Injuries In Pediatric Patients Research Articles

C.4 Neurologic injury in pediatric patients cannulated for rescue extracorporeal life support

Background: Historical literature suggests the risk of neurologic injury in children supported by extracorporeal life support (ECLS) is between 10-20%, however recent studies suggest the incidence may be much higher. Methods: The Alberta Children’s Hospital (ACH) Rescue ECLS program cannulates patients who are then transferred to the partner program at Stollery Children’s Hospital. Data was systematically collected from all patients cannulated for Rescue ECLS at ACH October 2011 and May 2023. Neuroimaging (CT, MR) performed after cannulation was reviewed for evidence of ischemic and hemorrhagic strokes and hypoxic-ischemic brain injury. Results: Seventy-one patients were included in the Rescue ECLS cohort. Median age at cannulation was 1.74 years (range 0-17.6 years, 51% female). Survival to hospital discharge was 65%. Primary indication for ECLS included cardiac (42%), respiratory (33.3%), extracorporeal cardiopulmonary resuscitation (ECPR; 23.2%) and trauma (1.4%). Seventy four percent of the cohort underwent neuroimaging, of whom 67% had evidence of neurologic injury including stroke (ischemic 67%; hemorrhagic 50%) or hypoxic-ischemic injury (33%). Risk of neurologic injury did not differ by indication for ECLS. Conclusions: Neuroimaging abnormalities are present in most pediatric patients imaged post-cannulation for Rescue ECLS. Further research into modifiable risk factors for specific ECLS-related brain injuries may help to improve outcomes for survivors.

Pathobiological signatures of dysbiotic lung injury in pediatric patients undergoing stem cell transplantation.

Hematopoietic cell transplantation (HCT) uses cytotoxic chemotherapy and/or radiation followed by intravenous infusion of stem cells to cure malignancies, bone marrow failure and inborn errors of immunity, hemoglobin and metabolism. Lung injury is a known complication of the process, due in part to disruption in the pulmonary microenvironment by insults such as infection, alloreactive inflammation and cellular toxicity. How microorganisms, immunity and the respiratory epithelium interact to contribute to lung injury is uncertain, limiting the development of prevention and treatment strategies. Here we used 278 bronchoalveolar lavage (BAL) fluid samples to study the lung microenvironment in 229 pediatric patients who have undergone HCT treated at 32 children's hospitals between 2014 and 2022. By leveraging paired microbiome and human gene expression data, we identified high-risk BAL compositions associated with in-hospital mortality (P = 0.007). Disadvantageous profiles included bacterial overgrowth with neutrophilic inflammation, microbiome contraction with epithelial fibroproliferation and profound commensal depletion with viral and staphylococcal enrichment, lymphocytic activation and cellular injury, and were replicated in an independent cohort from the Netherlands (P = 0.022). In addition, a broad array of previously occult pathogens was identified, as well as a strong link between antibiotic exposure, commensal bacterial depletion and enrichment of viruses and fungi. Together these lung-immune system-microorganism interactions clarify the important drivers of fatal lung injury in pediatric patients who have undergone HCT. Further investigation is needed to determine how personalized interpretation of heterogeneous pulmonary microenvironments may be used to improve pediatric HCT outcomes.

Characteristics of Intracranial Injuries in Pediatric Patients Following Blunt Head Trauma.

