, and use. The prevalence and odds of RFCSS use in reference to hypothesized determinants were estimated. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression.

Results: In total, 56% (491/877) of potentially eligible caregivers completed the survey. Of these, 62% reported RFCSS use for their child. Race, education, rurality and household income were associated with RFCSS use after controlling for potential confounders. Additionally, caregivers who reported having discussed car seats with their child’s health care provider (aOR=1.7; CI=1.1-2.6), received their child’s primary care in pediatrics compared to family practice (aOR=2.4; CI=1.1-2.6) and were aware of the AAP rear-facing recommendation (aOR=2.8; CI=1.8-4.1) were significantly more likely to still be using RFCSSs. Conversely, caregivers who previously used a car seat with another child were less likely to still have their child rear-facing (aOR=0.6; CI=0.4-0.9).

Conclusion: Many families surveyed continued to keep their children in RFCSSs through 17-19 months of age. Children cared for by pediatricians were more likely to remain rear-facing than those cared for by family practitioners. Caregivers who were aware of the AAP recommendations and had discussed best-practice RFCSS use with their child’s primary care provider were more likely to remain rear-facing, suggesting that anticipatory guidance and public education remain crucial tools in preventing motor vehicle related injuries. Caregivers who had previous car safety seat experience were more likely to have prematurely turned their child forward-facing, suggesting the need for targeted programs to encourage correct RFCSS use among experienced caregivers.

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13- Pediatric Injury Prevention Programs Today: Identifying Markers for Success and Sustainability

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Purpose: Childhood injury remains the top cause of mortality in children ages 1-19. Despite national awareness campaigns and advocacy for evidence-based state laws that reduce the risk of serious injuries, local efforts in education, outreach, and research vary considerably. This study sought to identify the characteristics of a successful and sustainable pediatric injury prevention program by focusing on programs affiliated with the Injury Free Coalition for Kids (IFCK). IFCK is a national network of hospital-based, academic, community-oriented pediatric injury prevention programs with sites in over 30 states.

Methods: All 42 IFCK sites were sent a 30-question survey via e-mail; data was managed via a REDCap database. Survey questions were developed by the study team and focused on organizational structure, demographics, injury prevention activities, finances, academic productivity, legislative activities, and self-efficacy. Counts and frequencies were calculated and compared using chi-square tests when applicable.

Results: Survey was completed by 67% (28) of the sites. The majority of IFCK sites were associated with a freestanding children’s hospital (64%) and a level 1 pediatric trauma center (89%). Programs were typically at least 10 members or larger (54%) with 80% having at least one full-time equivalent (FTE) employee dedicated to injury prevention programming. Most programs (80%) offer outreach and education in child passenger safety, home safety, bicycle safety, pedestrian safety, and teen driving. The 32% of programs offering educational curricula to healthcare providers were more likely to have FTE support than other sites (p = 0.018). Although 68% of programs were affiliated with a medical school, 38% a school of public health, and 14% either a current or past CDC research control center, only 14% of programs published 16 or more peer-reviewed publications over the prior 5 years and 60.7% had 5 or fewer publications. Steady sources of funding were identified for 57% of programs, with 50% identifying their hospital as the primary source of funds. While 71% of respondents were confident in their program’s capacity to sustain activities, these were more likely to be larger programs (p = 0.0108) and have a steady source of funding (p= 0.0042). In the prior 2 years, 54% of programs impacted legislative or policy changes. However, funding, size of program, and FTE had no statistical correlation with research productivity or number of legislative/policy changes.

Conclusion: This study characterizes the variation among pediatric injury prevention programs. These results can assist programs in identifying their strengths and weaknesses in relation to their peers, as well as provide data for programs to advocate for additional resources. This study also highlights that financial and FTE support from individual program institutions is associated with sustainable programming.

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14- Injury Recidivism Among Children in the United States: Findings from a Population-based Sample

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Background
An estimated 9 million children sustain injuries every year in the United States. Many of injured children remain at risk of repeated injuries, as known as injury recidivism, posing a significant burden on population health and healthcare settings. Therefore, identifying those at risk of recidivism can highlight targeted populations for primary prevention to improve health and reduce expenditures. Because there has been limited research on factors associated with recidivism in the U.S., the aim of this study is to identify the prevalence and risk factors for injury recidivism among non-institutionalized children.

Methods
Using the Medical Expenditure Panel Survey (MEPS), 4,490 children, age 3-17, with at least one reported injury were followed for about two years. Parent-reported injuries were those associated with at least one hospitalization, one emergency department visit, or one visit to a phycician’s office. The independent associations between risk factors for recidivism were evaluated incorporating a weighted logistic regression model.

