Browpexy as an adjunct to blepharoplasty.
Explore the source record for details and available documents.
Blepharoplasty↗
Biomedical subjects
G A Smith
Publications and source records attributed to G A Smith.
Clinical criteria for using radiography for children with acute knee injuries.
OBJECTIVE: To evaluate clinical criteria for selective radiography for knee injuries in children. DESIGN: Retrospective chart review. SETTING: Emergency department (ED) of a children's hospital. PARTICIPANTS: All patients evaluated by radiography for an isolated, acute knee injury during 12 months. Patients were excluded for injuries: >1 week; isolated to superficial lacerations/abrasions; with prior knee surgery; being reassessed. RESULTS: Two hundred fifty-four patients (60% male; 12.7 years median age) were included. Twelve patients (4.7%) sustained a fracture. Evaluated criteria were point tenderness, inability to bear weight in the ED, and inability to flex the knee to 90 degrees. Point tenderness was not statistically associated with fracture, P = 0.7. Inability to bear weight in the ED (37% fracture rate, P = 0.001) and inability to flex to 90 degrees (52% fracture rate, P < 0.001) were associated with the presence of fracture.[table in text] Applying a rule combining nobearwt and noflex90 would decrease the number of x-rays by 73%, with no missed fractures. CONCLUSIONS: Point tenderness was not a good predictor of knee fracture in children. Using the clinical criteria to select patients requiring knee radiography may greatly reduce the number of unnecessary x-rays.
Acute Disease↗
The Modified Card Sorting Test: test-retest stability and relationships with demographic variables in a healthy older adult sample.
OBJECTIVES: To investigate the test-retest stability of a standardized version of Nelson's (1976) Modified Card Sorting Test (MCST) and its relationships with demographic variables in a sample of healthy older adults. DESIGN: A standard card order and administration were devised for the MCST and administered to participants at an initial assessment, and again at a second session conducted a minimum of six months later in order to examine its test-retest stability. Participants were also administered the WAIS-R at initial assessment in order to provide a measure of psychometric intelligence. METHODS: Thirty-six (24 female, 12 male) healthy older adults aged 52 to 77 years with mean education 12.42 years (SD = 3.53) completed the MCST on two occasions approximately 7.5 months (SD = 1.61) apart. Stability coefficients and test-retest differences were calculated for the range of scores. The effect of gender on MCST performance was examined. Correlations between MCST scores and age, education and WAIS-R IQs were also determined. RESULTS: Stability coefficients ranged from .26 for the percent perseverative errors measures to .49 for the failure to maintain set measure. Several measures were significantly correlated with age, education and WAIS-R IQs, although no effect of gender on MCST performance was found. CONCLUSIONS: None of the stability coefficients reached the level required for clinical decision making. The results indicate that participants' age, education, and intelligence need to be considered when interpreting MCST performance. Normative studies of MCST performance as well as further studies with patients with executive dysfunction are needed.
Adult↗
Changes in ventricular repolarization during acidosis and low-flow ischemia.
