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Biomedical subjects

D R Durbin

Publications and source records attributed to D R Durbin.

28 records · Page 2Linked to original sources
PubMed2000

Trends in incidence of pediatric injury hospitalizations in Pennsylvania.

OBJECTIVES: This study analyzed short-term trends in pediatric injury hospitalizations. METHODS: We used a population-based retrospective cohort design to study all children 15 years or younger who were admitted to all acute care hospitals in Pennsylvania with traumatic injuries between 1991 and 1995. RESULTS: Injuries accounted for 9% of all acute hospitalizations for children. Between 1991 and 1995, admissions of children with minor injuries decreased by 29% (P < .001). However, admissions for children with moderate (P = .69) or serious (P = .41) injuries did not change. CONCLUSIONS: Significant declines in pediatric admissions for minor injuries were noted and may reflect both real reductions in injury incidence and changes in admission practices over the period of the study.

Abbreviated Injury Scale↗
PubMed2000

Discovery of predictive models in an injury surveillance database: an application of data mining in clinical research.

A new, evolutionary computation-based approach to discovering prediction models in surveillance data was developed and evaluated. This approach was operationalized in EpiCS, a type of learning classifier system specially adapted to model clinical data. In applying EpiCS to a large, prospective injury surveillance database, EpiCS was found to create accurate predictive models quickly that were highly robust, being able to classify > 99% of cases early during training. After training, EpiCS classified novel data more accurately (p < 0.001) than either logistic regression or decision tree induction (C4.5), two traditional methods for discovering or building predictive models.

Artificial Intelligence↗
PubMed2000

Factors influencing pediatric injury in side impact collisions.

Side impacts collisions pose a great risk to children in crashes but information about the injury mechanisms is limited. The heights and weights of children vary widely and as a result, the injury patterns may vary across the pediatric age range. This study involves a case series of children in side impact collisions who were identified through Partners for Child Passenger Safety, a large child-focused crash surveillance system. The aim of the current study was to use in-depth crash investigations to identify injury mechanisms to children in side impact collisions. 93 children in 55 side impact crashes were studied. 23% (n = 22) of the children received an AIS > or = 2 (clinically significant) injury. In these 22 children, head (39%), extremity (22%), and abdominal injuries (17%) were the most common significant injuries. The cases revealed that serious injuries occur even in minor crashes. Cases that illustrate body region-specific injury mechanisms are discussed.

Abbreviated Injury Scale↗
PubMed1999

Development and validation of the injury severity assessment survey/parent report: a new injury severity assessment survey.

OBJECTIVE: To develop and pilot test a telephone-based survey instrument that enables parents to identify and characterize the body region and severity of childhood injuries using the Abbreviated Injury Scale (AIS) scoring system. DESIGN: A prospective cross-sectional survey. SETTING: The emergency department of an urban, tertiary care, pediatric trauma center. PARTICIPANTS: One hundred forty-seven parents of children younger than 18 years and seen in the emergency department for acute treatment of an unintentional injury. INTERVENTIONS: None. MAIN OUTCOME MEASURE: The degree of agreement, measured as sensitivity, specificity, and kappa statistic, between medical record information and parents' responses to the telephone survey regarding the identification and characterization of clinically significant (AIS > or =2) injuries. RESULTS: The survey, known as the Injury Severity Assessment Survey/Parent Report, was developed via a systematic review of the AIS 1990 manual. Answers to questions were developed in a way that enabled automated coding of responses into AIS scores or ranges of scores. The sensitivity of the survey (its ability to detect injuries scoring 2 or more on the AIS that were documented in the medical record) varied somewhat by the body region of injury, ranging from 88% for head, face, neck, and spine injuries to 95% for extremity injuries. Intermediate sensitivity (92%) was noted for the detection of significant chest and abdomen injuries. The specificity of the survey (its ability to rule out the presence of a significant injury when one was not documented in the medical record) was more than 95% in each of the 3 body region groups. The kappa statistics for the 3 body region groups ranged from 0.89 to 0.92. CONCLUSIONS: A new telephone-based survey has been developed that enables parents to characterize their child's injuries by body region and to differentiate between minor injuries and more significant injuries using a well-established injury classification system. This survey has a significant advantage over previous telephone-based or written surveys of childhood injuries and may be particularly valuable in population-based (e.g., random-digit dial surveys) or multi-institutional studies of pediatric injuries.

Adolescent↗
PubMed1999

Preventing motor vehicle injuries.

Prevention of injuries to child passengers is a significant public health priority, as motor vehicle-related injuries remain a leading cause of death for children. Improvements in child restraint use have contributed to significant declines in child occupant mortality rates over the past 20 years. However, although overall restraint use has improved, many children are currently not optimally restrained for their age. Errors in installing and using child safety seats, as well as the premature graduation of children to vehicle safety belts, contribute to reducing the effectiveness of restraints for children. Further prevention of motor vehicle occupant injuries to children will require the combined approaches of engineering, education, and enforcement. This review presents current information regarding inappropriate restraint of children and highlights current engineering, education, and legislative efforts to improve child occupant protection.

Accidents, Traffic↗
PubMed1997

The effect of insurance status on likelihood of neonatal interhospital transfer.