Result
The weighted study sample was representative of 10,073,210 children. Of those, 1,225,289 (12.2%) children were recidivists over a 2-year follow-up. Compared with those who sustained a single injury, recidivists were more likely to be older (mean=12.0 vs. 10.5, p < 0.01), white, hold private insurance, report a higher total health expenditure (mean= 6,329.1$ vs. 4,369.7$, p < 0.01), and a higher prevalence of asthma. Age, race/ethnicity, health insurance and asthma diagnosis were significant predictors of recidivism. Compared to 3-7 years age group, children between 13 to 18 years old were 2.4 (95% CI 1.8- 3.1) more likely to be recidivists adjusting for other variables. The result showed that asthma diagnosis was associated with 1.6 (95% CI 1.2- 2.1) higher odds of injury recidivism despite adjusting for other covariates.

Conclusions
This study found a higher recidivism rate among injured children in this study than previously reported. Our findings emphasize the pressing need for injury prevention in order to reduce the burden of repeated injuries among children. Preventative efforts may benefit from focusing on 13- 18 years old age group and those with comorbidities such as asthma.

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15- Identifying Factors to Improve Safety Seat Use in Children

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Background: Restraining a child in an appropriate safety seat can greatly reduce the mortality rate of children resulting from motor vehicle collisions, a leading cause of death in children in the US.

Purpose: To identify modifiable factors associated with having a child in an inappropriate safety seat and to evaluate safety seat knowledge among parents/guardians.

Methods: Parents/guardians whose child was managed in the emergency department (ED) completed a survey asking about demographics, safety seat use and practices, knowledge of safety seats and preferred source of information about safety seats. Initially a descriptive analysis was performed. Subsequently logistic regression models were developed to test what impacted the odds a parent/guardian properly used a safety seat for their child.

Results: One hundred fifty families seen in the ED were surveyed. The mean age of the child was 2.8 years (SD= 2.3); the mean age of the parent completing the survey was 28.7 (SD= 6.2). 133 surveys (88.7%) were completed by the mother. While a majority of individuals reported that their child was appropriately placed in a safety seat (n=104, 69.3%), knowledge scores were low (mean score of 32.8%, SD=21.4). The child’s age was inversely associated with the odds of proper placement (OR=0.75, 95% CI 0.59-0.92, p=0.035), while the parent’s age was positively associated with the odds of proper placement (OR=1.12, 95% CI 1.02-1.27, p=0.046). Fathers were less likely to properly place a child in a car seat (OR=0.14, 95% CI 0.07-0.33, p=0.002). Those who received information concerning proper placement from a pediatrician (OR=2.31, 95% 2.01-2.68, p < 0.001) or the internet (OR=1.49, 95% CI 1.31-1.67, p=0.012) had increased odds of proper placement, when compared to receiving the information from a relative or friend.

Conclusion: Understanding the modifiable factors that can lead to improvements in properly restraining a child in a safety seat is warranted and a fruitful area of research to combat a leading cause of death for children. Our results suggest that tailored interventions for younger parents, fathers, and families with older children could lead to the greatest improvements.

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16- Hoverboard Safety: Lessons Learned from the First Year of Injuries

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Purpose: Hoverboards were recently introduced in the United States consumer market and have rapidly increased in popularity. Concern regarding the safety of hoverboards has largely focused on the risk of fire, drawing media attention and prompting investigation by the United States Consumer Product Safety Commission (CPSC). At our institution, we noted an increase in musculoskeletal injuries related to hoverboard use. We sought to analyze hoverboard injuries to characterize the frequency of injury, pattern of musculoskeletal injury, and provide families with safety information.
Methods: An IRB approved retrospective review of all patients with musculoskeletal injury related to hoverboards was performed at a tertiary care children’s hospital from January 2015 – January 2016. Medical records were queried for keywords relating to hoverboard including “hover board” and “self balancing”. Patient encounters in the emergency department, urgent care centers, and outpatient clinics were included. All relevant notes, operative reports and radiographs were reviewed.
Results: During the study period, eighty-seven patients presented with hoverboard-related musculoskeletal injuries. From November 2015–January 2016, 3.87% (79/2038) of fractures seen were related to hoverboards (Figure 1). This represents an approximately 10-fold increase in the incidence of hoverboard-related fractures compared to the preceding three-month period (p < 0.0001). The average age at time of injury was 11.5 (SD= 3.28) years and over half of the injuries (51%) occurred in children 10-13 years. Female patients accounted for 53% (n=46) of all injuries. The most common mechanisms of injury were fall from hoverboard (79%) and finger entrapment between wheel and wheel-base (10%). There was not a significant difference in age or gender between patients who suffered injuries from falls and entrapment (p>0.05). Of the injuries presented, the most frequent injuries sustained were closed fractures (54%), contusions (13%), open fractures (7%), and lacerations (7%). Frequently fractured sites included the distal radius (43%), phalanx (17%), ankle (11%), and humerus (11%) (Figure 2). Sixteen patients (18%) required surgical treatment. The most common procedures were nailbed repair and pinning for Seymour fracture (n=6), closed reduction and percutaneous pinning for distal radius fracture (n=3), and open reduction internal fixation for ankle fracture (n=2).
Conclusion: Hoverboard-related injuries represent a significant proportion of recent musculoskeletal injuries in children. Previous research indicates males are more likely to be injured from wheeled recreation devices such as skateboards, roller skates, and scooters. This investigation found nearly the same rate of hoverboard injury for males and females suggesting that injury prevention efforts should target both genders. Furthermore, children who use hoverboards are at high risk for distal radius fractures from falls and phalanx fractures from entrapping their fingers between the wheel and wheel-well. As the CPSC investigates the safety of hoverboards, special attention should be given to the use of wrist-guards and wheel-well design.

