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Elise M Van De Putte - One of the best experts on this subject based on the ideXlab platform.
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value of systematic detection of physical child abuse at Emergency Rooms a cross sectional diagnostic accuracy study
BMJ Open, 2016Co-Authors: Judith S Sittig, Cuno S P M Uiterwaal, Karel G M Moons, I M B Russel, Rutger A J Nievelstein, Edward E S Nieuwenhuis, Elise M Van De PutteAbstract:Objectives The aim of our diagnostic accuracy study Child Abuse Inventory at Emergency Rooms (CHAIN-ER) was to establish whether a widely used checklist accurately detects or excludes physical abuse among children presenting to ERs with physical injury. Design A large multicentre study with a 6-month follow-up. Setting 4 ERs in The Netherlands. Participants 4290 children aged 0–7 years attending the ER because of physical injury. All children were systematically tested with an easy-to-use child abuse checklist (index test). A national expert panel (reference standard) retrospectively assessed all children with positive screens and a 15% random sample of the children with negative screens for physical abuse, using additional information, namely, an injury history taken by a paediatrician, information provided by the general practitioner, youth doctor and social services by structured questionnaires, and 6-month follow-up information. Main outcome measure Physical child abuse. Secondary outcome measure Injury due to neglect and need for help. Results 4253/4290 (99%) parents agreed to follow-up. At a prevalence of 0.07% (3/4253) for inflicted injury by expert panel decision, the positive predictive value of the checklist was 0.03 (95% CI 0.006 to 0.085), and the negative predictive value 1.0 (0.994 to 1.0). There was 100% (93 to 100) agreement about inflicted injury in children, with positive screens between the expert panel and child abuse experts. Conclusions Rare cases of inflicted injury among preschool children presenting at ERs for injury are very likely captured by easy-to-use checklists, but at very high false-positive rates. Subsequent assessment by child abuse experts can be safely restricted to children with positive screens at very low risk of missing cases of inflicted injury. Because of the high false positive rate, we do advise careful prior consideration of cost-effectiveness and clinical and societal implications before de novo implementation.
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systematic detection of physical child abuse at Emergency Rooms
Nederlands Tijdschrift voor Geneeskunde, 2016Co-Authors: Judith S Sittig, Cuno S P M Uiterwaal, Karel G M Moons, I M B Russel, Rutger A J Nievelstein, Edward E S Nieuwenhuis, Elise M Van De PutteAbstract:Objective The aim of our diagnostic accuracy study Child Abuse Inventory at Emergency Rooms (CHAIN-ER) was to establish whether a widely used checklist accurately detects or excludes physical abuse among children presenting to ERs with physical injury. Design A large multicentre study with a 6-month follow-up in 4 ERs in The Netherlands. Method Participants were 4290 children aged 0-7 years, attending the ER because of physical injury. All children were systematically tested with an easy-to-use child abuse checklist (index test). A national expert panel (reference standard) retrospectively assessed all children with positive screens and a 15% random sample of the children with negative screens for physical abuse, using additional information, namely, an injury history taken by a paediatrician, information provided by the general practitioner, youth doctor and social services by structured questionnaires, and 6-month follow-up information. Our main outcome measure was physical child abuse; secondary outcome measure was injury due to neglect and need for help. Results 4253/4290 (99%) parents agreed to follow-up. At a prevalence of 0.07% (3/4253) for inflicted injury by expert panel decision, the positive predictive value of the checklist was 0.03 (95% CI 0.006 to 0.085), and the negative predictive value 1.0 (0.994 to 1.0). There was 100% (93 to 100) agreement about inflicted injury in children, with positive screens between the expert panel and child abuse experts. Conclusion Rare cases of inflicted injury among preschool children presenting at ERs for injury are very likely captured by easy-to-use checklists, but at very high false-positive rates. Subsequent assessment by child abuse experts can be safely restricted to children with positive screens at very low risk of missing cases of inflicted injury. Because of the high false positive rate, we do advise careful prior consideration of cost-effectiveness and clinical and societal implications before de novo implementation.
