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Biomedical subjects

J Pasternack

Publications and source records attributed to J Pasternack.

6 recordsLinked to original sources
PubMed1997

Pediatric cervical spine injury sustained in falls from low heights.

STUDY OBJECTIVE: To determine whether history and clinical examination findings can identify young children who have sustained cervical injury after falling short distances. METHODS: We conducted a retrospective review of the medical records of children younger than 6 years old with the diagnosis of cervical vertebral fracture or cervical spinal cord injury after a fall of less than 5 feet. Data from medical records over an average time span of 11 years at four large children's hospitals were compiled. RESULTS: We identified eight children who sustained cervical spine injury after a fall of less than 5 feet. These children ranged in age from 9 to 68 months. Three had rotary subluxation of C1, and three had subluxation of C1-C2. One of the children in the latter group also had an odontoid fracture. Two children had a fracture of C2. All the children had limited range of motion of the neck or neck pain. CONCLUSION: All children in this study with the diagnosis of cervical spine injury had clinical evidence of that injury on history or physical examination. Clinicians treating asymptomatic young children who sustain short falls may not need to perform radiographic evaluation of the cervical spine.

Accidental Falls↗
PubMed1990

Prediction rules for selective radiographic assessment of extremity injuries in children and adolescents.

To assess the potential for selective use of roentgenography in evaluating extremity injuries, prediction rules were developed based on prospective observations for 617 injured children and adolescents examined in our Emergency Department (phase 1) and tested on 601 examined 1 year later (phase 2). Logit analysis produced best-fitting statistical models for phase 1 data with significant (P less than 0.05) direct effects of gross signs, point tenderness, activity not routine, swelling moderate or severe, time from injury less than 6 hours, and pain with motion for upper extremity injuries; and, for lower extremity injuries, not knee injury, activity not routine, point tenderness, and foot injury. Prediction rules developed in phase 1 performed equally well when tested on phase 2 injuries. Data from both phases were combined, therefore, in analysis that produced risk estimates. For all injury types (ie, for injuries with all possible combinations of presence or absence of these findings), risk for fracture was derived. For upper extremity injuries, with a threshold risk for fracture of 20% used to select specific injury types for roentgenography, prediction rule outcomes were 18.1% of roentgenograms avoided and 5.3% of fractures missed. For lower extremity injuries, using a threshold risk of 10% to select injury types for roentgenography, outcomes were 25.8% of roentgenograms avoided and 5.3% of fractures missed. Alternative prediction rules allowed still greater roentgenogram avoidance, although missed fractures also increased. Risk of adverse functional outcome from missed fractures appeared small. Annual national cost savings from the elimination of 18.1% of upper and 25.8% of lower extremity roentgenographic evaluations was estimated at $103 million.

Adolescent↗
PubMed1988

Behavioral and sociocognitive correlates of ratings of prosocial behavior and sociometric status.

Although peers' and teachers' evaluations of children's prosocial behavior and peers' sociometric ratings frequently have been used in studies of social development, the validity of young children's ratings of others has been questioned, as has that for teachers' ratings of prosocial behavior. In this study, preschoolers' ratings of peers' sociometric status and prosocial behavior, as well as teachers' ratings of children's prosocial dispositions, were obtained. These were correlated with children's naturally occurring prosocial or social behavior; ratings of prosocial behavior also were correlated with children's prosocial moral reasoning and prosocial self-attributions. Peers' sociometric ratings were positively related to children's sociability whereas prosocial ratings were related to helping (but not sharing) behavior. Teachers' ratings of prosocial behavior were not related to frequency of prosocial behaviors, but were positively related to developmentally mature moral judgments and self-reported motives.

Child Behavior↗
PubMedDate not supplied

Developing prediction rules and evaluating observation patterns using categorical clinical markers: two complementary procedures.

Substantial uncertainty often remains at the time that important diagnostic or therapeutic decisions must be made, despite the availability of multiple clinical indicators. Multiple indicators may be used to define observation patterns that are associated with the presence or absence of disease. Clinical prediction rules based on groups of observation patterns have been used to quantify probabilities and reduce error rates for some medical problems, but efficient use of multiple indicators remains a major challenge in medical practice. Medical outcomes and clinical observations are frequently categorical. Two statistical techniques appropriate for generating prediction rules from categorical data are logit analysis (LA) and recursive partitioning analysis (RPA). LA and RPA were compared in evaluating observation patterns for fractures among 666 upper-extremity injuries in children, and in developing prediction rules for selective radiographic assessment. Fracture estimates and error reductions provided by RPA and LA were very similar. Each technique generated a set of prediction rules with a range of misclassification probabilities, and evaluated the probabilities of fracture for all observation patterns. LA used more information than RPA in observation pattern evaluations, however, and provided fracture estimates specific to each pattern. With currently available statistical software, RPA output provides better statistical guidance in generating prediction rules, whereas LA provides more statistical information of use in evaluating observation patterns. LA warrants attention similar to that conferred on RPA. It appears that complementary use of LA and RPA would be valuable in developing clinical guidelines.

Arm Injuries↗