Biomedical subjects

M D Baker

Publications and source records attributed to M D Baker.

At least 73 records · Page 4Linked to original sources

PubMed1995

Identification and characterization of three Encephalitozoon cuniculi strains.

Microsporidia are increasingly recognized as causing opportunistic infections in immunocompromised individuals. Encephalitozoon cuniculi is probably the most studied mammalian microsporidian that infects insects and mammals, including man. In this study, 8 E. cuniculi isolates were compared and were found to fall into 3 strains. Strain type I includes the rabbit type isolate, as well as isolates from an additional rabbit, a dwarf rabbit, and a mouse. Strain type II includes 2 murine isolates and strain type III includes 2 isolates obtained from domestic dogs. By SDS-PAGE, the 3 strains differ primarily in the molecular weight range of 54-59 kDa where strain type I displays an apparent broad singlet at 57 kDa, strain type II displays an apparent doublet at 54 and 58 kDa, and strain type III displays an apparent broad band at 59 kDa. Antigenic differences were detected in the molecular weight regions of 54-58 kDa as well as 28-40 kDa by Western blot immunodetection using murine antisera raised against E. cuniculi, Encephalitozoon hellem, and the Encephalitozoon-like Septata intestinalis. Polymerase chain reaction (PCR) products containing only small subunit rDNA sequences from the different E. cuniculi isolates formed homoduplexes whereas PCR products containing intergenic rRNA gene sequences formed heteroduplexes in mobility shift analyses. Fok I digestion of the PCR products containing the intergenic rRNA gene region resulted in unique restriction fragment length polymorphism patterns, and DNA sequencing demonstrated that in the intergenic spacer region, the sequence 5'-GTTT-3' was repeated 3 times in strain type I, twice in strain type II, and 4 times in strain type III. This study indicates that there exist at least 3 E. cuniculi strains which may become important in the epidemiology of human E. cuniculi infections. Furthermore, as additional E. cuniculi isolates are characterized, these strains will be named or reclassified once the criteria for taxonomy and phylogenetic tree construction for microsporidia become better defined.

Animals↗

PubMed1995

High-frequency gene conversion between repeated C mu sequences integrated at the chromosomal immunoglobulin mu locus in mouse hybridoma cells.

The occurrence of mitotic recombination between repeated immunoglobulin mu gene constant (C mu) region sequences stably integrated at the haploid chromosomal immunoglobulin mu locus in murine hybridoma cells was investigated. Recombination events are detected as changes in hapten-specific immunoglobulin M production. Recombination occurs with high frequency (0.5 to 0.8%) by a mechanism consistent with gene conversion. A double-strand break repair-like mechanism is suggested by the finding that repair of a 2-bp deletion mutation and a 2-bp insertion mutation occurs with parity in a donor-directed manner. The results also suggest that the gene conversion process is directional in that the 5' C mu region sequence is preferentially converted.

Animals↗

PubMed1994

The action of capsaicin on type I delayed rectifier K+ currents in rabbit Schwann cells.

Capsaicin, a lipophilic alkaloid, blocked type I K+ currents in rabbit cultured Schwann cells when applied by superfusion. The concentration-response relation at equilibrium was well described by a rectangular hyperbola, with a KD of 8.7 microM. The kinetics of block resembled an 'inactivation', the rate of blockade increasing with increasing concentrations of capsaicin (1-100 microM). Unlike internal tetraethylammonium (TEA) ions (5-10 mM), which preferentially reduced outward current in symmetrical high [K+], capsaicin reduced both inward and outward type I current by the same proportion. The block achieved by capsaicin during a voltage-clamp step that activated the current was relieved by subsequent hyperpolarization, and the rate of relief from block at -70 mV and -100 mV could be reasonably accounted for on the assumption that capsaicin had to unbind to allow the channels' to close.

Aging↗

PubMed1994

Restoration of a normal level of immunoglobulin production in a hybridoma cell line following modification of the chromosomal immunoglobulin mu gene by gene replacement.

In the present investigation, we have measured the levels of IgM mRNA and protein in recombinant cell lines in which the chromosomal immunoglobulin mu gene has been modified by gene replacement (gene conversion or double reciprocal recombination) or vector integration (single reciprocal recombination) events. Our studies reveal that chromosomal immunoglobulin mu genes modified by gene replacement are expressed at wild-type levels whereas those modified by vector integration have lower levels of immunoglobulin mu gene expression. These results suggest that gene replacement may a preferred method for the construction of hybridoma and myeloma cell lines producing optimized immunoglobulins and for studies of immunoglobulin gene function.

