Common Pediatric Emergency Research Articles

THE IMPACT OF PAEDIATRIC EMERGENCY MANAGEMENT SKILLS ON PATIENT OUTCOMES IN ZARIA

Paediatric emergencies represent a critical challenge in Nigeria, where approximately 2,300 children under the age of five die daily, predominantly from preventable and treatable conditions such as pneumonia, malaria, and diarrheal diseases. Mortality rates are disproportionately higher in rural areas, where primary health care (PHC) centers often serve as the only point of access to medical services. The effectiveness of these centers is largely dependent on the emergency management skills of their healthcare workers. Despite their importance, there has been limited research on how the skills of PHC workers in managing paediatric emergencies impact patient outcomes. This study aimed to assess the proficiency of healthcare workers in primary healthcare centers in Zaria in managing common paediatric emergencies. A cross-sectional descriptive study was conducted among 139 health workers selected through a multi-stage sampling technique in Sabon Gari and Zaria Local Government Areas. Data collection was carried out using a pre-tested semi-structured self-administered questionnaire. The data were analyzed using SPSS version 21, and associations were tested using the chi-square test, with results presented in tables and charts. The findings revealed a significant deficiency in the emergency management skills of healthcare workers. A majority of respondents demonstrated inadequate skills in handling paediatric emergencies, with 66 (48.5%) exhibiting very poor competency in the management of common paediatric emergencies, and 32 (23.5%) displaying poor competency. Only a small fraction, 4 (2.9%) of respondents, demonstrated excellent skills in emergency management. Similarly, 46.7% of the respondents had very poor skills in the treatment of common paediatric emergencies, while only 3.0% exhibited excellent treatment skills. A statistically significant relationship was observed between the level of academic qualification and emergency management skills (p < 0.05). The results underscore the critical need to enhance the skill levels of healthcare workers in PHCs through continuous professional development. This could be achieved through collaborative efforts between the Department of Paediatrics at Ahmadu Bello University Teaching Hospital and the Primary Health Care Departments of Zaria and Sabon Gari local governments, focusing on regular training and workshops. Improving the skills of healthcare workers in managing paediatric emergencies is essential for reducing child mortality and improving health outcomes in the region.

IMPLEMENTING AND EVALUATING A PAEDIATRIC EMERGENCY MANAGEMENT TRAINING PROGRAM FOR PRIMARY HEALTHCARE WORKERS IN ZARIA

Nigeria continues to grapple with alarmingly high under-five mortality rates, with approximately 2,300 children dying daily due to preventable and treatable diseases such as pneumonia, malaria, and diarrheal illnesses. This crisis is particularly pronounced in rural areas, where childhood mortality rates are significantly higher than in urban centres. For many rural communities, primary healthcare (PHC) centres serve as the sole access point to medical services, making these centres critical to addressing this public health challenge. Despite their importance, PHC centres often face significant challenges, including inadequate infrastructure, limited access to essential medications, and a shortage of adequately trained health personnel. This study aimed to implement and evaluate a Paediatric Emergency Management Training Program for healthcare workers at PHC centres in Zaria, Kaduna State. The primary objective was to assess the effectiveness of the training in improving the competency of health workers in managing common paediatric emergencies, thereby enhancing the overall quality of care provided at these centres. A cross-sectional descriptive study was conducted involving 139 healthcare workers from selected PHC centres in Sabon Gari and Zaria Local Government Areas, utilizing a multi-stage random sampling technique. Data collection was performed using a pre-tested, semi-structured, self-administered questionnaire designed to evaluate the participants' baseline knowledge, followed by an assessment after the training intervention. The data were analysed using SPSS version 21, with chi-square tests employed to examine the associations between variables. Results were presented using tables and charts for clarity. The findings revealed a generally low baseline competency in managing common paediatric emergencies among the healthcare workers. Specifically, 66 (48.5%) of the respondents demonstrated very poor knowledge regarding the causes of common paediatric emergencies, 32 (23.5%) had poor knowledge, 34 (25.0%) had good knowledge, and only 4 (2.9%) of the respondents exhibited excellent knowledge. Similarly, knowledge regarding the treatment of these emergencies was also lacking, with 46.7% of respondents showing very poor understanding, 34.1% having poor knowledge, 16.3% demonstrating good knowledge, and only 3.0% showing excellent knowledge. A statistically significant relationship was observed between academic qualifications and knowledge levels in both causes (p = 0.004) and treatment (p = 0.000) of paediatric emergencies. The low baseline knowledge underscores the critical need for targeted training interventions. The study highlights the importance of establishing a sustained partnership between the Department of Paediatrics at Ahmadu Bello University Teaching Hospital and the Departments of Primary Health Care in Zaria and Sabon Gari Local Governments. Regular training workshops, held quarterly, are recommended to continuously equip PHC workers with the necessary skills to effectively manage paediatric emergencies, ultimately contributing to a reduction in childhood mortality rates in the region.