Myocardial ischemia, primarily a metabolic insult, is also defined by altered cardiac mechanical and electrical activity. We have investigated the metabolic contributions to the electrophysiological changes during low-flow ischemia (7.5% of the control flow) using 31P NMR spectroscopy to monitor metabolic parameters, suction electrodes to study epicardial monophasic action potentials, and 86Rb as a tracer for K+-equivalent efflux during low-flow ischemia in the Langendorff-perfused ferret heart. Shortening of the action potential duration at 90% repolarization (APD90) was most marked between 1 and 5 min after induction of ischemia, at which time it shortened from 261 +/- 4 to 213 +/- 8 ms. The period of marked APD90 shortening was accompanied by a fivefold increase in the rate of 86Rb efflux, both of which were inhibited by the ATP-sensitive K+ (KATP)-channel blockers glibenclamide and 5-hydroxydecanoate (5-HD), as well as by a significant fall in intracellular pH (pHi) from 7.14 +/- 0.02 to 6.83 +/- 0.03 but no change in intracellular ATP concentration ([ATP]i). We therefore investigated whether a fall in pHi could be the metabolic change responsible for modulating cardiac KATP channel activity in the intact heart during ischemia. Both metabolic (30 mM lactate added to extracellular solution) and respiratory (PCO2 increased to 15%) acidosis caused an initial lengthening of APD90 to 112 +/- 1.5 and 113 +/- 0.9%, respectively, followed by shortening during continued acidosis to 106 +/- 1.2 and 106 +/- 1.4%, respectively. The shortening of APD90 during continued acidosis was inhibited by glibenclamide, consistent with acidosis causing activation of KATP channels at normal [ATP]i. The similar responses to metabolic (induced by adding either l- or d-lactate) and respiratory acidosis suggest that lactate has no independent metabolic effect on action potential repolarization.
Acidosis↗
Tetracaine-lidocaine-phenylephrine topical anesthesia compared with lidocaine infiltration during repair of mucous membrane lacerations in children.
This study compared the effectiveness of a new topical anesthetic, tetracaine-lidocaine-phenylephrine (TetraLidoPhen), with that of lidocaine infiltration during repair of mucous membrane lacerations in children. It was conducted in the emergency department of an urban children's hospital with use of a prospective, randomized, blinded study design. Participants were 90 children 1 year of age or older with a laceration 5 cm or less in length on or near a mucous membrane that required suturing. They were randomly assigned to one of two treatment groups, with 45 patients in each group. Pain felt during suturing was scored by suture technicians, research assistants, a videotape reviewer, parents, and patients 5 years of age and older using a Visual Analogue Scale (VAS). Suture technicians, research assistants, a videotape reviewer, and parents also scored pain using a seven-point Likert scale. In addition, suture technicians completed an Anesthesia Effectiveness scale and a Wound Blanching scale. The laceration was located near the eyes in 71 patients (79%), and on or near the lips in 19 (21%). Lidocaine infiltration performed significantly better than topical TetraLidoPhen in comparisons of Likert scores of suture technicians (P = 0.007), research assistants (P = 0.005), the videotape reviewer (P = 0.003), and parents (P = 0.03); Anesthetic Effectiveness scale scores of suture technicians (P = 0.00002; relative risk (RR) = 1.83, 95% confidence interval 1.36 < RR < 2.46); and VAS scores of suture technicians (P = 0.002), research assistants (P = 0.001), and the videotape reviewer (P = 0.005). No significant difference in performance was detected between lidocaine and TetraLidoPhen in comparing VAS scores of parents and patients. There was a 4.4% wound complication rate, including two (2.2%) wound infections. The authors conclude that TetraLidoPhen is a new topical anesthetic that appears to be safe when applied on or near mucous membranes. Its performance among study participants was statistically inferior to that of lidocaine infiltration; however, the differences in pain scores were small and may not be clinically significant. Also, comparisons of pain scores in this study did not take into account the pain associated with the initial injection of lidocaine. Therefore, study findings may underestimate the comparative performance of TetraLidoPhen. Further investigation of this new topical anesthetic is warranted.
Anesthesia, Local↗
Injuries to children in the United States related to trampolines, 1990-1995: a national epidemic.