Cell Line↗

PubMed1994

Epiglottitis in children, 1979 through 1992. Effects of Haemophilus influenzae type b immunization.

OBJECTIVE: To examine secular trends in the epidemiology, bacteriology, and clinical presentation of acute epiglottitis in children in the years surrounding the introduction of vaccine against Haemophilus influenzae type b. DESIGN: Retrospective chart review of patient series. SETTING: Large, urban, tertiary care pediatric hospital. SUBJECTS: One hundred forty-two children with epiglottitis admitted during a 14-year period (1979 through 1992). MAIN RESULTS: The average annual incidence of epiglottitis declined from 10.9 per 10,000 admissions before 1990 to 1.8 per 10,000 admissions from 1990 through 1992. The median age increased from 35.5 months in the earlier period to 80.5 months (P = .007). Overall, H influenzae type b was identified as the causative organism in 76% of patients, but in only 25% of the cases since 1990 (P = .004). Of the eight cases from 1990 through 1992, three had group A beta-hemolytic streptococcus isolated from a surface culture of the epiglottis; three other cases of group A beta-hemolytic streptococcus were identified earlier. These patients were significantly older than those with H influenzae type b disease (117.5 vs 35 months, P = .004). No important differences were found in any of a number of clinical characteristics based on causative organism or year of diagnosis. CONCLUSION: Acute epiglottitis has diminished in frequency since 1990. Patients whose conditions have been diagnosed since then tend to be older and to have disease caused by organisms other than H influenzae type b (particularly group A beta-hemolytic streptococcus). However, the clinical presentation appears to be similar to that seen previously.

Child↗

PubMed1994

Phylogenetic relationships among Vairimorpha and Nosema species (Microspora) based on ribosomal RNA sequence data.

A portion (approximately 350 nucleotides) of the large subunit ribosomal RNA (rRNA) 5' to the 580 region (Escherichia coli numbering) was sequenced using the reverse transcriptase dideoxy method and compared for several species of Nosema and Vairimorpha. Comparison among Nosema species suggests that this genus is composed of several unrelated groups. The group which includes the type species, Nosema bombycis, consists of closely related species found primarily in Lepidoptera. Other Nosema species sequenced (Nosema kingi, Nosema algerae, and Nosema locustae) do not appear to be closely related to each other or to the lepidopteran Nosema group. Comparison among the Vairimorpha species indicates that two distinct but very closely related groups exist. The Lymantria group consists of species isolated from the gypsy moth, Lymantria dispar, while the Vairimorpha necatrix group consists of species isolated from other Lepidoptera. Intergeneric comparison of the sequence data suggests that the lepidopteran Nosema species are closely related to the Vairimorpha species.

Animals↗

PubMed1994

High-frequency loss of specific immunoglobulin production in hybridoma cell lines bearing a chromosomal immunoglobulin kappa gene modified by homologous recombination.

We have examined the stability of trinitrophenyl (TNP) -specific IgM production in hybridoma cell lines in which homologous recombination was used to change the variable region of an endogenous chromosomal immunoglobulin kappa gene to one specific for TNP. Mutant hybridomas that have lost TNP-specific IgM production are detected with a frequency of approximately 1%. Characterization of the mutant cells reveals a variety of gross rearrangements in the recombinant kappa TNP gene as well as in the endogenous kappa and muTNP genes.

Animals↗

PubMed1994

Individual and combined effects of relaxin, estrogen, and progesterone in ovariectomized gilts. I. Effects on the growth, softening, and histological properties of the cervix.