Hoverboard related fractures by month
Hoverboard related fractures by anatomic location

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17- Demographics and Characteristics of Violent Deaths in Children

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Background:
Injury is the leading cause of death in children in United States. While much attention has been paid to accidental deaths (falls, motor vehicle crashes, etc), homicide and suicide are among the most common causes of death from injury. Better understanding of the characteristics of violent deaths will permit the development of intervention strategies to prevent violence and reduce violence deaths among children.
Objectives:
(1) Describe the characteristics of child violent deaths in the Chicago metropolitan area from 2005 to 2010;
(2) Identify areas within the Chicago metropolitan area that have the disproportionately high rates of child violent deaths;
(3) Evaluate factors associated with increased violent mortality in certain areas of the region.
Methods:
Data was abstracted from the Illinois Violence Death Reporting System database. Preliminary analysis has been completed, using data obtained from The Lurie Children's Hospital IVDRS team. The data sources of the IVDRS include death certificates, medical examiner reports, law enforcement reports, and crime lab reports relating to violent death cases that occurred in the Chicago areas from 2005 to 2010. Secondary analysis will include distribution analyses, stratified by age groups to describe the characteristics of violent deaths, such as sex, race/ethnicity, place where the violence occurred, use of emergency medical services, cause of death, type of weapon, and survival time of post-injury. We will sort child violent deaths by zip codes where the injury occurred. We will identify emergency departments of the regions with high number of child violent deaths.
Results:
Preliminary analysis showed that there were 856 child violent deaths (80% males) for the six-year period. Of them, 18% were age 0 to 5 years, 5% were age 6 to 11 years, and 77% were age 12 to 18 years. Non-Hispanic, black race comprised 56% of the total deaths. 45% of injuries happened inside or vicinities of houses. 91% of all cases utilized EMS. The most frequent cause of death was homicide (78%), followed by suicide (14%). Most frequently used weapon was firearm (59%). We will continue our analyses to achieve the objectives.
Conclusion:
In this study, we examined the demographics and characteristics of violent deaths in children in greater Chicago area using IVDRS. Nearly one-fifth of violent deaths were in children under 5 years of age. Non-Hispanic Blacks accounted for a disproportionate number of deaths relative to their overall representation in the Chicago Metropolitan area population (roughly 25% in Cook County). Suicide remains a significant cause of death and would be a potential target for intervention. Limiting access to firearms might reduce the lethality of violence, reducing death rates among children. Additional analysis will provide formative information on child violent death and help emergency medical services address the needs of the community.

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18- Keeping an Eye on Bb/pellet Guns and Children – United States Injury Patterns and Trends Between 2005 and 2015

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Objective: While often misconstrued as toys, non-powder firearms including BB guns, pellet guns, and air rifles have the potential to cause serious harm. Our objective was to examine contemporary trends in fatal and non-fatal injury rates related to non-powder firearms for persons aged 18 years and younger in the United States.

Method: National estimates on BB/pellet gun related injuries and deaths were examined using the National Electronic Injury Surveillance System (NEISS) database between January 2005 and December 2014. Demographics, injury patterns, and mechanisms of injury were analyzed.

Results: BB/pellet gun injury rates have declined in the United States from 17.5/100,000 in 2005 toward a nadir of 11.1/100,000 in 2011. The age at injury increases steadily from age 2, peaking at age 13 with approximately one third of all injuries occurring in children ages 12-14 years. Extremities are the most common body area injured (39%); followed by the eye (26%), face (26%), and trunk (8%). Though infrequent, internal organ injuries were noted in 1.2% of cases, most commonly occurring in the head (76%) followed by the trunk (20%) and pubic region (4%). Half of all injuries are self-inflicted, followed by injuries from friends and siblings (20%). The majority of children are evaluated and discharged from the emergency department without treatment (90%), while children with more significant injuries are either admitted directly (5%) or transferred to a higher level of care (2%).