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child abuse inventory at Emergency Rooms chain er rationale and design
BMC Pediatrics, 2011Co-Authors: Judith S Sittig, Cuno S P M Uiterwaal, Karel G M Moons, Edward E S Nieuwenhuis, Elise M Van De PutteAbstract:Background Child abuse and neglect is an important international health problem with unacceptable levels of morbidity and mortality. Although maltreatment as a cause of injury is estimated to be only 1% or less of the injured children attending the Emergency room, the consequences of both missed child abuse cases and wrong suspicions are substantial. Therefore, the accuracy of ongoing detection at Emergency Rooms by health care professionals is highly important. Internationally, several diagnostic instruments or strategies for child abuse detection are used at Emergency Rooms, but their diagnostic value is still unknown. The aim of the study 'Child Abuse Inventory at Emergency Rooms' (CHAIN-ER) is to assess if active structured inquiry by Emergency room staff can accurately detect physical maltreatment in children presenting at Emergency Rooms with physical injury.
Takehiro Umemura - One of the best experts on this subject based on the ideXlab platform.
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resuscitative endovascular balloon occlusion of the aorta performed by Emergency physicians for traumatic hemorrhagic shock a case series from japanese Emergency Rooms
Critical Care, 2018Co-Authors: Ryota Sato, Akira Kuriyama, Rei Takaesu, Nobuhiro Miyamae, Wataru Iwanaga, Hayato Tokuda, Takehiro UmemuraAbstract:Resuscitative endovascular balloon occlusion of the aorta (REBOA), which has been increasingly used for the management of hemorrhagic shock, is a less invasive strategy for the management of patients with very severe hemorrhage. However, its effectiveness remains controversial. This retrospective case series included trauma patients who underwent REBOA for hemorrhagic shock due to trauma in four Japanese tertiary care Emergency centers from January 2013 to March 2017. Patients in cardiac arrest at the time of REBOA and those who underwent REBOA for nontraumatic causes during the study period were excluded. A total of 24 patients underwent REBOA during the study period. The median age was 52 years (interquartile range (IQR) 36.5–62.5), 17 (70.8%) of the patients were male, and 23 (95.8%) had blunt trauma. The 24-h survival was 50% (n = 12), and the in-hospital survival rate was 41.7% (10/24). In all cases, REBOA was performed in Emergency Rooms by Emergency physicians without fluoroscopic guidance. Complications of REBOA were mesenteric ischemia (n = 1, 4.2%), ischemia of the lower extremities (n = 1, 4.2%), and placement of REBOA in thoracic aortic injury (n = 3, 12.5%). REBOA can be an effective and feasible tool for controlling massive hemorrhage due to trauma. However, caution should be exercised regarding complications including placement of REBOA in aortic injury and limb ischemia in cases where REBOA is performed in an Emergency department setting with minimal or no support from trauma surgeons.
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Resuscitative endovascular balloon occlusion of the aorta performed by Emergency physicians for traumatic hemorrhagic shock: a case series from Japanese Emergency Rooms
BMC, 2018Co-Authors: Ryota Sato, Akira Kuriyama, Rei Takaesu, Nobuhiro Miyamae, Wataru Iwanaga, Hayato Tokuda, Takehiro UmemuraAbstract:Abstract Background Resuscitative endovascular balloon occlusion of the aorta (REBOA), which has been increasingly used for the management of hemorrhagic shock, is a less invasive strategy for the management of patients with very severe hemorrhage. However, its effectiveness remains controversial. Methods This retrospective case series included trauma patients who underwent REBOA for hemorrhagic shock due to trauma in four Japanese tertiary care Emergency centers from January 2013 to March 2017. Patients in cardiac arrest at the time of REBOA and those who underwent REBOA for nontraumatic causes during the study period were excluded. Results A total of 24 patients underwent REBOA during the study period. The median age was 52 years (interquartile range (IQR) 36.5–62.5), 17 (70.8%) of the patients were male, and 23 (95.8%) had blunt trauma. The 24-h survival was 50% (n = 12), and the in-hospital survival rate was 41.7% (10/24). In all cases, REBOA was performed in Emergency Rooms by Emergency physicians without fluoroscopic guidance. Complications of REBOA were mesenteric ischemia (n = 1, 4.2%), ischemia of the lower extremities (n = 1, 4.2%), and placement of REBOA in thoracic aortic injury (n = 3, 12.5%). Conclusions REBOA can be an effective and feasible tool for controlling massive hemorrhage due to trauma. However, caution should be exercised regarding complications including placement of REBOA in aortic injury and limb ischemia in cases where REBOA is performed in an Emergency department setting with minimal or no support from trauma surgeons
Judith S Sittig - One of the best experts on this subject based on the ideXlab platform.