Multicenter comparison of non-operative techniques of intussusception reduction: saline versus air versus barium

Purpose: Intussusception is a common pediatric surgical emergency and non-operative reduction is its first line of management. We aimed to compare 3 contemporary techniques of intussusception reduction.Methods: A retrospective study was performed in 3 tertiary care centers in India from January 2017 through December 2019. In the 3 centers, the primary reduction techniques were ultrasound-guided saline reduction (USR), fluoroscopy-guided pneumatic reduction (FPR), and fluoroscopy-guided barium reduction (FBR), respectively. As per these techniques used, we compared clinical characteristics, such as the successful reduction.Results: A total of 255 patients underwent one of the 3 reduction techniques in the study period. Reduction was successful in 90.3%, 85.1%, and 87.7% in the USR, FPR, and FBR groups, respectively (P = 0.961). Mean time to reduction was shorter in the FPR group (30.8 ± 8.9 seconds), compared with the USR (575.0 ± 242.3 seconds) and FBR groups (495.0 ± 118.4 seconds; P < 0.001). Recurrence rates were 11.8%, 20.3%, and 15.8% in the USR, FPR, and FBR groups, respectively (P = 0.522). No association was found between the patients’ age or symptom duration and the successful reduction. One patient in the USR group, 3 in the FPR group, and 4 in the FBR group reported second recurrences. Perforation occurred in 1 patient in the FPR group while no complications occurred in the other groups. There was no in-hospital mortality.Conclusion: All 3 techniques are equally effective, with FPR requiring a shorter time than the other 2 techniques. The reduction technique should be chosen based on the strengths and weaknesses of each technique, as well as local availability.

Assessing the Knowledge Gap in Paediatric Emergency Management among Primary Healthcare Workers in Zaria, Nigeria

Paediatric emergencies remain a significant cause of mortality in Nigeria, particularly in rural areas where primary healthcare centres (PHCs) often serve as the sole source of medical care. This study aimed to assess the knowledge gap among healthcare workers in PHCs in Zaria regarding the management of common paediatric emergencies. A cross-sectional descriptive study was conducted among 139 randomly selected healthcare workers in Sabon Gari and Zaria Local Government Areas. A pre-tested questionnaire was used to collect data, which was analysed using SPSS version 21. Results revealed a generally low level of knowledge among healthcare workers regarding both the causes and treatment of common paediatric emergencies. Only a small percentage of respondents demonstrated adequate knowledge in these areas. A statistically significant association was found between academic qualifications and knowledge levels. These findings underscore the urgent need for targeted interventions to improve the skills and knowledge of healthcare workers in PHCs. Collaborations between academic institutions and local health departments can play a crucial role in organising regular training programs to address these deficiencies and enhance the quality of care provided to children in need.

349 Evaluating the Efficacy of ChatGPT in Generating Discharge Instructions for Common Pediatric Emergency Conditions

349 Evaluating the Efficacy of ChatGPT in Generating Discharge Instructions for Common Pediatric Emergency Conditions

The Ingestion Question: Public Knowledge of Safe Food Introduction in Children.