Conclusions: The incidence of BB/pellet gun injuries has declined over the past decade. Injury rates appear to have plateaued in recent years indicating the need for further efforts in securing safety legislation, education and prevention.

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19- Youth-size Atv Seat Design: Variability and Lack of Consistent Changes in Vehicles Designated for Different Ages Demonstrates Need for Evidence-based Standardization

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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Purpose: Carrying passengers is an independent risk factor for crash and injury on all-terrain vehicles (ATVs). Optimal seat design would allow for safe vehicle operation while decreasing the likelihood of multiple riders and use by underage operators. A previous study of adult-size ATVs found a wide variability in seat length and placement among manufacturers and between sport (mean 31.3 in.) and utility ATVs (mean 26.1 in.). Seat lengths overall ranged from 19.8-37.0 inches. Many models had seats long enough to accommodate multiple riders. There are no published studies related to youth-size ATV seat design. The study objective was to determine the variability in seat length characteristics among youth-size ATV models (Y6+ for youth ≥6 yrs, Y10+ for youth ≥10 yrs, Y12+ for youth ≥12 yrs, and Y14+ for youth ≥14 yrs) from major manufacturers.
Methods: Measurements of 37 models were performed using an image-based method previously validated that utilizes tools from Adobe Photoshop. Seat characteristics were compared by model age designation, manufacturer, and by ATV type (sport vs. utility).
Results: Seat lengths ranged from 20.5-30.4 inches with a mean of 24.6 inches. The difference in the seat length of the average Y6+ model and the average Y14+ model was only 1.4 inches. Youth utility models (eight) had an average seat length of 25.7 inches (range 23.1-27.9 in.) which was similar to sport models for youth 10 years and older (mean 25.0 in., range 22.1-30.4 in.). The seat front to handle grip distance ranged from 2.7-10.4 inches with a mean of 6.3 inches. The difference in this average distance between Y6+ and Y14+ models was only 1 inch. Variability was noted in seat length and in seat front to handle grip distance among manufacturers for ATV models designated for the same aged youth. The mean footrest to seat height was the same between Y6+ and Y14+ models.
Conclusion: The seat lengths of youth-size ATVs are very similar to that of adult models and there was little difference in the seat length and placement for youth models that were designated for various aged children. It is likely that these seat lengths allow and potentially encourage the carrying of passengers. The seat front to handle grip distance was quite short for many youth models, and the footrest to seat height did not vary much among models for various aged children. This may allow the use of these vehicles by children younger than which they are designated. Regulations are needed to standardize safe seat design for ATVs.

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20- Pediatric Moped-related Injuries in the United States

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

Take Evaluation

Purpose: Mopeds have become an increasingly popular means of transportation over the past decade especially in urban areas. A Swedish study found moped riders have a 20-fold higher injury risk per kilometer traveled as compared to automobile occupants. Few studies have investigated pediatric moped-related injuries in the United States. The goal of this study was to better understand the demographics, mechanisms and injury patterns of pediatric moped-related injuries. Methods: The National Electronic Injury Surveillance System (NEISS), a system that prospectively collects injury data from a stratified sampling of emergency departments from across the nation, was utilized to identify pediatric moped-related injuries between 2002 and 2014. Descriptive and comparative analyses were performed. Results: Pediatric moped-related injuries did not change over the study period for those 14-17 years of age, whereas those involving children < 14 years of age decreased significantly. Overall, more than three-fifths of those injured were male, however, the percentage of injured who were female was higher among victims < 14 years of age (34%) than among victims 14-17 years old (25%), p=0.0032. A higher proportion of 14-17 year olds were Caucasian (76%) as compared to those injured who were < 14 years of age (63%), p=0.0007. Mechanisms varied by age group. Injured riders < 14 years old had higher proportions that had struck an object or had a non-collision crash and those 14-17 years of age had a higher percentage that had been in a collision with another motor vehicle as compared to their older and younger peers, respectively. Children < 14 years of age had a higher proportion of injuries that occurred off of public roadways (45%) as compared to those 14-17 years of age (23%), p < 0.0001. Contusions, lacerations and fractures were the most common diagnoses. Differences in diagnoses by age were seen with children < 14 years old having more burns, and those 14-17 years old suffering more concussions. Only 15% of those injured were documented in the database narratives as having been wearing a helmet. Conclusions: Although adult moped-related injuries identified by the NEISS database increased substantially during the study period, pediatric injuries did not. Still, too many children are being injured while operating these vehicles and the differences in crash mechanism and injury patterns suggest the need for age-specific interventions that separately target children less than 14 years of age and those 14 years and older.

