Biomedical subjects

James G Linakis

Publications and source records attributed to James G Linakis.

7 recordsLinked to original sources

PubMed2006

Emergency department visits for injury in school-aged children in the United States: a comparison of nonfatal injuries occurring within and outside of the school environment.

OBJECTIVES: To compare the demographic and injury characteristics of children visiting the emergency department (ED) for nonfatal injuries occurring at school with those of same-aged children who were injured outside of school. METHODS: Data from a stratified probability sample of U.S. hospitals providing emergency services in the National Electronic Injury Surveillance System (NEISS) were analyzed for 2001 and 2002. School and nonschool injury-related ED visits were analyzed for patients who were 5 through 19 years of age. RESULTS: There were an estimated 58,147,518 injury visits in all ages to the ED in 2001 and 2002. Injuries to school-aged children (ages 5-19) accounted for an estimated 15,405,392 (26%) visits overall, of which 1,859,215 occurred at school (16.5% of visits by school-aged children when location of injury was known). Males accounted for 63% of injuries at school; middle-school children (ages 10-14 yr) accounted for a significantly greater proportion of injuries (46%) than did primary- (5-9 yr, 24%) or secondary-school (15-19 yr, 30%) children (p < 0.001). In contrast, for injuries outside of school, secondary-school children were injured most (40%), followed by middle- (32%) and primary-aged children (27%). Nearly 11% of school injuries were classified as violent, whereas only 6.4% of the nonschool injuries in school-aged children were violent (p < 0.001). Similarly, sports injuries were significantly more common at school (53% of injuries) than outside of school (32.9%; p < 0.001). CONCLUSIONS: A significant proportion of injuries to school-aged children occur at school. Notable differences exist between the epidemiology of in- and out-of-school injuries. The nature of these injuries differs by age group. Efforts to reduce school injuries will require that these differences be examined further and incorporated into prevention initiatives.

Accidents↗

PubMed2006

Emergency department visits for sledding injuries in children in the United States in 2001/2002.

OBJECTIVES: To describe the characteristics of nonfatal sledding-related injuries in U.S. children resulting in emergency department (ED) visits in 2001/2002 and to explore the implications of these findings for injury prevention efforts. METHODS: A stratified probability sample of U.S. hospitals providing emergency services in the National Electronic Injury Surveillance System-All Injury Program was utilized for 2001/2002. ED visits resulting from injuries involving sleds, snow discs, snow tubes, and toboggans were analyzed for patients 19 years of age or younger. RESULTS: In 2001/2002, there were an estimated 57,866 ED visits for sledding-related injuries in the United States for all age groups. Of these, 41,272 (71%) occurred in patients 19 years of age or younger, 58% of whom were male. The highest number of injuries occurred in children between five and 14 years of age (74%), and the injuries were most often caused by falls or collisions (75%). The head or neck was the most frequently injured body region among those 0-9 years of age, while the extremities were injured most commonly among those 10-19 years of age. Head and neck injuries occurred in 56% (95% confidence interval [CI] = 32% to 81%) of children 0-4 years of age versus 19% (95% CI = 9% to 29%) of patients 15-19 years of age. Nine percent (95% CI = 6% to 12%) of patients sustained a traumatic brain injury. Three percent (95% CI = 1% to 5%) of patients required admission to the hospital. CONCLUSIONS: Sledding injuries resulting in ED visits predominantly affect children and are a source of measurable morbidity in this population. An increase in injury prevention efforts for this activity is warranted.

Adolescent↗

PubMed2005

Bispectral analysis during deep sedation of pediatric oral surgery patients.

PURPOSE: Bispectral (BIS) analysis uses electroencephalogram information from a forehead electrode to calculate an index score (0 to 100; 0 = coma; 90 to 100 = awake). This index score correlates with the level of alertness in anesthetized patients. Classically, sedation has been monitored with clinical sedation scales such as the Observers Assessment of Alertness Sedation Scale (OAA/S), Modified Ramsey Scale, or a Visual Analog Scale (VAS). Our objective was to determine the correlation between clinical sedation scales and BIS index in pediatric patients undergoing sedation in an outpatient oral surgery setting. MATERIALS AND METHODS: Prospective cohort study of patients aged 2 to 17 years undergoing sedation in an outpatient oral surgery office. Sedation was performed in the customary manner with the addition of BIS monitoring. Three clinical sedation scores (OAA/S: 5 to 1; 5 = awake, 1 = unresponsive; Modified Ramsey: 1 to 6; 1-2 = awake, 6 = unresponsive; VAS: 0 to 10; 0 = awake, 10 = unresponsive) were assigned every 5 minutes by an investigator blinded to the BIS index. Data were analyzed using a repeated measures linear regression model. RESULTS: Sixteen subjects undergoing oral surgery, ages 4.5 years to 17 years, were enrolled, mean age 12.6 years +/- 4.3 years (standard deviation). Patients received methohexital in addition to 1 or more of the following: nitrous oxide, fentanyl, or midazolam. The results of the longitudinal regression analysis showed a highly significant association between the sedation scales and the BIS index. CONCLUSION: The BIS monitor may be a useful adjunct in monitoring pediatric patients receiving sedation in the outpatient setting.

Adolescent↗

PubMed2005

Bispectral analysis during pediatric procedural sedation.