National guidelines advise delaying initiation of solid foods until after 4-6 months of age and avoiding "high-risk" foods under the age of 4 years. However, foreign body aspiration of food remains a common preventable pediatric emergency. Our primary aim was to investigate public knowledge regarding the safe age of introduction of different foods to children and determine if demographic factors affect this knowledge. An online survey was designed following a literature review and consultation with an expert panel. This was distributed via social media platforms. A review of our institutional data of bronchoscopy/foreign body retrievals was performed to identify trends. There were 1000 survey responses: 79.4% of respondents cared for children and 21.5% were medical professionals; 37.7% of respondents (n = 385) would offer high-risk foods to children <2 years of age and 56.9% (n = 582) to children <3 years. At our institution nuts (65.7%) were the most common food-related foreign body retrieved from a total of 265 over 21 years. Notably, 80% of respondents (n = 800) would offer whole nuts to children <4 years. Respondents with medical training were more likely to hold off on introducing nuts to children until a later age. Although the public has an overall appreciation of food safety, a significant proportion would feel comfortable offering high-risk foods to children under 2 and 3 years. There is a poor understanding of the danger of nuts and the appropriate age of introduction. Further research into effective public education strategies on safe food introduction in children are warranted. V Laryngoscope, 2024.

Analysis of Risk Factors for Recurrence Following Conservative Treatment of Acute Appendicitis-Related Abscesses in Children

Background: Acute appendicitis accompanied by a periappendiceal abscess is a common pediatric surgical emergency, with a risk of recurrence. Objectives: To analyze the risk factors for the recurrence of acute appendicitis-related periappendiceal abscesses in children following the resolution of clinical symptoms. Methods: We retrospectively collected data from children admitted to the hospital with periappendiceal abscesses between 1 January 2015 and 31 December 2021. These children were categorized into recurrent and non-recurrent groups based on whether a periappendiceal abscess recurred. Gender, age, length of hospitalization, white blood cell (WBC) count, and C-reactive protein (CRP) levels at admission and discharge were compared between the two groups. Logistic regression was used to analyze the risk factors for the recurrence of periappendiceal abscesses in children following conservative treatment. Results: After 2 years of outpatient follow-up, 65 children were included in the study, nine of whom experienced recurrence. Significant differences were observed between the recurrent and non-recurrent groups in terms of abscess size at discharge (6.50 vs. 2.80 cm, P = 0.022), WBC count at discharge (13.25 × 10⁹/L vs. 6.98 × 10⁹/L, P = 0.016), and CRP level at discharge (32.80 vs. 8.60 mg/L, P = 0.002). A multifactorial logistic regression analysis indicated that both WBC count and CRP level at discharge were independently associated with the recurrence of periappendiceal abscesses. Conclusions: Increased attention should be given to the risk of recurrence in pediatric patients with elevated WBC counts and CRP levels at the time of discharge.

Value of combining targeted emergency nursing with psychological nursing in children with febrile convulsions.

Febrile convulsions are a common pediatric emergency that imposes significant psychological stress on children and their families. Targeted emergency care and psychological nursing are widely applied in clinical practice, but their value and impact on the management of pediatric febrile convulsions are unclear. To determine the impact of targeted emergency nursing combined with psychological nursing on satisfaction in children with febrile convulsions. Data from 111 children with febrile convulsions who received treatment at Nantong Maternal and Child Health Care Hospital between June 2021 and October 2022 were analyzed. The control group consisted of 44 children who received conventional nursing care and the research group consisted of 67 children who received targeted emergency and psychological nursing. The time to fever resolution, time to resolution of convulsions, length of hospital stays, Pittsburgh Sleep Quality Index, patient compliance, nursing satisfaction of the parents, occurrence of complications during the nursing process, and parental anxiety and depression were compared between the control and research groups. Parental anxiety and depression were assessed using the Hamilton Rating Scale for Depression (HAMD) and the Hamilton Rating Scale for Anxiety (HAMA). The fever resolution, convulsion disappearance, and hospitalization times were longer in the control group compared with the research group (P < 0.0001). The time to falling asleep, sleep time, sleep quality, sleep disturbance, sleep efficiency, and daytime status scores were significantly better in the research group compared with the control group (P < 0.0001). The HAMD and HAMA scores for parents of children in the research group were lower than the scores in the control group after nursing (P < 0.05). Compliance with treatment of children in the research group was higher than in the control group (P < 0.05). Parental satisfaction with nursing in the research group was higher than in the control group (P < 0.05). The total complication rate of children in the control group was higher than in the research group (P < 0.05). Combining psychological nursing with targeted emergency nursing improved the satisfaction of children's families and compliance with treatment and promoted early recovery of clinical symptoms and improvement of sleep quality.