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21- Reducing Violence Through the Integration of Hospital and Police Data

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

Take Evaluation

Objectives:
The utilization of de-identified Emergency Department (ED) information on assaults to inform law enforcement and public health organizations has proven successful in European cities. In Cardiff, Great Britain real time geocoded hospital data has allowed for the development and evaluation of novel policy and program interventions for violence prevention. The purpose of this study was to assess the feasibility of the implementing this model within the electronic medical record (EMR) in a pediatric ED and to describe initial findings.
Methods:
Beginning Jan 1, 2015 data was collected in the EMR for all patients reporting an assaultive injury upon arrival to the pediatric ED. Descriptive statistics were utilized to describe initial data gathered from implementation. Seventy seven ED nurses were recruited to participate in a survey to assess implementation and to provide qualitative feedback. Online survey administration occurred from August 2015 to October 2015. Results of the survey were disseminated back to the nurses and used to assess study procedure and EMR question format.

Results:
A total of 539 patients were identified as having assaultive injuries during the study period. The majority of the assault victims were male (58%), African American (74%), suffered blunt injuries (44%) and had public insurance (84%). 275 cases (51%) had sufficient data for geocoding and mapping. Of these, 64% of the cases occurred in the afternoon and 44% occurred at school. Nurses completed EMR questions in 98% of patients reporting an assaultive injury over the study period. Triage times during pilot implementation did not change (4.2 minutes vs. 3.9 minutes). Forty-three nurses (55.8%) completed the feasibility survey. Ninety-three percent of nurses were satisfied with their participation, and most felt that it was useful for clinical care (79%); was integrated well into workflow (89%); should continue over the next year (88%); and was congruent with the ED and hospital goals and mission (93%). Qualitative data suggested some modifications to further streamline the data collection process. Nurses also felt that data collection facilitates the nurses understanding of the incidents, and what services and resources may be required by patients.

Conclusion:
It is both feasible and meaningful to implement assaultive injury specific questions into the EMR with little perceived disruption of workflow and triage times. Nurses, as key members of the emergency department team, are receptive to participating in the collection of information that may inform clinical care and community violence prevention activities.

Goecoded Hospital Injuries Combined with Police Data
Many ED data points fall within areas of high assaultive violence activity recorded by police. ED data is adding information to police data to more accurately describe the burden of assaultive violence in the community.

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22- Disparities Among In-hospital Unintentional Childhood Poisoning-related Deaths and Underreporting to the Regional Poison Control Center

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

Take Evaluation

Purpose: Childhood poisoning is an important cause of unintentional injury death in the United States. In 2014, the American Association of Poison Control Centers recorded over 1,000,000 poison exposures for children under the age of six years with 16 documented fatalities. Like all regional poison control centers (PCCs), our PCC offers medical advice to both lay persons and healthcare providers in an effort to improve patient care and decrease poisoning morbidity and mortality. Unfortunately, we believe there is tremendous underreporting of serious pediatric poisoning cases to the PCC. The objective of this study was to characterize the epidemiology of in-hospital childhood poisoning deaths in our region and to assess the degree of PCC underreporting.

Methods: We performed a retrospective review of all unintentional childhood (age < 10 years) poisoning-related deaths (ICD10: X80-X84, T20-T32, T36-T65, T90-T98) examined by our local Office of the Chief Medical Examiner (OCME) from 2000 through 2012. Because of regulations governing the OCME, all acute poisoning-related deaths in children are examined as sudden deaths in persons of prior good health. Characteristics of decedents and cause and manner of death were examined. An additional review of all childhood deaths reported to the PCC during the same study period was performed. PCC cases were matched to OCME decedents by name and year. The study was granted exempt status by the IRB.

Results: A total of 136 poisoning-related deaths were identified in children less than 10 years. Forty-five of these deaths occurred at home and were excluded from further analysis. Of the 97 children who died at a healthcare facility, 57% were male. Ages were: less than 1 year (13%), ages 2-5 years (54%), and ages 6-9 years (33%). Black children (59%) and those living in a high poverty-zip codes (38%) were disproportionately affected. The majority of in-hospital deaths were due to smoke inhalation both “with” (35%) and “without burns” (42%); mean peak carboxyhemoglobin of 44% (range 6%-78%). The remaining causes of death included toxicity from: opioids (10%), household products (4%) other drugs (3%), calcium-channel blockers (2%), cocaine (1%) and carbon monoxide without fire (1%). Despite mandatory reporting laws, only 12 childhood deaths were reported to the PCC. Of these, 9 were confirmed to be poisoning-related with 5 reported from a healthcare facility and 4 reported post-mortem from the OCME or a laboratory.

