Injuries In Pediatric Population Research Articles

Urinary Calprotectin as a Marker to Distinguish Functional and Structural Acute Kidney Injury in Pediatric Population

Background: Acute kidney injury (AKI) is a serious, common and occasionally under-recognized condition. To date, the clinical and some laboratory parameters are routinely applied to distinguish between functional and structural AKI which can be challenging in certain occasions. In the present paper, we investigate the accuracy of urinary calprotectin as a diagnostic biomarker in this dubious situation. Methods: This is a cross-sectional study among 75 children with AKI defined by Acute Kidney Injury Network (AKIN) and 20 healthy children as controls which was carried out for about six months (September 2014 to March 2015). Random urinary calprotectin concentration was assessed by ELISA in both groups within 48 hours after diagnosis. Patients with obstructive uropathy, malnutrition, renal transplantation, chronic renal failure, urinary tract infection, and malignancy were excluded. Receiver-operating characteristic (ROC) curves were drawn to determine the accuracy of urinary calprotectin to detect children with structural AKI. P value less than 0.05 was considered significant. Results: Median urinary calprotectin was 1240 ng/mL in structural AKI, 28.5 in functional, and 33 in controls. Receiver operating curve analysis revealed high levels of accuracy for measuring calprotectin in predicting structural AKI. A cutoff level of 230 ng/mL for urinary calprotectin showed high sensitivity and specificity. The urine calprotectin/creatinine ratio indicated the same accuracy as urinary calprotectin in diagnosing structural AKI. The ROC curve function was better for urine calprotectin and its ratio in comparison to fractional excretion of sodium (FENa). Conclusions: Calprotectin is a biomarker that can rapidly and easily recognize structural from functional AKI with high sensitivity and specificity in comparison to traditional most accurate diagnostic test; FENa.

A comparison between non-powder gun and powder-gun injuries in a young pediatric population

IntroductionNon-powder guns (NPG) are viewed as toys for children by the general public. Literature on firearm injuries in the pediatric population is increasing, however there are still large gaps in the published literature regarding NPG. We intended to identify and compare the epidemiology, circumstances of injury and outcomes of children with NPG versus powder-gun injuries (GSW). Patients and methodsWe performed a 6-year retrospective analysis of children 0–14 years old treated for NPG and GSW injuries at our level one pediatric trauma center. Mann-Whitney U test and Pearson’s X2 were used to compare continuous and categorical variables, respectively. ResultsThere were 43 NPG and 112 GSWs. Patients were predominantly male (36 children; 84%) NPG vs. 92 children; 82% GSW) with a median age in both groups of 11 years. Analysis of residential zip codes showed that 74% (32 children) NPG injuries and 85% (95 children) GSW lived in regions with higher poverty than the national level. Children with NPG injuries were more likely to be Caucasian (24 children; 56%) and to have suffered an unintentional injury (36 children; 84%), while children with GSW were African-American (80 children; 71%; p=0.0002) and victims of assault (50 children; 45%; p<0.0001). When compared with NPG, children with GSW had more severe injuries, longer hospital stays, and higher overall mortality. There were no significant differences in rate of emergent OR intervention and ED mortality between the two groups. ConclusionOur results highlight two important findings. First, NPG injuries were accidental and thus preventable with improved legislation and public education. Second, health disparities related to gun violence among African-Americans are prevalent even in early childhood and prevention efforts should include this younger population.

Penetrating eye injuries in pediatric population: An epidemiological study and visual outcome