Role of expiratory chest X-ray in pediatric foreign body aspiration

PurposeTracheobronchial foreign body aspiration is a common pediatric emergency and a leading cause of accidental deaths in children. The diagnosis remains sometimes difficult even with physical examination, medical history, and basic X-rays. This challenge necessitates the performance of endoscopy under general anesthesia, regardless of the potential for serious complications. The benefit of strategies like expiratory chest X-rays to reduce unnecessary endoscopies remains uncertain. We evaluated the effectiveness of expiratory chest X-rays in detecting airway foreign bodies to potentially reduce the need for endoscopies. MethodsWe retrospectively studied children with suspected foreign body aspiration who had X-ray and endoscopy. ResultsA total of 70 children were included in the study. Out of these, 19 cases (27.1 %) showed pathological findings on standard chest X-rays. However, when expiratory chest X-rays were added, the number of pathological radiographies increased to 37 cases (52.9 %). Out of the 36 foreign bodies that were present, only 2 were not detected. Furthermore, 3 chest X-rays displayed pathological results, while the endoscopies indicated normal findings. Consequently, the overall sensitivity, specificity, positive predictive value, and negative predictive value stood at 94.4 %, 91.1 %, 91.9 %, and 93.9 % respectively. ConclusionThe remarkable sensitivity of expiratory chest radiography can eliminate the need for unnecessary endoscopy, but it should be limited to centers lacking access to MDCT. The performance of endoscopy should only be considered when persistent clinical symptoms are observed during auscultation.

Completeness and readability of GPT-4-generated multilingual discharge instructions in the pediatric emergency department

Abstract Objectives The aim of this study was to assess the completeness and readability of generative pre-trained transformer-4 (GPT-4)-generated discharge instructions at prespecified reading levels for common pediatric emergency room complaints. Materials and Methods The outputs for 6 discharge scenarios stratified by reading level (fifth or eighth grade) and language (English, Spanish) were generated fivefold using GPT-4. Specifically, 120 discharge instructions were produced and analyzed (6 scenarios: 60 in English, 60 in Spanish; 60 at a fifth-grade reading level, 60 at an eighth-grade reading level) and compared for completeness and readability (between language, between reading level, and stratified by group and reading level). Completeness was defined as the proportion of literature-derived key points included in discharge instructions. Readability was quantified using Flesch-Kincaid (English) and Fernandez-Huerta (Spanish) readability scores. Results English-language GPT-generated discharge instructions contained a significantly higher proportion of must-include discharge instructions than those in Spanish (English: mean (standard error of the mean) = 62% (3%), Spanish: 53% (3%), P = .02). In the fifth-grade and eighth-grade level conditions, there was no significant difference between English and Spanish outputs in completeness. Readability did not differ across languages. Discussion GPT-4 produced readable discharge instructions in English and Spanish while modulating document reading level. Discharge instructions in English tended to have higher completeness than those in Spanish. Conclusion Future research in prompt engineering and GPT-4 performance, both generally and in multiple languages, is needed to reduce potential for health disparities by language and reading level.

Paediatric testicular torsion in low- and middle-income countries: an OxPLORE scoping study.

Literature on paediatric surgical conditions in low- and middle-income countries (LMICs) remains limited. As a common emergency, timely treatment of testicular torsion acts as a benchmark of adequate emergency service delivery in paediatric surgery. This scoping study aims to synthesise all existing literature on paediatric testicular torsion in LMICs. A database search was conducted by the OxPLORE global paediatric surgery research group to identify studies containing the terms 'testicular torsion' or 'acute scrotum' originating from LMICs. A thematic analysis was applied to the results of the search and the quality of evidence was appraised for all included articles. This review included 17 studies with 1798 patients. All studies originated from middle-income countries and the majority (76%) had sample sizes smaller than 100 patients. All studies were appraised as providing less than adequate evidence. Included studies identified long delays to treatment and highlighted ongoing debates on the value of scoring systems and Doppler ultrasonography in diagnosing torsion. Major heterogeneity in surgical approaches to treatment of testicular torsion in children was also observed. Literature on paediatric testicular torsion in LMICs is scarce and heterogeneous. Prospective, multi-centre research on the management of this common paediatric surgical emergency is urgently required.

