Sun City Center, United States
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Badaki-Makun O.,Emergency Medicine and Trauma Center | Donoghue A.,Center for Simulation | Niles D.,Center for Simulation | Seacrist T.,Center for Injury Research and Prevention | And 3 more authors.
Pediatrics | Year: 2013

Background: Chest compression (CC) quality deteriorates with time in adults, possibly because of rescuer fatigue. Little data exist on compression quality in children or on work done to perform compressions in general. We hypothesized that compression quality, work, and rescuer fatigue would differ in child versus adult manikin models. Methods: This was a prospective randomized crossover study of 45 inhospital rescuers performing 10 minutes of single-rescuer continuous compressions on each manikin. An accelerometer recorded compression qualitymeasures over 30-second epochs. Work and power were calculated from recorded force data. A modified visual analogue scale measured fatigue. Data were analyzed by using linear mixed-effects models and Cox regression analysis. Results: A total of 88 484 compression cycles were analyzed. Percent adequate CCs/epoch (rate ≥ 100/minute, depth ≥ 38 mm) fell over 10 minutes (child: from 85.1% to 24.6%, adult: from 86.3% to 35.3%; P = .15) and were <70% in both by 2 minutes. Peak work per compression cycle was 13.1 J in the child and 14.3 J in the adult (P = .06; difference, 1.2 J; 95% confidence interval, 20.05 to 2.5). Peak power output was 144.1 W in the child and 166.5 W in the adult (P < .001; difference, 22.4 W, 95% confidence interval, 9.8-35.0). Conclusions: CC quality deteriorates similarly in child and adult manikin models. Peak work per compression cycle is comparable in both. Peak power output is analogous to that generated during intense exercise such as running. CC providers should switch every 2 minutes as recommended by current guidelines. Copyright © 2013 by the American Academy of Pediatrics.


PubMed | University of Michigan, Center for Injury Research and Prevention and Children's Hospital of Philadelphia
Type: Journal Article | Journal: American journal of preventive medicine | Year: 2015

New Jersey (NJ) implemented the first Graduated Driver Licensing (GDL) decal provision in the U.S. in May 2010. An initial study reported a 1-year post-decal decrease in the crash rate among NJ intermediate drivers aged <21 years. Longer-term analysis is critical for policymakers in other states considering whether to implement a decal provision.To evaluate the longer-term (2-year) effect of NJs decal provision on overall and age-specific crash rates of young drivers with intermediate licenses.Monthly per-driver police-reported crash rates during January 2006-June 2012 were estimated. Specific crash types included injury, midnight-4:59am, single-vehicle, multiple-vehicle, and peer passenger crashes. Negative binomial modeling compared pre- versus post-decal crash rates, adjusting for age, gender, calendar month, gas price, and 21- to 24-year-old licensed driver crash rates; piecewise negative binomial regression models accounted for pre-decal crash trends among intermediate drivers. Analyses were conducted in 2013.The adjusted crash rate for intermediate drivers was 9.5% lower in the 2-year post-decal period than the 4-year pre-decal period (95% CI=0.88, 0.93). Crash rates decreased 1.8% per year before the provision and 7.9% per year in the post-decal period (p<0.001 for difference in slopes). For several crash types, effects appeared to be particularly strong for 18- and 19-year-olds. An estimated 3,197 intermediate drivers had crashes prevented.NJs decal provision was associated with a sustained decline in intermediate driver crashes. Future research should aim to better understand the causal mechanism by which NJs decal provision may have exerted an effect.

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