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value of systematic detection of physical child abuse at Emergency Rooms a cross sectional diagnostic accuracy study
BMJ Open, 2016Co-Authors: Judith S Sittig, Cuno S P M Uiterwaal, Karel G M Moons, I M B Russel, Rutger A J Nievelstein, Edward E S Nieuwenhuis, Elise M Van De PutteAbstract:Objectives The aim of our diagnostic accuracy study Child Abuse Inventory at Emergency Rooms (CHAIN-ER) was to establish whether a widely used checklist accurately detects or excludes physical abuse among children presenting to ERs with physical injury. Design A large multicentre study with a 6-month follow-up. Setting 4 ERs in The Netherlands. Participants 4290 children aged 0–7 years attending the ER because of physical injury. All children were systematically tested with an easy-to-use child abuse checklist (index test). A national expert panel (reference standard) retrospectively assessed all children with positive screens and a 15% random sample of the children with negative screens for physical abuse, using additional information, namely, an injury history taken by a paediatrician, information provided by the general practitioner, youth doctor and social services by structured questionnaires, and 6-month follow-up information. Main outcome measure Physical child abuse. Secondary outcome measure Injury due to neglect and need for help. Results 4253/4290 (99%) parents agreed to follow-up. At a prevalence of 0.07% (3/4253) for inflicted injury by expert panel decision, the positive predictive value of the checklist was 0.03 (95% CI 0.006 to 0.085), and the negative predictive value 1.0 (0.994 to 1.0). There was 100% (93 to 100) agreement about inflicted injury in children, with positive screens between the expert panel and child abuse experts. Conclusions Rare cases of inflicted injury among preschool children presenting at ERs for injury are very likely captured by easy-to-use checklists, but at very high false-positive rates. Subsequent assessment by child abuse experts can be safely restricted to children with positive screens at very low risk of missing cases of inflicted injury. Because of the high false positive rate, we do advise careful prior consideration of cost-effectiveness and clinical and societal implications before de novo implementation.
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systematic detection of physical child abuse at Emergency Rooms
Nederlands Tijdschrift voor Geneeskunde, 2016Co-Authors: Judith S Sittig, Cuno S P M Uiterwaal, Karel G M Moons, I M B Russel, Rutger A J Nievelstein, Edward E S Nieuwenhuis, Elise M Van De PutteAbstract:Objective The aim of our diagnostic accuracy study Child Abuse Inventory at Emergency Rooms (CHAIN-ER) was to establish whether a widely used checklist accurately detects or excludes physical abuse among children presenting to ERs with physical injury. Design A large multicentre study with a 6-month follow-up in 4 ERs in The Netherlands. Method Participants were 4290 children aged 0-7 years, attending the ER because of physical injury. All children were systematically tested with an easy-to-use child abuse checklist (index test). A national expert panel (reference standard) retrospectively assessed all children with positive screens and a 15% random sample of the children with negative screens for physical abuse, using additional information, namely, an injury history taken by a paediatrician, information provided by the general practitioner, youth doctor and social services by structured questionnaires, and 6-month follow-up information. Our main outcome measure was physical child abuse; secondary outcome measure was injury due to neglect and need for help. Results 4253/4290 (99%) parents agreed to follow-up. At a prevalence of 0.07% (3/4253) for inflicted injury by expert panel decision, the positive predictive value of the checklist was 0.03 (95% CI 0.006 to 0.085), and the negative predictive value 1.0 (0.994 to 1.0). There was 100% (93 to 100) agreement about inflicted injury in children, with positive screens between the expert panel and child abuse experts. Conclusion Rare cases of inflicted injury among preschool children presenting at ERs for injury are very likely captured by easy-to-use checklists, but at very high false-positive rates. Subsequent assessment by child abuse experts can be safely restricted to children with positive screens at very low risk of missing cases of inflicted injury. Because of the high false positive rate, we do advise careful prior consideration of cost-effectiveness and clinical and societal implications before de novo implementation.