Introduction: Penetrating eye injury is an important cause of visual impairment in pediatric population.Aims and Objectives: To study the epidemiology and visual outcome of penetrating eye injuries in pediatric population presented to Lumbini Eye Institute, the tertiary eye hospital of western Nepal.Materials and Methods: This retrospective study was conducted at the Department of Pediatric Ophthalmology and Strabismus, Lumbini Eye Institute over a period of one year from June 2014 to May 2015. All patients of penetrating eye injuries up to the age of 15 years were included in the study. The demographics of the patient, cause and duration of injury were recorded. The presenting and final best corrected visual acuity, anterior and posterior segment findings were recorded in specially designed proforma.Results: A total number of 127 children (127 eyes) presented with penetrating eye injuries during a year. The incidence of penetrating eye injury in one year was 127 out of 12927 new patients. Minimum age was 11 months, while the maximum age was 15 years with mean of 7.29 years (SD= ±3.49). Male and female patients were 99 (78%) and 28 (22%) respectively. Involvement of right eye was seen in 69 cases (54.33%) and left eye 58 (45.67%). The most common cause of injury was wooden stick in 55 cases (43.31%) followed by iron wire 12 (9.45%) and the stone 11 (8.66%). Corneal laceration was found in 102 cases (80.31%), scleral laceration in 10 (7.87%) and corneo-scleral laceration in 15 (11.81%). Seventy three percent patients were blind at the time of presentation whereas at discharge 37.63% were blind and 11.43% of patients had visual acuity better than 6/18 at presentation whereas 35.48% had visual acuity better than 6/18 after treatment.Conclusion: Penetrating eye injury is one of the common causes attending Pediatric Ophthalmology Department. Penetrating eye injury is common in male and majority of trauma is caused by wooden stick. The awareness of ocular trauma and its consequences should be increased to reduce incidence of childhood blindness.Asian Journal of Medical Sciences Vol.7(4) 2016 84-87

Spinal Injury in Pediatric Population: Review of 152 Cases

Introduction Injury to the spinal cord and the spinal column is relatively uncommon in pediatric population. It accounts for roughly 5% of the total spinal cord injuries. SCI in children younger 5 years are even rarer. Objective of the study was to analyze the incidence, type of spinal injuries, and epidemiological parameters in Indian children with spinal injury admitted at Indian Spinal Injury Centre (ISIC). Patients and Methods Hospital medical records were reviewed and patients with the diagnosis of cervical spine injury in age group 0 to 18 years admitted between 2002 and 2011 were included. The injury characteristics of patients were compared across three groups of 0 to 9, 10 to 14 and 15 to 18 years of age. Results A total of 152 spinal injury patients were included in this study, which represents 10% of the total pediatric trauma admitted at our hospital. Boys (78%) were more commonly injured than girls. Fall (51%) was the most common mode of injury followed by motor vehicle accident. Cervical spine was the most common level of injury with 34% of cases followed by thoracic region with 30% of cases. However, the proportion of both genders, mode of injury, and levels of injury were not different across the age groups ( p &lt; 0.05). Fracture was the most common pattern of injury in all age groups. SCIWORA was not very common (6.6%) in our study. Patients were divided according to ASIA scale in to complete and incomplete category. Outcome was measured on the basis of improvement in patient neurological level and their dependency level. Conclusion This retrospective study in Indian children is comparable with other international studies and provides important information regarding patient and injury characteristics of pediatric trauma cases.

An emerging etiological factor for hand injuries in the pediatric population: public exercise equipment.

The purpose of this study was to describe the role of public exercise equipment in pediatric hand traumas as a preventable etiological factor. Pediatric patients with hand injuries referred from the emergency department were evaluated retrospectively. Age and gender of the patients, timing, etiology, mechanism of hand trauma, localization of the injury, diagnoses of the patients, and hospitalization rates were reviewed. Amongst the 310 pediatric patients evaluated, 31 patients (10%) experienced injury related to public exercise equipment. Within this group of patients, most were between 5 to 9 years of age, and all injuries were blunt and crush type. Lacerations and fractures were the main diagnoses. Complex injuries that required inpatient care were reported in 19.3% of the patients. Public exercise equipment-related injuries are increasingly prevalent in pediatric hand traumas. Preventive actions such as shielding the moving parts should be taken to reduce these rates.