Marked growth and softening of the uterine portion of the cervix occur during the last third of the 115-day gestation period in the gilt. These changes in the cervix are temporally correlated with elevated blood levels of relaxin, estrogen, and progesterone. We recently demonstrated that relaxin plays a major role in promoting both the growth and softening of the cervix that occur in pregnant gilts. The roles of estrogen and progesterone in these cervical changes remain poorly understood. Accordingly, this study determined the influence of relaxin, estrogen, and progesterone, individually and in combination, on cervical growth and softening in gilts. Fifteen days after ovariectomy, six to nine nonpregnant, sexually mature gilts were assigned to one of the following eight treatment groups: ovariectomized controls, relaxin treated, estrogen treated, progesterone treated, estrogen plus relaxin treated, progesterone plus relaxin treated, estrogen plus progesterone treated, and progesterone plus estrogen plus relaxin treated. Treatment was given for 10 days, with doses of relaxin (0.5 mg, four times daily), estradiol benzoate (1 mg, twice daily), and progesterone (50 mg, twice daily) selected to provide blood levels resembling those between days 100-110 of gestation. The growth, softening, and histological characteristics of the cervices were determined. Treatment with relaxin significantly increased the growth and softening and altered the histological characteristics of the uterine portion of the cervix in the absence of steroid treatment. Estrogen treatment alone increased cervical growth, but when given in combination with relaxin, estrogen did not augment relaxin's ability to increase either cervical growth or softening. Progesterone alone had little or no effect on the growth or softening of the uterine portion of the cervix. Unexpectedly, when given in combination with relaxin, progesterone augmented markedly relaxin's effects on softening and alteration of the histological characteristics of the cervix. In conclusion, this study is consistent with recent reports that relaxin promotes both the growth and softening of the cervix in the pig. Additionally, this study provides evidence that estrogen and relaxin act independently to promote the growth of the cervix in gilts, whereas progesterone acts in concert with relaxin to promote softening of the cervix and a reduction in the organization and density of cervical collagen fibers. This study provides evidence that relaxin, estrogen, and progesterone all very likely play important roles in the modifications of the cervix that occur during late pregnancy in the gilt.

Animals↗

PubMed1994

Individual and combined effects of relaxin, estrogen, and progesterone in ovariectomized gilts. II. Effects on mammary development.

Marked development of the mammary parenchyma (ducts, lobules, and alveoli) occurs during the last third of the 115-day gestation period in the gilt. These changes in the mammary gland are temporally correlated with elevated blood levels of relaxin, estrogen, and progesterone. We recently demonstrated that relaxin plays a major role in promoting the development of the mammary parenchyma that occurs in pregnant gilts. The roles of estrogen and progesterone in the mammary gland in gilts remain poorly understood. Accordingly, this study determined the influence of relaxin, estrogen, and progesterone, individually and in combination, on mammary development. Fifteen days after ovariectomy, six to eight nonpregnant sexually mature gilts were assigned to one of the following eight treatment groups: ovariectomized controls, relaxin treated, estrogen treated, progesterone-treated, estrogen plus relaxin treated, progesterone plus relaxin treated, estrogen plus progesterone treated and progesterone plus estrogen plus relaxin treated. Treatment was given for 10 days, with doses of relaxin (0.5 mg, four times daily), estradiol benzoate (1 mg, twice daily), and progesterone (50 mg, twice daily) selected to provide blood levels similar to those occurring between days 100-110 of gestation. The fourth mammary gland from the anterior end was collected. The cross-sectional area of the parenchymal tissue was used to measure the extent of parenchymal development. To examine mammary parenchymal development in more detail, the effect of hormone treatment on lobulo-alveolar development was conducted using morphometric analysis. Relaxin alone had little effect on mammary development, and estrogen alone stimulated mammary development only modestly. In contrast, combined treatment with estrogen and relaxin stimulated mammary development markedly. Progesterone alone had no effect on lobulo-alveolar development, but, surprisingly, when administered in combination with relaxin, progesterone reduced the organization of the collagen fibrils of the mammary stroma. In conclusion, this study is consistent with recent reports that relaxin plays an important role in the development of the mammary gland in gilts. Moreover, it demonstrates that relaxin acts in concert with estrogen to stimulate development of the mammary parenchyma. Finally, this study demonstrates that relaxin in concert with progesterone decreases the organization of the collagen matrix surrounding the growing mammary gland. This study is consistent with the view that relaxin, estrogen, and progesterone all very likely play roles in the development of the mammary gland in gilts.

Animals↗

PubMed1993

Outpatient management without antibiotics of fever in selected infants.

