Children Aged 0-18years Research Articles

The effect of full blood count and cardiac biomarkers on prognosis in carbon monoxide poisoning in children.

In this study, cardiac biomarkers, blood parameters, electrocardiography (ECG), and echocardiography were investigated in children with carbon monoxide (CO) poisoning, and the diagnostic value of these parameters was investigated. The demographical, clinical, and laboratory data of children aged 0-18years who were admitted to the pediatric emergency department due to CO poisoning between January 2019 and January 2022 were retrospectively scanned from medical records. The patients were divided into two groups as troponin-I positive and troponin-I negative. There were 107 children aged 0-18years (average age, 10.46 ± 5.77years; 51% female) with CO poisoning. There were 13 patients with troponin-I positive myocardial injury. Troponin-I was positive in 3 patients whose carboxyhemoglobin (COHb) level was below 2% at the time of admission. In one patient, troponin-I, which was normal at admission, increased by the 24th hour of hospitalization. Hyperbaric oxygen therapy was given due to headache in one patient, although the COHb level of that patient was below 25%. An NT-proBNP level of ≥ 219.5ng/L predicted the development of troponin-I positivity with a sensitivity of 70% and a specificity of 86.7% (AUC, 0.967 (0.58-0.994); p = 0.017). White blood cell (WBC), neutrophil, neutrophil-to-lymphocyte ratio (NLR), immature granulocyte (IG), and IG% levels were found to be significantly higher in the troponin-positive patient group. DISCUSSIONAND CONCLUSION: NT-proBNP has been shown to be an early diagnostic marker for myocardial dysfunction. Additionally, when cardiac markers are not available, full blood parameters may assist clinicians for patient treatment and referral.

The yield of ophthalmoscopy as a screening tool for intracranial pathology in pediatric headache.

Headache is a common complaint in children who present at the pediatric emergency department (PED). Serious conditions such as intracranial tumors and idiopathic intracranial hypertension (IIH) should be rapidly ruled out. Ophthalmoscopy for the presence of papilledema has long been considered critical to the assessment of headaches in children; however, the yield of this procedure is poorly validated. This retrospective study implemented a computerized search of the medical records of a single tertiary center to identify all children aged 2-18years who presented at the PED complaining of headache between 2007 and 2017. The clinical, demographic, radiographic, and laboratory data were analyzed. Of the 948 children aged 2-18years who presented at the PED complaining of headache, 536 had an ophthalmoscopy examination carried out by an ophthalmologist. Forty-one had papilledema, of whom 7 had an intracranial tumor, 15 had IIH, and 9 had optic nerve head drusen. Of the 495 children without papilledema, 3 had intracranial tumor, and 11 had IIH. The sensitivity and specificity of papilledema for the diagnosis of intracranial tumor were 70% and 93.5%, respectively, with an NPV and PPV of 99.4% and 17.1%, respectively. The sensitivity and specificity of papilledema for the diagnosis of intracranial pathology in general were 61.1% and 96.2%, respectively, with an NPV and PPV of 97.2% and 53.7%, respectively. Conclusion: Assessment by ophthalmoscopy for papilledema in children presenting to the PED with headache had high sensitivity and high specificity, thus reinforcing the importance of ophthalmoscopy as a screening tool in these children. What is Known: •Headache is a common complaint in children. Serious intracranial pathologies need to be rapidly excluded. • Ophthalmoscopy for the presence of papilledema is commonly used as a screening tool for intracranial pathology, but this procedure is poorly validated. What is New: •Ophthalmoscopy for the assessment of papilledema in children who present with headache to the pediatric emergency department is shown to exhibit sensitivity and specificity for the diagnosis of intracranial pathology.

Risk factors for habitual snoring among children aged 2-14years in Chengdu, Sichuan.