The Impact of Recurrent Epistaxis on the Quality of Life of Children and the Functioning of Their Families.

Introduction Epistaxis, or nosebleeds, is a common pediatric emergency, impacting their quality of life (QoL). Existing research on epistaxis has predominantly focused on clinical aspects, overlooking its broader impact on the quality of life of affected children and the functioning of their families. This study seeks to fill that gap by assessing the impact of recurrent epistaxis on children's QoL, family dynamics, and parental stress in Saudi Arabia's Eastern region. Methods A survey was conducted involving 168 parents of children with recurrent epistaxis, using the Pediatric Quality of Life InventoryTM (PedsQL 4.0TM) Short Form (SF) for QoL assessment across different age groups, the PedsQL 2.0 Family Impact Module to evaluate the effect of the child's health on family dynamics, and a custom questionnaire for gathering sociodemographic and health-related information. Better QoL and family functioning were indicated by higher scores. Results Recurrent epistaxis was more frequent (>4 times per year) in 58.9% of cases, with unknown causes in 72%. A total of 116 (69%) of the children never needed medical intervention for epistaxis and 52 (31%) visited ER 1-2 times. The lowest scores for both children and parents were in the emotional functioning domains (77.9 and 78.2, respectively). In the study, both parents and children who had no history of ER visits exhibited significantly higher quality of life (QoL) scores compared to those who did, with parents reporting 83.7% versus 77.2% (P=.022), and children showing 84.6% versus 79.9% (P=.049), respectively. Parents of older children, ages 13-18 years, reported a higher Quality of Life (QoL) at 83.9%, compared to those with younger children, ages 2-4 years, who reported a QoL of 57.3% (P=.003). Conclusion The overall QoL scores of families of children with recurrent epistaxis were relatively high, indicating a variable and limited general impact. Significantly higher QoL was observed in families of older children and those without ER visits.

X-ray interpretation in emergency department in the Kingdom of Saudi Arabia. Do we need the radiologist?

Chest x-rays are widely used for diagnosing chest pathology worldwide. Pediatricians frequently interpret chest radiographs in the emergency department, guiding patient management. This study aims to assess the competency of non-radiologists in interpreting emergency chest x-rays and compare it with trainees of different levels to determine the necessity of radiologist input. A cross-sectional online survey was conducted in Saudi Arabia from September to October 2023, involving 385 participants, including pediatricians and medical interns from various regions. Carefully selected questions addressed a range of x-ray abnormalities in pediatric emergencies, assessing fundamental understanding of x-ray interpretation, such as inspiratory vs. expiratory and AP or PA films. The study included 385 participants, primarily Saudi nationals in the eastern region, with an equal gender distribution and ages ranging from 20 to 29years. Approximately 29.09% demonstrated fair knowledge, with 28% being Junior Pediatrics Residents, 18% Pediatric Consultants, and 15% Senior Pediatrics Residents. Fair knowledge was significantly associated with individuals aged 20-29years, residents of the western region, and Junior Pediatrics Residents. Clinical knowledge varied among different groups, with 59% correctly identifying atypical pneumonia and 65% recognizing asymmetrical hyperinflation. However, rates for other conditions differed, with low identification of potential foreign body aspiration and film type. Accuracy in identifying tension pneumothorax and hyperlucency varied among clinicians. Pleural effusion films had a 65% identification rate for the diagnosis, but only 28% accurately described the X-ray and selected the correct answer for lung opacity. The study concluded that 29.9% of the participating physicians exhibited fair knowledge of common pediatric emergency radiological films. Junior pediatric residents showed the best knowledge, and Tetralogy of Fallot, asymmetrical hyperinflation, and pleural effusion had the highest recognition rates. In conclusion, there is still a need for radiologists in the pediatric emergency department to ensure optimal functioning.