BACKGROUND: In many academic centers it is standard practice to hospitalize all febrile infants younger than two months of age, whereas in community settings such infants are often cared for as outpatients. METHODS: We conducted a controlled study of 747 consecutive infants 29 through 56 days of age who had temperatures of at least 38.2 degrees C. After a complete history taking, physical examination, and sepsis workup, the 460 infants with laboratory or clinical findings suggestive of serious bacterial illness were hospitalized and treated with antibiotics. The screening criteria for serious bacterial illness included a white-cell count of at least 15,000 per cubic millimeter, a spun urine specimen that had 10 or more white cells per high-power field or that was positive on bright-field microscopy, cerebrospinal fluid with a white-cell count of 8 or more per cubic millimeter or a positive Gram's stain, or a chest film showing an infiltrate. The 287 infants who had unremarkable examinations and normal laboratory results were assigned to either inpatient observation without antibiotics (n = 148) or outpatient care without antibiotics but with reexaminations after 24 and 48 hours (n = 139). RESULTS: Serious bacterial illness was diagnosed in 65 infants (8.7 percent). Of these 65 infants, 64 were identified by our screening criteria for inpatient care and antibiotic treatment (sensitivity = 98 percent; 95 percent confidence interval, 92 to 100). Of the 287 infants assigned to observation and no antibiotics, 286 (99.7 percent) did not have serious bacterial illness. Only two infants assigned to outpatient observation were subsequently admitted to the hospital; neither was found to have a serious illness. Outpatient care without antibiotics of the febrile infants at low risk for serious illness resulted in a savings of about $3,100 per patient. CONCLUSIONS: With the use of strict screening criteria, a substantial number of febrile one-to-two-month-old infants can be cared for safely as outpatients and without antibiotics.

Ambulatory Care↗

PubMed1993

Analysis of mutations introduced into the chromosomal immunoglobulin mu gene.

We have introduced a pSV2neo-derived vector that contains a 2-base-pair (bp) deletion in its immunoglobulin mu gene constant region into hybridoma cells bearing a single copy of the wild-type chromosomal immunoglobulin mu gene. Homologous recombination between the transferred mutant C mu region and the wild-type chromosomal C mu region is expected to introduce the 2-bp deletion into the chromosomal mu gene, generating recombinant cells synthesizing noncytolytic IgM. Analysis of the DNA in independent noncytolytic transformants indicates that in one case the mu gene has the structure expected for correct homologous recombination. Unexpectedly, the remaining transformants, bear chromosomal mu gene deletions.

Animals↗

PubMed1993

The adult patient in the pediatric emergency department.

STUDY OBJECTIVE: To establish the frequency of use of pediatric emergency departments by adult patients and the spectrum of disease with which they present. DESIGN: Prospective, descriptive study and unblinded survey. SETTING: Children's Hospital pediatric ED. TYPE OF PARTICIPANTS: Seventy-two adult patients presenting to a pediatric ED during a two-year period and 31 pediatric emergency medicine fellowship directors. INTERVENTIONS: For each patient, we recorded demographic information, chief complaint, interventions by physicians, diagnosis, condition, and disposition after initial care. Pediatric emergency medicine fellowship training program directors were surveyed by telephone regarding their experiences with adult patients and the extent of adult emergency medicine training within their programs. MAIN RESULTS: Of the 72 adult patients evaluated, one third (22) were treated for trauma and the remaining 50 for medical illness. More than 40 different diagnoses were encountered, including stroke and myocardial infarction. Twenty patients (27.8%) required hospitalization, four (5.6%) in intensive care settings. Of the 31 fellowship directors surveyed, 27 (87.1%) indicated that adult patients had been managed in their EDs during the previous year. All but one reported that their fellowship programs incorporated between one and four months of adult emergency medicine in their curricula. CONCLUSION: Adults frequently present to pediatric EDs for both minor and serious illnesses. Training in adult emergency medicine should be a part of all pediatric emergency medicine fellowship programs.

Adult↗

PubMed1993

Substance abuse in adolescent trauma.

STUDY OBJECTIVE: To determine if there is a significant prevalence of drug or alcohol use among adolescents evaluated for significant acute trauma. DESIGN: A prospective, age-matched controlled study over a 20-month period. SETTING: Urban pediatric emergency department in a Level I pediatric trauma center. PARTICIPANTS: Patients between 13 and 19 years of age requiring admission to the trauma service following evaluation in a pediatric ED and an age-matched control group of asthmatic patients. RESULTS: A total of 134 patients (mean age, 14.8 years) were admitted for trauma-related injuries, and 22 of 65 (34%) were positive for alcohol or drugs of abuse. The mean age of patients with a positive toxicology screen was 15.4 years. Most commonly detected drugs were alcohol (eight), benzodiazepines (eight), cocaine (five), and cannabinoids (four). The number of positive screens in the trauma group (22 of 65) was significantly higher than controls (one of 49) (P < .001). This remained statistically significant even when those trauma patients not screened were assumed to have a negative toxicology screen (22 of 134 versus one of 49) (P < .01). There was also a significantly higher number of positive toxicology screens among adolescents with an intentional versus unintentional mechanism of injury (21 of 71 versus one of 63) (P < .001). CONCLUSION: A significant number of adolescents admitted to the hospital for trauma-related injuries have a toxicology screen positive for alcohol or drugs of abuse. A toxicology screen should be a standard laboratory test in adolescents involved in significant trauma, especially if the mechanism was intentional.