Habitual snoring (HS) is a prominent symptom of sleep-disordered breathing; thus, it isalso important to consider the associated, multidimensional risk factors for HS in children. This study was aimed to identify risk factors for HS in children. A cross-sectional survey was performed in Chengdu. Children aged 2-14years from four districts were randomly chosen to participate. Questionnaires were voluntarily completed by the children's guardians. The survey included 926 boys and 622 girls, who were an average of 6.4 ± 3.0years old. The sample included 463 habitual snorers (30.4%), 683 occasional snorers (44.8%), and 402 nonsnorers (26.4%). HS was found in 51.8% of children under 7years old and 26.6% of children aged 7years old or older. The prevalence of pregnancy complications was significantly lower in mothers who bore children with HS (p = .006). Among the HS group, 86.6% had an immediate family member who snores. Breastfeeding duration among the HS group was significantly less than among the occasional snoring and nonsnoring groups. History of symptoms of allergic rhinitis, rhinosinusitis, tonsillitis, and pneumonia/bronchitis in the past 6months was associated with HS. Likewise, maternal smoking during pregnancy, maternal exposure to secondhand smoke during pregnancy, and child exposure to secondhand smoke were also associated with HS. The prevalence of HS was higher in children under 7years old. Having a mother with more education, a family history of snoring, a shorter period of breastfeeding, upper respiratory tract inflammation, and passive smoking are important risk factors for HS. Pregnancy complications may be associated with lower prevalence of snoring in childhood.

Risk factors for falls among children aged 0–18 years: a systematic review

Accidental falls are the most common cause of injury in children. These falls not only result in pain and injury to children but also can pose a significant financial burden to their families and society. The aim of this study is to identify risk factors for falls in children. We conducted a systematic review of the literature describing falls in children aged 0-18years. Studies of falls from a height of 1m or more were excluded from the analysis. We analyzed the included studies to identify risk factors for falls. A total of 1496 articles were initially retrieved, leading to an included set of nine articles, which were published from 1995 to 2021. Risk factors related to fall injury in children aged 0-18years included age, sex, extroversion, rural areas, history of falls, family factors, caregiver factors, medication use, intravenous therapy, tests requiring movement, disease factors and long hospital stay. We identified 12 risk factors affecting falls in children, including individual characteristics and family and social factors.

Ethnicity, gender and seasonal variations all play a role in vitamin D deficiency.

(1) To explore the adherence of recommendations of vitamin D supplementation to children aged 0-4years. (2) To compare serum levels of vitamin D in children and adolescents aged 0-17years originating from different parts of the world. (3) To compare levels between boys and girls and (4) To determine seasonal variation. A review of vitamin D levels in children with parents from different parts of the world was conducted. 2502 children aged 0-17years were included between 22January 2004 and 17May 2021. Fifty-nine of 363 children aged 0-4years received the recommended vitamin D supplementation. Children from all parts of the world had lower levels of serum 25(OH)D than Swedish children. Girls from the Indian subcontinent, Middle East and Africa had the lowest levels of s-25(OH)D. Seasonal variation with higher levels during the summer was seen in children from Sweden, the rest of Europe, Russia and Latin America. Overall prevalence of vitamin D deficiency (≤25nmol/L) was 928/2198 (42%) in children not receiving supplementation. Seven children had clinical rickets. Adherence of giving children aged 0-4years the recommended vitamin D supplementation was very low. Vitamin D deficiency is common in immigrant children of all ages in Sweden.

Differential gene expression in nasal airway epithelium from overweight or obese youth with asthma.

The mechanisms underlying the known link between overweight/obesity and childhood asthma are unclear. We aimed to identify differentially expressed genes and pathways associated with obesity-related asthma through a transcriptomic analysis of nasal airway epithelium. We compared the whole transcriptome in nasal airway epithelium of youth with overweight or obesity and asthma with that of youth of normal weight and asthma, using RNA sequencing data from a cohort of 235 Puerto Ricans aged 9-20years (EVA-PR) and an independent cohort of 66 children aged 6-16years in Pittsburgh (VDKA). Differential expression analysis adjusting for age, sex, sequencing plate number, and sample sorting protocol, and the first five principal components were performed independently in each cohort. Results from the two cohorts were combined in a transcriptome-wide meta-analysis. Gene enrichment and network analyses were performed on top genes. In the meta-analysis, 29genes were associated with obesity-related asthma at an FDR-adjusted p<.05, including pro-inflammatory genes known to be differentially expressed in adipose tissue of obese subjects (e.g., CXCL11, CXCL10, and CXCL9) and several novel genes. Functional enrichment analyses showed that pathways for interferon signaling, and innate and adaptive immune responses were down-regulated in overweight/obese youth with asthma, while pathways related to ciliary structure or function were up-regulated. Upstream regulatory analysis predicted significant inhibition of the IRF7 pathway. Network analyses identified "hub" genes like GBP5 and SOCS1. Our transcriptome-wide analysis of nasal airway epithelium identified biologically plausible genes and pathways for obesity-related asthma in youth.