STUDY OBJECTIVE: To describe the epidemiology of trampoline-related injuries among children in the United States. DESIGN: A retrospective analysis of data for children 18 years old and younger from the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission for 1990 through 1995. RESULTS: There were an estimated 249 400 trampoline-related injuries [95% confidence interval (CI), 166 300-332 500] to children 18 years old and younger treated in hospital emergency departments in the United States during the 6-year study period. The number of injuries increased by 98% from 29 600 in 1990 to 58 400 in 1995, with an average of 41 600 (95% CI, 27 700-55 500) injuries per year, or 59.4 injuries per 100 000 United States children per year (95% CI, 39.6-79.3). The median age of injured children was 10 years, and 50% were males. Ninety-three percent of injuries occurred at home. Injuries to the extremities predominated among children of all ages and accounted for more than 70% of all injuries. This study identified several age-specific injury patterns. There was an inverse relationship between age versus the relative frequency of upper extremity injuries, and fractures and dislocations; and there was a direct relationship between age versus lower extremity injuries and soft tissue injury. There was also an inverse relationship between age versus facial injuries, head and neck injuries, and lacerations. Annually, an estimated 1400 children (95% CI, 800-2000), or 2.0 per 100 000 United States children (95% CI, 1. 1-2.9), required hospital admission or interhospital transfer because of a trampoline-related injury. This represented 3.3% of all children with a trampoline-associated injury. Fractures or dislocations accounted for 83% of injuries among admitted or transferred children, and children with a fracture or dislocation were more likely to be admitted or transferred to another hospital (8.4%) than children with other types of injury (relative risk, 10.80; 95% CI, 9.40 < relative risk < 12.29). Among children released home from the emergency department, soft tissue injuries (53%), fractures or dislocations (30%), and lacerations (14%) were the most common injuries treated. CONCLUSION: Injuries related to trampolines, especially backyard trampolines, are an important cause of pediatric morbidity. These injuries have also resulted in death. The rapid increase in the number of trampoline-related injuries to children during recent years is evidence that current prevention strategies are inadequate. Children should not use trampolines at home, and the sale of trampolines for private recreational use should be stopped.
Adolescent↗
The summer penile syndrome: seasonal acute hypersensitivity reaction caused by chigger bites on the penis.
OBJECTIVE: To describe the seasonal acute hypersensitivity reaction of the penis due to chigger bites, known as the summer penile syndrome. DESIGN: A consecutive series of patients. SETTING: The emergency department of an urban academic children's hospital in the midwestern United States. PARTICIPANTS: Male pediatric patients with an acute hypersensitivity reaction of the penis. RESULTS: Ninety-four patients were treated for summer penile syndrome during the four-month period from June through September. Patients ranged in age from seven months to 11 years (mean = 5.1, SD = 2.5). Twenty-one percent of patients had also experienced a similar prior episode of penile swelling. Symptoms included pruritus in 84% of cases, dysuria in 33%, and decreased strength of urine stream in 8% of patients. Eighty-four percent of patients had recent exposure to the woods, park, lawn, or poison ivy. In addition to edema, findings on physical examination included a papule or bite puncture mark in 50% of patients, erythema in 32%, and excoriation in 6% of patients. Fifty-six percent of patients had bites on other areas of the body. The emergency physician attributed the penile edema to an insect or chigger bite in 98% of cases. Treatment consisted of an oral antihistamine and cold compresses in most cases. The reported duration of penile swelling ranged from one to 18 days with a mean of 4.1 days (SD = 3.5), and the reported duration of pruritus ranged from 0 to 14 days with a mean of 3.0 days (SD = 2.6). CONCLUSION: This study provides an understanding of the summer penile syndrome for pediatric care providers. To our knowledge, this study is the first to describe this seasonal syndrome in the medical literature.
Acute Disease↗
(E)-5-(2'-bromovinyl)-2'-deoxyuridine inhibition of macropodid herpesvirus 1 in vitro.
Herpesviruses have caused the death of kangaroos and wallabies in European and North American zoos. Eight antiherpetic purine or pyrmidine nucleoside compounds were tested in plaque reduction neutralization tests for in vitro inhibition of macropodid herpesvirus 1, a virus that has been associated with illness in captive macropods in Australia. The virus was most susceptible to inhibition by (E)-5-(2'-bromovinyl)-2'-deoxyuridine (BVDU) and 5'-iodo-2'-deoxycytidine. Because BVDU effectively inhibits macropodid herpesvirus 2 in vitro, it may be the drug of choice for experimental therapy in herpesvirus infections in captive macropodids.