Pediatric head trauma is a frequent reason for presentation to the emergency department. Despite this, there are few reports on specific characteristics and injury patterns in head injured children. The goal of this study was to evaluate head injury patterns in children with blunt head injury and their prevalence by age group. This is a planned secondary analysis of the NEXUS II Head CT validation study. Consecutive patients with blunt head trauma were enrolled between 2006 and 2015. Demographics and criteria from 2 clinical decision instruments (NEXUS and Canadian Head CT rules) were gathered at the time of enrollment. We abstracted and cataloged injuries for pediatric patients based on radiologist report. Frequencies of injuries and severity were analyzed by developmental age group. A total of 1018 pediatric patients were enrolled, 128 (12.6%) of whom had an injury on computed tomography scan. Median age was 11.9 (Interquartile range 4.5-15.5) for all patients and 12 (4.8-15.5) for injured patients. Of injured patients, 49 (38.3%) had a significant injury, and 27 (21.1%) received an intervention. Teenagers had the highest rate of significant injury (50%) and intervention (30%). Injuries were most frequently noted in the temporal (46.1%), frontal (45.3%), and parietal (45.3%) regions. Subarachnoid hemorrhage (29.7%) and subdural hematoma (28.9%) were the most common injuries observed.Intraparenchymal hemorrhage and cerebral edema were more prevalent in older age groups. The most common injury mechanism overall was fall from height (24.7%). Motor vehicle accidents and nonmotorized wheeled vehicle accidents were more common in older patients. Serious injuries requiring intervention were rarely encountered in pediatric patients experiencing blunt head trauma. Mechanisms of injury, type of injury, and rates of intervention varied between developmental age groups.

Tics Temporally Associated with Mild Traumatic Brain Injury in Pediatric Patients: A Sui Generis Case Series

Traumatic brain injury (TBI) is a major public health concern in Canada, with falls, blows to the head, car accidents, and sports-related injuries being the leading causes. Post-traumatic movement disorders, such as tics, can occur after a TBI, but their association with mild TBIs has been less explored. This manuscript presents two pediatric cases of de novo tics following mild TBIs, shedding light on this unique phenomenon. Possible mechanisms linking mild TBI and tics, such as genetic predisposition and stress-induced activation of the hypothalamic-pituitary-adrenal axis, are discussed. This paper emphasizes the importance of recognizing tics as a potential consequence of mild TBIs in children, and underscores the need for further research to shed light on the mechanism involved.

The Risk of Kidney Injury in Patients With Sickle Cell Disease Treated With Ketorolac for Acute Pain.

Ketorolac, a nonsteroidal anti-inflammatory drug, is used in combination with opioids to manage vaso-occlusive episodes (VOEs). The relationship between ketorolac use and kidney injury in pediatric patients with sickle cell disease (SCD) remains incompletely understood. We hypothesize that ketorolac is associated with acute kidney injury (AKI) in patients with SCD presenting with pain. All nonsurgical hospitalizations for VOEs treated with ketorolac between January 2014 and December 2022 were included. We used optimal matching methodology to identify control admissions (2:1 ratio) and used nonparametric tests to compare ketorolac administration between cases and controls. A total of 1319 encounters/253 patients were included in this study. AKI was noted in 1.1% of encounters and 5.5% of patients. Cases had significantly higher initial BUN than controls (9.0 vs. 6.0mg/dL, P=0.012). In cases versus controls, there was significantly lower serum sodium (136.0 vs. 138.0mmol/L, P=0.021). There was no association between ketorolac dose and development of AKI among children with SCD. Higher BUN and lower sodium in cases suggest that patients with AKI were more volume depleted on admission than controls. This highlights the need for strict assessment of fluid status upon admission for VOE.

Management of Pediatric Supracondylar Humerus Fractures Using Lateral Cross-Wiring Technique Under Fluoroscopic Guidance.

Supracondylar humeral fractures are the most prevalent elbow fractures in pediatric patients. Current treatment modalities typically involve closed reduction and fixation using percutaneous Kirschner wires. The lateral cross-wiring technique has demonstrated favorable functional and cosmetic outcomes, thereby reducing the incidence of ulnar nerve injury. This study aimed to assess the efficacy of the lateral cross-wiring technique in achieving optimal functional and cosmetic recovery while mitigating the risk of ulnar nerve injury in pediatric patients with displaced supracondylar humeral fractures. A prospective analysis was conducted on 48 patients who underwent lateral cross-wiring for displaced supracondylar fractures (Gartland type III, including extension and flexion types) of the humerus. Follow-up assessments were performed over a minimum period of eight months post-surgery. Among the 48 patients, all demonstrated satisfactory restoration of the carrying angle and functional ability postoperatively. Notably, no iatrogenic cases of radial or ulnar nerve injury were observed during the follow-up period. The lateral cross-wiring technique emerges as an effective treatment option for displaced supracondylar fractures of the humerus in pediatric patients. It facilitates both functional and cosmetic recovery while concurrently reducing the risk of ulnar nerve injury, thus warranting consideration in the management of such fractures.