Mortality During Readmission Among Children in United States Children's Hospitals

To identify demographic, clinical, and hospital factors associated with mortality on readmission within 180days following an inpatient hospitalization. We conducted a retrospective cohort study including 33 US children's hospitals in the Pediatric Health Information System from January 2010 to June 2020. Our primary outcome was death during readmission within 180days of an index hospitalization among children aged 0-18years. Illness severity during the index hospitalization was defined according to the All Patient-Refined Diagnosis-Related Group-categorized illness severity (ie, minor, moderate, or major/extreme). We performed multivariable logistic regression analysis to identify factors during the index hospitalization associated with mortality during readmission. Among 2 677 111 children discharged, 337 385 (12.6%) were readmitted within 180days of the index hospitalization and 2913 (0.8%) died during readmission. More than one-quarter (26.2%) of deaths among children who were readmitted and died occurred within 10days after discharge from the index hospitalization. Factors independently associated with mortality during readmission included multiple complex chronic conditions, index admissions lasting >7days, moderate or severe/extreme illness during the index hospitalization, and public insurance. Children whose race was reported as Black had greater odds of mortality during readmission compared with children of other races. Among hospitalized children, several demographic and clinical factors present during index hospitalizations were associated with mortality during readmission. Greater odds of mortality during readmission among children whose race was reported as Black likely reflects disparities in social determinants of health and clinical care. Interventions to reduce mortality during readmission may target high-risk populations in the period immediately following discharge.

Relationship Between Food Insecurity and Neighborhood Child Opportunity Index

To evaluate the association between the Child Opportunity Index (COI) and food insecurity. This was a secondary analysis of a comprehensive screening instrument for social determinants of health and behavioral health risks. It was administered in 2 urban pediatric emergency departments to adolescents aged 13-21years and caregivers of children aged 0-17years. Food insecurity was assessed using the 2-item Hunger Vital Sign. Residential addresses were geocoded and linked with COI data. Bivariable and multivariable logistic regression models were developed to measure the relationship between COI and food insecurity. Of the 954 participants (384 adolescents, 570 caregivers) who underwent screening, 15.7% identified food insecurity (14.3% of adolescent and 16.7% of caregiver participants). The majority of participants were non-Hispanic Black (overall, 62.3%; food secure, 60.9%; food insecure, 72.0%), were publicly insured (overall, 56.6%; food secure, 53.1%; food insecure, 73.3%), and lived in neighborhoods of low/very low opportunity (overall, 76.9%; food secure, 74.7%; food insecure, 88.3%). In adjusted analyses, participants living in neighborhoods of low/very low child opportunity had 3-fold greater odds of being food insecure compared with children living in neighborhoods of high child opportunity (aOR, 3.0; 95% CI, 1.4-6.3). We demonstrate that food insecurity is associated with lower neighborhood opportunity. Our results could inform future screening initiatives and support the development of novel, place-based interventions to tackle the complex issue of food insecurity.

Thunderclap Headache in Children and Adolescents.

This work aimed to review the epidemiology, clinical criteria, and primary and secondary diagnoses of pediatric thunderclap headache and to compare to adult thunderclap headache. Thunderclap headache among children aged 6-18years are rare; this headache presented in 0.08% of the patients admitted to a pediatric emergency department in a tertiary pediatric center. In that recent single-center study, thunderclap was a headache of grade 10 on the pain scale and conferred a benign course. Contrary to adults, in children, most thunderclap headaches are due to either a primary thunderclap headache or another type of primary headache. A number of case reports have attributed pediatric thunderclap to reversible vasoconstriction syndrome and bleeding due to intracranial aneurysm. However, 3-year data from a pediatric emergency department of one center did not find these reasons to be causes of secondary thunderclap headache. This may be due to the rarity of these diagnoses in children compared to adults. Four of the 19 patients with thunderclap headache reported in that single study had secondary thunderclap; the causes were infection in three and malignant hypertension in one. All the patients had a benign course. Although urgent imaging and lumbar puncture are required in the workup of pediatric thunderclap, severe causes are very rare. More research is needed to investigate pediatric thunderclap headache.