Study of clinical profile and outcome of children presented with poisoning in tertiary care hospital

Background: Poisoning is a common paediatric emergency. Worldwide estimate suggests that the rate of poisoning in under 20 years is 1.8 per one lakh population and for India it ranges between 0.6 to 11.6%. Methods: The study was conducted at B. J. Medical College Ahmedabad and Civil Hospital, Ahmedabad. A prospective analytical study consisting of total 110 patients, admitted in the intensive care unit during the period from June 2018 to November 2018 with inclusion criterion of children &lt;12 years of age, presented with history of consumption of poisonous substances/insect bite irrespective of signs and symptoms excluding cases of food poisoning and idiosyncratic drug reactions. Detailed proforma was filled after taking necessary consent from the parents. Routine investigations and gastric samples for forensic analysis were sent in all irrespective of type or route of poisoning. Specific investigations done wherever required. Analysis of outcomes done using chi square. Results: The most common age group was 3-6 years with male to female ratio of 1.5:1. 99.1% poisoning were accidental with hydrocarbon poisoning being the most common of all (27.2%), followed by household substance poisoning in 20.9%. Snakebite was the most common insect bite (10.9%). The average duration of stay was 3.9 days, 8.1% children died with maximum mortality happened in children presented after 6 hours of intoxication. Conclusions: Management of poisoning requires immediate advice and first aid, followed by a directed treatment. Decontamination, enhanced elimination, antidotes, and supportive care are commonly used to manage poisoning cases.

The Changing Face of Childhood Intussusception: A Refinement in the Technique of Saline Reduction and Outcome.

Intussusception is a common pediatric surgical emergency and an indicator for primary healthcare. We report our experience with childhood intussusception at a tertiary care hospital in the private sector in Central Kerala and add our refinement to the technique of hydrostatic saline reduction which had more desirable outcome. Children presenting with the diagnosis of intussusception which were managed in our department of pediatric surgery at a private hospital in Kerala, India. Eighty children, up to 15 years of age, (43 boys, 37 girls) confirmed to have intussusception on ultrasound and managed in our institution from October 2016 to July 2020 with hydrostatic saline reduction. Sixty-two (77%) of them were aged 3 months to 3 years (numbers <10 to be written in words); the age of idiopathic intussusception. SPSS V25. Association between variables using Chi square test and independent t test. A total of 80 children met the criteria out of that (n = 79) had successful nonoperative reduction. Hydrostatic saline enema 73, One Barium and five air enema. A child presented in shock was taken up for laparotomy and reduced operatively. Six recurred within 24 h (7% early recurrence) and a second attempt at nonoperative reduction succeeded in all six of them. (numbers <10 in words). Eleven children (14%) had a late recurrence, the attempt at saline hydrostatic reduction was successful in only 3 (27%) and 8 went on to have surgery. Six were successfully reduced operatively and 2 had resection anastomosis. After excluding those who need surgery on clinical grounds, we report a 98.7% success with nonoperative reduction for the first instance of intussusception, a 24 h recurrence of 7%, with successful repeat reductions in all. With the refinement in the technique, we could achieve a desirable outcome. At the first presentation, surgery was indicated in 1 of the 80 children. We report a late recurrence rate of 14%, with a 27% success rate for nonoperative reduction. No pathological lead points were identified even in this group. All the children had an uneventful and a faster recovery. In our series, we had 97.5% follow-up rate.

Management and Immediate Outcome of Common Pediatric Oncological Emergencies from a Single Centre

The first presentaion of children with a malignancy is often an emergency. Pediatric oncological emergencies need to be recognized and managed early and effectively for a better outcome. In this prospective study of children, with oncological emergencies, we aimed to study the nature of oncological emergencies, emergency management and immediate outcome. There were 83 patients with 110 visits with median age of 6 years. Leukemia constituted 50.6% and 92.8% was acute lymphocytic, 26.5% intracranial malignancies 59% of them posterior fossa tumors. 36.4%, presented with fever, 18% severe anemia and 16.45 % febrile neutropenia, 8% TLS (tumor lysis syndrome) and 4.5% had respiratory distress as the presentation. Presenting symptoms in 31% were neurological. 42.7% required parenteral antibiotics and 16.4% packed cell tranfusion. 90.4% of blood cultures were negative. 26.5% needed intensive care, 12 required neurosurgical procedure.