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child abuse inventory at Emergency Rooms chain er rationale and design
BMC Pediatrics, 2011Co-Authors: Judith S Sittig, Cuno S P M Uiterwaal, Karel G M Moons, Edward E S Nieuwenhuis, Elise M Van De PutteAbstract:Background Child abuse and neglect is an important international health problem with unacceptable levels of morbidity and mortality. Although maltreatment as a cause of injury is estimated to be only 1% or less of the injured children attending the Emergency room, the consequences of both missed child abuse cases and wrong suspicions are substantial. Therefore, the accuracy of ongoing detection at Emergency Rooms by health care professionals is highly important. Internationally, several diagnostic instruments or strategies for child abuse detection are used at Emergency Rooms, but their diagnostic value is still unknown. The aim of the study 'Child Abuse Inventory at Emergency Rooms' (CHAIN-ER) is to assess if active structured inquiry by Emergency room staff can accurately detect physical maltreatment in children presenting at Emergency Rooms with physical injury.
Timothy E Hewett - One of the best experts on this subject based on the ideXlab platform.
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youth versus adult weightlifting injuries presenting to united states Emergency Rooms accidental versus nonaccidental injury mechanisms
Journal of Strength and Conditioning Research, 2009Co-Authors: Gregory D Myer, Carmen E Quatman, Jane C Khoury, Eric J Wall, Timothy E HewettAbstract:Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. Emergency Rooms by age, type, and mechanism of injury. We hypothesized that older athletes would sustain greater percentages of joint sprains and muscle strains, whereas younger athletes would sustain a greater percentage of accidental injuries that would result in an increased percentage of fractures in youths. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System was queried from 2002 to 2005 using the CPSC code for "Weightlifting." Subjects between the ages of 8 and 30 were grouped by age categories 8 to 13 (elementary/middle school age), 14 to 18 (high school), 19 to 22 (college), and 23 to 30 (adult). Injuries were classified as "accidental" if caused by dropped weight or improper equipment use. Multiple logistic regression was used to compare accidental injuries between age groups. The sample consisted of 4,111 patients. Accidental injuries decreased (p 14 to 18 > 19 to 22 years = 23 to 30 years. Conversely, sprain/strain injuries increased in each successive age group (p < 0.05). Evaluation of only the nonaccidental injuries (n = 2,565) showed that the oldest categories (19-22 and 23-30 yr) demonstrated a greater percentage of sprains and strains relative to younger age categories (p < 0.001). Two thirds of the injuries sustained in the 8 to 13 group were to the hand and foot and were most often related to "dropping" and "pinching" in the injury descriptions, and there was an increased percentage of fractures in the 8 to 13 group relative to all other groups (p < 0.001). The study findings indicate that children have lower risk of resistance training-related joint sprains and muscle strains than adults. The majority of youth resistance training injuries are the result of accidents that are potentially preventable with increased supervision and stricter safety guidelines.
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sex differences in weightlifting injuries presenting to united states Emergency Rooms
Journal of Strength and Conditioning Research, 2009Co-Authors: Carmen E Quatman, Gregory D Myer, Jane C Khoury, Eric J Wall, Timothy E HewettAbstract:Benefits of resistance training include improved muscle strength and sports performance and may include reduced injuries. However, few studies have examined sex differences in resistance training-related injuries. The objective of this investigation was to evaluate sex differences in injuries associated with strength training in adolescents and young adults by type (sprains and strains, fractures), mechanism (accidental, nonaccidental), and location (head, trunk, arm, hand, leg, foot) of injury. We hypothesized that there would be sex differences in type, mechanism, and location of strength training injuries. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS) was queried from 2002 to 2005 using the CPSC code for "Weightlifting." Subjects between the ages of 14 and 30 years were included in the study. CPSC sampling weights were used to calculate national estimates from the sample of 3,713 patients (men = 3,102; women = 611). Weighted Chi-square analyses were used to compare differences in mechanism, type, and location of injury for men versus women. Men had significantly more sprains and strains (p = 0.004), whereas women demonstrated increased accidental injuries compared to men (p < 0.001). The trunk was the most commonly injured body part for both men (36.9%) and women (27.4%). Men had more trunk injuries than women (p < 0.001), whereas women had more foot (p < 0.001) and leg (p = 0.03) injuries than men (p < 0.001). The findings indicate that men may suffer more exertional-type resistance injuries during strength training (sprains and strains) compared to women, especially at the trunk. Conversely, women may be more susceptible to lower-extremity injuries resulting from accidents during resistance training.