Optical coherence tomography angiography in healthy children: normative data and age-related changes in microvascular structure of the optic disk and macula.

To determine normative data and reference ranges according to age groups by measuring the foveal avascular zone (FAZ), superficial capillary plexus vascular density (SCP-VD), deep capillary plexus vascular density (DVP-VD), radial peripapillary capillary plexus vessel density (RPC-VD), and peripapillary retinal nerve fiber layer (ppRNFL) in healthy children and to determine the age and sex-related changes of these values. This prospective study included data from 370 eyes of 370 healthy children (202 girls, 168 boys) aged 7-18years. Participants were divided into four groups according to their age. Optical coherence tomography angiography (OCTA) measurements were taken using AngioVue (Avanti; Optivue). No statistically significant difference was observed in terms of FAZ, SCP-VD, DCP-VD, RPC-VD, and ppRNFL thickness values according to the age groups (except the RPC-VD superior) (p > 0.05 for all). VDs in all deep parafoveal regions in groups 1 and 2 were higher in girls. While FAZ values were higher in girls in all age groups (statistically significant in groups 1, 3, and 4), ad SPD and DPD values were higher in boys in all age groups (statistically significant in group 1 and 2 for SPD, and group 1 and 3 for DPD). We report normal reference ranges for macula and disk vessel density and ppRNFL parameters in healthy children aged 7-18years using OCTA. These normative values could be useful in diagnosing retina and optic disk disease early in childhood.

US Postarrival Evaluation of Immigrant and Refugee Children with Latent Tuberculosis Infection Diagnosed Overseas, 2007-2019

To assess outcomes from the US postarrival evaluation of newly arrived immigrant and refugee children aged 2-14years who were diagnosed with latent tuberculosis infection (LTBI) during a required overseas medical examination. We compared overseas and US interferon-γ release assay (IGRA)/tuberculin skin test (TST) results and LTBI diagnosis; assessed postarrival LTBI treatment initiation and completion; and evaluated the impact of switching from TST to IGRA to detect Mycobacterium tuberculosis infection overseas. In total, 73 014 children were diagnosed with LTBI overseas and arrived in the US during 2007-2019. In the US, 45 939 (62.9%) completed, and 1985 (2.7%) initiated but did not complete a postarrival evaluation. Among these 47 924 children, 30 360 (63.4%) were retested for M tuberculosis infection. For 17 996 children with a positive overseas TST, 73.8% were negative when retested by IGRA. For 1051 children with a positive overseas IGRA, 58.0% were negative when retested by IGRA. Overall, among children who completed a postarrival evaluation, 18 544 (40.4%) were evaluated as having no evidence of TB infection, and 25 919 (56.4%) had their overseas LTBI diagnosis confirmed. Among the latter, 17 229 (66.5%) initiated and 9185 (35.4%) completed LTBI treatment. Requiring IGRA testing overseas could more effectively identify children who will benefit from LTBI treatment. However, IGRA reversions may occur, highlighting the need for individualized assessment for risk of infection, progression, and poor outcome when making diagnostic and treatment decisions. Strategies are needed to increase the proportions receiving a postarrival evaluation and completing LTBI treatment.

Electrodermal Activity Moderates Sleep-Behavior Associations in Children with Autism Spectrum Disorder.

Relative to children without autism spectrum disorder (ASD), children with ASD experience elevated sleep problems that can contribute to behavioral comorbidities. This study explored the interaction between psychophysiology and sleep to determine which children with ASD may be at risk for, or resilient to, effects of poor sleep on daytime behavior. Participants included 48 children (aged 6-10years) with ASD. Measures of sympathetic nervous system activity (electrodermal activity; EDA) were collected during a baseline and in response to a laboratory challenge task. Parents reported on their children's sleep problems and behavioral functioning, including broad externalizing symptoms and situational noncompliance, using standardized questionnaires and a clinical interview. EDA moderated the significant positive associations between sleep problems and both behavioral outcomes. The link between sleep problems and broad externalizing symptoms and situational noncompliance was positive and significant in the context of lower baseline EDA and nonsignificant in the context of higher baseline EDA. Sleep problems also interacted with EDA reactivity in predicting situational noncompliance, but not broad externalizing symptoms. Findings highlight the complex interplay among sleep, daytime behavior, and psychophysiology in children with ASD. Results are interpreted in the context of differential susceptibility and dual-risk frameworks. This study underscores the importance of high-quality sleep for children with ASD, especially those with the biological sensitivity or vulnerability factors (i.e., EDA) identified in this study. Clinical implications are discussed, and directions for future research are provided.