Management of pediatric posterior cruciate ligament avulsion fractures: a systematic review.

Both open and arthroscopic surgical techniques have been used for PCL avulsion fractures. The goal of this study is to evaluate the effectiveness and safety of the different management strategies proposed for PCL avulsion fractures in children. A systematic literature review was performed utilizing Medline, Scopus, and EMBASE databases from 1977 to the present. PRISMA guidelines were followed. Data were selected and extracted by two independent reviewers. Inclusion criteria were clinical studies reporting injuries in pediatric patients with PCL avulsion injuries. Exclusion criteria were combined PCL and ACL injuries and ligamentous injuries requiring reconstruction. A subgroup analysis was performed between open reduction and arthroscopic surgeries. Twenty-six studies were included in this systematic review. Patient sex was reported in 39 patients with a higher number of males (32/39). The age range was 7-18years old. In the open group, 30/31 patients had clinical improvement or returned to pre-injury activity level with two complications. Lysholm scores ranged from 66 to 99. In the arthroscopic group, 11/12 patients experienced clinical improvement or returned to normal activity levels with only one complication. Lysholm scores ranged from 90 to 100 with a mean of 95. In the non-operative group, 3/3 recovered with evidence of fracture healing, full or near full knee range of motion. One Lysholm score was reported 14months after injury and was 100/100. Open reduction and arthroscopic surgeries are effective and safe treatment options for pediatric PCL avulsion fractures-97% of open reduction and 92% of arthroscopic patients significantly improved symptoms. The complication rates for the open and arthroscopic groups were 11 and 9%, respectively. All three non-operative made full or near full recovery of pre-injury knee status. Systematic review of Level-II-IV studies. Prospero Registration No CRD42021290899.

Social Deprivation Index Affects Time to MRI after knee injury in pediatric patients and is predicted by patient demographics

ABSTRACT Objectives This study aims to characterize the association between the timing of MRI ordering and completion for pediatric knee injuries and Social Deprivation Index (SDI), which is a comprehensive, validated, county-level, measure of socioeconomic variation in health outcomes based upon combining geography, income, education, employment, housing, household characteristics, and access to transportation. Methods A retrospective chart review was completed of patients 21 years old and younger from our institution with a history of knee sports injury (ligamentous/soft tissue injury, structural abnormality, instability, inflammation) evaluated with MRI between 5/26/2017 and 12/28/2020. Patients were from three states and attended to by physicians associated with an urban academic institution. Patients were assigned SDI scores based on their ZIP code. Excluded from the study were patients with a non-knee related diagnosis (hip, foot, or ankle), patients from ZIP codes with unknown SDI, and non-sports medicine diagnoses (tumor, infection, fracture). Results In a multivariate regression analysis of 355 patients, increased SDI was independently associated with increased time from clinic visit to MRI order (p = 0.044) and from clinic visit to MRI completion (p = 0.047). Each 10-point increase in SDI (0-100) was associated with a delay of 7.2 days on average. SDI itself was found to be associated with a patient’s race (p < 0.001), ethnicity (p < 0.001), and insurance category (p < 0.001). Conclusion Increased SDI is independently associated with longer time from clinic visit to knee MRI order and longer time from clinic visit to knee MRI completion in our pediatric population. Recognizing potential barriers to orthopedic care can help create the change necessary to provide the best possible care for all individual patients.

Complications Following Tissue Expander-Based Reconstruction in Pediatric Burn Injuries: A Retrospective Analysis.