Animals↗
Prilocaine-phenylephrine topical anesthesia for repair of mucous membrane lacerations.
OBJECTIVE: To compare the effectiveness of prilocaine-phenylephrine (Prilophen), a new topical anesthetic that does not contain cocaine, to that of lidocaine infiltration during repair of lacerations on or near mucous membranes in children. DESIGN: A prospective, randomized, blinded trial. SETTING: The emergency department of a large academic children's hospital. PATIENTS: Children one year of age or older with a laceration 5 cm or less in length on or near a mucous membrane. INTERVENTIONS: Forty patients were randomly assigned one of the two local anesthetics, with 20 patients in each treatment group. OUTCOME MEASURES: Pain felt during suturing was scored by suture technicians, research assistants, a videotape reviewer, parents, and patients five years of age and older using a visual analog scale (VAS). RESULTS: There was no statistically significant difference in performance between topical Prilophen and lidocaine infiltration when VAS pain scores of research assistants, parents, and patients were compared. However, lidocaine infiltration performed significantly better than topical Prilophen when comparing VAS scores of suture technicians (P = 0.003) and the videotape reviewer (P = 0.02). When power analyses were performed using alpha = 0.05 and beta = 0.20, it was possible to detect a difference of 2 units for VAS scores of suture technicians, 2 VAS units for research assistants, 3 VAS units for the videotape reviewer and parents, and 7 VAS units for patients. There were no wound healing or other complications. CONCLUSIONS: Prilophen is a new topical anesthetic alternative to lidocaine infiltration for closure of lacerations on or near mucous membranes, where use of tetracaine-adrenaline-cocaine is contraindicated. The performance of Prilophen was rated by two of the observer groups as statistically inferior to that of lidocaine infiltration; however, the differences in pain scores were small and may not be clinically significant. Further investigation of this new topical anesthetic is warranted.
Adolescent↗
Method to impact in vivo rabbit femoral cartilage with blows of quantifiable stress.
The purpose of this study was to develop a technique by which a known stress could be applied uniformly across the femoral cartilage of a rabbit as a model for the development of post-traumatic arthritis. A system to impact the cartilage was designed that consisted of an apparatus to deliver a blow of quantifiable force, a method to apply the stress uniformly over the impact area, and a way to accurately measure the impact area. The knee joints of cadaveric New Zealand White rabbits were surgically exposed with the knee flexed so that the distal femoral articular surface was perpendicular to an impactor. With the knee fixed in position, a cup containing polymethylmethacrylate bone cement was applied to create an exact contour of the femoral surface, and the cement was allowed to cure. The form was then rested on the rabbit knee, and a drop tower released a weight of known mass from a known height onto an impactor (instrumented with strain gauges to measure the compressive force) that was attached to the cup. The area of the impacted surface was determined and, with the measured force, was used to calculate an accurate estimate of the impact stress. This method can be performed under sterile conditions, and therefore it is well suited for survival experiments in which the long-term effects of impact to cartilage will be studied.
Animals↗
Evaluation of a model for improving emergency medical and trauma services for children in rural areas.
