This retrospective study examined the accuracy of the International Classification of Diseases, Clinical Modification (ICD-10-CM) coding for physical child abuse among patients less than 18 years of age who were evaluated due to concern for physical abuse by a multidisciplinary child protection team (MCPT) during 2016–2017 (N=312) in a paediatric level I trauma centre. Sensitivity, specificity, predictive values and diagnostic OR for ICD-10-CM coding were calculated and stratified by admission status, using as a reference standard the abuse determination of the MCPT recorded in a hospital registry. Among inpatients, child physical abuse coding sensitivity was 55.6% (95% CI 41.4% to 69.1%) and specificity was 78.6% (95% CI 59.0% to 91.7%), with diagnostic OR of 4.58 (95% CI 1.64 to 12.70). Among outpatients, sensitivity was 22.2% (95% CI 15.5% to 30.2%) and specificity was 86.3% (95% CI 77.7% to 92.5%), with diagnostic OR of 1.80 (95% CI 0.89 to 3.64). Use of ICD-10-CM coded data sets alone for surveillance may significantly underestimate the occurrence of physical child abuse.

Background: Multiple descriptive studies have been published on refracture patterns, particularly for forearm fractures. However, few large cohorts have been analyzed quantitatively including the odds of refracture, and with a comprehensive assessment of the possible predictive factors associated with refracture. This study aimed to assess the frequency and timing of upper extremity refracture in a large pediatric orthopaedics practice, and to evaluate the strength of association of various patient-level and fracture-related factors with refracture. Methods: Medical records were reviewed retrospectively for patients 1 to 18 years of age with at least 1 upper extremity fracture (ICD-9 codes 810 to 819) between June 1, 2010 and May 31, 2011. Characteristics of patients and fractures were assessed for the association with refracture using bivariate analysis and multivariable logistic regression. Results: Among 2793 patients with a total of 2902 upper extremity fractures, 2% were treated for refracture within 2 years, at a median of 6 months (188 d) after the initial injury. Midshaft location, and characterization of the fracture as angulated or buckle, were associated with being more likely to refracture. Eighty percent of refractures were the result of a fall, with almost 25% involving a high-energy mechanism and about 15% from monkey bars or other playground equipment. The adjusted odds of refracture were 4 times higher if noncompliance with treatment recommendations was documented, when controlling for insurance type and number of days before orthopaedic evaluation. Forearm fractures were almost 4 times more likely to refracture compared with other bones, controlling for midshaft location, days immobilized, and buckle or torus characterization of the fracture. Conclusions: Our practice saw a refracture occurrence in 2% of patients, with median time to refracture of ~6 months. The factors most strongly associated with refracture were midshaft fracture location, forearm fracture as opposed to clavicle or humerus, and noncompliance as defined in the study. Falls and high energy activities, such as use of wheeled devices, skis, or trampolines, were important mechanisms of refracture.Level of Evidence: This study is a Level II prognostic study. It is a retrospective study that evaluates the effect of patient and fracture characteristics on the outcome of upper extremity refracture.

In October 2014, a health-care worker who had been part of the treatment team for the first laboratory-confirmed case of Ebola virus disease imported to the United States developed symptoms of Ebola virus disease. A presumptive positive reverse transcription PCR assay result for Ebola virus RNA in a blood sample from the worker was confirmed by the CDC, making this the first documented occurrence of domestic transmission of Ebola virus in the United States. The Texas Department of State Health Services commissioner issued a control order requiring disinfection and decontamination of the health-care worker's residence. This process was delayed until the patient's pet dog (which, having been exposed to a human with Ebola virus disease, potentially posed a public health risk) was removed from the residence. This report describes the movement, quarantine, care, testing, and release of the pet dog, highlighting the interdisciplinary, one-health approach and extensive collaboration and communication across local, county, state, and federal agencies involved in the response.

Surgical correction of postaxial polydactyly type B has several potential advantages over the traditional approach of suture ligation. Benefits include achieving more cosmetic results, reduced risk of neuroma or bothersome scar, and decreased likelihood of needing a second procedure. Previous reports with small numbers of patients have described surgical polydactyly excision using local anesthesia only, either in the operating room or office setting. We now routinely perform these removals in the office using local anesthesia combined with a fast, feed and wrap (FFW) technique to improve the comfort of the patient and parents. Details and photos of this technique are provided, and we encourage those who still perform routine suture ligation to consider this method as a simple and effective alternative.