Tissue expansion has been widely used to reconstruct soft tissue defects following burn injuries in pediatric patients, allowing for satisfactory cosmetic and functional outcomes. Factors impacting the success of tissue expander (TE)-based reconstruction in these patients are poorly understood. Herein, we aim to determine the risk factors for postoperative complications following TE-based reconstruction in pediatric burn patients. A retrospective review of pediatric patients who underwent TE placement for burn reconstruction from 2006 to 2019 was performed. Primary outcomes were major complications (TE explantation, extrusion, replacement, flap necrosis, unplanned reoperation, readmission) and wound complications (surgical site infection and wound dehiscence). Descriptive statistics were calculated. The association between primary outcomes, patient demographics, burn characteristics, and TE characteristics was assessed using the chi-squared, Fisher's exact, and Mann-Whitney U tests. Of 28 patients included in the study, the median [interquartile range (IQR)] age was 6.5 (3.3-11.8) years, with a follow-up of 12 (7-32) months. The majority were males [n = 20 (71%)], Black patients [n = 11 (39%)], and experienced burns due to flames [n = 78 (29%)]. Eleven (39%) patients experienced major complications, most commonly TE premature explantation [n = 6 (21%)]. Patients who experienced major complications, compared to those who did not, had a significantly greater median (IQR) % total body surface area (TBSA) [38 (27-52), 10 (5-19), P = 0.002] and number of TEs inserted [2 (2-3), 1 (1-2), P = 0.01]. Ten (36%) patients experienced wound complications, most commonly surgical site infection following TE placement [n = 6 (21%)]. Patients who experienced wound complications, compared to those who did not, had a significantly greater median (IQR) %TBSA [35 (18-45), 19 (13-24), P = 0.02]. Pediatric burn injuries involving greater than 30% TBSA and necessitating an increasing number of TEs were associated with worse postoperative complications following TE-based reconstruction.

Epidemiological Study of Traumatic Brain and Spinal Injuries in a Pediatric Population: A One-Year Analysis of Prevalence, Causes and Trends.

Background Traumatic brain injury (TBI) and spinal cord injury (SCI) are leading causes of morbidity and mortality in pediatric patients. However, the epidemiology of pediatric brain and spine injuries in Bulgaria is poorly documented. This study aims to analyze and identify the prevalence, causes, and trends of traumatic brain and spinal cord injuries in pediatric patients during the period of 1st June 2022 to 30th June 2023. Methods A retrospective study was conducted on the medical records of patients under 18 years of age who visited the emergency department of University Multiprofile Hospital for Active Treatment (UMHAT) Burgas, Bulgaria between 1st June 2022 and 30th June 2023. The incidence and etiology were stratified by age, gender, and anamnesis.Data processing and analysis were performed with the statistical package IBM SPSS v. 26.0 (IBM Corp., Armonk, NY, USA), and graphical analysis with MS Office Excel 2016 (Microsoft, Redmond, WA, USA). Means ± standard deviation and 95% confidence interval were calculated. All p-values less than 0.05 were considered indicative of statistical significance. Results Data for patients aged <18 years, admitted to the emergency department (ED) of UMHAT Burgas, Bulgaria from 1st June 2022 to 30th June 2023 were analyzed (n=38504). Of these patients, 32% were children (n=13857). One hundred thirty-four (0.3%) of the pediatric patients were hospitalized in the neurosurgical ward, and 4653 (10.7%) were hospitalized in other wards. Of the analyzed patients, 89 are boys (66.4%), 45 are girls (33.6%) (male-female ratio 2:1) and the mean age of the patients with a head trauma was 8.07 years old. The average number of patients by diagnosis is 13.4±35.37. The largest percent are patients with brain concussion (85.07%, n=114), followed by contusion of the nerve roots in the lumbar region or late contusion wound of the head (with 2.99% each, n=4); hydrocephalus or skull fracture (with 2.24% each, n=3); contusion of the nerve roots in the thoracic region (1.49%, n=2); and fracture at Th9 vertebrae, fracture at C2 vertebrae, brain trauma or brain tumor (with 0.75% each, n=1). The average number of patients by anamnesis is 13.2±17.99.The largest percent are patients who fall from their own height (44.78%, n=60); followed by falls from height (20.90%, n=28); car accident (7.46%, n=10); injured by fight, fall from a bicycle or incident during a football game (with 5.97% each, n=8); fall from electric scooter (4.48%, n=6); hit in the closet (2.99%, n=4); and finally from bike accident or hit by a rock (with 0.75% each, n=1). From 134 hospitalized patients in neurosurgery, 114 (85.07%) did not require surgical treatment and were treated with conservative treatment and 20 (14.93%) were treated surgically. Conclusion In conclusion, this study highlights a significant burden of pediatric traumatic brain and spinal injuries in Bulgaria. The majority of cases were managed conservatively, emphasizing the need for preventive measures.