Conclusions: In our large, diverse urban population, we found unintentional childhood poisoning related deaths to have highest prevalence among the black population and those living in high-poverty zip codes. The large number of smoke inhalation-related deaths offers a target for future prevention strategies. Additionally, with only 5% of in-hospital childhood poisoning-related deaths reported to our regional PCC, outreach should focus on improving PCC utilization.

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23- Historic First in Hopes That Others Will Follow - Child Death Review for Maintenance of Certification Credit! kentucky Child Death Review as a Quality Improvement and Prevention Tool for Safe Sleep

Monday, October 24
5:00PM - 5:45PM
Moscone West, 2005/2007

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In December 2015 the ABP accepted this project for MOC credit, a historic first that accomplished a major goal of the AAP Provisional Section on Child Death Review (CDR). It is being submitted in hopes that other pediatricians around the country can utilize this process to support their CDR work as a QI tool to enhance pediatric medicine and public health prevention efforts. For more than 20 years KY has worked to implement multidisciplinary, multi-agency child death review as a tool for better understanding cause, manner and strategies for the prevention of death and serious injury to infants, children and adolescents. CDR represents an effort to improve the quality of child death data from the investigative process through local county review to prevention. Prevention efforts can only be as good as the quality of data that informs them. Safe Sleep was chosen as a topic to embody this process as QI.

Every month in KY we review deaths of infants who die in unsafe sleep conditions, with suffocation being the leading cause of injury-related death to infants < age 1. What is learned at those reviews is utilized to help inform prevention efforts that reach newborn nurseries, pediatricians, local health departments both urban and very rural, WIC and home visitor programs, child care health consultants and child care providers. Several databases are maintained including this one that tracks notification, investigation and review of child deaths with data on the county of residence, county of incident and county of death. (With only two Children’s Hospitals in the state, many critically ill children are transferred far from home.) Follow-ups are done with the County Coroners in a mixed Medical Examiner/Coroner system, and as many county-level reviews as possible are attended. In KY the county of death has responsibility for the death, rather than the county of residence (which may also choose to review), and about half the counties have CDR teams that are functional at any given time. As part of our Injury Center CDC Core Injury grant process, every year we analyze death, hospital admission and ED data for children under age 5. Fatality data for safe sleep as summarized in that report from 2010 to 2013 was utilized for baseline and end data. The number of infant injury deaths decreased during that time from 35 to 25. The percent of infant deaths caused by suffocation in that time decreased from 60% to 40%. The 111 cases from that total time period were analyzed to assess how many were reviewed at the county of death level and what information came from that review, versus how many were reviewed only at the state CDR program level. Results and MOC process will be discussed.

Suffocation/unsafe sleep in Ky 2010-13
Source: Kentucky Special Emphasis Report: Infant and Early Childhood Injury, 2013. Kentucky Injury Prevention and Research Center, University of Kentucky College of Public Health. Available at http://www.mc.uky.edu/kiprc/reports/KY-Yr-4-Infant-and-Early-Childhood-Injury.pdf.

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Ibrahim Abdelshafy, MD

Resident
Cohen Children's Medical Center
New Hyde Park, NY

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Tasnim Ahmed

Steven and Alexandra Cohen Children's Medical Center of New York
Lake Success, NY

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Faisal Alqahtani, MD, MPH

Pediatric resident
Department of Pediatrics, University of Dammam, Saudi Arabia
Alexandria, VA

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Paulo Alves, MD

MedAire
Tempe, AZ

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Allison Black, MD

Resident Physician
University of Louisville
Louisville, KY

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Kylie Bushroe, B.S.

Medical Student
The Ohio State University College of Medicine
Columbus, OH

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Sofia Chaudhary, MD

Pediatrician
Children's Healthcare of Atlanta
Emory University School of Medicine
Atlanta, GA

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SunHee Chung, MD

Resident
Mount Sinai Children's Hospital
Chicago, IL

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Rachelle Damle, MD, MSCI

General Surgery Resident
University of Massachusetts School of Medicine Department of General Surgery
Worcester, MA

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Emily DeDonato, B.S.

Nationwide Children's Hospital
Maumee, OH

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Andrea Diebel, MD

Pediatric Emergency Medicine Fellow
University of Texas Southwestern
Dallas, TX

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Madhulika Eluri

Medical Student
Case Western University School of Medicine
Cleveland Heights, OH

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Michael Flaherty, D.O.

Pediatric Critical Care Fellow
Massachusetts General Hospital/Harvard Medical School
Boston, MA

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Mariano Garay, B.S.