OBJECTIVE: Bispectral analysis (BIS) is a technology using EEG information from a forehead electrode to calculate an index (0-100; 0 = coma, 90-100 = awake). Our objective was to determine the degree of agreement between sedation scales and BIS values in pediatric patients undergoing sedation. METHODS: Patients ages 2 to 17 years, undergoing procedural sedation, were enrolled. Sedation was performed in the customary manner with the addition of BIS monitoring and assessment of a clinical sedation scale: the Observer's Assessment of Alertness/Sedation (OAA/S), every 5 minutes during the sedation procedure. Clinical scales were performed by an investigator blinded to the BIS index. The association between a clinical scale and BIS scores was analyzed using longitudinal regression analysis. RESULTS: We enrolled 47 subjects; 55% were sedated with ketamine and midazolam and the remaining 45% received methohexital, propofol or midazolam and a narcotic. The results of the regression analysis demonstrated a highly significant association between the OAA/S score and BIS value (beta = 5.0, 95% CI 4.3 to 5.7, P < 0.0001). Patients were divided into 2 groups, those sedated with ketamine and those sedated with nonketamine medications. The association between OAA/S score and BIS value was not statistically significant for the ketamine population (beta = 0.809, 95% CI -0.1 to 1.7, P = 0.09), but remained significant for the nonketamine subjects (beta = 8.6, 95% CI 7.7 to 9.4, P < 0.0001). CONCLUSIONS: The OAA/S sedation scale predicts the BIS value for pediatric patients undergoing procedural sedation when sedated with certain medications, excluding ketamine.

Adolescent↗

PubMed2004

Treatment of pediatric migraine headaches: a randomized, double-blind trial of prochlorperazine versus ketorolac.

STUDY OBJECTIVE: We compare the effectiveness of intravenous ketorolac and intravenous prochlorperazine in the treatment of pediatric migraine headaches. METHODS: We performed a prospective, randomized, double-blind clinical trial in 2 pediatric emergency departments (EDs) within children's hospitals. Children aged 5 to 18 years presenting to the ED with migraine headaches were eligible for the study. Contraindications to either medication or the inability to complete the pain score resulted in exclusion. Children were randomized to receive intravenous ketorolac (0.5 mg/kg; maximum 30 mg) or intravenous prochlorperazine (0.15 mg/kg; maximum 10 mg). All children also received a normal saline solution bolus. Successful treatment was defined as a 50% or greater reduction in the Nine Faces Pain Scale score at 60 minutes. If a less than 50% improvement occurred by 60 minutes, the child received the other medication. Forty-eight-hour follow-up telephone calls were made to each family to assess recurrence and late side effects. RESULTS: Sixty-two children were enrolled: 33 initially received prochlorperazine, and 29 initially received ketorolac. By 60 minutes, 16 (55.2%) of 29 of those who received ketorolac and 28 (84.8%) of 33 of those who received prochlorperazine were successfully treated (difference=30%; 95% confidence interval [CI] 8% to 52%). Fifty-six (93.3%) of the 60 children who completed the study were successfully treated by the study's conclusion. Approximately 30% of each group had a recurrence of some headache symptoms. Only 2 children reported side effects, both mild and self-limited. CONCLUSION: In children, intravenous prochlorperazine is superior to intravenous ketorolac in the acute treatment of migraine headaches.

Adolescent↗

PubMed2004

Evaluation of promotility agents to limit the gut bioavailability of extended-release acetaminophen.

BACKGROUND: Erythromycin and neostigmine have both been shown to act as gastrointestinal promotility agents. OBJECTIVES: The purpose of this study was to determine whether either erythromycin or neostigmine, administered parenterally, would result in lower serum levels of a recently ingested drug, when compared with placebo. METHODS: Ten volunteers ingested 1300 mg of extended-release acetaminophen on each of three occasions. They were then given an intravenous dose of erythromycin (200 mg), neostigmine (2 mg), or placebo. Each volunteer received all three treatments in a counterbalanced fashion, each separated from the next by at least two weeks. Blood for serum acetaminophen concentration was drawn at 1, 2, 4, 6 and 8 h after treatment, and the serum acetaminophen elimination curves were compared for the three treatments. RESULTS: The elimination phase of the curves did not differ among the treatments as a result of administration of the prokinetic agents. CONCLUSIONS: Under the present conditions, administration of erythromycin and neostigmine as prokinetic agents failed to alter the kinetics of an ingested dose of sustained-release acetaminophen.

Acetaminophen↗

PubMed2002

Pediatric emergency department utilization within a statewide medicaid managed care system.

OBJECTIVES: To describe pediatric emergency department (ED) utilization within a Medicaid managed care system and to investigate the association between pediatric ED utilization and the type of medical home. METHODS: This was a retrospective cohort study, set at Rhode Island's statewide Medicaid managed care program (RIte Care). The study population was a random sample of 2,000 children aged 19 to 35 months at the conclusion of a period of continuous RIte Care enrollment from July 1, 1996, until June 30, 1997. For description of ED utilization, rates of utilization and percentages were calculated. Bivariate and multivariate analyses were used to determine the effect of type of medical home and individual/family characteristics on ED utilization. Logistic regression models were used to determine odds ratios for types of medical home while controlling for sociodemographic factors and practice level variation. RESULTS: Of the 1,988 children who were eligible for analysis, 791 children utilized the ED during the study year at a rate of 68 ED visits/100 person-years. Thirty-one percent of those visits were for injuries/poisonings. Logistic regression analysis demonstrated decreased ED utilization for patients enrolled in a staff-model health maintenance organization (HMO) (OR 0.34; 95% CI = 0.27 to 0.42) or a health center (OR 0.71; 95% CI = 0.53 to 0.95) compared with hospital-based clinics. There was no significant association between the receipt of preventive services and ED utilization. CONCLUSIONS: Despite the presence of a defined medical home, ED use was common among preschool children enrolled in the statewide Medicaid managed care program. The type of medical home was an important determinant of ED use in this population.

Child, Preschool↗