Utility of fast MRIs in pediatric elbow injuries

BackgroundPediatric elbow trauma presents a diagnostic challenge for clinicians. Radiographs may be insufficient in assessing the radiocapitellar alignment and advanced imaging or invasive procedures such as an intraoperative arthrogram may be indicated. The purpose of this study is to describe the application and utility of fast magnetic resonance imaging (MRI) in the diagnosis and management of traumatic elbow injuries in pediatric patients. MethodsWe reviewed pediatric patients who underwent a fast MRI of the elbow between 2014-2022. A fast MRI was defined as an MRI using rapid sequences, accelerated conventional sequences, or fewer conventional sequences than a standard exam. Imaging for chronic or non-traumatic injuries was excluded. We identified patient demographics, MRI scan times, and clinical course. ResultsTwenty-three patients (8 females and 15 males) with fast elbow MRI scans were identified. The mean age was 5 years (range 2-12 years, SD 2 years). All patients had radiographs and four had CT scans prior to MRI. The average scanning time was 14 minutes (SD 6 minutes). Only one patient required anesthesia. Twenty of the 23 patients had a fracture identified on elbow radiographs and 8 were Monteggia fracture-dislocations. Nine of these patients demonstrated subluxation of the radiocapitellar joint requiring operative management in 8 patients, and one additional patient underwent surgery for displaced radial neck fracture. Three patients sustained an elbow dislocation without fracture identified on radiographs; of these, one had persistent radiocapitellar subluxation on MRI requiring surgical management. A total of 13 patients (56.5%) did not require operative management based on fast MRI findings. Outcome data was available for 22 patients with mean follow up was 23.6 months. One patient had residual pain and 8 had some range of motion limitation at final follow-up. All patients had reduced elbow joint on follow-up radiographs. ConclusionsFast MRIs can assist with the clinical evaluation of acute elbow injury in pediatric patients with equivocal radiographic findings and particularly in those with possible radiocapitellar subluxation/dislocation. This novel imaging technique has the potential to change clinical management, decrease the need for unnecessary procedures, and prevent complications of missed injuries.

Incidence of hospital-acquired pressure injuries and predictors of severity in a paediatric hospital.

Hospital-acquired pressure injuries (HAPIs) pose significant challenges in healthcare and cause increased patient suffering, longer hospital stays, and higher healthcare costs. Paediatric patients face unique risks, but evidence remains scarce. This study aimed to identify and describe HAPI admission incidence and severity predictors in a large Australian children's hospital. This retrospective cohort study investigated all paediatric patients between January 2020 and December 2021 using a census approach. Demographic and clinical data including HAPI-related data were accessed from the incident monitoring and hospital administration databases. The incidence rate (per 1000 patient admissions) was calculated based on all admissions. Predictors of HAPI severity were identified using multivariable multinomial logistic regression. The study adhered to the STROBE guidelines for retrospective cohort studies. The HAPI incidence rate was 6.96 per 1000 patient admissions. Of the age groups, neonates had the highest HAPI incidence (15.5 per 1000 admissions). Critically ill children had the highest rate for admission location (12.8 per 1000 patient admissions). Most reported cases were stage I (64.2%). Age was associated with injury severity, with older paediatric patients more likely to develop higher-stage HAPIs. Additionally, Aboriginal and/or Torres Strait Islander patients had a higher HAPI severity risk. HAPI injuries in paediatric patients are unacceptably high. Prevention should be prioritized, and the quality of care improved in Australia and beyond. Further research is needed to develop targeted prevention strategies for these vulnerable populations. This research emphasizes the need for standardized reporting, culturally sensitive care and tailored prevention strategies. The research has the potential to influence healthcare policies and practices, ultimately enhancing the quality of patient care. STROBE guidelines. There was no patient or public contribution to the conduct of this study.