STUDY OBJECTIVE: To evaluate the effectiveness of a rural emergency medical and trauma services project in increasing the knowledge and confidence of emergency care personnel in the management of acutely ill and injured children. METHODS: This prospective, quasi-experimental study used an untreated control group design with pretest and posttest of pre-hospital and hospital-based emergency care personnel in two rural counties in central Ohio. Project evaluation compared 50 emergency care providers from the intervention county with 43 emergency care providers from the control county. Changes in knowledge and confidence of these personnel in the assessment and management of pediatric emergencies were compared. RESULTS: Providers in the intervention county demonstrated a significantly greater increase in test scores regarding knowledge of pediatric emergencies than did providers in the control county (P = .001). Significantly greater improvement was also seen when comparisons of test scores were made for field (P = .02) and hospital (P = .03) emergency care personnel separately. Self-reports on a visual analog scale indicated that providers in the project intervention county had a significantly greater decrease in anxiety than did control subjects when presented a scenario of a child experiencing a respiratory arrest (P = .01). On the basis of scores from a five-point Likert scale, emergency personnel in the intervention county had a greater increase in confidence regarding management of the pediatric airway (P = .0003) and a greater increase in the belief that they had adequate pediatric training (P = .000001) after participating in the project than emergency personnel in the control county. CONCLUSION: The rural pediatric emergency medical and trauma services project was effective in increasing the knowledge and confidence of emergency care personnel in the management of acutely ill and injured children. This project offers a model that can be replicated in other rural areas nationally.
Child↗
How the Listeria monocytogenes ActA protein converts actin polymerization into a motile force.
The ActA protein is an essential determinant of pathogenicity that is responsible for the actin-based motility of Listeria monocytogenes in mammalian cells and cell-free extracts. ActA appears to control at least four functions that collectively lead to actin-based motility: (1) initiation of actin polymerization, (2) polarization of ActA function, (3) transformation of actin polymerization into a motile force and (4) acceleration of movement mediated by the host protein profilin.
Actins↗
Epidemiology of dental trauma treated in an urban pediatric emergency department.
STUDY OBJECTIVE: To describe the epidemiology of traumatic dental injuries to children treated in an urban pediatric emergency department (ED). DESIGN: A descriptive study of a consecutive series of patients. SETTING: The ED of a large, academic children's hospital. PARTICIPANTS: Children presenting to the ED with dental trauma from December 1992 to November 1993. RESULTS: Of 1459 children treated for dental emergencies, 541 had dental trauma (37%) and were enrolled in this study. Patients ranged in age from five months to 18 years. Fifty-nine percent of patients were less than seven years of age, and 59% of patients were male. Falls caused 63% of injuries, followed by being struck (17%), and motor vehicle crashes (2%). Injuries to the soft tissues included lacerations (32%), swelling (8%), abrasions (7%), and contusions (6%). Injuries to hard dental structures included tooth fractures (33%), luxations (18%), concussions (12%), avulsions (8%), and jaw fractures (1%). Tooth luxation and concussion were more common among children less than seven years of age, and fractures to the tooth crown with dentin exposure (Ellis class II) were seen most often among children with permanent dentition (chi 2 = 41.4, P < 0.005). The central incisors were the teeth most frequently traumatized. CONCLUSION: Findings of this large consecutive series provide a useful description of the epidemiology of this common type of pediatric trauma for pediatric emergency care providers.
Accidental Falls↗
Deficits on self ordered tasks associated with hyperostosis frontalis interna.
A 74 year old patient, EW, with dorsolateral frontal cortical compression due to hyperostosis frontalis interna, in the absence of the Morgagni or Stewart-Morel syndromes, is described. In addition to conventional neuropsychological measures EW was administered one nonspatial and two spatial self ordered working memory tasks, as well as a standard measure of fluid intelligence or g. She showed impaired performance on all three self ordered working memory tasks compared with a normal control group of 10 subjects matched for age, education, sex, and IQ. By contrast, her performance on the fluid intelligence test was comparable with that of the controls. It is concluded that the compression of dorsolateral frontal cortex accompanying hyperostosis frontalis interna may produce selective cognitive impairment.
Aged↗
Comparison of topical anesthetics with lidocaine infiltration during laceration repair in children.