Epidemiological Analysis and Cost of Hospitalization Associated with Pediatric Burns in Kermanshah, Iran

Background: burn injuries are a major public health in the world, especially in developing countries. The aim of this study was investigate to the epidemiological data and cost of hospitalization due to burn in pediatrics in Kermanshah provinces from 2011 to 2013.Material and Methods: this was a retrospective cross sectional study. The study subject was all of patient lee than 15 years who admitted in Burns Center at Imam Khomeini Hospital in Kermanshah, Iran, from 21 March 2011 to March 2013 (two years). The data including age, gender, cause of burn, burn degree, place of burn, length of stay (LOS), burned body surface (BBS) and cost of hospitalization was obtained from hospital data and analyzed by SPSS version 18. Results: the overall mean age was 5.27 ± 4.52 years; the ages ranged from less than 1 year to 15 years. The mean BBS % and LOS was 22.8 % and 7.48 day, respectively. The mean cost per patient, per hospitalization day and per % BBS were 15000000 IRR, 657981 IRR and 20045348 IRR, respectively. Conclusion: The current study showed the main cause of burn and mortality in the pediatric population was hot liquids and flame, respectively. An important point is that most of burn injuries in pediatric population are preventable and avoidable if the necessary training about cause of these burns provides for their parent.

Children are safer in states with strict firearm laws

Firearm control laws vary across the United States and remain state specific. The aim of this study was to determine the relationship between variation in states' firearm control laws and the risk of firearm-related injuries in pediatric population. We hypothesized that strict firearm control laws impact the incidence of pediatric firearm injury. All patients with trauma Ecodes and those 18 years or younger were identified from the 2009 Nationwide Inpatient Sample. Individual states' firearm control laws were evaluated and scored based on background checks on firearm sales, permit requirements, assault weapon and large-capacity magazine ban, mandatory child safety lock requirements, and regulations regarding firearms in college and workplaces. States were then dichotomized into strict firearm laws (SFLs) and non-strict firearm laws (non-SFLs) state based on median total score. The primary outcome measure was incidence of firearm injury. Data were compared between the two groups using simple linear regression analysis. A total of 60,224 pediatric patients with trauma-related injuries across 44 states were included. Thirty-three states were categorized as non-SFL and 11 as SFL. Two hundred eighty-six (0.5%) had firearm injuries, of which 31 were self-inflicted. Mean firearm injury rates per 1,000 trauma patients was higher in the non-SFL states (mean [SD]: SFL, 2.2 [1.6]; non-SFL, 5.9 [5.6]; p = 0. 001). Being in a non-SFL state increased the mean firearm injury rate by 3.75 (β coefficient, 3.75; 95% confidence interval, 0.25-7.25; p = 0.036). Children living in states with strict firearm legislation are safer. Efforts to improve and standardize national firearm control laws are warranted. Prognostic study, level III.

Outcome and Patterns of Traumatic Brain Injury in Pediatric Population of a Third World Country Secondary to TV-Trolley Tip over (P06.237)

Outcome and Patterns of Traumatic Brain Injury in Pediatric Population of a Third World Country Secondary to TV-Trolley Tip over (P06.237)

Subacute and delayed period microsurgical management of traumatic extremity injuries in pediatric population

The purpose of the present report is to evaluate the outcome of subacute and delayed period microsurgical reconstructions of traumatic extremity defects of the pediatric patients. Eighteen free tissue transfers had been performed in 18 patients. Patients ranged in age from 5 to 17 years of age and had a median age of 12.05 years. The time between trauma and free flap transfer varied between 8 and 86 days (mean, 30.8 days). Hospital stay ranged from 8 to 90 days, with a mean stay of 38.7 days. Postoperative complications were seen in 8 of 18 patients (44.4%). Re-exploration for venous thrombosis was necessary in two patients, and total flap loss occurred in one case. The average follow-up time was 34 months. One could conclude from our report and the reference literature that the frequently quoted dogma of a definitive defect closure within 7 days may have lost much of its justification. The final results obtained after delayed definitive soft tissue reconstruction compare favorably with results previously reported in the literature from patient groups whose wounds could be closed in the early period within 7 days.