Opioids Safety in Pediatric Procedural Sedation with Ketamine

To evaluate the effects of pre- and intraprocedural opioids on adverse events in children undergoing procedural sedation with ketamine in the emergency department (ED). We conducted a retrospective cohort study of all children aged 0-18years who underwent procedural sedation with intravenous ketamine alone, or in combination with an opioid, at a tertiary-care pediatric ED between June 1, 2018, and August 31, 2020. We explored predictors of serious adverse events (SAEs), desaturation or respiratory intervention, and vomiting. Of 1164 included children (694 male, 59.6%; median age 5.0years [IQR 2.0-8.0]), 80 (6.8%) vomited, 63 (5.4%) had a desaturation or required respiratory interventions, and 6 (0.5%) had SAEs. Pre- and intraprocedural opioids were not independent predictors of sedation-related adverse events. A concurrent respiratory illness (aOR 3.73; 95% CI 1.31-10.60, P=.01), dental procedure (aOR 3.05; 95% CI 1.25-7.21, P=.01), and a greater total ketamine dose (aOR 1.75; 95% CI 1.21-2.54, P=.003) were independent predictors of desaturation or respiratory interventions. A greater total ketamine dose (aOR 1.86; 95% CI 1.16-2.98, P=.01) and older age (aOR 1.15; 95% CI 1.07-1.24, P<.001), were independent predictors of vomiting. Pre- and intraprocedural opioids do not increase the likelihood of sedation-related adverse events. SAEs are rare during pediatric procedural sedation with ketamine in the ED.

Assessment of biomarkers in pediatric atopic dermatitis by tape strips and skin biopsies.

The cytokine profile of atopic dermatitis (AD) depends on age, ethnicity, and disease severity. This study examined biomarkers in children with AD collected by tape strips and skin biopsies, and examined whether the levels differed with filaggrin genotype, disease severity, and food allergy. Twenty-five children aged 2-14years with AD were clinically examined. Skin biopsies were collected from lesional skin and tape strips were collected from lesional and non-lesional skin. We analyzed natural moisturizing factor (NMF) and 17 immune markers represented by mRNA levels in skin biopsies and protein levels in tape strips. Common filaggrin gene mutations were examined in all children. The cytokine profile in lesional skin was dominated by a T helper (Th) 2 response in skin biopsies, and by a general increase in innate inflammation markers (interleukin (IL)-1α, IL-1β, IL-8, IL-18) along with TARC and CTACK in tape strips. The levels of TARC, CTACK, IL-8, IL-18showed significant correlation with AD severity in both lesional and non-lesional tape stripped skin, while no significant correlations were observed in skin biopsy data. In tape strips from lesional and non-lesional skin, the levels of NMF and selected cytokines differed significantly between children with and without FLG mutations and food allergy. Sampling of the stratum corneum with non-invasive tape strips can be used to identify biomarkers that are associated with disease severity, food allergy and FLG mutations. Skin biopsies showed robust Th2signature but was inferior for association analysis regarding severity.

Changes of cancer diagnosis disclosure to children in Japan in the last 20 years.