Association Between Posterior Tibial Slope and ACL Injury in Pediatric Patients: A Systematic Review and Meta-analysis.

The posterior tibial slope (PTS) has been proposed to be a radiographic risk factor for anterior cruciate ligament (ACL) injury in adults. However, this has not been well established in pediatric patients. This systematic review and meta-analysis was performed to investigate any association between PTS and ACL tears in the pediatric population. Systematic review and meta-analysis; Level of evidence, 4. A systematic review was performed to identify studies that examined the relationship between PTS, medial tibial slope (MTS), and lateral tibial slope (LTS) and ACL tears in children and adolescents aged ≤18 years. Full-text observational studies comparing PTS, MTS, and/or LTS values between pediatric (≤18 years of age) patients with and without ACL injury were included in this analysis. Review articles and case series were excluded. The authors calculated the mean difference (MD) via a restricted maximum-likelihood estimator for tau square and a Hartung-Knapp adjustment for random-effects model. A total of 348 articles were identified in the initial database search, yielding 10 for final inclusion and analysis. There was no statistically significant association between PTS (MD, 1.13°; 95% CI, -0.55° to 2.80°; P = .10), MTS (MD, 0.36°; 95% CI, -0.37° to 1.10°; P = .27), or LTS (MD, 1.41°; 95% CI, -0.20° to 3.02°; P = .075) and risk for ACL injury in this population. The current study found that unlike what has been shown in adult populations, increased PTS may not be a significant risk factor for ACL tears in pediatric and adolescent patents. LTS was the only measured parameter that neared statistical significance, perhaps suggesting a potential role for this measurement in determining ACL risk if further research is done in this population.

The Impact of EG and DEG Cases on Sales of Over-The-Counter Syrup

The Indonesian Food and Drug Authority (BPOM) investigated and listed safe and unsafe syrup products in response to the contamination of Ethylene Glycol (EG) and Diethylene Glycol (DEG), causing Acute Kidney Injury in pediatric patients. Unsafe products were recalled and removed from distribution, leading to uncertainty and panic among the public and significantly impacting over-the-counter syrup sales in several pharmacies. This retrospective observational study assessed the impact of EG and DEG contamination on the sales of over-the-counter syrup in Pharmacy X in South Denpasar. Data from three months before (August to October 18th, 2022) and three months following the official instruction was published (October 19th, 2022 to December 2022) were analyzed using Wilcoxon test. The findings reveal a staggering decline in the sales of over-the-counter syrup by 35,03% (p-value of 0.03). Moreover, there was a notable increase of prescriptions in powder forms. The contamination cases caused panic, resulting in changes in behavior and consumption patterns. Despite the availability of safety information on an official website, public hesitance toward syrup products persists, indicating the need to implement a more effective strategy to address misinformation and restore public trust. Each individual must be responsible for educating the public during crises to prevent the spread of misinformation, ultimately restoring trust and normal consumer behavior. Furthermore, efficient stock management should be implemented to anticipate potential health crises in the future proactively.

Development and Validation of a Nomogram for Predicting Acute Kidney Injury in Pediatric Patients Undergoing Cardiac Surgery.