Acute Disease↗

PubMed1993

Endotracheal tube selection in children: a comparison of four methods.

STUDY OBJECTIVE: To determine the accuracy of four methods of endotracheal tube size selection in the pediatric population. STUDY DESIGN: Prospective, blinded comparison. SETTING: The Children's Hospital of Philadelphia. PARTICIPANTS: Two hundred thirty-seven children aged 1 month to 9 years old undergoing elective surgery requiring endotracheal intubation. SELECTION PROCEDURES: Consecutive sample. INTERVENTIONS: Four methods of determining proper endotracheal tube size in children were compared. These methods included direct comparison with the width of the fifth finger, direct comparison with the diameter of the fifth finger using a ring-sizing device, direct comparison with the width of the fifth fingernail, and estimation using a formula ([age in years + 16]/4). In infants, a 3.0-mm (internal diameter) endotracheal tube was predicted for those 3 months of age and younger, and a 3.5-mm endotracheal tube was predicted for those from 3 to 9 months of age. The size of the endotracheal tube used in the operating room was recorded, as was the "air leak" around the tube. An appropriately sized endotracheal tube was determined by an air leak with ventilation pressures between 5 and 40 cm of water. MAIN RESULTS: Direct comparison using the width and the diameter of the fifth finger predicted an endotracheal tube between 1 mm smaller and 0.5 mm larger than that used by the anesthesiologists in 11% and 14% of patients, respectively. The age-based formula predicted an endotracheal tube size in this range in 97.5% of patients, and direct comparison with the width of the fifth fingernail predicted an endotracheal tube in this same range in 91% of patients. These findings were consistent within all age groups studied. CONCLUSION: Neither fifth finger width nor fifth finger diameter accurately predicts proper endotracheal tube size in most children. A more accurate estimation can be made using the age-based formula, but when the child's age is unknown or when calculation is awkward or impossible, an accurate estimate can be made using the width of the fifth fingernail.

Child↗

PubMed1993

Effect of ambient temperature on capillary refill in healthy children.

OBJECTIVES: To assess the effect of moderately decreased ambient temperature on capillary refill (CR) time in healthy children, and to measure the reliability of CR measurements between observers. DESIGN: Prospective interventional study with cross-over design. SETTING: Urban pediatric emergency department. PARTICIPANTS: 32 well-hydrated children aged 1 month to 12 years brought to the emergency department for care of minor illness or injury. INTERVENTIONS: Participants were assigned in random order to a 15-minute waiting period in each of two rooms, with and without air-conditioning (cool and warm rooms, respectively). At the end of each waiting period, fingertip CR was measured with a stopwatch, three times by each of one or more three trained observers. RESULTS: Mean CR time was 0.85 +/- 0.45 seconds in the warm room (mean ambient temperature (25.7 degrees C) vs 2.39 +/- 0.76 seconds in the cool room (mean temperature 19.4 degrees C). The mean overall difference in CR time between the two environments was 1.53 seconds (95% confidence interval [CI]: 1.31, 1.75; P < .001); the difference was significant regardless of age or sequence of exposure. 100% of patients were considered to have normal CR (less than 2 seconds) in the warm room, whereas only 31% were considered normal in the cool room. In the 16 patients with CR measured by three observers, interobserver reliability was fair, with an intraclass correlation coefficient of 0.70 (95% CI: 0.56, 0.85), and kappa of 0.54 (95% CI: 0.33, 0.73). CONCLUSIONS: Decreases in ambient temperature within a range found in typical office/emergency department settings may cause significant prolongation of CR time in children with normal circulatory status. There is marked interobserver variability in the measurement of CR even when performed by experienced observers. These findings suggest limitations to the use of CR in the assessment of ill or injured children.