OBJECTIVE: To determine the effect of insurance status on the likelihood of interhospital transfer for neonates. DESIGN: Population-based retrospective cohort study. SETTING: All general acute care nonpediatric hospitals in the five counties of southeastern Pennsylvania. PATIENTS: Fifty-six thousand, seven hundred eighty-nine infants from 0 to 28 days of age admitted to or born in study hospitals between January 1 and December 31, 1991. INTERVENTION: None. MAINS OUTCOME MEASURE: Transfer to another general or specialty acute care hospital. RESULTS: The incidence (95% confidence interval) of interhospital transfer was 1.69% (1.60, 1.78). Uninsured infants were nearly twice as likely [relative risk (RR) = 1.96 (1.67, 2.31)] to be transferred as commercially insured infants, even when adjusted for the effects of prematurity, severity of illness, and the level of neonatal intensive care unit in the referring hospital. Similarly, infants with Medicaid were more likely to be transferred [RR = 1.20 (1.01, 1.43)] than similar commercially insured neonates. Uninsured and publicly insured infants were also more likely to be born premature [RR 1.49 (1.39, 1. 60)] than privately insured neonates, and were more likely to have both moderate [RR 1.11 (1.04, 1.23)] and high [RR 1.21 (1.11, 1.32)] illness severity on admission to the hospital than privately insured infants. CONCLUSIONS: Neonates with no insurance and those with Medicaid coverage were more likely to be transferred than infants with private insurance. These results are consistent with those of other investigators who have studied financially motivated patient transfers- so-called patient dumping-in nonpediatric populations of patients. Our study may represent the first documentation of this phenomenon in a pediatric population. Our results are also consistent with those of other investigators who have examined the effect of insurance status on maternal interhospital transfer, thus providing further evidence for the existence of financially motivated transfers within regional systems of perinatal care. Future investigation into the effect of economic factors on variation in the utilization of transport services, and on how transfer influences ultimate patient outcome, is needed as managed care health systems become more widespread.

Analysis of Variance↗
PubMed1996

Residents on the transport team. Balancing service and education.

OBJECTIVES: To describe an educational program for pediatric house staff who participate in interhospital transport and to present an evaluation of the educational program. DESIGN: Educational program evaluation that used multiple confidential surveys of participating pediatric house staff. SETTING: The interhospital transport team of a large, urban pediatric hospital. PARTICIPANTS: Twenty-six pediatric second-year residents who participated in required rotations with the transport service. INTERVENTION: The institution of an educational program designed specifically for the clinical transport rotation. RESULTS: Before their service with the transport team, residents have doubts about their clinical skills, fund of knowledge, and ability to practice independently in a mobile environment. These doubts decrease as the residents participate in the educational program during their transport clinical service. All residents perceive service on the transport rotation to be of educational benefit with regard to communications or cognitive skills. Alternatively, transport service provides little opportunity for residents to improve technical skills. Among the various skills that residents could obtain during transport service, improvement in clinical judgement was most commonly cited by residents who performed more than 10 transports. Among the specific curricular components in the educational program, interactive teaching methods were judged to be more valuable than written materials. CONCLUSIONS: Serving as a physician on interhospital transports can be an important educational opportunity for pediatric house staff when that experience is concentrated in a designated rotation and combined with a focused educational program. Contrary to expectations, there was little opportunity for residents to develop technical skills on transport. Therefore, educators should focus on the development of communications and cognitive skills. Interhospital transport programs that debate the use of residents as members of the service should consider the potential educational benefit of the clinical service to house staff.

Adult↗
PubMed1989

Management of acute iron overdose.

Treatment of severe iron overdose in two children is described, and the pathophysiology of iron toxicity and management of acute iron poisonings are reviewed. An 11-month-old boy was comatose and in shock several hours after ingesting approximately 50 ferrous sulfate tablets (elemental iron 390 mg/kg). He had hyperglycemia and leukocytosis. Lavage was performed with a solution containing deferoxamine and sodium bicarbonate, and deferoxamine was given by continuous i.v. infusion for 48 hours. The initial serum iron (SI) concentration of 14,250 micrograms/dL decreased to 657 micrograms/dL nine hours after i.v. deferoxamine therapy was initiated. A roentgenogram showed tablets in the stomach and small bowel. Packed red blood cells were administered to treat apparent necrotizing gastroenteritis. SI concentration returned to normal by day three [corrected], and the child recovered. A 2.5-year-old boy was examined 1.25 hr after ingesting an estimated 55 tablets of ferrous gluconate 325 mg (elemental iron 130 mg/kg). Initial SI concentration was 134 micrograms/dL, and total iron-binding capacity (TIBC) was 219 micrograms/dL. A roentgenogram indicated iron concretion in the stomach and iron tablets in the small bowel. He underwent lavage with solution containing sodium bicarbonate. An i.m. dose of deferoxamine was administered, followed by i.v. deferoxamine therapy. SI concentration eight hours after the ingestion was 290 micrograms/dL, and whole-bowel irrigation was begun with polyethylene glycol-electrolyte solution. The irrigation and deferoxamine therapy were discontinued 20 hours after the ingestion, when SI concentration was 73 micrograms/dL, and the child recovered. Acute iron ingestions of more than 60 mg/kg are potentially serious. Patient 1 had severe iron intoxication, while aggressive treatment prevented severe toxicity in patient 2. Acute iron toxicity includes effects on the GI tract and the cardiovascular, metabolic, hepatic, and central nervous systems. Guidelines for assessing the severity of an overdose and selecting the most appropriate therapy are provided. The indications for chelation therapy with deferoxamine, gastric decontamination procedures including use of lavage solutions and whole-bowel irrigation, and adjunctive measures are described. Management of acute iron overdose includes supportive care, GI decontamination, and chelation therapy.

Chelating Agents↗