ISP1-01 Low income as a risk factor for traumatic brain injury in pediatric population in Taiwan

ISP1-01 Low income as a risk factor for traumatic brain injury in pediatric population in Taiwan

Association of persistent hyperglycemia with outcome of severe traumatic brain injury in pediatric population

Hyperglycemia is a common secondary insult associated with an increased risk of mortality and poor outcome in traumatic brain injury (TBI), but the effect of hyperglycemia on outcomes of severe TBI in children and adolescents is less apparent. The aim of this study was to evaluate the association of hyperglycemia with mortality in pediatric patients with severe TBI. In this cross-sectional study, data of all children and adolescents with severe TBI admitted to Poursina Hospital in Rasht, including age, gender, Glasgow Coma Scale (GCS) upon admission, mortality rate, hospital length of stay, and serial blood glucose during the first three consecutive ICU days following admission, were reviewed from April 2007 to May 2011. After univariate analysis and adjustment for related covariates, logistic regression model was established to determine the association between persistent hyperglycemia and outcome. One-hundred and twenty-two children were included with a median admission GCS of 6 (interquartile range (IQR) 5-7) and a median age of 13 years (IQR 7.75-17). Among them, 91 were boys (74.6%) and 31 were girls (26.6%); the overall mortality was 40.2% (n=49). Patients who died had a significantly greater blood glucose levels than survivors for the first 3 days of admission (P=0.003, P<0.001, P=0.001, respectively). Moreover, persistent hyperglycemia during the first 3 days of admission had an adjusted odds ratio of 11.11 for mortality (P<0.001). Early hyperglycemia is associated with poor outcome, and persistent hyperglycemia is a powerful and independent predictor of mortality in children and adolescents with severe TBI.

Effect of age on cervical spine injury in pediatric population: a National Trauma Data Bank review

Background The objective of this study was to characterize the incidence, risk factors, and patterns of cervical spine injury (CSI) in different pediatric developmental ages. Methods A retrospective review of the National Trauma Data Bank was conducted for the period of January 2002 through December 2006 to identify pediatric patients admitted following blunt trauma. Patients were stratified into 4 developmental age groups: infants/toddlers (age 0-3 years), preschool/young children (age 4-9 years), preadolescents (age 10-13 years), and adolescents (age 14-17 years). Patients with a CSI were identified by the International Classification of Diseases, Ninth Revision codes. Demographics, clinical injury data, level of CSI, and outcomes were abstracted and analyzed. Results A total of 240,647 patients met the inclusion criteria. Of these, 1.3% (n = 3,035) sustained a CSI. The incidence of CSI in the stratified age groups was 0.4% in infants/toddlers, 0.4% in preschool/young children, 0.8% in preadolescents, and 2.6% in adolescents. The level of CSI (upper [C1-C4] vs lower [C5-C7]) according to the age groups was as follows: infants and toddlers, 70% vs 25%; preschool/young children, 74% vs 17%; preadolescents, 52% vs 37%; and adolescents, 40% vs 45%, respectively. The adjusted risk for CSI increased 2-fold in preadolescents and 5-fold in adolescents. Conclusion The incidence of pediatric CSI increases in a stepwise fashion after 9 years of age. We noted an increase in lower CSI and a decrease in upper CSI after the age of 9 years. The incidence of upper CSI compared with lower CSI was higher in preadolescents (52% vs 37%) and almost equal in adolescents (40% vs 45%).

P1-536 Epidemiology of paediatric burn injuries in Shiraz, Iran in 2009

IntroductionBurn injuries are very important causes of morbidity and mortality among children. The aim of this study was to determine the burn related injuries in paediatric population in Shiraz, which...

Management of mandibular fracture in a medically compromised pediatric patient

Maxillofacial injuries in pediatric population warrant special attention because of anatomic considerations, potential for growth disturbances and rapidity of healing. We report a case of displaced mandibular fracture in a child who tested positive for hepatitis B surface antigen (HbsAg) and, therefore, was managed conservatively by closed reduction stabilized with acrylic dental splints fabricated on reduced dental models.