Body Temperature↗

PubMed1993

Management of cardiopulmonary and trauma resuscitation in the pediatric emergency department.

The etiology and management of critical illness and injury in a pediatric emergency department were reviewed to survey the use of cardiopulmonary and trauma resuscitation and to compare these data with the educational content of Pediatric Advanced Life Support (PALS) courses. The emergency department records of 183 patients treated in the cardiopulmonary/trauma resuscitation room of a pediatric emergency department over a 17-month period were reviewed for data on diagnosis, morbidity, presence of apnea or pulselessness, and utilization of several resuscitation skills: intubation, cardioversion, tibial interosseous line placement, and other resuscitation techniques. Apneic and pulseless pediatric patients had poor survival (10.3%), but apneic patients had excellent survival (96.9%). Endotracheal intubation (57.9%), bag-valve-mask ventilation (63.9%), and medications for rapid-sequence induction of anesthesia prior to endotracheal intubation (25.7%) were used frequently. Inasmuch as asystole was the most common rhythm in pulseless patients, cardioversion and defibrillation were rarely used (2.2%). Specialized vascular access techniques, tibial interosseous lines (24.0%), and femoral intravenous lines (19.7%), were used frequently in pediatric patients. The frequent use of airway management skills and the excellent survival of apneic pediatric patients supports the current emphasis on airway management in PALS courses. Cardioversion/defibrillation should receive less emphasis in PALS courses. The frequent use of rapid-sequence induction of anesthesia prior to endotracheal intubation indicates that these techniques might warrant increased emphasis in the training of pediatric emergency department personnel and in PALS courses.

Apnea↗

PubMed1992

Lacerations involving glass. The role of routine roentgenograms.

OBJECTIVE: To determine, when evaluating a laceration caused by glass, whether seeing that the bottom of the wound is free of glass eliminates the possibility that glass is present in the wound. RESEARCH DESIGN: Prospective patient series. SETTING: Two pediatric emergency departments. PARTICIPANTS: 226 children with lacerations due to glass occurring in a period of 21 months. SELECTION PROCEDURES: Consecutive sample. INTERVENTIONS: Before obtaining a roentgenogram, the triage nurse or the managing physician visually inspected each wound and recorded whether the bottom of the wound was seen, if glass was seen in the wound, and the length and depth of the wound. Further treatment of the wound was at the discretion of the managing physician. MEASUREMENTS/MAIN RESULTS: Glass was seen in the wounds of 10 children on initial inspection. Of the remaining 216 injuries, glass was contained in 12 (21.4%) of the 56 lacerations when the bottom of the wound was not visualized, and in 11 (6.9%) of the 160 lacerations when the bottom of the wound was visualized. There was a significant association between the depth of the wound and an inability to see the bottom of the wound, and deeper wounds were significantly more likely to contain glass. All but one of the lacerations containing glass had a depth of at least 0.5 cm. CONCLUSIONS: In the population studied, seeing that the bottom of the laceration was free of glass reduced, but did not eliminate, the possibility that glass was present in the wound. In addition, superficial lacerations (less than 0.5 cm) rarely contained undetected glass fragments. We recommended that further investigation concerning the mechanism of injury, the depth of the wound, and the type of glass involved is needed before physicians abandon routine roentgenography for lacerations due to glass.

Child↗

PubMed1992

Infections in severely traumatized children.

To study the incidence and types of infection among severely traumatized children, we reviewed the medical charts of 212 children, hospitalized following traumatic injury, who received antibiotics at sometime during their hospitalization. Infection occurred in 19%. Eleven children had trauma-related infections, whereas 29 (71% of those infected) had 36 nosocomial infections. Tracheitis, sepsis, and urinary tract infections were the most common nosocomial infections and were diagnosed in the second week (10 +/- 3 days) following injury. Nosocomial infections were more likely to develop in children who were more severely injured and who had a greater number of invasive procedures. Severe head injury (cerebral edema or subarachnoid hemorrhage) was more common in those with nosocomial infection (P < .0002, odds ratio 6.8, 95% confidence interval 2.2 to 21.3). Those without these injuries were much less likely to develop nosocomial infections (specificity 97% and negative predictive value 86%). Finally, the development of any nosocomial infection prolonged the hospitalization by a mean of 16 +/- 6 days when comparing children with the same degree of traumatic injury. Prevention of nosocomial infection in children with severe trauma will significantly reduce length of hospitalization.

Accidents, Traffic↗