Acute kidney injury (AKI) is a common complication after cardiac surgery and associated with adverse outcomes. The purpose of this study is to construct a nomogram to predict the probability of postoperative AKI in pediatric patients undergoing cardiac surgery. We conducted a single-center retrospective cohort study of 1137 children having cardiac surgery under cardiopulmonary bypass. We randomly divided the included patients into development and validation cohorts at a ratio of 7:3. The least absolute shrinkage and selection operator regression model was used for feature selection. We constructed a multivariable logistic regression model to select predictors and develop a nomogram to predict AKI risk. Discrimination, calibration and clinical benefit of the final prediction model were evaluated in the development and validation cohorts. A simple nomogram was developed to predict risk of postoperative AKI using six predictors including age at operation, cyanosis, CPB duration longer than 120min, cross-clamp time, baseline albumin and baseline creatinine levels. The area under the receiver operator characteristic curve of the nomogram was 0.739 (95% CI 0.693-0.786) and 0.755 (95% CI 0.694-0.816) for the development and validation cohort, respectively. The calibration curve showed a good correlation between predicted and observed risk of postoperative AKI. Decision curve analysis presented great clinical benefit of the nomogram. This novel nomogram for predicting AKI after pediatric cardiac surgery showed good discrimination, calibration and clinical practicability.

The Effect of Insurance Type on Time to Anterior Cruciate Ligament Reconstruction in Pediatric Patients: A Critically Appraised Topic

Clinical Scenario: Delay in surgery for anterior cruciate ligament (ACL) injuries increases the risk of complications including secondary injuries. Previous research has shown individuals with public insurance have greater delays in care for a variety of health conditions. Clinical Question: In pediatric patients with ACL injuries, is the time from injury to surgery longer for patients with public insurance than patients with private insurance? Summary of Key Findings: Four studies met the inclusion criteria. All studies reported a greater wait time for surgery in pediatric patients with public insurance. Clinical Bottom Line: There is moderate evidence indicating that there is a delay in ACL surgery for pediatric patients with public insurance compared to those with private insurance. Strength of Recommendation: Grade B evidence exists that there is a delay in surgery for ACL injuries in pediatric patients with public insurance compared to those with private insurance.

Traditional game of spinning top gone wrong: Short communication of a pediatric facial penetrating injury

Introduction A spinning top is a traditional game in some countries. The top is often made of wood or mud and the bottom is made of a sharp metal pin. Penetrating injuries can occur if the spinning top is incorrectly thrown. Case report We report a spinning top penetrating injury on the nose of an 8-year-old girl. Clinical examination revealed a spinning top that had penetrated her nasal bridge. Plain computed tomography (CT) of paranasal sinuses revealed a spinning top with its sharp pointed nail penetrating through the left nasal bone into the left nasal cavity. Examination under general anesthesia and rigid nasoendoscopy showed the tip of spinning top situated in between middle turbinate and nasal septum. The spinning top was then removed following the direction of entry. Discussion While air gun pellet facial injuries in pediatric patients have been reported, other playthings as culprits of facial penetrating injuries is still unheard of. Projectile objects can easily penetrate pediatric facial skeleton due to thinner facial bones. It is vital to exclude life- and sightthreatening injuries first, followed by imaging to assist decision-making and surgical planning. Computed tomography (CT) imaging is the gold standard for the radiographic evaluation of facial injuries. It assists in evaluating trauma extent, trajectory, depth, and course of foreign body. Following that, examination under anaesthesia including rigid nasal endoscopy is warranted. Conclusion We would like to highlight the importance of parental supervision and the value of pre-operative imaging. Neglecting seemingly harmless children’s toys can potentially cause fatal injuries.

