Children's Hospital Of Eastern Ontario Research Articles

An Umbrella as a Potential Foreign Body in the Oral Cavity of the Pediatric Population: Report of Two Cases

Foreign bodies in the oropharynx of the pediatric population are a well-known subject within the medical field. This report deals with two cases of a very unusual foreign body: an umbrella. Case 1 A 5-year-old boy was brought to the emergency room at the Children's Hospital of Eastern Ontario (CHEO) with the handle of an umbrella protruding through his mouth. The child had fallen face first on the handle while at school. On physical examination, the child was quiet and calm. His vital signs were all stable with oxygen saturation 100% on room air. The umbrella was protruding through his mouth., with minimal bleeding around its handle (Figure 1). Plain film radiography was not helpful because the intraoral part was radiolucent. The patient was rushed to the operating room. Under intravenous sedation, the umbrella was manipulated out of the child's mouth, and then he was endotracheally intubated. A thorough examination under anesthesia and exploration of the oropharynx revealed a 4 cm laceration in the right floor of the mouth, sparing the submandibular duct. There were no other observed injuries. The laceration was repaired primarily. The patient was discharged home on the same day once oral intake was established and covered with oral antibiotics. No long-term sequelae resulted.

A 4-year review of severe pediatric trauma in eastern Ontario: a descriptive analysis.

The objective of this study was to describe a population of children admitted to a tertiary care pediatric hospital with severe trauma to identify key areas for injury prevention research, and programming. Retrospective chart review conducted on all children 0-17 years admitted to the Children's Hospital of Eastern Ontario (CHEO) between April 1, 1996, and March 31, 2000, following acute trauma. Each record was reviewed and assigned an ISS using the AIS 1990 revision. All cases with an ISS > 11 were included in the study. There were 2610 trauma cases admitted to CHEO over the study period. Of these, 237 (9.1%) had severe trauma (ISS > 11). Sixty-two percent were male. Twenty-nine percent were between the ages of 10 and 14 years, 27% between 5 and 9 years, 16% between 15 and 17 years, 15% between 1 and 4 years, and 13% less than 1 year old. The most common mechanisms of injury were due to motor vehicle traffic (39%), falls (24%), child abuse (8%), and sports (5%). Of those resulting from motor vehicle traffic, 53 (57%) were occupants, 22 (24%) were pedestrians, and 18 (19%) were cyclists. When combining traffic and nontraffic mechanisms, 26 (11% of all severe trauma cases) occurred as a result of cycling incidents. The most severe injury in 65% of patients was to the head and neck body region. Research efforts and activities to prevent severe pediatric trauma in our region should focus on road safety, protection from head injuries, avoidance of falls, and prevention of child abuse.

Know before you mow: A review of lawn mower injuries in children, 1990-1998

Purpose: The authors evaluated lawn mower injuries in Canadian children from 1990 through 1998. Data regarding age of the patient, location, and severity of injuries were tabulated. Methods: Data were collected through the CHIRPP questionnaire (Canadian Hospitals Injury Reporting & Prevention Program). Initially, a regional study examined data in the pediatric population presenting to Children's Hospital of Eastern Ontario (CHEO), Hôspital Ste-Justine (HSJ), and Montreal Children's Hospital (MCH) emergency departments. This was followed by review of all lawn mower injuries reported in Canada (including all ages) that presented to the 16 emergency departments (ER) where CHIRPP is administered. Results: Ninety cases were reported between 1990 and 1998 (MCH) and 1991 through 1997 (HSJ and CHEO). A bimodal age distribution was noted with 36% (29 of 81) younger than 4 years, and 37% (30 of 81) 10 to 14 years of age. Ninety-three percent of all injuries involved children 14 or under. Lacerations were the most common type of injury comprising 29 (32%) followed closely by amputations, 26 (29%); burns and fractures were the other main subtypes comprising 16 (18%) and 12 (13%), respectively. Eighty-seven percent of all injuries involved distal upper or lower extremity. Forty-two percent (34 of 81) required hospitalization; another 37% (30 of 81) were classified as major injuries treated in emergency and followed up. In the national data set, 354 patients with 427 injuries presented between 1990 and 1995. Sixty percent or 214 of 354 were 19 years of age or younger; furthermore, 51% or 182 of 354 were younger than 15 years. Lacerations and amputations were the most common injuries comprising 50% and 12% respectively. Lower extremity injuries were the most numerous at 184 of 427 (43%). A total of 159 of 354 (45%) were treated in ER and required hospital follow-up, a further 70 (20%) required hospital admission. No fatalities were reported. Conclusions: Recommendations for a proposed prevention campaign include the following: (1) children younger than 15 years should not operate lawn mowers, (2) children younger than 15 years should not be in the yard when lawn is being mowed, (3) no passengers should be carried on the ride-on style mowers, (4) wearing hard closed-toe shoes should be mandatory. J Pediatr Surg 35:665-668. Copyright © 2000 by W.B. Saunders Company.

An Analysis of an Air-Ambulance Program for Children

Air-ambulance services are extremely expensive to operate and maintain. The value of their existence has been questioned in this era of rationalization and downsizing. We examined the cost, safety, flight crew composition, types of trauma, and effectiveness of our air-ambulance program at the Children's Hospital of Eastern Ontario (CHEO) over a 3-year period, 1994-1997. During this time, 392 children were aeroevacuated to CHEO, 113 surgical (29%), 136 medical (35%), and 143 neonates (36%). Of the surgical cases, 43% were transferred for orthopaedic trauma, the commonest being fractured femur, 23% for general surgical cases, most common being thoracoabdominal trauma, and 22% for neurosurgical reasons, most commonly basilar skull fractures. The average response time (time from which the call was received to the time when the helicopter reached the patient site) for all of the cases was 46 min. The average travel time (time from departure of patient site to arrival at CHEO) for these same cases was 25.59 min. The air-ambulance program for children in the Ottawa-Carleton Eastern Ontario areas, was found to be safe, effective, and allowed earlier specialized medical care to be provided.

An Analysis of an Air-Ambulance Program for Children

Air-ambulance services are extremely expensive to operate and maintain. The value of their existence has been questioned in this era of rationalization and downsizing. We examined the cost, safety, flight crew composition, types of trauma, and effectiveness of our air-ambulance program at the Children's Hospital of Eastern Ontario (CHEO) over a 3-year period, 1994-1997. During this time, 392 children were aeroevacuated to CHEO, 113 surgical (29%), 136 medical (35%), and 143 neonates (36%). Of the surgical cases, 43% were transferred for orthopaedic trauma, the commonest being fractured femur, 23% for general surgical cases, most common being thoracoabdominal trauma, and 22% for neurosurgical reasons, most commonly basilar skull fractures. The average response time (time from which the call was received to the time when the helicopter reached the patient site) for all of the cases was 46 min. The average travel time (time from departure of patient site to arrival at CHEO) for these same cases was 25.59 min. The air-ambulance program for children in the Ottawa-Carleton Eastern Ontario areas, was found to be safe, effective, and allowed earlier specialized medical care to be provided.