This study is a randomized, blinded trial that compares the effectiveness of a new topical anesthetic preparation of 2% mepivacaine and 1:100,000 norepinephrine (Mepivanor); a topical solution of 1% tetracaine, 1:4,000 adrenaline, and 4% cocaine (TAC); and 1% lidocaine infiltration during laceration repair in children. The study was conducted in the emergency department of a large academic children's hospital. Study participants were children 2 years of age or older with a laceration on the face or scalp, 5 cm or less in length, that required suturing. Patients were randomly assigned to receive Mepivanor topical solution, TAC topical solution, or lidocaine infiltration anesthesia prior to laceration repair. Seventy-one patients were enrolled in the study during a 2-month period. Outcome measures assessed pain perceptions using a Visual Analogue Scale (VAS) and a seven-point Likert scale. There was statistical power to detect differences of 1.2 to 1.7 units for the VAS outcome measures using alpha = 0.05 and beta = 0.20. There were no statistically significant (P > 0.05) differences between TAC and 1% lidocaine infiltration in providing effective anesthesia. Mepivanor was generally less effective in providing adequate anesthesia during laceration repair than TAC and lidocaine infiltration, with Tukey's post hoc test for ANOVA demonstrating statistically significant (P < 0.05) differences between Mepivanor and these agents for research assistant and suture technician VAS scores. Wound blanching was judged to be less with Mepivanor than with TAC, although this difference was not statistically significant. There were no adverse reactions, wound infections, or healing difficulties for any of the patients who received TAC or Mepivanor. It was concluded that non-cocaine-containing Mepivanor was generally less effective than TAC and lidocaine infiltration in providing adequate local anesthesia during laceration repair. TAC containing only 120 mg of cocaine (3 mL of 4% cocaine) was as effective as 1% lidocaine infiltration in providing local anesthesia during laceration repair. This will allow the amount of cocaine in TAC to be reduced, thereby decreasing costs and the likelihood of adverse reactions.
Adolescent↗
Nontraumatic dental emergencies in a pediatric emergency department.
The objectives of this study were to describe nontraumatic dental emergencies among children treated in a pediatric emergency department. The children studied received emergency treatment for a nontraumatic dental problem from December 1992 through November 1993. Among the 1,459 children treated for dental emergencies, 949 had a nontraumatic emergency (65%) and were enrolled in this study. Patients ranged in age from 1 month to 19 years, with a mean age of 6.9 years. Fifty-two percent of patients were male. The teeth were involved in 99% of cases. An abscess was present in 33% of patients; and among these patients, 26% also had a fistula. Pericoronitis was seen in 4% of patients, primary viral stomatitis in 1%, and an eruption hematoma in 0.5%. Caries is the etiology of the problem prompting the emergency department visit in 73% of patients, and baby bottle caries accounted for 18% of all cases of caries. Other etiologies included the late effects of trauma (8%), iatrogenic (7%), idiopathic (3%), and periodontal processes (2%). Tooth extraction was performed in 45% of patients. Findings of this large consecutive series provide a better understanding of this type of visit to the pediatric emergency department.
Adolescent↗
High-dose cytarabine dose modification reduces the incidence of neurotoxicity in patients with renal insufficiency.