Medical Student
Penn State College of Medicine
Hummelstown, PA

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Jonathan Goldman

Steven and Alexandra Cohen Children's Medical Center of New York
Great neck, NY

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Elizabeth Hines, MD

Fellow, Medical Toxicology
New York Univeristy School of Medicine
New York, NY

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Michelle Ho, BSE

The Children's Hospital of Philadelphia
Philadelphia, PA

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Ashley Jones, MD, FAAP, CPST

Fellow, Pediatric Critical Care Medicine
Oregon Health and Science University
Oregon Health and Science University
Hillsboro, OR

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Sarah Koffsky

Steven and Alexandra Cohen Children's Medical Center of New York
Lake Success, NY

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Sarah Koffsky

Steven and Alexandra Cohen Children's Medical Center of New York
Lake Success, NY

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Michael Levas, MD, MS

Assistant Professor Pediatric Emergency Medicine
Medical College of Wisconsin
Wauwatosa, WI

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Jamie Macklin, MD, FAAP

Assistant Professor, Division of Hospital Pediatrics
Nationwide Children's Hospital
Columbus, OH

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Erik Pearson, MD

Pediatric Surgery Fellow
Children's Healthcare of Atlanta at Egelston
Avondale Estates, GA

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Tammy Pham, BS/BA

Steven and Alexandra Cohen Children's Medical Center of New York
Lake Success, New York

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Susan Pollack, MD, FAAP

Assistant Professor
University of Kentucky Colleges of Medicine and Public Health
Lexington, KY

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Suliman Alghnam, PhD, MHA

Postdoctoral fellow
Department of Health Policy and Management | Johns Hopkins Bloomberg School of Public Health
Baltimore, MD

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Claire Castaneda, Undergraduate

University of Iowa College of Engineering
Iowa City, IA

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Laura Fletcher

Steven and Alexandra Cohen Children's Medical Center of New York
Lake Success, NY

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Michael Gittelman, MD, FAAP

Professor, Clinical Pediatrics, Division of Emergency Medicine; Co-Director, Comprehensive Children’s Injury Center
Cincinnati Children's Hospital
Cincinnati, OH

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Jonathan Green, MD

General Surgery Resident
University of Massachusetts School of Medicine Department of General Surgery
Worcester, MA

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Erinn Hade, Ph.D.

Research Scientist
The Ohio State University College of Medicine
Columbus, OH

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Benjamin Hoffman, MD, MPH, FAAP, CPSTI

Professor of Pediatrics
Oregon Health and Science University
Portland, Oregon

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Robert Hoffman, MD

Director Division of Medical Toxicology, Ronald O Perelman Department of Emergency Medicine
New York University School of Medicine
New York, NY

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B. David Horn, MD

The Children's Hospital of Philadelphia
Philadelphia, PA

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Brandon Johnson, Undergraduate

University of Iowa
Iowa City, IA

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Soyang Kwon, Ph.D

Research Assistant Professor
Ann & Robert H. Lurie Children’s Hospital of Chicago
chicago, Illinois

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Courtney Lattimore

Medical Student
University of Louisville
Louisville, KY

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Talia Migdal

Cohen Children's Medical Center
New Hyde Park, NY

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Daniel Oscislawski, MD

MedAire
Tempe, AZ

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Anqi Pan, BE

Research Assistant
Emory University School of Public Health, Department of Biostatistics
Atlanta, GA

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Adarsh Patel, BS

Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta
Atlanta, GA

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Tammy Pham, BS/BA

Steven and Alexandra Cohen Children's Medical Center of New York
Lake Success, New York

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Tammy Pham, BS/BA

Steven and Alexandra Cohen Children's Medical Center of New York
Lake Success, New York

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Tammy Pham, BS/BA

Steven and Alexandra Cohen Children's Medical Center of New York
Lake Success, New York

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Nancy Piotrowski, RN

Children's Hospital of Wisconsin
Milwaukee, WI

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Toby Raybould, M.S.

Massachusetts General Hospital
Boston, MA

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Brian Robertson, PhD

Instructor, Pediatrics
University of Texas at Southwestern
Dallas, TX

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Jillian Savino, BA

Cohen Children's Medical Center
New Hyde Park, NY

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Michael Singleton, PhD

Assistant Professor
Department of Biostatistics, College of Public Health, Univ of Ky
Lexington, KY

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Gary Smith, MD, PhD

Center for Injury Research and Policy at Nationwide Children’s Hospital
Columbus, Ohio

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Gary Smith, MD, PhD

Center for Injury Research and Policy at Nationwide Children’s Hospital
Columbus, Ohio

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Jessica Waters, BS

University of Iowa Carver College of Medicine
Iowa City, IA

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Douglas Armstrong, MD

Penn State Hershey Medical Center
Hershey, Pennsylvania

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Michael Braida, MD

MedAire
Tempe, AZ

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Nathan Christopherson, RN, MSN, MBA, TCRN, CPEN, CEN, EMT-P

