PubMed · 10161664
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E Zablocki. Sharing expertise.. https://pubmed.ncbi.nlm.nih.gov/10161664/
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CONTEXT: Violence-related injuries among children are common, but age-based incidence data are not easily available. OBJECTIVES: To describe injuries due to violence in a population-based case series of children and to estimate injury incidence. DESIGN: Prospective surveillance of children residing in Boston, Mass, who received pediatric emergency department treatment for violence-related injury during a 4-year period beginning April 15, 1995. SETTING: Pediatric emergency departments in Boston. PATIENTS: Children aged 3 through 18 years who came to a hospital emergency department between April 1995 and April 1999. Violence-related injuries were defined as those resulting from a situation of conflict involving 2 or more persons with intent to harm, as assessed by health care personnel caring for the patients. Self-inflicted injuries and injuries caused by child abuse (including any injury resulting from a conflict with a parent or guardian) were excluded. Homicides of Boston children aged 3 through 18 years who were killed during the study period were included based on police data. MAIN OUTCOME MEASURE: Population-based violence-related injury rates. RESULTS: There were 2035 injury-related visits caused by violence, which reflects a rate of 52.7 (95% confidence interval, 50.5-54.9) per 10 000 person-years. Most injuries were relatively minor; 6.4% of visits resulted in admission. The youth violence-related injury rate in Boston declined at an average rate of 12% annually during the period studied. CONCLUSION: Pediatric emergency department monitoring of violence-related injury in Boston suggests that childhood injuries due to violence declined during the late 1990s.
Discrepancy rates between original and review histopathologic diagnoses have been well-studied, and range as high as 30% in some studies. While the sensitivity and specificity rates for a variety of cytologic specimens are well-known, few data exist as to the discrepancy rates associated with in-house, second-opinion reviews of outside material. We studied the 2-yr experience of two university-based medical centers' reviews of outside cytology materials. A total of 146 cases underwent second-opinion review. The majority were fine-needle aspiration specimens obtained from the breast, thyroid, lung, and hematobiliary system. Nine cases were cervical vaginal specimens, 19 were bronchial brushes, washings, or lavage specimens, 13 were pleural fluid specimens, 5 were bile duct brushings, and the remainder were exfoliative cytologies, including those from the cerebrospinal fluid, urine, and pelvis. In all, 24 disagreements were encountered, 11 of which were considered major in that a significant change in therapy occurred due to an alteration in diagnosis, while 13 were considered minor in that a different diagnosis or subclassification was given by the consultant pathologist, but this diagnostic change did not significantly alter therapy. The overall diagnosis disagreement rate of 16% is similar to the diagnostic discrepancy rate encountered in second-opinion reviews of surgical pathology specimens. The 8% major discrepancy rate is slightly higher than that seen in similar studies of surgical pathology material.