The practice of cancer diagnosis disclosure to children has been changed with the times. The regulations of clinical trials in the 2000s might change the practice in Japan. However, the perspective of this topic among children and adults has not been investigated in detail. We studied changes in the practice of information sharing with children with cancer at pediatric cancer centers and the perspective of cancer diagnosis disclosure to children among school children, their parents and pediatric oncologists in the last 20years by comparing the results of questionnaire surveys conducted in 1998, 2008 and 2018. This study revealed that the performing rate has increased with the times, but the institutions actively performing for children aged 7-9years were 36.4% even in the 2018 survey. More than 70% of children wished diagnosis disclosure if they suffer from cancer in the series of surveys, while the ratio of parents who tell cancer diagnosis to their children hovered at 34.5 to 53.7% (p < 0.001 in all surveys). The ratio of pediatric oncologists having the policy to perform diagnosis disclosure proactively increased from 9.3 to 60.0%, while that of parents having the same policy stayed at 5.3% even in 2018. The performing rate of information sharing with children with cancer was significantly changed in the last 20years. The opinion gaps were observed between parents and children and between parents and pediatric oncologists.

Blood and Stool Arsenic Levels Are Decisive for Diagnosing Children's Functional Gastrointestinal Disease (FGD).

Pediatric gastroenteritis is a potentially fatal disease that accounts for 10% of childhood deaths. The main risk is environmental factors and nutrition. Arsenic (As) is commonly found in the earth's crust. As is an essential element that can form many organic compounds. In children, it causes diarrhea, gums, tongue lesions, diabetes, conjunctivitis, ocular opacity, and impaired immune response. It also causes low growth, mental retardation, and neurological problems. It is also known as the cause of many cancers that originate at an early age. Regionally, there is an iron and steel industry for almost a century. According to the Rome IV criteria, the blood and stools of 50 children aged 6-18years, male and female, living in our province with functional gastrointestinal disease (FGD), were screened for As, and compared with the Healthy group (control) of 30 children. The results were evaluated with the Mann-Whitney Rank Sum Test. When blood and stool As values in males were compared with control samples, a high level of significance (p = 0.001) was found between both blood and stool As values in sick males and the control group (p < 0.005). In females, blood and stool As median values were also highly significant when compared with the control group (p = 0.001). According to these data, when the sick children (children with male and female gender) are compared with the healthy ones, the difference is highly significant (p < 0.005). High blood As levels in children indicate environmental pollution. It can be said that blood As levels are high as a result of food, water, and inhaler exposure. The presence of a high level of significant difference in stool means that the amount of As is high in the foods consumed daily. High levels of As are in blood and stools; It was evaluated that FGD could be the cause of nausea, diarrhea, vomiting, and colic. The increase in blood and stool As values due to environmental pollution is an important reason for FGD. For diseases of uncertain cause (such as FGD) resulting from chronic As exposure, blood and especially stool As values are more significant than urinary As levels. In conclusion, As a diagnostic criterion, it was concluded that blood and stool As values are an important marker in children with functional abdominal pain with other metals.

Cyclosporine A C1.5 monitoring reflects the area under the curve in children with nephrotic syndrome: a single-center experience.

The currently used single-monitoring method for drug-blood-level evaluation in cyclosporine A (CsA) treatment for nephrotic syndrome (NS) was established through hourly measurements based on adult organ transplantation. However, the pharmacokinetics may differ due to different concomitant medications, age, and conditions. This study was conducted to determine the measurement timing that best reflects the CsA area under the curve (AUC) in pediatric NS. This retrospective study included children aged 2-14years who were started on CsA treatment for idiopathic NS during 2013-2020. AUC0-4 was calculated from 7 points, before and 0.5, 1, 1.5, 2, 3, and 4h after administration. Mean values at each timing were compared with age-dependent different drug forms. Correlation between AUC0-4 and measurement timing was analyzed. There were 13 patients (11 boys) whose median age during testing was 7.3years, and the total number of measurements was 94. The highest timing of CsA concentrations was found in C1 59.6%. The content liquid used at younger ages had a faster absorption time to peak value and lower blood concentration than those of capsules. Among the significant correlations observed, AUC0-4 and C1.5 showed the strongest significant correlation coefficient (r = 0.93, P < 0.001). In pediatric NS, CsA metabolism may be faster than that in previous organ transplantation. Compared with C2, C1.5 monitoring may result in better disease control as it can best reflect the AUC0-4 and peak values associated with side effects, which are indicators of therapeutic efficacy.

Changes in pediatric major trauma epidemiology, injury patterns, and outcome during COVID-19-associated lockdown.