Cohen Children's Medical Center
New Hyde Park, NY

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Chelsey Clark

Steven and Alexandra Cohen Children's Medical Center of New York
Lake Success, NY

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Sarah Denny, MD, FAAP

Associate Professor of Clinical Pediatrics, Division of Emergency Medicine
Nationwide Children's Hospital
Columbus, OH

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Tess Gilbert, MHS

Senior Research Associate
Division of Epidemiology, School of Public Health, Oregon Health and Science University
Portland, Oregon

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Alyson Gutman, MD

Steven and Alexandra Cohen Children's Medical Center of New York
Lake Success, NY

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Jennifer Hernandez-Meier, MPH

Injury Research Center Medical College of Wisconsin
Milwaukee, WI

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Maguire Herriman

Steven and Alexandra Cohen Children's Medical Center of New York
Lake Success, NY

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Pam Hoogerwerf, BA

University of Iowa Children's Hospital
Iowa City, Iowa

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Dave Ishaan, BS

CHOA
Atlanta, GA

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Nathaniel Johnson, Undergraduate

University of Iowa
Iowa City, IA

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Rebecca Kasper, MPH

Medical Student
University of Massachusetts School of Medicine
Worcester, MA

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Ines Lin, MD

University of Pennsylvania
Philadelphia, PA

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Alvin Long, Undergraduate

University of Iowa College of Engineering
Iowa City, IA

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Maryann Mason, Ph.D

Research Assistant Professor
Ann & Robert H. Lurie Children’s Hospital of Chicago
Chicago, IL

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Tara McCarthy, B.S.P.H.

Clinical Research Coordinator
Nationwide Children's Hospital
Columbus, OH

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Ruth Milanaik, DO

Steven and Alexandra Cohen Children's Medical Center of New York
Lake Success, New York

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John Myers, MSPH, PhD

University of Louisville
Louisville, KY

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Jo-Ann Nesiama, MD, MS

Associate Professor and Assistant Program Director, Pediatric Emergency Medicine
University of Texas at Southwestern
Dallas, TX

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Wendy Pomerantz, MD, MS

Professor, Pediatric Emergency Medicine
Cincinnati Children's Hospital
Cincinatti, OH

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Raghu Seethala, M.D.

Brigham and Women's Hospital
Boston, MA

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Mark Su, MD

Director
New York City Poison Control Center
New York, NY

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Sujit Vettam

Cohen Children's Medical Center
New Hyde Park, NY

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Andrew Adesman, MD

Chief of the Division of Developmental and Behavioral Pediatrics
Cohen Children's Medical Center
New Hyde Park, New York

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Adam Alder, MD, MSCS, FACS, FAAP

Assistant Professor, Department of Pediatric Surgery, Surgeon Champion, NSQIP-Pediatric
University of Texas at Southwestern and Children's Medical Center
Dallas, TX

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Esther Borer, CPST

Department of Injury Prevention, University of Massachusetts Medical School
Worcester, MA

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Jeff Bridge, Ph.D.

Principal Investigator/ Professor
Nationwide Children's Hospital/ The Ohio State University College of Medicine
Columbus, OH

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Becky Carothers, MD

Norton Healthcare
Louisville, KY

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Benjamin Chang, MD

University of Pennsylvania
Philadelphia, PA

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Adrienne Gallardo, MA, CPSTI

Tom Sargent Safety Center Program Manager
Tom Sargent Safety Center, Doernbecher Children's Hospital, Oregon Health and Science University, Portland Oregon
Portland, OR

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Hess Joseph, RN

Penn State College of Medicine
hershey, PA

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Sara Kohlbeck, MPH

Injury Research Center Medical College of Wisconsin
Milwaukee, WI

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Jarone Lee, M.D., M.P.H.

Massachusetts General Hospital
Boston, MA

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Beverly Miller, MEd

Associate Director, Injury Prevention Center
Arkansas Children's Hospital, University of Arkansas for Medical Sciences
Little Rock, AR

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Neil Nerwich, MD

MedAire
Tempe, AZ

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Chuck Ng, DO

Steven and Alexandra Cohen Children's Medical Center of New York
Lake Success, NY

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Chuck Ng, DO

Steven and Alexandra Cohen Children's Medical Center of New York
Lake Success, NY

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José Prince, MD

Cohen Children's Medical Center
New Hyde Park, NY

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Heather Short, MD

Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta
Atlanta, Georgia

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Michael Slater, MD

Attending Physician, Emergency Medicine
Mount Sinai Hospital
chicago, IL

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Hayley Southworth, MS

Development and Program Manager
Ohio Chapter, American Academy of Pediatrics
Columbus, OH

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