PURPOSE: To determine the impact of high-dose cytarabine (ARA-C) (HDAC) dose modification, based on renal function, on the incidence of neurotoxicity (NT). PATIENTS AND METHODS: We retrospectively analyzed the records of 256 patients treated with HDAC (> or = 2.0 g/m2 per dose) for acute myelogenous leukemia (AML) at the University of California, San Francisco (UCSF). From 1985 to 1994, a total of 358 cycles of HDAC were administered, using either a twice-daily schedule (n = 208) or a once-daily regimen (n = 48). In 1989, a dose-modification algorithm was initiated at our institution, which reduced ARA-C doses in the setting of renal insufficiency (RI). For patients with a serum creatinine (Cr) level of 1.5 to 1.9 mg/dL during treatment, or an increase in Cr during treatment (deltaCr) of 0.5 to 1.2 mg/dL, ARA-C was decreased to 1 g/m2 per dose. For patients with a Cr > or = 2.0 mg/dL or a deltaCr greater 1.2 mg/dL, the dose was reduced to 0.1 g/m2/d. RESULTS: Overall, the incidence of NT was 16% (34 of 208) for patients treated with twice-daily HDAC and 0% (none of 48) for patients treated with daily HDAC (P = .003). NT occurred more often in patients treated on a twice-daily schedule with 3 g/m2 per dose compared with 2 g/m2 per dose (25% v 8%; P = .009). NT occurred in 55% of the twice-daily-treated patients with RI, compared with 7% of those with normal renal function (P = .00001). In patients with RI, NT occurred in none of 11 dose-modified cycles versus five of 11 (45%) total unmodified cycles (P = .01). None of 14 patients treated with once-daily HDAC given during RI developed NT, compared to 55% of patients (23 of 42) receiving twice-daily HDAC during RI (P = .009). By univariate analysis, NT was not associated with patient age or serum alkaline phosphatase, but NT was significantly increased in patients treated with twice-daily HDAC when the serum bilirubin was > or = 2.0 mg/dL compared with twice-daily HDAC given when the total bilirubin was less than 2.0 mg/dL (33% v 14%; P = .017). Multivariate analysis confirmed that RI was the most significant risk factor associated with the development of NT. CONCLUSION: HDAC NT is strongly associated with RI. The risk of HDAC NT can be reduced by the following: (1) routinely reducing the ARA-C dose from 3 to 2 g/m2 per dose; (2) modifying the ARA-C dose based on daily Cr values; and (3) administering HDAC on a once-daily rather than twice-daily schedule.
Adult↗
Babywalker-related injuries continue despite warning labels and public education.
OBJECTIVE: To describe the epidemiology of babywalker-related injuries to children treated in a pediatric emergency department despite current prevention efforts, and to investigate the beliefs of parents regarding babywalker use. DESIGN: A descriptive study of a consecutive series of patients. SETTING: The emergency department of a large, academic children's hospital. PARTICIPANTS: Children treated for babywalker-related injuries during the 3-year period of March 1993 through February 1996. RESULTS: There were 271 children treated for babywalker-related injuries. The mean age was 9.2 months, and 62% of patients were boys. Ninety-six percent of children were injured when they fell down stairs in their babywalker. The number of stairs that a child fell down was significantly associated with skull fracture and admission to the hospital, and a fall down more than 10 stairs had a relative risk (RR) of skull fracture = 3.28 (95% confidence interval, 1.35 < RR < 7.98). There were 159 children with contusions/abrasions (58.6%), 35 concussions/head injuries (12. 9%), 33 lacerations (12.2%), 26 skull fractures (9.6%), 9 epistaxis (3.3%), 4 nonskull fractures (1.5%), 4 avulsed teeth (1.5%), and 1 burn (0.4%). Three of the skull fractures were depressed, and three also had accompanying intracranial hemorrhage. Ten patients (3.7%) were admitted to the hospital, and all had skull fractures resulting from falls down stairs. Supervision was present in 78% of cases, including supervision by an adult in 69% of cases. Forty-five percent of families kept the walker, and 32% used the walker again for the study patient or another child after the injury episode. Fifty-nine percent of parents acknowledged that they were aware of the potential dangers of babywalkers before the injury event. Fifty-six percent of parents favored a national ban on the sale of walkers, and 20% were opposed. CONCLUSION: Despite the currently used prevention strategies, including adult supervision, warning labels, care giver education programs, and stairway gates, serious injuries associated with babywalkers continue to occur to young children. The US Consumer Product Safety Commission should promulgate a rule, similar to the voluntary standard adopted in Canada, regarding design requirements for babywalkers that will prevent their passage through household doorways at the head of stairs. The manufacture and sale of mobile babywalkers that do not meet this new standard should be banned in the US. A recall or trade-in campaign should be conducted nationally to decrease the number of existing babywalkers.
Accident Prevention↗