The COVID-19 pandemic and its associated preventive measures such as national and regional lockdowns have dramatically changed the epidemiology of pediatric admissions to the emergency department. Nevertheless, there are scant data on the epidemiology and injury patterns of major pediatric trauma injuries during these lockdown periods. A single-center retrospective study of data obtained from a tertiary level 1 trauma hospital trauma registry. The data included demographics, injury mechanisms, injury severity and type, treatment, and resource utilization in children aged 0-18years who required trauma team activation upon arrival. The analysis compares the data from the 5-week lockdown period from March to May 2020 in Jerusalem, Israel, to its parallel periods in 2018-2019. A total of 187 trauma visits that required trauma team activation (TTA) were analyzed: 48 visits during the lockdown period vs. 139 in 2018-2019, corresponding to a 40% drop in TTA. There was a significant decrease of 34% in MVA-related injuries (p = 0.0001) but a significant increase of 14% in burns (p = 0.01) and a 16% increase in bicycle-related injuries (p = 0.001). No changes in ISS, injury patterns, admission rate, PICU utilization, or need for interventions were observed. There was a significant decrease in the number of overall pediatric trauma visits during the 2020 lockdown, mainly in MVA-associated trauma, but an increase in burns and bicycle injuries. These findings can thus inform policy makers as to the need to formulate prevention awareness programs alerting the public to indoor hazards and the dangers of activities outside the home. Furthermore, it can inform hospital policy decision-making in future lockdowns. The fact that PICU admissions and the need for operating rooms stayed unchanged suggests that it is vital to maintain trauma team capabilities even during lockdowns.

Association of Race/Ethnicity and Social Determinants with Rehospitalization for Mental Health Conditions at Acute Care Children's Hospitals

To evaluate associations of race/ethnicity and social determinants with 90-day rehospitalization for mental health conditions to acute care nonpsychiatric children's hospitals. We conducted a retrospective cohort analysis of mental health hospitalizations for children aged 5-18years from 2016 to 2018 at 32 freestanding US children's hospitals using the Children's Hospital Association's Pediatric Health Information System database to assess the association of race/ethnicity and social determinants (insurance payer, neighborhood median household income, and rurality of patient home location) with 90-day rehospitalization. Risk factors for rehospitalization were modeled using mixed-effects multivariable logistic regression. Among 23 556 index hospitalizations, there were 1382 mental health rehospitalizations (5.9%) within 90days. Non-Hispanic Black children were 26% more likely to be rehospitalized than non-Hispanic White children (aOR 1.26, 95% CI 1.08-1.48). Those with government insurance were 18% more likely to be rehospitalized than those with private insurance (aOR 1.18, 95% CI 1.04-1.34). In contrast, those living in a suburban location were 22% less likely to be rehospitalized than those living in an urban location (suburban: aOR 0.78, 95% CI 0.63-0.97). Non-Hispanic Black children and those with public insurance were at greatest risk for 90-day rehospitalization, and risk was lower in those residing in suburban locations. Future work should focus on upstream interventions that will best attenuate social disparities to promote equity in pediatric mental healthcare.

Linguistic and content validity of the Swedish version of the PedsQL™ gastrointestinal symptoms scales and symptoms module for paediatric patients.

To describe the process of linguistic and content validity of the Swedish version of the PedsQL™ Gastrointestinal Symptoms Scales and Symptoms Module, measuring health-related quality of life (HRQOL) in children with gastrointestinal (GI) disorders. The establishment of linguistic and content validity was carried out in compliance with international standards on patient-reported outcome measurements. The process included forward translation, expert review and reconciliation, backward translation, backward translation review and interviews with 15 children aged 5-18years with GI tract symptoms and 20 parents of children with GI tract symptoms aged 2-18years. The Swedish version of the PedsQL™ Gastrointestinal Symptoms Scales and Symptoms Module (child report 5-18years, parent report for children 2-18years) was achieved without major difficulties. Eight issues needed discussion after forward translation, and there was one change after backward translation and three revisions following patient and parent testing. A conceptually equivalent Swedish language version of PedsQL™ Gastrointestinal Symptoms Scale and Symptoms Module for children aged 2-18years old was developed. This enables improved HRQOL evaluations in children with GI disorders in Sweden. Future research using a larger sample is recommended to evaluate validity and reliability of the Swedish language version of the module.