Gregory D Myer - One of the best experts on this subject based on the ideXlab platform.
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youth versus adult weightlifting injuries presenting to united states Emergency Rooms accidental versus nonaccidental injury mechanisms
Journal of Strength and Conditioning Research, 2009Co-Authors: Gregory D Myer, Carmen E Quatman, Jane C Khoury, Eric J Wall, Timothy E HewettAbstract:Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. Emergency Rooms by age, type, and mechanism of injury. We hypothesized that older athletes would sustain greater percentages of joint sprains and muscle strains, whereas younger athletes would sustain a greater percentage of accidental injuries that would result in an increased percentage of fractures in youths. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System was queried from 2002 to 2005 using the CPSC code for "Weightlifting." Subjects between the ages of 8 and 30 were grouped by age categories 8 to 13 (elementary/middle school age), 14 to 18 (high school), 19 to 22 (college), and 23 to 30 (adult). Injuries were classified as "accidental" if caused by dropped weight or improper equipment use. Multiple logistic regression was used to compare accidental injuries between age groups. The sample consisted of 4,111 patients. Accidental injuries decreased (p 14 to 18 > 19 to 22 years = 23 to 30 years. Conversely, sprain/strain injuries increased in each successive age group (p < 0.05). Evaluation of only the nonaccidental injuries (n = 2,565) showed that the oldest categories (19-22 and 23-30 yr) demonstrated a greater percentage of sprains and strains relative to younger age categories (p < 0.001). Two thirds of the injuries sustained in the 8 to 13 group were to the hand and foot and were most often related to "dropping" and "pinching" in the injury descriptions, and there was an increased percentage of fractures in the 8 to 13 group relative to all other groups (p < 0.001). The study findings indicate that children have lower risk of resistance training-related joint sprains and muscle strains than adults. The majority of youth resistance training injuries are the result of accidents that are potentially preventable with increased supervision and stricter safety guidelines.
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sex differences in weightlifting injuries presenting to united states Emergency Rooms
Journal of Strength and Conditioning Research, 2009Co-Authors: Carmen E Quatman, Gregory D Myer, Jane C Khoury, Eric J Wall, Timothy E HewettAbstract:Benefits of resistance training include improved muscle strength and sports performance and may include reduced injuries. However, few studies have examined sex differences in resistance training-related injuries. The objective of this investigation was to evaluate sex differences in injuries associated with strength training in adolescents and young adults by type (sprains and strains, fractures), mechanism (accidental, nonaccidental), and location (head, trunk, arm, hand, leg, foot) of injury. We hypothesized that there would be sex differences in type, mechanism, and location of strength training injuries. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS) was queried from 2002 to 2005 using the CPSC code for "Weightlifting." Subjects between the ages of 14 and 30 years were included in the study. CPSC sampling weights were used to calculate national estimates from the sample of 3,713 patients (men = 3,102; women = 611). Weighted Chi-square analyses were used to compare differences in mechanism, type, and location of injury for men versus women. Men had significantly more sprains and strains (p = 0.004), whereas women demonstrated increased accidental injuries compared to men (p < 0.001). The trunk was the most commonly injured body part for both men (36.9%) and women (27.4%). Men had more trunk injuries than women (p < 0.001), whereas women had more foot (p < 0.001) and leg (p = 0.03) injuries than men (p < 0.001). The findings indicate that men may suffer more exertional-type resistance injuries during strength training (sprains and strains) compared to women, especially at the trunk. Conversely, women may be more susceptible to lower-extremity injuries resulting from accidents during resistance training.