Ultrasonographic Evaluation of Nontraumatic Gastrointestinal Emergencies in Children

AbstractAcute, nontraumatic gastrointestinal pathologies are commonly encountered in the pediatric emergency department. They often pose a diagnostic dilemma with an assemblage of various etiologies, depending on the age and clinical features. Despite the advent of computed tomography, various issues pertinent to children make ultrasonography (USG) the initial imaging modality of choice in investigating acute gastrointestinal pathologies. This article discusses the ultrasonographic approach to acute gastrointestinal pathologies in children, and how sonography is instrumental in guiding diagnosis and treatment. Characteristic USG findings of common pediatric gastrointestinal emergencies—including acute appendicitis, intussusception, Meckel's diverticulitis, midgut volvulus, bowel perforation, and abdominal tuberculosis—are illustrated in this pictorial review.

Prevalence of Foreign Bodies Ingestion in Children

Foreign body ingestion is one of the common pediatric emergency conditions and can lead to childhood morbidity, and mortality. We think that the results of this study will be of utmost usefulness for pediatric surgeons when considering foreign bodies' ingestion in children. We decided to study the age distribution, nature, the site of impaction, and fate of foreign body ingestion in children. This cross-sectional study was conducted on 77 children with foreign body ingestion, from February 2017 to July 2021(54 months). A total of 77 patients with foreign body ingestion were diagnosed during the study period. Forty percent were boys and 60% were girls. The maximum age of participants was 1-2 years, accounting for 55%. Batteries were the most common foreign bodies ingested accounting for 26% followed by magnets (13%), and coins 6.5%. The most common site of foreign body impaction was the stomach (34%), colon (26%), and small bowel (23%). Majorities of foreign bodies (72%) were passed through the gastrointestinal tract without complication, 18 % required extraction by the upper endoscope, and 10% were removed surgically. We conclude that increasing awareness among parents to check the quality and safety protocols of electronic toys that contain batteries and magnets.

A CLINICAL STUDY OF INTUSSUSCEPTION IN CHILDREN

A CLINICAL STUDY OF INTUSSUSCEPTION IN CHILDREN

Post-Traumatic Stress as a Psychological Effect of Mild Head Injuries in Children.

Head trauma is one of the most common pediatric emergencies. While the psychological effects of severe head injuries are well studied, the psychological consequences of mild head injuries often go overlooked. Head injuries with a Glasgow Coma Scale score of 13-15, with symptoms such as headache, vomiting, brief loss of consciousness, transient amnesia, and absence of focal neurological signs, are defined as mild. The aim of this study is to evaluate the stress of children with mild head injuries and their parents' relevant perception during the early post-traumatic period. This is a prospective cross-sectional study on a cohort of children with mild head injuries and their parents. Two questionnaires were implemented, the Child Trauma Screening Questionnaire (CTSQ) which was compiled by the children, and the Children's Revised Impact of Event Scale (CRIES-13), compiled by their parents. Both questionnaires are widely used and reliable. The first presents an excellent predictive ability in children with a risk of post-traumatic stress disorder, while the second is a weighted self-completed detecting instrument for the measurement of post-traumatic stress in children and adolescents, with a detailed evaluation of their reactions to the traumatic incident. The participants responded one week and one month after the traumatic event. A total of 175 children aged 6-14 years and 174 parents participated in the study. Stress was diagnosed in 33.7% of children after one week, and in 9.9% after one month. Parental responses suggesting stress presence in their children were 19.0% and 3.9%, respectively. These outcomes showed that mild head injuries are not so innocent. They are often underestimated by their parents and may generate a psychological burden to the children during the early post-traumatic period. Mild head injuries may affect the emotional welfare of children. Healthcare providers should understand the importance of the psychological effect of this overlooked type of injury. They should be trained in the psychological effect of trauma and be aware of this probability, promptly notify the parents accordingly, and provide psychological assistance beyond medical treatment. Follow-up and support are needed to avoid the possibility of future post-traumatic stress disorder. More extensive research is needed as the outcomes of this study regarded a limited population in numbers, age, and survey period. Furthermore, many children with mild head injuries do not ever visit the emergency department and stay at home unrecorded. Community-based research on the topic should therefore be considered.