The usefulness of S100ß protein and fractalkin in predicting traumatic brain injury in pediatric patients with minor head trauma

Aims: In this study it was aimed to demonstrate the effectiveness of S100B protein levels which are biomarkers related to central nervous system, and fractalkin levels, which are known to play a role in inflammation processes in prediction trauma induced brain damage. Methods: Patient aged 2 to 18 years who came to the emergency department due to minor head trauma and underwent brain ct were included in our study. It was investigated whether there was a relationship between the two groups, according to the causes of trauma, symptoms at presentation and the level of serum s100b and FCN according to the lesions detected in CCT. Results: The other symptoms including Vomiting, retrograde amnesia, loss of consciousness, confusion, post traumatic amnesia is significantly higher in patients with brain lesions (p&lt;0,05). Patients with lesions on BCT have significantly low Glassgow coma score. (p&lt;0,05). Patients with lesions on BCT have a significantly high S100B and FKN levels. (p&lt;0,05). S100B area under the curve (CUA) 0.700 sensivity is 55%, spesificity is 87.5%. FKN CUA 0,785, sensitivity is 62.5% specifisity is 85%. Conclusions: As a result, the child patients with BCT lesions from minor cranial trauma levels for S100B and FKN levels are significantly higher and can be a criteria for BCT usage in emergency medicine.

Medical device-related pressure injuries in paediatric patients: An incidence study in a children's hospital.

To determine the incidence of pressure injuries from medical devices in children. Medical devices can cause pressure injuries on skin and soft tissues. A prospective, descriptive study adhering to STROBE guidelines. This study was conducted in the third-level Paediatric Intensive Care Unit of Ege University Hospital in İzmir, Türkiye between April 2019 and October 2019 in Türkiye. Patients aged between 1 month and 18 years with medical devices were observed for pressure injuries using Braden scales and a specific monitoring form. In this study, we followed 522 medical devices applied to 96 patients. The three most commonly used medical devices were the ECG probe (21%), the blood pressure cuff (16%) and the saturation probe. Out of the 522 medical devices followed, 36 caused pressure injuries (6.8%). The incidence of medical device-related pressure injuries was found to be high. Effective training and implementation strategies need to be devised for paediatric nurses to prevent pressure injuries associated with medical devices. The results of this study reveal that pressure injuries related to medical devices are an important health problem in paediatric hospitals. Therefore, awareness-raising and educational activities among health professionals and nurses should be accelerated. No patient or public contribution in the study.

Family caregiver perspectives on strengths and challenges in the care of pediatric injury patients at a tertiary referral hospital in Northern Tanzania.

Pediatric injuries are a leading cause of morbidity and mortality in low- and middle-income countries (LMICs). It is important that injured children get quality care in order to improve their outcomes. Injured children are nearly always accompanied by family member caregivers invested in their outcome, and who will be responsible for their recovery and rehabilitation after discharge. The purpose of this study was to identify family member caregiver perspectives on strengths and challenges in pediatric injury care throughout hospitalization at a tertiary hospital in Northern Tanzania. This study was conducted at a zonal referral hospital in Northern Tanzania. Qualitative semi-structured in-depth interviews (IDIs) were conducted by trained interviewers who were fluent in English and Swahili in order to examine the strengths and challenges in pediatric injury care. IDIs were completed from November 2020 to October 2021 with 30 family member caregivers of admitted pediatric injured patients. De-identified transcripts were synthesized in memos and analyzed through a team-based, thematic approach informed by applied thematic analysis. Strengths and challenges were identified throughout the hospital experience, including emergency medicine department (EMD) care, inpatient wards care, and discharge. Across the three phases, strengths were identified such as how quickly patients were evaluated and treated, professionalism and communication between healthcare providers, attentive nursing care, frequent re-evaluation of a patient's condition, and open discussion with caregivers about readiness for discharge. Challenges identified related to lack of communication with caregivers, perceived inability of caregivers to ask questions, healthcare providers speaking in English during rounds with lack of interpretation into the caregivers' preferred language, and being sent home without instructions for rehabilitation, ongoing care, or guidance for follow-up. Caregiver perspectives highlighted strengths and challenges throughout the hospital experience that could lead to interventions to improve the care of pediatric injury patients in Northern Tanzania. These interventions include prioritizing communication with caregivers about patient status and care plan, ensuring all direct communication is in the caregivers' preferred language, and standardizing instructions regarding discharge and follow-up.